Takanari Miyamoto

Oral health is crucial to overall health, and periodontal disease (PDD) is a chronic inflammatory disease. Over the past decade, PDD has been recognized as a significant contributor to systemic inflammation. Here, we relate our seminal work defining the role of lysophosphatidic acid (LPA) and its receptors (LPARs) in the oral system with findings and parallels relevant to cancer. We discuss the largely unexplored fine-tuning potential of LPA species for biological control of complex immune responses and suggest approaches for the areas where we believe more research should be undertaken to advance our understanding of signaling at the level of the cellular microenvironment in biological processes where LPA is a key player so we can better treat diseases such as PDD, cancer, and emerging diseases.

Introduction: This case series illustrates the use of the new classification system of periodontal diseases and conditions. This case series highlights how the assessment of the rate of progression of periodontal disease, that is, grading, allows for the identification of individual patients, who are more likely to require active periodontal treatment intervention to prevent onset of disease, need long‐term disease control, or referral to a periodontist.Case Presentation: A 17‐year‐old female presents with slight gingival inflammation. However, exploration into indirect evidence of disease progression, that is, family history of periodontal disease, leads to the discovery of advanced disease in the mother. The patient was diagnosed with generalized Stage I Grade C periodontitis. The patient was managed with initial periodontal therapy, consisting of scaling and root planing with systemic antibiotic therapy. Special consideration was taken to mitigate the potential for rapid disease progression because of indirect evidence of familial history of aggressive periodontitis and indicated the need for early intervention. The case resulted in remission of the progression of periodontal disease.Conclusions: Applying the staging and grading system leads to an understanding of the need for periodontal referral and early periodontal treatment intervention. Wide adoption of staging and grading could increase early referral leading to early periodontal treatment intervention, decreased tooth loss, and have a potential effect on overall health improvement and wellness.

Background: Evidence exists on the clinical efficacy and safety of periodontally accelerated osteogenic orthodontics (PAOO) with “Piezocision”—a minimally invasive, flapless alternative to corticotomy for alveolar bone augmentation. Allograft has been extensively studied for alveolar bone augmentation in Piezocision; however, the use of deproteinized bovine bone mineral with 10% collagen (DBBM‐C) in Piezocision for PAOO has not been investigated.Methods: This study is a prospective, observational, cohort study of 19 patients of Angle Class I malocclusion with a total of 692 teeth assessed for maintenance of health of the periodontal attachment apparatus. Patient‐centered pain, sensitivity, and satisfaction outcomes, digital photographs and radiographs, and changes in probing depth, clinical attachment level, width of keratinized tissue, percussion sensitivity, pulp vitality tests, radiographic pathology, and root‐crown‐ratio were all recorded.Results: Overall treatment was significantly faster (5 to 7 days between clear aligner tray changes), periodontal parameters remained stable, and alveolar bone loss was not observed. Visual analog score for healing, sensitivity/duration, bleeding/duration, swelling/duration, appearance, and inflammation, demonstrated no significant differences between DBBM‐C and control (no bone graft) groups. Patient‐centered outcomes revealed high levels of satisfaction with Piezocision. Piezocision‐treated teeth with DBBM‐C tended to exhibit less root resorption, although it was not statistically significant (P = 0.074).Conclusions: Within the limits of the study, our results show that the use of DBBM‐C with piezosurgically enhanced orthodontics is effective and safe. This study was not designed to demonstrate equivalence with other materials that might be used in Piezocision. To understand whether there is an advantage to using DBBM‐C, additional studies may be required.

Background: Existing evidence concerning the validity of an appropriate regular periodontal maintenance (PM) regimen and the role of patient compliance is controversial and inconsistent. The objectives of this study are to identify the impact of patient compliance (complete versus erratic) on alveolar bone loss and tooth survival.Methods: A retrospective study was conducted using data from 295 patients with ≥20 years of observation, which included treatment and ≥15 years of maintenance therapy, in a private practice in Yamagata, Japan. Subject‐level variables and tooth‐level variables were recorded at the initial visit, the reevaluation visit, and the final visit. In total, 7,502 teeth in 295 subjects met inclusion criteria and were divided into two groups: non‐molar teeth (n = 5,585) and molar teeth (n = 1,917). A tooth‐level multivariate survival model and multiple logistic regression model using the method of generalized estimating equations were constructed to analyze the effects of compliance and periodontal maintenance intervals on tooth loss and alveolar bone loss, respectively.Results: Of 7,502 teeth, 284 molar teeth and 364 non‐molar teeth were lost. Molar teeth had an approximately 30% reduction in risk of tooth loss for complete compliance, with 2‐year compliance classification achieving statistical significance (P = 0.033), and 30% compliance classification approaching statistical significance (P = 0.072). Complete compliers under 30% compliance classification showed over 50% reduction in the risk of alveolar bone loss among non‐molars (P = 0.015).Conclusion: Complete patient compliance with increased frequency of periodontal maintenance is important for improved dental prognosis through reduction of tooth loss among molars and minimization of alveolar bone loss among non‐molars.

The purpose of the present longitudinal study was to evaluate the association between root proximity and the risk for alveolar bone loss (ABL). We used data from the Veterans Affairs Dental Longitudinal Study, a closed-panel longitudinal cohort study of 1,231 men enrolled in 1968 with triennial follow-up examinations. Periapical radiographs of mandibular incisors from subjects with > or =10 years of follow-up were selected. Interradicular distance (IRD) at the cemento-enamel junction and alveolar bone levels at baseline and last follow-up were measured using digitized radiographs. The rate of progressive ABL was determined and expressed as millimeters per 10 years. Site-specific multivariate regression models were fit to evaluate the association between IRD and ABL rate, adjusting for age and smoking. Empirical standard errors and generalized estimating equations were used to account for the correlation among sites within subjects. There were 473 dentate subjects, aged 28 to 71 years at baseline, with > or =10 years of follow-up data available for analyses. The mean follow-up time was 23 years. The mean IRD was 1.0 +/- 0.3 mm, and the mean ABL rate during 10 years was 0.61 +/- 0.59 mm. There was a significant non-linear association between IRD and ABL rate (P or =0.8 mm, sites with IRD or =0.5 mm of bone during 10 years (relative risk: 1.28 [95% CI: 1.11 to 1.48]) and 56% (95% CI: 11% to 117%) more likely to lose > or =1.0 mm of bone during 10 years (relative risk: 1.56 [95% CI: 1.11 to 2.17]). IRD <0.8 mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth. Measurement of IRD may have important prognostic value in making treatment decisions.