MESSAGE FROM THE PRESIDENT

Cockeyed optimism is an awfully valuable quality in a teacher. Being too realistic, remembering too vividly students who didn't succeed or course plans that fell flat, saps the very thing that supports students in believing in themselves. And that is why the NEFDC is in the optimism business. When Randy Bass shared stories, as keynoter of last November's Conference, about a technology-assisted course strategy that hadn't worked as well as he had hoped, it was to help us understand the strength of his commitment to continually exploring and trying new things. When Bob Kegan, keynoter this coming November (November 15th, Holy Cross), leads us in an interactive exploration of Transformational Learning, it comes out of his powerful conviction of the extraordinarily positive ways that learning changes the student and the teacher. Our Consortium depends on that optimism in the dozens of teachers and faculty developers from across New England " and beyond " who come to the conferences to present sessions on the theories and programs and strategies they have built in their classes and their schools. Each of those conference sessions has at its core the thrill of having brought a new idea to fruition. And my fellow members of the NEFDC Board put aside the grading and planning and struggling in their classes and their schools in order to get together through the year to think about what they can do to help the NEFDC move forward, engaging and supporting faculty in New England in the consideration of effective teaching. In recognition of that optimism, I want to thank all the member of the Board and urge you to contact them at the Conference or by email to let them know what issues in teaching and learning are the center of your focus right now. I particularly want to thank Ellen Nuffer, from Keene State University in New Hampshire, who steps off the Board after several years of thoughtful and engaged contribution. And I most definitively want to recognize the optimism of our newest Board members, Rob Schadt, from the Boston University School of Public Health, and Jeanne Albert, from Castleton State College in Vermont. It is the continual renewal of the NEFDC and the Board by experienced and active teachers and faculty developers like Jeanne and Rob which makes it possible for the Consortium to bring so many faculty together for learning and for support. We look …


Message from the Dean
Held in partnership with the Japan Association of Dental Traumatology (JADT), this international conference encourages clinicians, educators, and researchers to meet and exchange ideas in a scientific meeting that stimulates learning, teaching, and dialogue, by bringing together people from Asia, and beyond. Held every two years, the Asian International Association of Dental Traumatology (AADT) has become a source of knowledge among young and expert researchers. This year, the 9 th AADT will be held in Cebu City, the Philippines.
Cebu is considered to be the Philippine's oldest city and the first capital of the Philippines. It is also considered to be the birthplace of Christianity in the Far East. It holds a prominent place in the archipelago as the capital of the South and is considered to be the most dynamic island in the country with the most ethnically diverse population. It is also a convenient place for business and leisure. Cebu has the oldest street and school in the Philippines. Thus, it will be the best venue for our scientific meeting.
I am confident that this meeting will afford exceptional opportunities for renewing old acquaintances, making new contacts, networking, and facilitating partnerships across national, international, and disciplinary borders. I am also hopeful that it will encourage young Filipinos to have a research oriented mind side by side with their clinical skills.
Together with the JADT and local organizing committee at Southwestern University PHINMA, I have no doubt that the 9 th AADT Conference will offer a remarkable opportunity for the sharing of research and best practice, especially in Dental Traumatology studies and its related fields. I expect the resultant professional and personal collaborations to endure for many years, and I look forward to seeing you in Cebu!

Clinical Significance of Peripheral Nerves from the Situation of Stomatology -The Mechanism of Neural Transmission from Periphery to Brain, from Birth through Adulthood -
The developmental process of the brain and neurons will be presented in terms of establishing stages of cerebral limbic system (feelings), prefrontal cortex (controlling) and hypothalamus of brain stem (decision making) from childhood through adulthood. The main themes will be focused on the neurons of the newly completed cerebral cortex, the dynamics of nerve fiber over the period of eruption to completion of tooth and the mechanism of neural transmission from the periphery to the completed cerebral cortex.

Oral Soft Tissues and Traumatic Injuries
Background: Aside from infection and chronic inflammatory diseases, trauma-related lesions could affect the soft tissues of the oral cavity. It is not uncommon for dental practitioners to see patients with ulceration and erosions, cystic lesions, hyperkeratosis, soft-tissue growth, and even necrotic tissues. These lesions may actually be due to physical and mechanical, thermal, chemical, and even radiation injuries.
It is therefore important to recognize these lesions so that proper treatment and management could be instituted.

Clinical Study on the Abnormal Position of Maxillary Canines
Background: An ectopic position of an unerupted maxillary canine may cause abnormal root resorption of the lateral or/and central incisors. The purpose of this study was to review and examine treatment options for preventing such a result.

Materials & Methods:
We reviewed panoramic radiographs of patients who visited the Aoba Dental Pediatric Clinic. The period of the dentitions examined was from the eruption of the bilateral maxillary central and lateral incisors to the completion of the eruption up to the first or second molars including bilateral maxillary canines. These cases were divided into the groups with and without denture guidance. The locations of the canine tooth germs were classified into the following six types: ① apex of the primary canine, ② mesial to the apex of the primary canine, ③ between the apexes of the primary canine and the lateral incisor, ④ distal to the apex of the lateral incisor, ⑤ the apex of the lateral incisor, ⑥ the tooth germs located at locations other than these sites. Results: If the canine tooth germ was located at ① or ② when the maxillary central and lateral incisors erupted, the eruption path of the canine was normal. However, when the canine tooth germ existed at ③, some types of denture guidance were conducted in one third of the cases. Denture guidance and fenestration were necessary when the canine tooth germ existed at ④ or ⑤. Recently, we have seen an increase of ectopic canine tooth germs in the site ⑥. Those germs were horizontally impacted on the palatal or labial sides, causing the root resorption of central incisors. Conclusion: It is of importance in radiographic examination of the canine tooth germ at the eruption of maxillary central and lateral incisors for the establishment of the proper treatment plans. Clinical approach to crown fracture due to the dental trauma in the period of growth and development Background: During the period of development, trauma to tooth with immature root often occurs regardless of whether it is a deciduous tooth or permanent tooth, and it is necessary to take into consideration the growth of the tooth root. In the case of fracture fragment due to crown fracture, adhesion is attempted, and if not, repair is performed using CR crown, etc. In the case of pulp exposure, consideration of its size, time since injury, degree of infection, alignment status, etc. is made and treatment according to the situation such as direct pulp capping, partial pulpotomy (Cvek), pulpotomy, pulpectomy, infected root canal treatment is performed. In the case of tooth with immature root in which infection of only the dental pulp of the crown is suspected, apexogenesis is attempted. In the case of apical periodontitis due to central cusp fracture, etc., pulp revascularization or apexification is attempted. In any case, it is important to protect the Hertwig epithelial sheath involved in tooth root development as much as possible. It is important to perform examination from a comprehensive angle and take appropriate measures at the appropriate time with continuous observation.

Approach to external root resorption of traumatized teeth
Background: External root resorption is observed in cases of replanted teeth with dental trauma. Root canal dressing containing calcium hydroxide (Ca(OH)2) is one recommended clinical approach for external root resorption. However, complete control of external resorption may not be possible due to certain factors such as the smear layer, which is formed by reaming and filing during root canal treatments. The smear layer plugs dentinal tubules and inhibits the effects of Ca(OH)2 as root canal dressing material.
Our studies showed root canal irrigation with ethylene-diamine-tetra-acetic-acid (EDTA) and sodium hypochlorite (NaOCl) with an ultrasonic device, is the most effective method to remove the smear layer. Additionally, an alkaline environment at the outer root surface due to ion diffusion from Ca(OH)2 was observed following this treatment.
Therefore, the combined use of EDTA and NaOCl with an ultrasonic device for root canal irrigation leads to good control of external root resorption. Stephen Almonte

Periodontal Considerations in Fixed and Partial Removable Prosthodontics Therapy
Background: The lecture will present various periodontal considerations for the success of prosthodontics both in fixed and removable partial dentures. The general practitioner needs to observe and be guided properly on the protocol of analyzing and having a closer look at the periodontal status of the remaining dentition prior to any prosthodontic procedures.

HSPs as Functional Factor of the Recovering Periodontal Ligament in due to Traumatic Mechanical Stress
Background: Dental traumatic injury is caused by sudden force to the mouth and teeth. To investigate the histopathological traumatic changes and repair, we examined the reactions of the mouse periodontal tissues after receiving the mechanical stress occurring upon clinical application. Histopathological changes as well as the expressions of HSP27 and p-HSP27 in the periodontal tissues were examined after removal of the mechanical stress.

Materials & Method:
A total of 40 8-week-old male ddY mice were used in the examination. Application of mechanical stress was performed according to the insertion of separator was performed following Waldo's method. After 20 minutes (m), 1 hour (h), 3 h, 9 h, 24 h, 3 days (d) and 1 week (w), the periodontal tissues of the right maxillary molar region were removed.

Results:
The increase in mechanical stress up to 3 hours led to pathological changes that caused a space in between stretched periodontal ligament fibrous bundles and fibroblasts as well as narrowing of the periodontal ligament space. Degenerative changes also occurred in the pressure side. Pathological changes did not only occur due to mechanical stress but also at the time of the release of mechanical stress exposure which increased over time. In the control group, both HSP27 and p-HSP27 were negative in the pressure side after mechanical stress was released 3 hours later. On the other hand, the tension side showed a strong positive reaction. The proteins were also expressed after 20 min, 1 hour, 3 hours and 9 hours. The strongest expression was observed at 24 hours. A decrease in the intensity of expression was observed 3 days and 1 week later Conclusion: The results suggest that HSP27 plays an important role in the recovery of injured cells in the periodontal tissues.

Kazuyo Yamamoto
Professor and Chair, Department of Operative Dentistry Osaka Dental University Email: yamamoto@cc.osaka-dent.ac.jp

The Restoration of Traumatized Teeth with the Latest Bonding Techniques
Background: Bonding systems are now essential for dental treatment. Composite resin restoration, resin cement, fissure sealant, and direct bonding for orthodontics. In the field of dental traumatology, bonding is also applied to various regions. Especially, bonding systems for teeth have recently progressed markedly from the first-generation system targeting only enamel to the latest system, 1 Bottle-1Step (All in One) system. Resin bonding systems are now the leading part of restorative treatment based on Minimal Intervention Dentistry (MID) proposed by the FDI because, together with their esthetics, they are capable of minimizing the amount of cutting and conserving the healthy parts of teeth as much as possible, and there is no doubt that they will further develop in the future. Using adhesive resin, not only can the amount of tooth cutting be markedly decreased but also traumatized teeth previously requiring sacrifice, such as pulpectomy and tooth extraction, may be conserved by minimizing invasiveness depending on cases. Therefore, the use of adhesive resin promotes protection of the teeth. In this lecture, I would like to talk about the adhesion mechanism of bonding systems, proper use of different systems, and treatment methods of fractured tooth using bonding.

Clinical evaluation of combination therapy of dental trauma and orthodontic treatments
Background: Tooth dislocation is often encountered in dental clinics and generally involves concussion, subluxation, lateral luxation, invagination, extrusion, and complete dislocation.
Case: In this study, we report the case of a patient who presented with a dislocated tooth along with maxillary protraction owing to labial inclination of maxillary incisors and moderate crowding of the mandibular lateral incisors. Combination therapy comprising treatment of the dislocated tooth, whitening, and orthodontic treatment was performed. The patient had a history of trauma. Orthodontic treatment was done for the ankylosed teeth. The patient was advised that root resorption of the tooth was likely to occur. Nonetheless, orthodontic treatment was performed according to the patient's wishes.

Discussion and Conclusion:
Kawai et al suggested that treating maxillary protraction at an early age is beneficial considering most injured patients show maxillary protrusion and injury to the maxillary incisors. They also suggested that examining the history of the injury at the initial visit is important because it will cause malocclusion. Combination therapy for a dislocated tooth owing to injury and orthodontic treatment is often required.

Why GP's should Include Temporary Anchoring Devices (TADS) in their Practice
Background: There is no doubt that the emergence of the use of temporary anchoring devices (TADs) in Orthodontics the past few years has eliminated the need for the traditional anchorages like the Transpalatal Arch (TPA), Nance Holding Arch, headgears, etc., and most traditional anchorages and had made treatment mechanics a little less complicated and in general, shortened treatment time. However, there are still a lot of dentists who still are not getting the advantages of TADs in their practice.
My presentation is about two cases that hopefully in my own small way, will convince my colleagues about the misconception of the use of TADs, what its true benefits are and how they will greatly benefit by its incorporation to their clinical practice. Background: In Indonesia, 31.4 % of accident is on the road, and 11.9 % of accident is related to head injury. The number of maxillofacial injuries, which is the main etiological factor in maxillofacial fractures, is continuously increasing due to the rise in traffic congestion. In the facial area, zygomatic-orbital fracture is one of the results of road traffic accident, characterized by sensory neuropathy in the area of innervation of the infraorbital nerve. Here, we conducted an animal study mimicking the infraorbital nerve damage by trauma and whether Botulinum toxin (BoNT) and cytokine therapy could reduce orofacial neuropathic pain.

Materials & Methods:
Male Sprague-Dawley rats were used in this study. We induced trigeminal neuropathic pain by infraorbital nerve constriction (IONC), measured as a decrease in the head withdrawal threshold. BoNT (100 pg in 0.1 ml of saline) or saline was intracutaneously administered at the center of the IONC side whisker pad three days after surgery. Cytokine therapy of recombinant IL-10 (0.4 μg/100 g) in PBS, anti-CXCL2 (66 μg/100 g) in PBS, or only PBS (control) was injected into IONC side trigeminal ganglion (total volume was 18 μl). Results: BoNT peripheral side injection attenuated neuropathic pain. Recombinant IL-10 or anti-CXCL2 injection into trigeminal ganglia decreased pain behavior.

Conclusions:
Our results show that BoNT, IL-10, or anti-CXCL2 are therapy options for neuropathic pain. Therefore, he requested to preserve his front teeth. Treatment outcome: We treated tooth #12 by tooth extraction and replantation, #21 by adhesion of broken pieces and #22 by extrusion. For all these teeth, ferrules were secured with crown prostheses were made. Prior to the crownwork, an orthotist had performed orthodontic treatment to improve excess overjet that increased the risk of the fractures. Discussion: This treatment followed the desire of the patient. It may have been impossible to achieve the favorable result if any sole dentist was engaged in the patient. We collaborated with a dental surgeon and an orthotist in addition to a primary physician certified by the Japan Association of Dental Traumatology. The interdisciplinary approach was considered effective. Objective: Traumatic dental injuries of the primary dentition (TDI-p) have a global prevalence of approximately 11%-47%. They have immediate and long-term effects. Original research analyzing the long-term sequelae of TDI-p on permanent dentition (LSP) are few in number. The aim of this study was to explore the correlation between age of TDI-p, type of TDI-p and LSP. Material and Methods: Retrospective analysis of patient data from 2008-2017, reporting with LSP due to TDI-p, was performed. Uniform protocols and complete radiographicphotographic records were analyzed. There were 638 LSP reported with 596 teeth having complete records. Results: There were 286 children with 153 males (53.5%) and 133 females (46.5%). Mean age of TDI-p causing LSP was 36.57 ± 11.51 months, with severity increasing in the younger age group. The highest number of LSP was associated with avulsion injuries (218, 36.58%), and the odds ratio of the type of TDI-p affect the severity of LSP was 2.0163. Mean age of reporting was 8.54 ± 2.19 years and was lowest for enamel discolorations. Most LSP were not associated with any associated feature (AF), although impaction was highest among all AF (63, 10.57%). Conclusion: Age and type of TDI-p affect LSP, with the former being the stronger determinant of its severity. Mean age of reporting of LSP is dependent upon both type of LSP and AF. LSP due to TDI-p can further be graded in terms of severity. Background: Ameloblastoma has long been recognized as a rare, benign odontogenic tumor. Although rare, it is considered as one of the most common odontogenic tumor to date. Because of its characteristic persistent growth and its ability to produce marked facial deformity, ameloblastoma tends to be easily recognized even with a general practitioner.

Brief CV
Having the knowledge on the nature, progression and possible complications of ameloblastoma will lead to the creation of a more comprehensive treatment plan that would render the best long-term prognosis and management for the patient. The temporomandibular joint (TMJ) plays a critical role in speech, mastication, and swallowing. This bilateral, diarthrodial, and ginglymoid joint is not exempt to injury. Late complications of traumatic TMJ injuries include facial asymmetry, malocclusion, growth disturbance, osteoarthritis, and ankylosis. The cyclin-dependent kinase inhibitor p21 is identified as a potent inhibitor of cell cycle progression. Recently, it has been proposed that p21 is a regulator of transcription factor activity. Furthermore, p21 regulated the expression of MMP13 and aggrecan (ACAN). These molecules are believed to be the onset of TMJ-OA in mandibular cartilage. In this study, we evaluated the role of p21 in response to mechanical stress. Materials and Methods: In in vivo study, eight-week-old p21+/+ and p21-/-mice were used. The TMJs were overloaded during a period of 10 days by application of a sliding plate on incisors to keep the mandibular position posterior by biting and upward. After the experimental period, all mice were sacrificed and the TMJs were dissected for histological, immunohistochemical and micro CT analyses. Result and Discussion: HE staining and micro-CT analysis, p21-/-mice showed subchondral bone destruction and also p21-/-mice had thinner cartilage and smaller areas of proteoglycans than WT mice. Immunohistochemical analysis indicated that MMP-9 and MMP-13 positive cell numbers were significantly larger in WT mice with mechanical stress compared to control mice while ACAN positive cell numbers were lower in WT mice with mechanical stress compared to p21-/-mice with sliding plates. Conclusion: Our results suggest that p21 in chondrocytes functions to maintain matrix synthesis by regulation of ACAN and MMP-13 expression. It is concluded that cell cycle related molecule p21 might regulate TMJ-OA pathogenesis in mice.  Background Tooth avulsion is one of the most serious of all dental injuries. In case of complete dislocation, replantation is possible when the local oral conditions are good. The most commonly affected teeth are the maxillary central incisors.

Educational
Case Report: This case report is regarding the replantation of the mandibular central and lateral incisors in an eight-year-old girl with hearing impairment who fell at school and visited our clinic approximately one hour after injury. The dislocated teeth were found and immersed in a preservative solution and brought with the patient. We immediately replanted those incisors and applied fixation for 3 weeks. Follow-up examinations were performed every 1 to 3 months. Three months after the injury, both the central and lateral incisors showed a positive reaction in dental pulp electro diagnosis findings. The patient was followed up until 12 months after injury, although no complications, such as crown discoloration, dental pulp cavity stenosis, or external root resorption, were observed. In addition, there were no suspicious findings in areas around the roots of the affected teeth. In the present case. We considered that the course might be clinically favorable without root canal treatment, as the condition from injury to replantation was good. ). An individual acrylic resin cap was fitted to each experimental tooth, and the photodiode and LED were fixed through a hole made on the labial and palatal side, respectively, of the cap. TLP with 525 nm LED and finger photoplethysmography were simultaneously recorded. All the subjects underwent foot bath (43 C warm water) for 30 minutes and TLP of the examined tooth, body temperature, blood pressure, heart rate, and skin blood flow were monitored. Values at -5 to 0 min (baseline), 25 to 30 min (foot warming), 30 to 35 min (just after foot warming) and 40 to 45 min (after removal of foot warming) were statistically analyzed using a repeated measures one-way ANOVA followed by Bonferroni post hoc test.

Results:
The TLP amplitudes were gradually decreased along with the duration of foot warming, increased again just after removing the foot warming, and decreased significantly (P < 0.05) at the end of the experiment to the level similar to the baseline. The body temperature, heart rate and skin blood flow were increased during foot bath (P < 0.05) and gradually decreased after foot bath but mean arterial pressure did not change significantly.

Conclusion:
Passive circulatory stimulus with foot warming caused a transient increase in pulpal blood flow followed by returning to its normal level, in healthy young adult human teeth. Background: It is widely accepted that various types of dental trauma can lead to a wide range of clinical consequences, even with or without immediate treatment. Unexpected injury brings out the different degree of damage and complications to oral tissues, most likely depending on site, severity, and teeth/tissues involved. Moreover, clinical consequences after the trauma depend on appropriateness of first aid, elapsed time, type of dentition and post-treatment care. These factors cause the management of dental trauma to become less straightforward and inevitably unpredictable. Therefore, it is worth learning the real clinical response of dental trauma cases in many aspects. The presentation will focus on the clinical consequences after long-term follow-up of those teeth experiencing trauma. Cases with tooth avulsion, as well as other cases with root fracture of deciduous and permanent teeth will be reported comparatively in order to find out any difference of their consequences. Background 1986Background -1994 Doctor

Background:
We introduce a follow-up case for 19 years in the maxillary central incisor with tooth crown fracture by dental trauma. When he was an eleven-year-old boy, a left maxillary central incisor with tooth crown fracture by dental trauma was injured at school. The dentist had treated to the crown restoration by resin after a pulp capping for the traumatic tooth. At 1 week after a treatment of the tooth, the patient visited our dental office. Occlusal and spontaneous pain occurred. I did pulpectomy. At one week later, the canal was filled with lateral pressurized roots with sealer and gutta percha points.
No particular abnormality was observed in the X-ray image without subjective symptoms until 8 years and 4 months after the injury. Although subjective symptoms were not observed at 16 years and 3 months after the injury at all, radiolucent area was detected in root apex at X-ray examination. The root canal treatment was performed after then. However, two years later, root resection was performed because swelling was observed on the palate side of the apical part.
In the case of traumatic teeth, it was suggested that a follow-up examination should be important for a long period of time even after normal treatment. Background: Pediatric trauma occurs suddenly and most often make no complaints about pain and fear of dental care at the visit. Then first of all, you should check if your patient's consciousness and brain condition are normal. If there is a suspicion of disturbance of consciousness, immediately introduce the patient to a doctor. If there is no disturbance of consciousness, it is necessary to listen exactly to when, where, and how the trauma has occurred, and to make a diagnosis of the oral cavity by checking that there is no abnormality in the whole body. For that end, it is necessary to carefully talk, behave, and explain how treatment will be performed, and remove as much as possible, the patient's anxiety about treatment.

Brief CV
The clinical response to infant children is changing due to the trend of the times, especially because younger patients are not able to cooperate with treatment for crying just by visiting a dental clinic. Further care must be taken in the clinical setting. To solve this situation, create a family clinic, have a regular visit to a dental clinic from a three-month checkup, and have the child practice dental treatment using the behavioral change method. It is important for a family to get used to a dental clinic and prepare for sudden accidents.
Based on the above, I would like to introduce how to deal with trauma at our clinic and explanations to patients and parents. Background: Odontoma is an odontogenic tumor which proliferates in a similar way to hamartoma. It is known that odontoma has unique x-ray image and tissue characteristics. On the other hand, inferior alveolar nerve palsy primarily occurs from the inferior alveolar block injection or from nerve damage during minor surgical intervention of the oral cavity. Therefore, it is very rare for a nerve palsy caused by the odontoma. Here, we reported a case of the compound odontoma which developed inferior alveolar nerve palsy. The case was a 27-yearold female who visited a nearby clinic in May 2016 due to paralysis of near the right corner of the mouth. Her dental X-ray revealed an impacted lower right 5th teeth and an odontoma-like radiopaque tumor. She was referred to our department in June 2016. Medical history revealed that she started experiencing discomfort near the apical area of the lower right first bicuspid from January of 2016, and by April 2016, she started experiencing paralysis in the aforementioned area. Although her face was symmetrical, obtundation from the right corner of the mouth to the lower lip was acknowledged. From palpation of the oral cavity, a small bonelike lump was felt at the apical area of the lower right first bicuspid, thought to be the crown of the lower right second bicuspid. We did not find any abnormalities in the surrounding areas of the mucosa. From x-ray, we found lower right second bicuspid impacted in the apical area of the lower right first bicuspid. We also acknowledged an unclear region, which size was approximately 10×10mm in diameter, at right above the mandibular foramen near the lower right first bicuspid. After diagnosis of the complete impact of the lower right second bicuspid and the surrounding odontoma she underwent surgical intervention to remove the odontoma and extract the impacted lower right second bicuspid under local anesthesia with intravenous sedation on July 12th 2016. Since then, we have closely followed-up the patient on a regular basis. Histopathological diagnosis was compound odontoma. Background: Universal Calcium Food Co., Ltd. has actively conducted research on calcium and produced calcium supplements we call "UNICAL" for 25 years. Our UNICAL is unique with its high ionization and high absorption rate in the human body. Regarding the mixture to allow UNICAL to be included in many food products, we discovered that we needed a more micronized form UNICAL. As a result, we started to develop "NANO-UNICAL". We tried two methods to develop NANO-UNICAL. At first, we tried a wet grinding method using a bead mill. The size of the products was satisfactory. However, we abandoned this method as it proved to be costly and inorganic substances contaminated the calcium. As a second way, we tested another method to discover if we could control the particle size safely without any contamination. We tested the production of calcium slurry in various conditions and made adjustments to determine the optimum particle size. We were able to successfully control the particle size to about 200 nm. Thereafter, we dried the calcium slurry with a spray dryer and obtained calcium powder. The size of the powder was 10 to 20 μm.

Brief CV
With this production method, we can achieve a calcium powder that has stable dispersibility and little variation between lots. As a result, we decided to adopt this method. NANO-UNICAL has 3 key features in addition to UNICAL's features. First, it does not precipitate when added to beverages. Second, it doesn't affect the color or taste of foods and doesn't disrupt other food ingredients and has a smooth texture when it's mixed into food items. Finally, it isn't adversely affected by the dietary fiber in the intestinal absorption. We have acquired two patents for this development in Japan. We developed various kinds of food products including NANO-UNICAL such as candies, beverages and so on. We believe these items will help people to take calcium more efficiently. Currently, we're conducting further research. Treatment and follow-up: After cleaning the exposed pulp tissue, calcium hydroxide was applied for direct pulp capping, then polycarboxylate cement was applied. After splinting the tooth due to the discoloration of the traumatized tooth, the fractured fragment was removed, and endodontic therapy was conducted. The patient showed up our office after one year and five months due to the fracture of the same left maxillary central incisor. After the tooth was restored with a resin jacket crown, the tooth is presenting satisfactory progress. Case 2: Age at injury: 8 years Chief complaint: Subluxation of the bilateral maxillary central incisors and a coronal fracture of the right central incisor History of present condition: The patient fell from the face to the floor and broke the crown of the tooth Present condition: The left maxillary central incisor was partially erupted, exposing half of the crown, and the two-thirds of the right central incisor crown was fractured with a punctiform pulp exposure. Treatment and follow-up: Direct pulp capping was conducted on the fractured surface using calcium hydroxide, and HY-Bond™ Polycarboxylate Cement was applied on the entire surface. Then, the teeth were splinted. The fragment was placed in saline and stored in a refrigerator. After about one year and two months, confirming the apex formation was complete, the fragment was bonded to the fractured surface. The tooth was vital. The patient is a 52-year-old male. His four maxillary anterior teeth were dislocated by injury (hit directly on the face by a ball while playing baseball) when he was about 30 years old, and since then he was using a conus denture. He visited our clinic on 22th of January in 2002. Requesting implant treatment and to restore the contour of the gingiva to its original shape．According to a panorama radiograph and CT scans，bone defect was extensive. The treatment plan was to conduct bone grafting in the region with extensive bone defect, and placing implants after the bone volume has been augmented.

Brief CV
March 27, 2002: The implant was placed at the portion of upper right central and side incisor. The implant was covered with covering screw after placement, and Bio-oss was applied. Since left maxillary alveolar ridge showed extensive bone resorption in every direction, we removed a bone graft from the mandibular corpus and fixed it to the maxillary bone by the pins. About 6 months after the operation, the survival of the bone graft was confirmed by clinical and radiological examinations. The pins were removed and one implant was placed into the grafted bone area.
May 17, 2004: The patient received treatment for the preparation of the attachments of screwon type prosthesis and gingival contouring.
February 2019: The prognosis has been favorable without any trouble for about 14 years 9 month up to date. The patient is satisfied functionally aesthetically The combined therapy of bone graft and implant treatments was effective for improvement in dentition and esthetics for the defect due to trauma. Since the maxillary bilateral central incisors could not be replanted, the root fractures were removed under local anesthesia. The dislocated and extracted teeth were stored and processed into Autogenous tooth bone graft material. Bone was constructed using autogenous tooth bone graft material, and then she implanted dental implant. Although 5 years have passed since the last prosthesis finished, the progress is good. Background: Some fractures of the anterior teeth happen due to unexpected contact or accident. However, it is very rare for 4 maxillary front teeth to fall off, all at once. With good progress, after following-up for four years and four months, I report the summary.

Case:
The patient is male, born in 2002, and 9 years old. He fell down and got a blow on the face in playground equipment at the school at 11:00 AM on February 10, 2012.The teeth which fell off at once by the injury were four but one of four teeth was lost, so I replanted the remaining three of them.
Convalescence of luxated tooth are key for periodontal cell membrane. This patient came for treatment after 80 minutes have passed from the time of injury. But fortunately, as for the progress, it was good because there was no infection of the alveolar bone. Because the patient is a 14-year-old child, I need to wait for a while until 18 years of age that is for the last time prosthetic measures age.
Examination: Most tooth injuries affect the 4 maxillary front teeth. This goes down due to anatomy properties of the oral cavity. As it projects as hard tissue, it easily receives external force. To reduce the loss of teeth due to the tooth injury, schools should have stock solutions for tooth storage and careful observation following the tooth injury. Background: Oral trauma occurring during sports has increased in recent decades, especially among young students in Japan. The number of students interested in football has hiked since the launch of the Japanese professional football league in 1990s. Since then, the number of oral injuries has surged among young soccer players. Despite this situation, countermeasures against safety have been delayed. This is a report of a treatment of lip laceration, alveolar bone fracture and tooth complete dislocation case that occurred due to lack of wearing a mouth guard.

Patient:
A16-year-old male, and made first visit on October 1, 2013.
History of the present complaint: While playing football during a club activity, the ball hit the mouth with LR1.LR2. LL1 alveolar bone fracture and UR1 tooth complete dislocation.
Treatment outcome: Promptly rectified UR2 UR1 UL1, reduced and fixed with dental adhesive cement using NITI white coated wire. The alveolar bone fracture of the LR2 LR1 LL1 part was invasively fixed. Three days later, root canal treatment was performed. After three months, the wire was removed as the prognosis was good. Currently, it is still stable after four years.

Discussion:
Other treatment methods were examined, but there was no applicable option. As a result, the treatment that was applied promoted healed the injury.