Periodontal therapy often requires orthodontic treatment in case of diastema and extreme maxillary protrusion associated with severe periodontitis. We report two periodontal cases with orthodontic treatment. Diastema and deep overbite of the first case with moderate periodontitis was improved by orthodontic therapy after periodontal surgery. At first examination, the second case with anterior crossbite seemed to be difficult to preserve the front teeth because of the severe periodontitis. But the crossbite tooth was improved by minor tooth movement after periodontal surgery, and was preserved for about ten years. The malposition of teeth even if with severe periodontitis seemed to improve the occlusion by appropriate orthodontic treatment after periodontal surgery, and to preserve the teeth for a long time.

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Periodontal therapy for severe periodontitis seems to be different from that for slight or moderate periodontitis. It is indispensable for preserving teeth with severe alveolar resorption to finish adequate initial treatment and to carry out periodontal surgery for complete elimination of the inflammation surrounding the teeth as soon as possible. Orthodontic treatment is often required in case of diastema and extreme maxillary protrusion associated with severe periodontitis. In addition, the cases with narrow attached gingiva sometimes need free gingival graft or apically positioned flap surgery. This is the report for periodontal therapy of a severe periodontitis patient with orthodontic treatment and free gingival graft. At first examination, many teeth seemed to be difficult to preserve, however the most of all were preserved for about 9 years. Through this case, we recognized that periodontal therapy for severe periodontitis required various treatment different from periodontal therapy for slight or moderate periodontitis.

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In this study, we examined an upper first premolar with three roots of very low prevalence. In addition, we examined the pulp cavity of this tooth three dimensionally without damageing the tooth using micro focus computed tomography (following Micro- CT). A left upper first premolar was obtained from a male (aged 12 yrs 7 mths) as a convenience extraction for orthodontic purposes. The subject's medical history was unremarkable. In the subject's family history, the mother also had a convenience extraction of upper and lower first premolar for orthodontic purposes when she was 16 yrs and 6 mths of age. The details of the extracted tooth were measured using vernier calipers (1/20 mm), and compared with the Japanese mean. Cystography by Micro-CT (SMX-225CT, Shimadzu Co.) was performed in the mesio-distal direction with a canal voltage of 85KV and a canal current of 300 uA. A two dimensional slice image of 20 um thickness was obtained, and transformed into a three dimensional reconstruction image of the contours and cavity of the tooth using the volume rendering method. Our results indicate that the left upper first premolar examined in this study was larger than the Japanese mean previously reported. Although no difference was observed between average Japanese tooth form and our observation of the fundamental configuration of the anatomical tooth crown, a longitudinal sulcus on the root trunk of the buccal side had acervical enamel projection on its surface. During the development of the teeth, the root trunk is formed at the end of the enamel formation, and the configuration of the tooth root is already determined by the cervical enamel projection. Our observations do not address whether the existence of the longitudinal sulcus promotes the formation of the enamel projection or vice versa. We confirmed by Micro-CT that this premolar had three root canals, with two horns of the pulp chamber on the buccal and lingual side. Therefore, while the horns of the pulp chamber resembled an upper premolar, the floor of the pulp chamber resembled an upper molar. Our results suggest that the cervical enamel projection onto the root trunk of the buccal side may induce a bifurcation of the buccal root in a mesio-distal direction.

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We encountered a case of duplication of the inferior vena cava in a cadaver. This was thought to be caused by persistence of the right and the left supracardinal veins, and this case was classified as type BC in the classification systems developed by McClure and Butler (1925) and Chuang et al. (1974). Double inferior vena cava is not a rare anomaly, and clinicians should be aware of this anomaly. Duplication of the inferior vena cava may cause other changes in the venous system, such as dislocation of the drainage position of the right gonadal vein from the inferior vena cava to the right renal vein. We also suggest that this anomaly causes duplication of the gonadal vein.

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Two cases of bifid rib were found in two cadavers during routine dissections at Iwate Medical University School of Dentistry. They were found in the fourth rib in one cadaver, and in the fifth rib in the other cadaver. In one case both the branching and the reunion of the rib occurred in the osseous part, and in the other case they occurred in the cartilage part. The space between the two branches was filled with presumably normal intercostal muscles. The blood supply had been maintained by small branches from the internal thoracic artery to the upper branch and the intercostal muscles. However, the intercostal nerves did not branch toward the upper branch but only ran along the lower margin of the lower branch of the bifid rib in both cases.

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Aminophylline, which is a potent and effective bronchodilator, is most useful for the treatment of bronchial spasms in pre- and intraoperative management. But it is well-known that the combination of aminophylline and inhalation often cause a severe ventricular arrhythmia. We reported that we suspected a premature ventricular constraction (PVC) was caused by administering intravenously aminophylline for controlled ventilation of a patient with severe chronic obstructive lung disease during general anesthesia. A 77-year-old male (height 155 cm, weight 54 kg) patient, diagnosed with right maxillary cyst, was scheduled for a right maxillary cyst extirpation under general anesthesia. Anesthesia was induced with thiopental sodium and maintained with N_2O, O_2 and sevoflurane. During the operation the patient was kept on controlled ventilation monitoring by per cutaneous SpO_2, arterial blood gas analysis, etc. without any complications. But it was suspected PVC occurred about five minutes after the intravenous administration of aminophylline given to prevent hypoxemia. It is important to take great care in administering medication, because drug-induced reactions, anesthetic stage and operative invasion may coincide to cause unexpected events.

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Pathological examinations diagnosed at our department in 2001 were statistically reviewed. There were 641 examinations for 516 cases (Male: 244, Female 272). Cases were most frequent in patients in their seventh decades (106 cases). In histological classifications of the lesions (mean age ±SD), odontogenic tumors consisted of 5 ameloblastomas (40.4±25.2), 2 odontomas (20.2±8.0), and one malignant ameloblastoma (33.0). The non-oclontogenic benign lesions were 44 fibrous hyperplasias (55.2±18.9), 28 hyperkeratosis (leukoplakia) (55.7±13.4), 7 hemangiomas (65.6±5.9), 6 pleomorphic adenomas (56.7±11.5), 6 osteomas (exostosis, enostosis), 4 papillomas (80.7±7.4), 4 epithelial dysplasias (61.5±11.9) and 3 periapical cemental dysplasias (30.1±13.7). Non-odontogenic malignant tumors consisted of 53 squamous cell carcinomas (68.1±12.6) and 3 verrucous carcinomas (71.7±4.8). The odontogenic cysts consisted of 45 radicular cysts (45.2±14.3), 21 dentigerous cysts (41.4±19.9) and 8 primordial cysts (29.9±11.3). The non-odontogenic cysts consisted of 44 mucoceles (30.3±22.6), 18 postoperative maxillary cysts (56.1±11.4), 3 incisive canal cysts (54.3±9.9) and 2 dermoid cysts (16.5±2.5). In addition, 10 Sjogren syndromes (53.9±11.0), 7 lichen planus (69.1±12.9), 26 chronic localized hyperplastic gingivitis (epulis) (60.1±15.7) and 6 dental granulomas (50.5±16.9) were revealed.

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