The number of patients with edentulous jaw suffering from the functional disturbance along with mandible deviation due to alveolar ridge absorption (alveolar bone, gnathic bone) is increasing. Many of these patients tend to be loaded with a type of low (infracclusion) and tiny (lack of denture space) complete denture with irregular occlusal plane (angle and arrangement position) - (negative cycle of conformation and function) .
In this regard, the instability of denture (insufficiency of retention and support), the occurrence of mandible deviation (deviation of temporomandibular joint and muscle tonus) and the disagreement of oral peripheral muscle and tongue) were observed. Thus, for patients having functional disturbance generated by the disorder of functional occlusion system related to the combination of muscle-temporomandibular joint?occlusion, we must produce complete denture after providing them with toothless jaw treatment applying treatment denture, rather than producing complete denture only with impression taking and maxillomandibular registration- (from production of complete denture to toothless jaw treatment) .
The conditions that curative denture should fulfill are as follows:
1. Having retention (four types with impression+two types with curative denture's functional pressure=six types) and support (alveolar ridge load+load with circumoral muscle and tongue) (stability) ;
2. Adequate occlusal plane (taking into consideration function and harmonizing with living organism) ;
3. Denture space satisfying muscular retention and balance of occlusion (height x width=denture space) ;
4. Compatibility to mucous membrane (taking into consideration masticatory mucous membrane, ratio of overlying mucosa and characteristics) ;
5. Artificial tooth selection and arrangement attaching importance to the stability of denture and eating and swallowing functions;
6. Stabilized mandibular position.
Meeting the above conditions will ensure functional improvement in the course of morphological recovery. Further improvement of function should apparently complete the conformation leading to the reconstruction of stomatognathic function- (positive cycle of conformation and function) .
I would like, on this occasion, to explain the recovery of denture space applying curative denture in toothless jaw treatment.

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[in Japanese]

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There is elasticity resin as one choice toward example complete denture of all floor artificial tooth accompanied with the absorption of the sharp jaw bone of the originality idea. Material of “Vertex Soft” thought to stand long use comparatively even of that was chosen, and it could get a good result. I want to introduce it including the idea about the production and the problem.

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In clinical case, it is common treatment to apply dental implant and use of partial denture for the patient with non-vertical stop occlusion by occlusal disintegration in molar region to recover correct occlusion. Especially, recent clinical studies suggest that the tooth which is not used for the occlusion in a prognosis should be extracted, and use a dental implant. However, it is difficult to use dental implant for all clinical case because of various reasons, it is necessary to maintain remaining teeth as possible. This case which we show has a symptom of non-vertical stop occlusion because of occlusal disintegration in molar region.
In missing teeth region, we tried to reconstruct of correct occlusion actively used the technique of distal moving and autograft of teeth. We report a two made a treatment plan to keep teeth as a top priority, and show 3-dimensional teeth movement by multi-bracket system anchored by dental implant. 2 years follow-up case after the period of final prosthodontic treatment.

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With the Cerec System it was the first time possible and practicable for the dentist to create chair side all ceramic restorations. In addition to the chair side system Cerec inLab, the CAD/CAM system for the dental laboratory. was developed in recent years. Cerec inLab utilizes the In Ceram system, an all ceramic system known for the excellent esthetic results that can be achieved, however also known as a system that requires a high level of skills and a time consuming process due to long sintering times. With Cerec inLab the process steps can be simplified and process time can be shortened. This allows the dental technician to concentrate on the creative steps of the In Ceram process to create excellent all ceramic restorations.

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Prosthetic dental restorations began to be used more frequently in 1907 when casting was introduced as a method to make fixed prostheses. Since then, cast crown and bridge restorations have been improved significantly and continue to contribute in a major way to dental restorative treatment. To provide tooth colored restorations with the cast metal, porcelain fused to cast metal was invented and opened the way to the present esthetic dentistry transformation. During the 20th century, metal and porcelain were the main materials for fixed prosthetic restorations. The cast metal and porcelain, being hard and strong materials, were considered to be excellent for fixed restorative treatment. Recently, there have been concerns that these materials, which are harder than living tissue and are very strong, may have a detrimental influence on the abutment and antagonistic teeth. Therefore, materials that wear closer to that of tooth structure, actually the same as tooth structure, are more desirable, and would be ideal. We believe ESTENIA can measure up to this rigorous 21st century request for a better, kinder material.

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The most esthetic way in restorative treatment is unanimously to use feldspathic ceramic material with enamel-like optical property (ie. porcelain laminate veneer), when the restoring tooth has no matter of its color and redisual volume.
Recent development in adhesive technique dramatically changed the preparation form, it makes difficulty in applying the conventional cavity classification.
Dr. Magne described that standard feldspathic material would be unproblematically placed up to 5.5mm without the residual tooth support, that means, there is less situation require full coverage restoration than have ever been previously thought. Considering that Japanese has an average of 11.7mm crown length, ≥50% loss of the coronal part and an abutment tooth are viewed as indications for the treatment.
The purpose of this text is to consider the function of the indication-extending porcelain laminate veneer, demonstrating clinical cases.

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Mechanisms of the periodontal tissue regeneration were verified by critical thinking (suspecting) the previously reported results. It is surmised that Melcher' s hypothesis is not entirely right when the processes of wound healing were considered in the long term. It is suggested that long junctional epithelium, which are created following periodontal surgery, is replaced from down growth to connective tissue attachment by changing of the epithelial proliferation.

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In this study, a new sharpening technique is proposed from the standingpoint of ergonomics and psychology.
First, I obtained the information regarding visual perception by using a stereomicroscope. It enables us to perform the sharpening of hand instruments with better viewing the manipulate task in the small area. In addition, a perceptual-motor learning becomes possible by the new technique, which leads to the improved motor skill for sharpening techniques.
Secondly, the efficiency of the sharpening can be increased by using a small sized rotating stones and an electric engine. A stable manipulate task is also obtained by having proper fulcrums, and therefore, motion tremor which had been caused by the standard sharpening procedure decreases drastically.

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[in Japanese]

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It is said that controlling the occlusal force leads to the healthy stomatognathic system. However, it has not been cleared what types of occlusal forces should be controlled. We have been paying attention to the habitual first stroke of mastication, and concluded that the occlusal force derived from this habitual mastication should be controlled. This force from the habitual first syroke of mastication results in mighty asymmetric and unbalanced loading to natural remaining teeth though it may not be pathogenic. It is obvious that controlling the occlusal force cannot be attained without controlling this habitual mastication, which means that removing the retro-posterior force of the habitual mastication side is needed. Thus, the sliding mandibular movement, not hinge movement is essential in order to remove this retro-posterior force.
In this report, we present the basic concept of controlling the occlusal force and the clinical remedy of the habitual first stroke of mastication.

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A dentist has been involved in the health care of the mouth for many years. But future dentistry won't be just confined in the tooth and the periodontium and it will be responsible for the diagnosis, prevention and treatment of the disease which occurs in the mouth, jaw and face. Although Temporomandibular Disorders (TMD) is one of those diseases, there are many possibilities in the disease which cause a pain in the orofacial structures. The pain in daily dental practice is usually caused by teeth, oral mucosa, temporomandibular joints and/or masticatory muscles; however, another organ can become a source of occurrence of the pain too. Therefore, it is essential to verify which organ a pain appears from first, in other words a differential diagnosis becomes very important. It is explained how you should differentiate TMD from the pain which occurs in other orofacial structures.

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Biologic denture is the method that used Hydro-cast material. Biological response produced by this method is a reaction, which goes to centric occlusion. It moves toward centric occlusion again, without stopping at habitual occlusal position, when notreaching by once. Change of occlusion will not be produced if centric occlusion is reached. And adjustment free denture is made.

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The program for the first staged approach is applied in place of the ideal therapeutic plan for patients with serious periodontitis or abnormal discrepancies. The patient's state of affairs concerning the difficulties and long term treatment must also be considered. In such cases, it is necessary to set the first staged goal without modification of the ideal therapeutic plan. The first staged goal without modification of the ideal therapeutic plan. The first stage is aimed at preventing the spread of serious disease through adequate documentation. While observing the results of the treatment, an additional second staged treatment is implemented and, after that, the final ideal comprehensive treatment can be achieved. In the following case, the steps that were used to obtain positive results in the first staged approach are explained in this paper.

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Electromyographic (EMG) activities of the superior (SUP) and inferior heads (INF) of the lateral pterygoid muscle (LPT) were recorded in humans during voluntary stepwise changes in biting force and jaw-position. The SUP behaved like a jaw closing muscle, while the INF like a jaw opening muscle. Stretch-reflex like responses were found in the SUP, the function of which was presumed to stabilize the condyle against the biting force that pulls the condyle posteriorly. This notion was verified by examining the biomechanics on the temporomandibular joint. The EMG amplitude of the SUP showed a quasi-linear inverse relation with rotational angle of the mandible in the hinge movement during which the condyle rotated with no movement in antero-posterior direction. This finding suggests that the SUP controls the angular relationship between the articular disk and the condyle.

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Cases in which the vertical dimension has decreased as a result of destruction of the molar area are difficult to treat, and in quite a few cases a combination of a variety of different methods is used.
In order to achieve alignment, restoration of the vertical dimension, and improvement of mandibular deviation in our own case, in which mandibular deviation had developed in association with a decrease in vertical dimension on the left side, we used occlusal therapy by means of orthodontic therapy before extracting molars that had been diagnosed as impossible to preserve. After the position of the mandible had improved, the molars were extracted, and an implant prosthesis was selected for the area of the defect to provide reliable posterior support. While diagnosis is obviously important when combinations of various treatment methods, such as orthodontic therapy, prosthetic therapy, and implant therapy, are used, as in our own case, the results of treatment are governed by the preparation of a precise treatment plan.

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In case of Implant superstructure, we pay attention to the crown contour, occlusal form, and many points.
They will be provided by the provisional restoration. The provisional restoration is generally used by acute cured resin. But the resin isn't good for long term use in Implant prostheses. Then metal provisional restoration that is occlusal metal with sandblasting is useful for observation of mandibular movement.
We report that occlusal form and contacts of Implant superstructure is decided by using the metal provisional restoration in observation.

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POI 2piece Implant^® which had first been started to apply clinically in 1991 has entailed a satisfactory result. This author et al. have examined the case of failed case from the clinical viewpoint and have reported the results of them this time.
The patient was a women of 67 years old who was introduced to our clinic from the dentistry of other hospital for making prosthesis using the implant. Using angle post for super structure because the angulated Implant placement was applied for implantation, fixed prosthesis using key-and-keyway was set. As the procedure of treatment, we directed her doctor to have the implants of 36 and 37 removed and have the residual root extracted, followed by making bilateral free-end dentures. We also directed her doctor that she come to our clinic for diagnosis then. Found her teeth of 34 still existing as the residual root looking panorama X-ray photograph.upon diagnosis of her on August 27, I extracted the teeth. After removing the anterior bridge, I repaired the bilateral free-end denture. Having loaded the fixture of 31 and 45 with attachment male each and then made temporary overlay denture on the same day. I abandoned the trial to apply the fixture of 43 because of parallelism and also 37 because of impossibility of long term stability. After the mucosa have healed, I have newly made the overlay denture. Result
1) Multiapplication of the angulated Implant placement will make the process of prothesis complicate, resulting in making difficult the control of post prothesis.
2) The ball attachment has been found effective for promoting the temporary prothesis on the same day.
3) I think it would necessary for us to communicate well each other as well as to communicate with patient well in treatment of them.

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The long-term prognosis for osseointegrated implants has been proven and implant therapy is recognized as a highly predictable treatment method. In particular, implant prosthesis is recognized as the most predictable treatment. Here, we present a patient in whom occlusion was favorably restored by replacing missing mandibular molars with implants and making a maxillary overdenture.
The patient was a 59-year-old man who visited our institution with the chief complaint of poor denture fit. At the initial visit, 33-7, 5-578 were confirmed along with chronic periodontitis, apical periodontitis and caries. The patient wore an upper denture and a mandibular prostheses that had a poor fit. Occlusion was unstable due to the lack of occlusal support in the right molar region. As basic periodontal treatments, 7, 58 with poor prognoses were extracted; scaling, root planing, caries control, and root canal were performed; and a therapeutic denture was prepared. After reassessment, periodontal surgery was performed on the remaining maxillary teeth, and dental implants combining autologous bone grafting and GBR were placed for the missing mandibular molars. During the second surgery, keratinized tissue around the implants was achieved, and after restoring occlusal function by provisional restoration, the final prostheses were placed. Also, a maxillary overdenture with magnetic attachments was prepared. At present, the periodontal tissue and occlusion are stable, and the patient has been doing fine.

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Vertical bone defects of the atrophic alveolar ridge have a negative impact on function and aesthetics. Horizontal ridge atrophy makes difficult to place dental implants that can be appropriately restored. Guided bone regeneration, bone grafting and distraction osteogenesis are well-accepted options for alveolar ridge augmentation.
The purpose of this article is to discuss techniques developed for vertical, horizontal and transport distraction of the alveolar ridge and their indications.
Distraction forces applied to bone also create tension in the surrounding soft tissue, initiating a sequence of adaptive changes turned distraction histogenesis.
Therefore, this method is considered a type of tissue engineering by which the surrounding soft tissue is simultaneously increased.
Indications for Alveolar Distraction Osteogenesis:
* Partial defects of the alveolar ridge
* Atrophic bone segments in the mandible and maxilla
* Simultaneous Sinus lift and vertical distraction for maxillary augmentation
* Vertical correction or replacement of edentulous segments
* Local open bite (Dentulous Segment Distraction)
* Assisted eruption of ankylosed impacted tooth (Dentulous Segment Distraction) Repositioning of malpositioned implants
Limitations of Alveolar Distraction Osteogenesis:
* Contraindicated in patients with osteoporosis
* Maximum transport segment width is limited in accord with size of distraction device.
* Minimum transport segment height is approximately 5 mm
* Inadequate bone volume in cases of severe mandibular atrophy due to the risk of fracture
* Patient cooperation Alveolar distraction osteogenesis offers an alternative treatment for three-dimensional ridge augmentation avoiding donor site morbidity. Its indications may be expanded if combined with standard bone grafting techniques.

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In recent years, the high predictability of oral implant treatment has been verified through both fundamental and clinical research, and this treatment modality is used ill various bone conditions. However, in the case of maxillary molars, which show failures that cannot be anticipated by anatomical characteristics, and which hold many challenges in implant placement surgery, predictability is poor.
From the clinical cases experienced during the 6 year and 2 month period from the establishment of this hospital in October 1997 to December 2003, we specifically analyzed the surgical techniques and the prognosis of implants placed in the maxillary molar region.
The total number of patients was 138 (22.1/month), on which 166 surgical procedures were performed (26.6/month) and 417 implants placed (5.6/month) . Of the total, implants placed in the maxilla numbered 148, or 35.5% of the total, with 77 of these (right side 43, left side 34) placed in the molar region, and the roughly equivalent remainder placed in the maxillary anterior region.
Examining by the type of surgical procedure, we found that 60 implants, or 78%, were placed using a non-standard surgical procedure, with socket lifts (Bone Added Osteotome Sinus Floor Elevation : BAOSFE) accounting for the majority with 30 cases and 47 implants; sinus lifts with 2 cases and 3 implants; and ridge expansion with 1 case and 2 implants. Standard surgical procedures accounted for the remainder of the total, with 7 cases and 17 implants, or 22% of the procedures. Examining by failure cases, early failures accounted for 5 implants, and late failures for 3 implants. Of these, 2 implants had been placed with standard surgical procedures, and 6 implants with nonstandard surgical procedures. The causes of these failures were further investigated.
For the most commonly performed socket lift procedure (BAOSFE), we observed differences in both low and extremely low maxillary sinuses, as well as changes in hone grafts over a period of time using a CT scanner and herein report on our findings.

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Several aspects of orthodontic treatment should be improved for eliminating the discomfort against to the patient. One of major concern is the pain during orthodontic treatment. The elimination of post-orthodontic adjustment pain in a physiologic manner would improve the acceptability of orthodontic treatment. The use of sonic electric toothbrush (Sonicare^®) for gingival tissue massage is employed to the patients under active multi-brackets orthodontic treatment.
Orthodontic tooth pain during treatment was scored as 0 to 5 by the index of verbal rating scores which is relating to biting foods by author's criteria. All pain index scores were collected during 6 months (before and after Sonicare^®) for initial stage group patients, and 3 months (with and without Sonicare^®) for second stage group which is on the track of treatment modality change and compared by Mann-Whitney test. Results demonstrated that Sonicare^® use significantly reduced total pain index scores, days index score becomes to 0 and scores after orthodontic adjustment. From these results, gingival tissue massage by Sonicare^®; might be helpful to reduce the pain associated with orthodontic tooth movement.

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Most of the facial asymmetry cases are indications of orthognathic surgeries. However, in the case of patients refuse the treatment plan including a surgical component, the orthodontists try to correct the occlusion without surgical intervention. This case report describes a transfer patient of 12-years-old girl who exhibited mandibular asymmetry and had already commenced the orthodontic treatment with four premolars extraction. Our rediagnosis revealed the difficulty of correcting her skeletal problem only with orthodontic treatment. While we proposed a new treatment plan, she hoped for continuance without surgical procedure. We decided to continue the treatment and noted the following points to achieve minimum requirements in an occlusion.
1. Geometrical relation between skull and mandible.
2. Mandibular rotation resulted from growth and treatment.
3. Limitation of upper anterior teeth movements by intermaxillary suture.
An appropriate occlusion was obtained as a result of the precise mechanotherapy, and a good occulsal relationship had been maintained during the retention period.
The patients worsen the facial asymmetry almost show some symptoms at the early mixed dentition. Therefore, careful observations and diagnosis are important before orthodontic treatments.

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We clinicians aim not only to treat dental disease but also to keep them in good condition for long time. Our goal is to support patients to enjoy good health and to improve their Q.O.L. through teeth treatment.
Adult orthodontics, which is increasing recently, requires more careful deliberation on periodontal treatment rather only esthetic one. In case of periodontal disease or missing arch, occlusal collapse sometimes occurs since teeth move and mandible replace easily. Therefore appropriate teeth movement for occlusal reconstruction is required.
It is not enough to improve shape and esthetic in orthodontic treatment. Proper function is also needed for constant maintenance. We need to examine a cause of periodontal or other disease from mandibular movement or functions of pronunciation, and to treat them for more stable occlusion.
Good shape makes good function and vise versa. They change patients' mental condition besides facial expression and improve their Q. O. L. by affecting their physical health.

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[in Japanese]

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It is said that dental caries and periodontal disease are infrequent disease originally. But, many patients who have visited to the dental clinic have experience of dental caries, and have inflammation of periodontal tissue. If these diseases have been advanced, dental treatment becomes difficult and a possibility of losing a tooth also becomes higher. From such clinical experience, I have felt that illness prevention is required.
When performing prevention, such as oral hygiene instruction, fluoride application and PMTC, it is important to grasp a patient's risk. Thereby, suitable prevention can be performed.
Now, there are a few patients who visit for the prevention to the dental clinic, and many patients have visited for the dental treatment. In order to prevent with such patients, all the staff of the dental clinic have to cooperate. And it is necessary to plan the prevention program according to each patient.
So, I want to report the prevention method, which we are actually performing in Kageyama dental clinic.

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Dry mouth, also known as xerostomia, is a condition which occurs when there is a decrease in the amount of saliva, and also the symptom of a dry feeling in the mouth. Saliva has many important functions, therefore a prolonged reduction in the saliva flow amount can have serious consequences to a person's overall health. In Japan, there are 8 million patients suffering from dry eye and it is thought that these patients have the same dry symptoms of their mouth. Also epidemiological data in Western countries state that 25% of the population has various dry mouth symptoms, so from this we can estimate that 30 million patients in Japan may suffer from dry mouth. In this chapter, I will review recent progress in understanding on pathological conditions of dry mouth.

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1. Try to clarify and establish [Philosophy/Idea] of your clinic, first of all.
2. Try to conduct [Survey questionnaires for the Patients/Clients] of your clinic in order to analyze your current problems. (In reference to [5 Stages of Customer Satisfaction] )
3. Try to clarify [Strong points] - [Weak points] of your clinic against your competitors in your area.
4. Try to make [Improvement Plans] based upon the analysis of the above 2 [Survey questionnaires] (By KJ methods)
-For clinical services -For managerial services
5. Try to rotate the cycle/wheel of [PDCA] (Plan-Do-Check-Action) of the above 4 [Improvement Plans] .
6. Try to prepare [One year and 3-5 years, mid/long term Plans] and update them every year based upon your review and analysis.
7. Try to count your [Investment Plan] based upon, not only the hardware, but including the improvement of ES (Employee Satisfaction) .
8. Try to behave in paying more attention to [Communication] matters.
-Toward Patients/Clients
-Toward Employee staffs
-Toward your local area (Develop potential clients)
9. Try to accomplish [Objective Management] through [Target numbers] .
10. Try to be [A leader who can solve the problems] as a top of your clinic. Try to be thoughtful and kind to others!

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The situation that we, the clinicians, face is becoming increasingly unsettling. For this reason, incorporating a system of health care in our daily practice that is outside the coverage of health insurance is unavoidable not only to increase income at a dental clinic but also to improve the quality of care covered by health insurance and to establish a dental clinic that will be preferred by more patients. To promote this type of practice, it is essential that clinicians continually strive to acquire new knowledge and improve their therapeutic techniques based on evidence-based medicine (EBM) . In addition, we propose the management of a medical practice that is financed by each patient, which is based on human-based medicine (HBM, i.e., humane medical care for people practiced by people) . By applying HBM, we believe that the image of a dental clinic can be improved and medical care outside the framework of health insurance will be more favorably accepted by the public.

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Until 1990, most dentists had had a lot of patients and had been in blocked because of high technology and their endeavors in the dental world.
In those days, rumors said that the dental world would be a hard environment in the near future, but a lot of dentists thought about it optimistically.
Concerning the number of patients-every dental office in Japan had had a lot of patients about 15 years ago in the bubble days, then the patients began decreasing gradually since 1995, eventually decreasing day by day since 2000.
Concerning dental earnings-lately many dentists earn less 70% than 15 years ago, because of government cut the medical bills and because many people are refraining from spending money. There were many dentists who behaved like haughty kings and hired dental technicians.and hygienists formerly.
But now a lot of patients are able to have many choices of dental office that are comfortable for them, so many dentists have no power over this. They had better try with their own staff. From now, the dental offices in which staff have strong power synthetically will only survive.
This paper talks about staff control concerning survival from now.

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It is necessary to establish healthy and long term successful rehabilitation using various therapeutic techniques step by step against serious disease. Therefore a patient and a doctor should have understanding common about definite treatment policy and also have responsibility as treatment and maintenance care with each other. This concept is most important to do future dentistry and is explained though the case.

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In order for American dentistry to treat periodontal disease successfully, it is essential to use the scaling technique that uses subgingiva calculus detection and subgingiva scaling. A high quality dental hygiene school should offer a 4-year curriculum that includes instruction in effective scaling techniques and caluculus detection for periodontal treatment. Classes should be taught by instructors who are competent in all of these procedures.
Upon completion of the dental hygiene curriculum, a student must have the ability to identify the very smallest amount of caluculus at the dental root surface. Also, a thorough knowledge of the dental root furcation and tooth anatomy and groove are essential.
In order to do effective scaling, the scaler and instrument machine should incorporate all the latest improvements that will enable the dental hygienist to do the best possible work. The hygienist must also know the right position for her tasks. Finally, she must be familiar with the many companies that are continually introducing new and improved scaling instruments and machines. The hygienist should be informed about the latest machines and products these companies are offering
I plan to speak about these topics and provide an update on the general state of dentistry in the United State.

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In this text, a concrete content of the reason and the Arabian medicine that the medicine including the odontology department develops in Arabia was dug down from the history of medicine. The record concerning the odontology department treatment remained comparatively, and it reported that there were a treatment method and preventive applied up to the present time in the Arabia medicine as a result. Moreover, the West medicine (present age medicine) also clarified the Arabia medicine and it was clarified to have developed as a base.

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