Osteoporosis patients are estimated to amount to 12 million in our country. The osteoporosis screening rate, however, remains low at 5％; hence, many of them are latent patients. As such, it is proposed to provide opportunistic screening of osteoporosis for the patients at the dental clinic using dental panorama radiographs (DPR). Using computer-aided diagnostic system with application of image analyzing software on DPR, we examined mandibular cortical index and mandibular cortical width, and then graded the osteoporosis risk into 3 phases. Among the subjects—176 patients aged 45 and older (average age 62.18 years old) who agreed to the osteoporosis risk evaluation program, 18 patients were at high risk while 68 at moderately high risk and 90 at low risk. It was demonstrated that among patients aged 50 and older the rate of patients at higher risks increased directly with aging. We advised high risk patients to visit the osteoporosis specialist, and 2 out of 18 followed our advice within 3 months.

【Objective】 Patients with edentulous maxillae and mandibular free-end missing often present with symptoms such as bone resorption in the maxillary anterior region, enlarged or/and elongated maxillary tuberosity, papillary hyperplasia in the hard palate mucosa, extrusion of mandibular anterior teeth, and resorption of bone under mandibular denture base—together called “combination syndrome” and are likely to be considered difficult denture cases. This report is to present a successful case of denture treatment for a patient (82 year-old, female) with such combination syndrome. The patient wearing maxillary full denture and mandibular bilateral free-end saddle denture had difficulty with mastication due to the loose dentures, clearly presenting the combination syndrome. Lip support improved by denture repair, restoration of vertical dimension, and singularized mandibular prostheses led to stability of both upper and lower dentures and improvement of chief complaints. Occlusal reconstruction was ministered in order to further mechanically stabilize the maxillary denture. 【Discussion】Masticatory dysfunction was successfully improved owing to the use of the mandibular denture fabricated on the basis of rigid support for the bilateral free-end saddle denture, re-establishment of occlusal plane curtailing sliding phenomenon of the maxillary denture, provision of bilateral occlusion to prevent denture overturn.

Impacted permanent teeth sometimes cause root resorption of adjacent teeth. On the one hand, such abnormal resorption mostly results from impacted maxillary canines interfering the roots of the incisors; there have been affluent reports of such cases. On the other hand, rarely seen are cases of mandibular first molars affected by impacted second molars due to low incident rate of impaction of second molars. Presented in this report, however, is an instance of such rare case to which full-mouth orthodontic and occlusal treatment was applied after extraction of bilateral mandibular first molars and bilateral maxillary first premolars. Full-mouth orthodontic treatment enabled establishment of anterior guidance and intercuspation of molars with natural teeth alone, which in turn resulted in stable occlusion. As in the present case, severe root resorption without any discomfort, symptom, or mobility, may be found only via X-ray assessment.

The patient had not visited the dentist for about 15 years. The patient presented with a chief complaint of loss of posterior occlusion and wished to receive occlusal reconstruction. An intraoral observation found the stumps of molars no longer providing the occlusal support, causing underbite when the mouth is closed. Based on medical interviews, intraoral examinations, X-rays, and a questionnaire on ingestible foods, the patient was diagnosed with mastication disorder and cosmetic disturbance. Our treatment plan was to first stabilize the jaw position with the help of a treatment denture, and then move on to the preparation of a final prosthesis. Upon the patient's consent, we conducted the full-mouth rehabilitation involving a crown restoration and the use of magnetic attachments and mini-SG attachments. The cosmetic recovery was achieved after the full mouth rehabilitation, provision of occlusal support, and consequent improvement of false underbite. At the initial visit, the mastication score was 48.2. After the attachment of the final prosthesis, the score improved to nearly the double score, 94.6. With the recovery of masticatory and pronunciation functions, the treatment successfully contributed to the improvement of the patient's quality of life.

The patient was a 60-year-old female whose lower remaining teeth deemed hopeless. Although it was a common case of upper and lower full denture treatment, the patient desired higher masticatory efficiency due to her food preference and hence an alternative treatment. After consultation with the patient, we decided to place 4 implants in the mandible and an overdenture with magnetic attachments. We compared the level of the masticatory function among preoperative full denture, final overdenture with/without attachments. The overdenture with attachments resulted in the most favorable outcome.

Enamel matrix derivative (EMD), based on the principle of periodontal tissue generation, was developed as biomaterial promoting regeneration of periodontal tissue once lost due to periodontal disease. According to recent studies, however, EMD may be applicable to bone regeneration due to its growth factor-like feature. As such, we investigated possible application of EMD to guided bone regeneration (GBR) in implant treatment, reviewing stepwise application of EMD in a series of clinical cases. Initially, we assessed post-implant placement wound healing by placing EMD on top of and around the healing caps and confirmed that EMD could be integrated into implant treatment. Secondly, we applied EMD in combination with bone filling material in socket preservation technique, which led to a favorable result. Finally, a case of EMDapplied GBR resulted in a clinically satisfactory outcome. Hence, we suggest possibility of wider application of EMD to GBR, based on due consideration of basic research. However, effect of EMD in implant treatment needs to be scrutinized based on long-term follow-up.