The practicing dentist faces a large number of difficulties in operating his clinic today. In particular, economic constraints have become quite serious, and are causing considerable difficulties in clinical operations.
This deterioration in the operating environment has its origin in the fact that the remuneration for medical treatment is being carried out as a controlled economy in a capitalist economic system. Although it is only common sense that necessary operating expenses be covered by income, this fact has not been acknowledged in the medical community.
Although the Ministry of Health and Welfare has detrmined that dentists are receiving adequate compensation based on their surveys of medical practice operations, there is no surplus to permit a reliable profit while including necessary expenses for the dentists who is burdened with daily clinical practice and the acquisition of rapidly progressing knowledge in the field of dentistry.
As practicing dentists, we must publicize our actual operating conditions by carrying out cost calculations based on accurate data, and endeavor to obtain appropriate remuneration. In this discussion I would like to clarify this situation from this point of view, by carrying out cost calculations for an actual clinical case.

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Beginning with this paper, I would like to discuss the fundamentals of clinical gnathology for those who would like an introduction to this field.
Gnathology was first introduced to Japan in 1960 by Ben Papone. Since that time gnathology spread rapidly throughout the world through the efforts of P.K. Thomas and has contributed greatly to the development of present day modern dentistry. This is due to the fact that the scientific basis and physiologic superiority of gnathology has been recognized. In contrast, together with the spread of gnathology, there have been several report on its detrimental effects.
Since gnathology puts considerable emphasis on the use of the pantograph and articulator, it has often been thought of as mechanical and non-physiologic. This view must be rejected as mistaken and based on ignorance of the truth about ganthology.
Mistaken beliefs like this are common throughout the world today. This tendency is particularly strong in the dental community in Japan where medicine is dominated by an inferior social health insurance system worse than any in the world. In the United States and Europe gnathology has already spread, and has become widely incorporated into daily clinical practice. Gnathology is even being practiced without the awareness that it is gnathology.
In preparation for the clinical aspects which will be covered next, while emphasizing the problems of introducing gnathology in Japan, the social background of that time, physiological aspects, the importance of periodontal tissues, and in particular high technology, I would like to discuss our predecessors who built up the tradition of gnathology by relentlessly pursuing the elevation of precision (physiology) and simplicity.

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Most full denture patients visiting dental offices have abnormal inflammation of the mucosa under the denture and disruptions in the mucosal tissues.
It is necessary to give consideration to the periodontal tissue during the prosthetic treatment of cases where there are remaining teeth. The same is true for full dentures. It is not acceptable to take an impression without considering the mucosa under the denture base.
The easiest way to obtain an accurate representation of the jaw and mucosa is to have the patient not use the denture 24 to 48 hours before taking the impression. However, in terms of the patient's lifestyle, this is rather difficult, and when consideration is given to the functional occlusal and masticatory pressures imparted on the denture, the degree of compression on the mucosal tissue under the denture is ignored.
Therefore in daily practice it is necessary to have a method that uses a treatment denture and tissue conditioner (a material for conditioning the mucosa-a functional impression material) and restores the mucosal tissue under the denture to a clinically healthy condition. I would like to discuss the necessary conditions for the use of tissue conditioners.

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