The following are guidelines on systemic diseases in accordance to enable more informed decisions to be made when treating oral implants.
1．It is important to prevent a silent pandemic because Antimicrobial Resistance (AMR) is projected to become the leading cause of mortality in 2050.
2．Amyloidosis is expected to be the leading cause of death in the older population. It is crucial to be attentive to carpal tunnel syndrome, a form of neuropathy, as it can serve as the initial indication of the disease.
3．Asthma often occurs for the first time in middle age, and an increasing number of patients have Chronic Obstructive Pulmonary Disease (COPD) as a co-morbid condition (Asthma/COPD Overlap Syndrome : ACO). Dental treatment of these patients should be prepared of the inhaled drug Short-acting β-agonists (SABA).
4．For chronic constipation, avoiding the use of stimulant laxatives is advisable whenever possible.
5．Obesity is a high risk for atherosclerotic disease ; therefore, prioritizing visceral fat reduction is more important.
6．An algorithm that prioritizes the concept of prescribing, rather than adhering to conventional guidelines, has been published and is considered a breakthrough in the management of type 2 diabetes mellitus.
7．Dyslipidemia is a latent disease, and risk management is necessary to prevent it from progressing to clinical inertia.
8．The association between periodontal disease and dementia and that between renal failure and dementia are increasingly evident, as is the interrelationship among each organ and each specific disease.
The process of oral implant treatment encompasses not only placement but also maintenance. Therefore, continuing lifelong intervention in accordance with the latest findings is necessary while accurately assessing the patient’s general condition.

Many patients receiving antithrombotic therapy (antiplatelet, anticoagulant drugs) visit our dental clinic. In the implant treatment of these patients, it is important to fully understand and manage antithrombotic therapy and antithrombotic agents. This article provides an overview of thrombosis, embolism, and antithrombotic therapy, and presents the 2020 version of clinical practice guidelines for tooth extraction in patients on antithrombotic therapy. The guidelines basically suggest that extraction should be performed under continuous antithrombotic medication and that local hemostasis should be ensured. However, this guideline was not developed for dental implant surgery. In dental implant surgery, it may be possible to use antithrombotic drugs under the same conditions as in normal tooth extraction, such as for placement of a few implants in a well-conditioned jaw crest or for minor procedures with a small area of mucoperiosteal elevation, where hemostatic measures can be performed as reliably as in normal tooth extraction. On the other hand, bone augmentation procedures are often accompanied by extensive mucoperiosteal detachment, which is a significant and extensive surgical invasion. In these cases, the extent of pressure hemostasis, the security of pressure, the fugue route of bleeding, and the presence of surrounding cellular tissue are all problematic, and careful and reliable hemostasis is essential. It is necessary to implement measures to address these issues and to work with medical facilities that can manage unexpected bleeding.

The position paper on medication-related osteonecrosis of the jaw （MRONJ) was revised in July 2023 in Japan. It is noted that the risk factors for MRONJ are persistent infections such as periapical lesions, periodontal disease, and peri-implantitis, rather than invasive procedures such as tooth extractions and dental implant surgery compared to the previous position paper (2016). In addition, the number of MRONJ patients caused by antiresorptive agents is still increasing in Japan, and so the importance of medical-dental-pharmacological cooperation is emphasized.
It is suggested that, in principle, there should be no prophylactic withdrawal of antiresorptive agents at the time of invasive procedures such as tooth extraction. Dental implant surgery in patients taking low doses of antiresorptive agents is not necessarily contraindicated if they do not have other MRONJ risk factors (diabetes, autoimmune diseases, undergoing dialysis, etc.). However, implant-associated MRONJ is often triggered by peri-implantitis. Therefore, careful consideration is required when planning dental implant treatment, and maintenance and patient education after dental implant surgery are particularly crucial.

To evaluate implant primary stability, the correlation between implant insertion torque and implant stability quotient (ISQ) was measured using human cadaver mandible. The implant was inserted at 10, 20, 30, 40, and 50 Ncm into the bilateral mandibular canines to the molar region with sufficient buccolingual bone height (n＝5). ISQ showed a significant correlation with insertion torque when the buccolingual bone height was maintained (condition Full, p＝0.0004), whereas all individual cadaver mandibles showed no significant correlation with ISQ. After the buccal bone wall was removed (condition Hemi), ISQ still showed a significant correlation with insertion torque (p＝0.0023) when all cadaver data were collected. Similarly, individual cadaver ISQ showed no significant correlation (p＞0.05). After the buccolingual bone wall was removed (condition Apex), the correlation between insertion torque and ISQ was lost (p＝0.9683), and also no correlation was observed for each individual cadaver. There was no significant difference in ISQ between values at any insertion torque under the Full and Hemi conditions (p＞0.05). However, condition Apex showed significantly lower ISQ value than conditions Full and Hemi at all insertion torques (p＜0.05).
When an implant is inserted in the presence of buccolingual bone, a higher torque results in a higher ISQ as a general tendency. A similar phenomenon was observed even when buccal bone was lost, and the ISQ was higher when inserted with a higher insertion torque. From these results, it is considered that it is difficult to use ISQ to detect buccal bone wall resorption, and it was found that ISQ tends to be maintained until the buccolingual bone wall is lost.