In the recent year, bioceramic (BC) system’s biomaterials are becoming one of the essential items in Modern Endodontics outside of Japan. Therefore, the development, popularization, and expansion of the evidence-based BC system’s biomaterial obtained from the basic and clinical research is necessary in the country. The systematic development of BC system’s biomaterials needs to be approached in consideration of the continuity of the disease and the bonding and compatibility between each biomaterial in Systematic because the diseases and tissues targeted for the endodontic treatment are various. We focused bioactive glass (BG), one of confirmed bioceramics, and are promoting the development of BG-based biomaterial (BG Material) for the wound healing and regeneration of dentin・pulp complex and periapical tissue with dental affiliated company. In translational research about the development of BG Material, we pushed forward development to a quality control process of the last product after having shown the evidence by basic researches. The BG-based endodontic biomaterial, Nishika Canal Sealer BG multi (BG multi), has been developed for root canal obturated sealer in 2017 and is also being applied for pulp capping material from 2021. This review shows the characteristics and clinical results to reflect the results of basic researches about BG Material. Additionally, we give an outline about the development of BG-based regenerative endodontic scaffold and want to mention the preservation of the tooth.

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Eighteen years have passed since bisphosphonate-related osteonecrosis of the jaws was first reported in 2003. However, since there are no guidelines yet, the treatment of anti-resorptive agents-related osteonecrosis of the jaws (ARONJ) remains controversial. We have also been treating ARONJ according to the position paper (PP). Our first approach to ARONJ is to perform conservative treatment when the healing ability of bones can be expected, and our second approach is to consider surgical treatment when the healing ability of bones cannot be expected. Therefore, we consider removal of necrotic bones as a conservative treatment using surgical techniques (surgical conservative treatment), because it facilitates local cleansing and promotes bone healing. In other words, conservative surgery is performed as conservative therapy. Resection of gingival flap performed to facilitate local cleansing is also considered conservative therapy (surgical conservative therapy) based on the same concept. In addition, we have been actively administering teriparatide to patients who can take it as an adjuvant therapy to conservative therapy in cooperation with the medical department, and we have achieved good treatment results. On the other hand, there are some cases in which the condition cannot be controlled even with such conservative therapy. We have been treating such cases with surgical therapy. Surgical treatment is basically aimed at the complete removal of pathological bones, including some healthy bones, and is considered to be extensive surgery. In order to completely remove the pathological bones, the wound is closed with reduced dead space. However, the problem in surgical treatment is how to determine the extent of pathological bone resection. Although some reports say that bones should be removed to the point of bleeding, we have long applied the bone fluorescence labeling technique using a fluorescent observation device as an adjunctive tool to determine the extent of jaw bone resection, and have obtained good results.

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Bone anchored device for the wide edentulous area is a treatment method covered by health insurance in Japan for extensive jaw defects, and ten years have passed since it was covered by the insurance. In our hospital, 55 devices have been implanted in 16 patients. The Kaplan-Meier method was used to calculate the cumulative survival rate of the bone anchored device implanted to date, which was 67.3% after 107 months of observation. The cumulative survival rate of jaw reconstruction and a bone anchored device for the wide edentulous area after resection of a malignant tumor was significantly lower than that after benign tumor or trauma. In addition, the survival curves for e bone anchored device for the wide edentulous area with malignancy as the primary disease differed from those of conventional implant treatment, with sporadic dropouts and removals after one year of implantation. These results indicate that long-term maintenance of bone anchored device for the wide edentulous area following reconstruction of the jawbone after resectioning malignant tumors is more challenging than in other primary diseases. In the future, it is necessary to accumulate objective evaluation data of oral function before and after implantation of the bone anchored device for the wide edentulous area to enable risk assessment for each patient and improve patient quality of life through collaboration among specialized departments.

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[in Japanese]

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In recent years, emphasis has been placed not only on collaboration between medicine and dentistry but also on collaboration among multiple professions. In team medicine, dentistry is expected to provide general dental care and supportive care to prevent the onset or worsening of oral adverse events in sick and perioperative patients. We have been studying oral management strategies to reduce the number of bacteria in saliva after surgery to prevent postoperative infections in the perioperative period. The study suggested that postoperative feeding status is a factor that influences the postoperative salivary bacterial count. This suggests that it is desirable to modify oral care methods according to the postoperative feeding status. Another topic of importance for collaboration with the medical community is Medication-Related Osteonecrosis of the Jaw (MRONJ), which is a side effect of drug therapy for osteoporosis. However, there are currently no guidelines for MRONJ. The current practice is to treat patients who have been treated for osteoporosis or cancer, or who have a history of taking medications with side effects that put them at risk for developing MRONJ. The patient's oral examination and periodic panoramic radiographs are important to identify risks, maintain good oral hygiene, and eliminate sources of infection. In the stage 1 situation when MRONJ has developed and there is no pain, efforts should be made to maintain oral hygiene, including intraoral examination, panoramic radiographs, and brushing of the exposed areas with a disinfectant to prevent deterioration. In Stage 2 or later, patients may experience pain, and it is necessary to develop a treatment plan with a surgery view.

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