Recently, more patients undergoing prosthodontic treatment of the anterior teeth have been expecting an improvement in esthetics as well as function. Reconstruction of the interproximal dental papilla by crown adjustment has become the most common means of meeting the demand for a mouth having a natural and balanced appearance. However, even with the currently available techniques, it is difficult to maintain the gingival margin in the long term unless the periodontal tissue is healthy. Here we describe a 43-year-old woman who presented with both esthetic and pronunciation problems due to generalized chronic periodontitis accompanied by facial flaring and extrusion of the anterior teeth. We controlled the periodontal inflammation and stabilized the occlusion by periodontal surgery and orthodontic treatment. After amelioration of the facial flaring of the anterior teeth, we improved the proportions of the gingival margin by orthodontic treatment. For the anterior teeth whose roots had become thin, we created a contour equivalent to that of the natural teeth by prosthodonti treatment. This interdisciplinary approach enabled substantial improvement in the patient's appearance and pronunciation. J Jpn Soc Periodontol, 45: 142-149, 2003.

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Periodontitis is a complex multifactorial disease whose etiology is not yet, well defined, and recently increasing attention has been focused on the genetic risk factors of periodontal disease. The purpose of this study was to analyze published literature on the association between genetic polymorphisms and periodontal disease by a systematic review method. A comprehensive medical literature database, including Medline, EMBASE, BIOSIS Previews, and Japana Centra Revuo Medicina, was searched to retrieve primary research papers on the relationship between genetic polymorphisms and periodontal diseases, and the papers included retrospective studies that compared the prevalence of genetic polymorphisms between periodontitis patients and healthy controls. The exclusion criteria were papers on the genes of microorganisms and on periimplantitis. Studies with subjects less than 10 were also excluded. There were 44 papers that met our selection criteria, and they were reviewed. Seven papers were on Fcγreceptors, 14 on interleukin-1 (IL-1), 8 on tumor necrosis factors (TNFs), and the rest were on other genetic polymorphisms. Most of the studies were fairly well documented in regard to the reproducibility of study methods and the definition of patients/controls, but many studies failed to describe examiner masking in regard to clinical status. All 7 papers on the genotype of Fcγreceptors reported evidence supporting a relationship to periodontitis. Two of 6 papers reported a positive association between IL-1 allele polymorphisms and adult periodontitis, and 1 of 3 papers reported a positive association between IL-1 polymorphisms and early-onset periodontitis. None of the 8 papers on TNFs demonstrated a significant correlation between polymorphisms and periodontitis. Due to the lack of the consistency of the definition of periodontal diseases and because of the great heterogeneity of each population studied, a cumulative meta-analysis of predictor measures for periodontal disease was impassible. The evidence from the articles reviewed indicated significant associations between periodontitis and some specific genetic polymorphisms, but some reports showed bidirectional results. Further rigorous studies based on well-defined disease and control criteria will be required to contribute to the prevention and management of periodontitis. J Jpn Soc Periodontol, 45: 150-462, 2003.

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This study used the polymerase chain reaction to investigate the prevalence of 7 putative periodontopathic bacteria in 20 periodontally healthy subjects (33. 5±7. 0 years old) and 21 adult periodontitis patients 44. 8±12. 0 years old) in China Beijing). Subgingival specimens were collected with a paper point (from subgingival sites in healthy subjects (n= 20) and from healthy (n=16) and from diseased subgingival sites n= 21) in adult periodontitis patients. Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia were frequently detected (from 85% to 95%) in the diseased sites of patients, and 3 species, Prevotella nigrescens, Prevotella pallens, and Actinobacillus actinomycetemcomitans, were moderately detected (from 24% to 33%). The distribution patterns of the 7 bacterial species were analyzed by Fisher's direct method. P. gingivalis, T. forsythensis, T. denticola, and P. intermedia showed a significantly similar pattern in the sampling sites (p<0. 0001), and they formed complex. P. nigrescens, P. Miens, and A. actinomycetemcomitans showed patterns that were partially similar to that of the above 4 species, and they formed four independent groups.
In contrast to P. nigrescens, P. intermedia seemed to be an important etiogenic periodontopathogen, the same as P. gingivalis, T. forsythensis, and T. denticola. J Jpn Soc Periodontol, 45 : 163-170, 2003.

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The purpose of this study was to establish a method of detection of premature contact under pathologic conditions. We hypothesiced that mobile teeth affected by periodontitis would lead to tooth extrusion and tooth migration, and ultimately cause premature contact during occlusion. This study used pressuresensitive sheets (Dental Prescale®) to measure occlusal force and occlusal area before and after mobile molars were fixed in the intercuspal relationship. The occlusal loading ratio and occlusal area ratio were also estimated in order to determine the relationship between the difference produced by fixation and the mobility of the tooth. Degree of mobility was evaluated by a modifieation of the Miller index as no/low mobility (M 0 and M 1) and high mobility (M 2 and M 3).
The results showed were as follows:
1. The occlusal force of the high mobility tooth group increased significantly after fixation compared to the no/low mobilility tooth group (p<0. 05).
2. The occlusal area of the high mobility tooth group showed a tendency to increase after fixation compared to the no/low mobility tooth group.
3. The occlusal loading ratio of the high mobilility toothgroup increased significantly after fixation compared to the no/low mobilility tooth group (p<0. 05).
4. The occlusal area ratio of the high mobility tooth groilp increased significantly after fixation eompared to the no/low mobility tooth group (p <0. 05).
These results suggested that the fixation of periodontally mobile teeth may improve the diagnosis of traumatic occlusion caused by premature contact of tooth extrusion or tooth migration. J Jpn Soc Periodontol, 45: 171-179, 2003.

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The present study was performed to investigate the influence of periodontal tissue destruction on tooth migration. Sixty-two periodontitis patients (1, 538 teeth) were the subject of this study. Periodontal parameters, including probing pocket depth and probing attachment level, and study cast impressions were taken at the baseline examination. The occlusal surface of study models was scanned with a tabletop optimetric scanner. Ideal dentition arch curves were set by connecting the cusps or incisal edges of teeth on the scanned images with an image-processing program (Scion Image® Scion Corporation). Tooth migration was defined as more than 2 mm displacement from ideal dentition. Non-parametric tests were employed to statistically analyse periodontal parameter and tooth migration data. Statistically significant differences in periodontal tissue breakdown measured by probing pocket depth and probing attachment level were observed between the buccal aspect and lingual aspect of migrated teeth. Buccally migrated teeth in the anterior region showed greater periodontal tissue breakdown on the lingual aspect, and lingually migrated teeth in the lower anterior region showed greater breakdown on the buccal aspect, in agreement with the results of our previous experiment in animals. By contrast, the lower premolar and molar region showed no relationship between the presence of inflammation and tooth migration, and this finding may have been due to an association with other factors, such as tongue or buccal muscle movements to maintain tooth position in the lower premolar and molar region. J Jpn Soc Periodontol, 45: 180-192, 2003.

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