Nowadays, while implant treatments are widely performed, the number of patients with peri-implantitis has been increasing. It has been reported that bacteria spread from the natural teeth to the implants in the mouth. Recently, full-mouth SRP (FM-SRP) using azithromycin (AZM) has been employed in an attempt to prevent the propagation of periodontal pathogens during the treatment of severe periodontitis. Some reports have indicated that this procedure yields good outcomes and stability during the treatment of severe periodontitis. The purpose of this study was to evaluate clinically and bacteriologically whether FM-SRP using AZM may also be more effective in the treatment of peri-implantitis as compared to Quadrant SRP. The results revealed better improvement in all of the clinical parameters of the implants as well as the natural teeth in the test group more than in the control group. In order to perform quantitative bacterial examinations, PCR-Invader methods were carried out to detect 5 periodontal pathogens. A controlled amount of periodontal pathogens was seen in both the implants and the natural teeth until 3 months of the start of treatment in the test group. Furthermore, Terminal Restriction Fragment Length Polymorphism(T-RFLP)analysis was carried out to study the diversity of the microbiota associated with periodontitis and peri-implantitis, followed by cluster analysis. The results revealed statistically significant differences in the bacterial flora between before and after the FM-SRP in both the implants and natural teeth. Based on the above findings, we suggest that changes in the bacterial flora substantially affect the symptoms of peri-implantitis, and that FM-SRP is an effective method, both from the point of view of clinical and bacteriological improvement, for the treatment of peri-implantitis.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(4) : 303-315, 2009.

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The purpose of the present study was to compare the efficacy of enamel matrix derivative (EMD) for periodontal tissue generation in patients classified according to the bone defect morphology and severity of periodontal disease. In total, 90 sites of 33 patients who were treated with EMD for periodontal tissue regeneration were investigated. In regard to the bone defect form, 60 of the 90 sites showed vertical bone loss (including 10 sites with 1 bony wall defect and 50 sites with 2 or 3 bony defects), while 30 sites showed horizontal bone loss. Additionary, patients were classified into a moderate group (probing pocket depth; PPD<6mm) and severe group (PPD≥6mm) just before the EMD treatment. The PPD, clinical attachment level (CAL), and bone loss ratio (BL) were measured before and after 6 months of treatment with EMD, and the amount of improvement and the improvement rate were calculated. The results in the entire subjects population were as follows: PPD improvement: 3.1mm (improvement rate; 46.8%); CAL improvement: 2.8mm(improvement rate; 37.1%), BL improvement: 15.2% (improvement rate; 34.5%); all were statistically significant. Moreover, there were significant differences in the bony defect measured before and after 6 months of treatment for all forms of bony defect, and there were no significant difference between the two bony defect groups. These results suggest the efficacy of EMD, evaluated after 6 months of treatment in this study, in not only patients with vertical bone loss, but also those with horizontal bone loss. However, the difference by the bone defect morphology was not admitted. When compared by the severity of disease, a greater tendency towards improvement was noted in the moderate as compared to the severe group severely, a marked tendency towards improvement was noted in the moderate horizontal defect group.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(4) : 316-325, 2009.

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A 53-year-old male with a noncontributory medical history was referred to our hospital in April 2003 with the chief complaint of mobility of the maxillary left second molar tooth. The patient was diagnosed as having generalized severe chronic periodontitis with exfoliation, pathologic migration of the maxillary anterior and premolar teeth by secondary occlusal trauma, and also posterior bite collapse. Following completion of the initial periodontal therapy by both periodontists and dental hygienists, the progression of the periodontal disease was dramatically inhibited and supportive periodontal therapy was started without periodontal surgery. The number of teeth present, the mean clinical attachment level, the probing depth (PD), sites with a PD of more than 4 mm or 7mm, and sites with bleeding on probing were improved and maintained from 18 teeth, 5.7mm, 4.7mm, 56 sites (51.9%), 32 sites (29.6%) and 67 sites (62.0%), respectively, before the treatment, to 17 teeth, 4.4mm, 2.9mm, 12 sites (11.8%), 0 and 20 sites (19.6%), respectively, in February of 2009. The periodontal condition was stable and fulfilled the patient's desire to keep his teeth healthy for about 6 years from the initial visit without periodontal surgery.
Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 51(4) : 326-333, 2009.

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The aim of this study was to investigate the smoking status and attitudes toward tobacco control among periodontists of the Japanese Society of Periodontology, a non-profit organization. The questionnaires to determine the smoking status and attitude towards the tobacco control policy were mailed to 861 periodontists. Four hundred thirty-five of them(53.3%), of whom 70.3% were in their 40s and 50s, returned the completed questionnaire. The respondents were divided into university staff(27.8%), university hospital staff(6.4%), general practitioners(61.6%), and others(3.0%). The sample included 225 non-smokers(51.7%), 140 ex-smokers(32.2%), and 64 smokers(14.7%). Of the respondents, 58.1 % agreed that patients with periodontal disease should not smoke and 81.7% agreed that periodontists should get a fee for managing nicotine dependence. Also, 76.8% thought that periodontists can easily assist patients to quit smoking. Of the total, 71.2% agreed that periodontists should not smoke and 60.3% of the periodontists indicated that periodontists knew their patients' smoking status. About 77.6% pointed out that the majority of patients with severe periodontitis smoked and 89.6% stated that the healing capacity in smokers was impaired. In addition, 69.3% had helped patients quit smoking. However, 22.7% said that they had not helped patients quit smoking, because they did not have the time, patients refused their support, they could not get insurance marks, or they did not know how to support patients in their efforts to quit smoking. Thus, it is necessary to understand that periodontists have a chance to help their patients quit smoking and that support by periodontists to patients to quit smoking is effective. Most periodontists would take more time to support patients in their efforts to quit smoking if dental insurance for such assistance were available.
Nihon Shishubyo Gakkai Kaishi(J Jpn Soc Periodontol)51(4) : 334-345, 2009.

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