The aim of this study was to evaluate the plaque removal efficacy of three tooth brushes：the Philips Sonicare Diamond Clean with a medium brush head, Philips Sonicare Diamond Clean with a mini brush head, and the Philips Sonicare Flexcare with a medium brush head. This study was an investigator-blinded,three-brush crossover design study. Twenty dentists with clinically healthy gingiva and without restorative materials or prosthetic teeth participated in this study. Prior to the experiment, the subjects received a professional prophylactic program and were requested to refrain from brushing their teeth for 48 hours. Assessment was carried out using the modified OʼLearyʼs plaque control record (6 sites per tooth) at the baseline and after each brushing interval by one blinded investigator. The PCR score was 100% at the baseline in all subjects. The results showed no statistically significant differences in the PCR score among the three tooth brushes. However, the Sonicare Diamond Clean (DS) provided a more pleasant brushing experience than the Flexcare (FS) in 90% of the subjects, which may be a significant factor advantage for long-term use. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 55(2)：140-147, 2013.

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The purpose of this study was to evaluate the factors that might influence a patientʼs choice of a mouth rinse. A structured questionnaire to determine the pattern of usage and reasons for choosing among mouth rinses was distributed to 53 outpatients at the Clinic of Operative Dentistry and Endodontics, Niigata University Medical and Dental Hospital. The plaque score was recorded based on the responses. The participants were also asked to rate, in a randomized double-blind manner, the taste and mouth-feel of four mouth rinses with different main ingredients [ConCool F^® (CHX), Listerine^® fresh mint (EO), Puora^® (PU) and GUM^® dental rinse (CP)] on a 5-point scale. The mean tooth brushing frequency of the participants was 2.8 times per day, and 87% of the participants used interdental and/or tongue cleaning products, and 43% used a mouth rinse on a regular basis. Mouth rinse users showed significantly lesser plaque formation as compared to non-users. The ranking of the reasons for the choices of mouth rinses showed significant consistency; and antimicrobial effects, refreshed feeling and taste were chosen as important reasons. Positive correlations were observed among the scores for taste and mouth-feel of the four mouth rinses, and the mean score was CHX＞CP＞PU＞EO for both items. It was concluded that professional advice, taste and mouth-feel, as well as the expectation for the prevention of caries and periodontal disease may be important factors influencing the patientsʼ choice of a mouth rinse. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 55(2)：148-155, 2013.

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The present study was a retrospective evaluation, from the clinical and microbiological perspectives,of the treatment response approximately one year after systemic antibiotic (SA) administration combined with scaling and root planing (SRP) in patients with severe periodontitis. The relationships between the treatment response and related factors were also evaluated using multilevel multiple regression analysis, in order to clarify the indications for SA administration in periodontal cause-related therapy. Clinical and microbiological assessments were conducted at the baseline, at follow-up after SRP combined with SA therapy (Exam 1), and at follow-up after further SRP combined with SA therapy as necessary, or after periodontal surgery (Exam 2). The diagnostic criteria for therapy-resistant periodontitis (TRP) comprised a post-treatment probing pocket depth (PD) reduction of＞2 mm in less than 70% of sites, with a baseline PD of＞6 mm. The following results were obtained. 1) The improvements in the PD, bleeding on probing (BOP) and suppression of periodontal pathogens in cases of non-surgical periodontal treatment combined with SA between Exam 1 and 2 were equivalent to those noted in the patients treated by periodontal surgery. 2) The rate of TRP occurrence after Exam 1 was 29%, and the post-treatment decrease of the BOP and bacterial risk improvement were insufficient in the TRP patients. 3) Comparison of the findings at the baseline and at Exam 1 revealed that the higher the pre-treatment PD, the greater the post-treatment reduction in the PD. In cases with a favorable treatment response, comparison of the tooth and site-level variables showed that the relative contribution to the total variance was greater for patient-related variables. Significant clinical and microbiological effects were obtained when systemic antibiotics were administered in combination with SRP in the treatment of severe periodontitis. In addition, these findings suggest that patient-related factors influencing the treatment response should also be evaluated in addition to the conventional classification of periodontal disease in patients in whom SA therapy is indicated. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 55(2)：156-169, 2013.

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We created a database of patient information and laboratory measurements for patients with severe periodontitis, and assessed how the patient-related prognostic factors and treatment response might be related to the risk of tooth loss and progression (recurrence) of periodontal disease during supportive periodontal therapy (SPT). To create the database, we retrospectively collected the case data of 208 patients with severe periodontitis receiving SPT at 11 dental centers. Data included the medical history, treatment history and laboratory measurements related to periodontitis and the general health status at the time of the first consultation, after scaling and root planing (SRP), at the start of SPT, and at the latest SPT session. Patients were defined as having therapy-resistant periodontitis (TRP) if the percentage of sites with a reduction of the periodontal pocket probing depth? (PD) of 2 mm or more from a baseline of 6 mm or more after SRP was less than 70%. Logistic regression analysis and the Kaplan-Meier survival regression method were used to analyze the risk factors for tooth loss and recurrence of periodontitis. There were no significant associations between the risk factors for tooth loss and the various patient-related prognostic factors at the first consultation, however, the number of teeth lost and a history of smoking were significant risk factors for the recurrence of periodontitis. TRP diagnosis was a significant risk factor for tooth loss (OR：2.81, p＝0.006), and patient compliance (regular vs. irregular visits) was a significant risk factor for periodontitis recurrence (OR：3.85, p＜0.001). Based on the survival curve analysis for the prediction of tooth loss, there was a tendency towards an increase of the event incidence rate immediately after the start of SPT in TRP patients and non-compliers, and at about 5 years after the start of SPT in high-risk patients identified by the periodontal risk assessment model, although only the latter was statistically significant (log-rank test, p＝0.0315). The results of the present study demonstrated the prospective usefulness of TRP diagnosis for assessing the prognosis in patients with severe periodontitis. They also suggested that careful attention to utilizing the characteristics of the various techniques for diagnosing patient-related risk factors may increase the accuracy of risk prediction. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 55(2)：170-182, 2013.

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In this case report, we describe the management of chronic periodontitis in a patient with type 2 diabetes mellitus, including periodontal, implant and restorative treatment, tooth extraction, and maintenance care for 5 years. A 57-year-old male visited our clinic complaining of pain and mobility of 17 teeth. The patient had been diagnosed as having type 2 diabetes for 15 years previously. The mean probing depth (PD) at the first visit was 3.4 mm, the percentage of tooth sites with PD 4 mm or more was 24.4%, the rate of bleeding on probing was 30.8%, and the OʼLearyʼs plaque control record was 36.6%. As vertical and horizontal bone loss was also observed on the radiograph. Although 24.4% of the total number of sites had PD 4 mm or more at the first visit,re-evaluation after periodontal initial therapy revealed reduction of the mean PD to 6.1%. We performed implant surgery and periodontal tissue regenerative therapy with enamel matrix derivative. After re-evaluation, the final restoration was placed and the patient entered the maintenance phase. In the present case, it was possible to perform periodontal treatment while stable glycemic control was maintained. However, if the HbA1c level exceeds 7.4% (NGSP) after the patient enters the maintenance phase, re-motivation for diabetes treatment will be necessary. The blood glucose levels should be continuously and carefully monitored while the patient is in the maintenance phase. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 55(2)：189-199, 2013.

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