Recently, dental implant therapy has been routinely undertaken at many dental hospitals and institutions. Consequently, complications associated with dental implant treatment have also increased.

There is no consensus on the management of bone prosthetic materials displaced into the maxillary sinus following maxillary sinus augmentation surgery (maxillary sinus floor elevation) for a dental implant.

When the displacement of bone prosthetic material into the maxillary sinus occurs, first of all, closure of the perforation between the oral cavity and maxillary sinus should be performed to prevent infection. Next, antibacterial therapy should be administered in conjunction with ventilation and drainage of the maxillary sinus. After the procedure, the bone prosthetic materials displaced into the maxillary sinus will, in most cases, be drained out of the maxillary sinus via the natural ostium.

When intractable maxillary sinusitis occurs following the initial treatment as mentioned above, endoscopic sinus surgery is indicated.

Management of bone prosthetic materials displaced into the maxillary sinus should be performed based on the pathophysiological conditions of the maxillary sinus.

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When a dental implant is displaced into the maxillary sinus following dental implant placement and/or maxillary sinus augmentation surgery, the exact procedures for dental implant extraction should be selected based on the pathophysiological condition of the nose and paranasal sinuses.

In the case of displacement of a dental implant alone, endoscopic transnasal extraction of the dental implant using maxillary sinus fenestration (via the middle meatus and/or via inferior meatus) is indicated. When it is accompanied by nasal septal deviation and/or inferior turbinate hypertrophy, endoscopic transnasal septoplasty and/or inferior turbinotomy are also indicated for obtaining working space. When it is accompanied by sinusitis, endoscopic transnasal sinus surgery is also indicated.

Endoscopic sinus surgery is indicated and is the procedure of first choice for the extraction of a displaced dental implant in the maxillary sinus in patients with any pathophysiological conditions of the nose and paranasal sinuses.

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Recently, dental implantation has been routinely performed in many dental hospitals and institutions. Inevitably, complications associated with dental implants have also increased.

Two hypotheses have been proposed for the pathogenesis of odontogenic maxillary sinusitis caused by dental implant placement and/or maxillary sinus augmentation surgery.

According to the first, odontogenic infections, such as odontogenic maxillary sinusitis, are caused by the surgical procedure in which dental implants are placed. The cycle of inflammation involving odontogenic infection and factors that interfere with successful treatment of sinusitis influences the outcomes of maxillary sinusitis.

The other hypothesis is that odontogenic infections, such as odontogenic maxillary sinusitis, are caused by chronic infection of neighboring teeth, such as apical periodontitis during dental implantation. According to this hypothesis, the inflammatory vicious cycle formed among dental lesions, odontogenic infection and factors that can disrupt the treatment of sinusitis can influence the outcomes of odontogenic maxillary sinusitis.

Both the hypotheses suggest that a vicious cycle of inflammation in the closed maxillary sinus results in intractable maxillary sinusitis.

Impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus and result in intractable maxillary sinusitis caused by dental implantation.

The maxillary sinus mucosa in cases of maxillary sinusitis caused by dental implantation is characteristic. From the histopathological point of view, the ciliated columnar epithelium in cases of intractable odontogenic maxillary sinusitis is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. The three aforementioned factors that potentially interfere with the treatment of odontogenic maxillary sinusitis, the treatment strategy is focused on how to manage the two remaining factors: infections and occlusion of the ostiomeatal complex.

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Dental implant therapy is now routinely undertaken at many dental hospitals and institutions. Consequently, the incidence of complications associated with dental implant treatment has also increased.

When a dental implant becomes displaced into the maxillary sinus following dental implant placement and/or maxillary sinus augmentation surgery, the appropriate procedures for extraction of the displaced dental implant should be based on the pathophysiological conditions of the nose and paranasal sinuses.

In the case of displacement of a dental implant alone, endoscopic transnasal extraction of the dental implant using maxillary sinus fenestration (via the middle meatus and/or inferior meatus) is indicated. In subjects with nasal septum deviation and/or inferior turbinate hypertrophy, endoscopic transnasal septoplasty and/or inferior turbinotomy are also indicated for obtaining adequate working space. In patients with associated sinusitis, endoscopic transnasal sinus surgery is also indicated.

Endoscopic sinus surgery is indicated and is the procedure of first choice for the extraction of a displaced dental implant from the maxillary sinus in patients with any pathophysiological conditions of the nose and paranasal sinuses.

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17種類の農薬について, ミジンコ2種の急性毒性試験および繁殖阻害試験, 魚卵仔魚短期毒性試験と単細胞緑藻成長阻害試験を行い, それらの毒性データについて主成分分析とクラスター分析を行い, 農薬毒性の分類を試みた。ミジンコ類については10ppbを下回る濃度で急性毒性を示した農薬が数種存在した。ミジンコの繁殖試験では多くの農薬で急性毒性値よりも低い濃度で毒性を示した。強い魚毒性, 緑藻毒性を示したのは1および2種であった (10ppb以下) 。各農薬の毒性データについて主成分分析を行ったところ, 寄与率が高かったのは3成分であった。それぞれミジンコ類への毒性寄与が大きい, 緑藻への毒性寄与が大きい, 魚への毒性寄与が大きい成分であった。また, その結果を使ってクラスター分析を行ったところ, 6つのクラスターに分類された。本研究のように数種の生物の毒性を評価することは, 生態系への配慮として重要であると考えられる。

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Two hypotheses have been proposed for the pathogenesis of maxillary sinusitis caused by dental implant placement and/or maxillary sinus augmentation surgery.

According to the first, odontogenic infections, such as odontogenic maxillary sinusitis, are caused by the surgical procedure in which dental implants are placed. The cycle of inflammation involving odontogenic infection and factors that interfere with successful treatment of sinusitis influences the outcomes of maxillary sinusitis caused by dental implantation.

The other hypothesis is that odontogenic infections, such as maxillary sinusitis, are caused by chronic infection of neighboring teeth, such as apical periodontitis, which occurs during dental implantation.

Both the hypotheses suggest that a vicious cycle of inflammation in the closed maxillary sinus results in intractable maxillary sinusitis.

Impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus and result in intractable maxillary sinusitis caused by dental implantation.

From the histopathological point of view, the pseudostratified ciliated columnar epithelium in cases of refractory maxillary sinusitis caused by dental implantation is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, the pathophysiology of refractory maxillary sinusitis caused by dental implantation is one of the reasons why transnasal endoscopic sinus surgery (ESS) is indicated in cases of refractory sinusitis requiring surgery.

The treatment results are good once the ventilation and drainage of the maxillary sinus is successfully restored after transnasal ESS and support the concept that ESS can be considered as the first-line therapy for refractory sinusitis caused by dental implantation, followed by treatment of the dental implant (extraction of the implant body and/or removal of bone substitute), where necessary.

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This study joins the “Sportwomen in the 2004 Olympic Games: A Global Research Analysis of Media Coverage”, and examines Japanese newspaper coverage during the 2004 Olympic Games from the perspective of gender. The sample in this study is taken from the Yomiuri. Content analysis was conducted to compare all the articles and photographs of female and male athletes on all pages. In addition to the Yomiuri, the Olympics photographs that appeared in the Asahi and the Mainichi newspapers are analyzed in the same way as the Yomiuri. In non-Olympics, the coverage of female athletes occupied less than 6% and there were a very small number of female sporting events. If the analysis of the coverage was conducted at another time, female athlete would receive more coverage than in this study. There will though continue to be great differences of coverage between males and females. On the other hand, in coverage of Olympics, female athletes received relatively equal newspaper coverage compared to male athletes. This is because the number of female athletes and female sporting events increased to the same level as male’s, and female athletes got almost as many medals as male athletes. However, seeing the Olympic photographic coverage of the athletes in the newspaper separately according to nationality, Japanese athletes’ coverage is found to reflect their results in the games for both gender, whereas in foreign athletes’ case, gender stereotype of sports can be perceived both qualitatively and quantitatively. The representation of gender in the newspaper is not likely to disappear easily. These representations of sport by the media have become an obstacle to the realization of gender equality and equity.

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The pathogenesis of maxillary sinusitis caused by maxillary sinus floor elevation (maxillary sinus augmentation surgery: MSAS) is that the surgical procedure causes odontogenic infections and triggers an inflammatory cycle between odontogenic infections and the factors that interfere with the treatment of sinusitis. Impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus and result in intractable maxillary sinusitis caused by MSAS.

There is no consensus on the management of bone prosthetic materials displaced into the maxillary sinus following MSAS. When the displacement of bone prosthetic material into the maxillary sinus occurs, first of all, closure of the perforation between the oral cavity and maxillary sinus should be performed to prevent infection. Next, antibacterial therapy should be initiated in conjunction with ventilation and drainage of the maxillary sinus. After this procedure, bone prosthetic materials displaced into the maxillary sinus will in most cases be drained out of the maxillary sinus via the natural ostium.

From the histopathological point of view, the pseudostratified ciliated columnar epithelium in cases of refractory maxillary sinusitis caused by MSAS is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, the pathophysiology of refractory maxillary sinusitis caused by MSAS is one of the reasons why endoscopic sinus surgery (ESS) is indicated in cases of refractory sinusitis requiring surgery.

The treatment results are good once the ventilation and drainage of the maxillary sinus are successfully restored after ESS, and support the concept that ESS can be considered as the first-line therapy for refractory maxillary sinusitis caused by MSAS, followed by removal of the bone substitute, where necessary.

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 目的 : ビスホスホネート (BP) 製剤静脈内投与患者において, 隣在歯の根尖性歯周炎により生じたと診断されたインプラント体周囲への骨欠損に対して, 非外科的歯内治療によって治癒を導くことができた症例について報告する.
 症例の概要 : 患者は51歳女性. 上顎左側前歯部の自発痛と歯肉腫脹を主訴とし, 21, 23歯と22部インプラントの保存治療を希望して来院された. 多発性骨髄腫の転移予防のために, BP製剤 (ゾメタ) の静脈投与を受けていた. 21歯, 23歯はともに打診痛・咬合時痛・根尖部圧痛を認め, 動揺度2度, プロービングデプスは全周3mm以内であった. 21, 22根尖部歯肉にサイクトを認めた. 22部インプラント周囲の歯肉に発赤, 腫脹はなく, 動揺も認められず, プロービングデプスは全周1mmで, エックス線写真にて歯頸部での皿状の吸収を認めたが, 炎症所見は認めなかった. エックス線写真とコーンビームCT (CBCT) 所見より, 21, 23根尖部から, 22部インプラント部を含む透過像を認めた. 以上の所見から, 上行性インプラント周囲炎と診断し, 21, 23歯の根尖性歯周炎は認められるがインプラント体への感染の可能性は少ないと判断した. 患者には保存治療と外科的治療のリスクを説明したところ非外科的な治療を希望されたため, 21, 23歯に対して非外科的歯内治療である根管治療を開始した.
 21歯に穿孔部を認めたためMineral Trioxide Aggregateにて穿孔封鎖を行い, 根管充塡後, テンポラリークラウンにて経過観察を行い, 治癒傾向が認められたため歯冠補綴を行った. 補綴1年後において21, 23歯の臨床症状は, 自覚症状は認めず, 打診痛・咬合時痛・根尖部圧痛はなく, プロービングデプスは全周2mm以内, 動揺もなく, サイクトは消失した. エックス線写真, CBCT所見において, 根尖部透過像は縮小傾向を認めていた. 咬合等の機能にも問題はなく, 治癒中と診断された. また22部インプラントも著変を認めなかった.
 考察および結論 : 今回の症例では, 根尖性周囲炎由来の大きな骨欠損を認め, インプラント周囲骨も吸収していたが, インプラント体まで感染が波及していなかったために, 根尖性周囲炎の治癒に伴い周囲骨も再生したものと考えられた. 早期における感染源の可及的除去と予防がBP製剤による顎骨壊死に大きく影響を与えるため, インプラントに近接する根尖性歯周炎は, インプラント周囲炎との鑑別, インプラント体への感染の有無の診断と迅速な治療が予後に大きく影響を及ぼすものと思われた.

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A knowledge of the clinical histoanatomy of the teeth, maxilla and maxillary sinus is very important for a clear understanding of the pathophysiology of odontogenic maxillary sinusitis.

In order to maintain the normal functions of the maxillary sinus, ventilation and drainage of the maxillary sinus via the natural ostium and ostiomeatal complex need to be preserved. The maxillary sinus is ventilated via the natural ostium, which is approximately 5 mm in diameter, and drained by the mucociliary transport system of the maxillary sinus epithelium. Consequently, lesions around the natural ostium and ostiomeatal complex disrupt the ventilation and drainage of the maxillary sinus, potentially resulting in maxillary sinusitis.

In regard to factors that could interfere with the treatment of maxillary sinusitis, impaired mucociliary function, bacterial and virus infections, occlusion of the ostiomeatal complex, or a combination of these three factors can perpetuate an inflammatory vicious cycle in the closed maxillary sinus, which could result in intractable maxillary sinusitis.

The ciliated columnar epithelium in cases of intractable odontogenic maxillary sinusitis is neither severely damaged nor irreversibly injured. As a result, the mucociliary function of the epithelium is almost certain to recover once the ventilation and drainage of the maxillary sinus are successfully restored. Consequently, out of the three aforementioned factors that potentially interfere with the treatment of odontogenic maxillary sinusitis, the treatment strategy is focused on the two remaining factors: infections and occlusion of the ostiomeatal complex.

The treatment goal of paranasal sinusitis, including maxillary sinusitis, is to sufficiently restore and improve the ventilation and drainage function of each sinus and to normalize the sinus epithelium, and thereby achieve cure of the sinusitis. Control of the aforementioned factors that could interfere with the treatment should be undertaken simultaneously.

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近年Endodontic Microsurgeryは成功率の高いModern Endodonticsのひとつとして捉えられている。いくつかの症例では、マイクロスコープ視野下で根管内が良好な状態と視認されても、自覚症状やサイクトが消失しない 症例もある。以前は長期にわたる歯内療法の後、抜歯及び欠損補綴がやむなく選択されていた。しかし、Endodontic Microsurgeryを中心に歯牙移植や再植術を診療に取り入れることでシームレスな治療体系を確立でき、治療期間を短縮することができるようになってきた。 当院は12年前にCBCT及びマイクロスコープを導入し、カリエスの除去・歯内療法・歯肉縁下歯石の除去・支台歯 形成及び口腔外科的処置等の日常の治療に積極的に利用してきた。本稿ではProf. Kimの提唱するEndodontic Microsurgeryを実践し、取り組んでいる私の歯内療法を中心に、日常診療について報告する。

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