Nippon Dental University Hospital

Apical periodontitis (AP) results from microbial infection within the root canal system. Although mechanical and chemical debridement techniques have advanced, real-time intraoperative visualization of bacterial persistence remains limited. This study evaluated whether fluorescence-aided root canal treatment (FARCT) using protoporphyrin IX fluorescence (PpIX-FL) could assist clinicians in visualizing bacterial persistence in real time during routine endodontic procedures. Fifty patients (23 initial treatments, 27 retreatments) underwent root canal treatment. PpIX-FL was visualized in real time under 405-nm excitation using a dental operating microscope. Fluorescent areas were documented, and multivariate logistic regression analysis was performed to assess associations with clinical factors. Histological examination and confocal microscopy were conducted to verify bacterial presence corresponding to PpIX-FL. PpIX-FL was detected in 56.0% of cases, particularly in isthmuses, fins, and contaminated gutta-percha. Fluorescence was significantly more prevalent in retreatment cases (OR=8.32; p = 0.05) and teeth with periapical lesions ≥2 mm (OR=61.06; p = 0.005). Confocal imaging and Gram staining confirmed that red autofluorescence areas corresponded with Gram-positive bacterial infiltration into dentinal tubules. PpIX-FL enables reagent-free, real-time visualization of bacterial contamination within the root canal system. FARCT should be regarded as an adjunctive visualization approach rather than a stand-alone diagnostic or therapeutic modality. The present findings demonstrate the clinical feasibility of PpIX-based autofluorescence for fluorescence-guided visualization in endodontic retreatment and anatomically complex cases.

Background and Objectives: We wished to evaluate the effect of antiresorptive agents (ARAs) on peri-implant tissues and to examine the risk factors for peri-implant medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: The study cohort consisted of patients who underwent implant surgery or maintenance treatment between March 2012 and December 2024. The patients were divided into two groups: those in whom bisphosphonates (BPs) or denosumab (Dmab) was used to treat osteoporosis after implant treatment (the ARA group) and a control group. Peri-implant clinical parameters (implant probing depth (iPPD), implant bleeding on probing (iBoP), marginal bone loss (MBL), and mandibular cortical index (MCI)) measured at the baseline and at the final visit were statistically evaluated and compared in both groups. Risk factors were examined using a multivariate analysis of adjusted odds ratios (aORs). Results: A total of 192 implants in 61 patients (52 female, 9 male) were included in this study. The ARA group consisted of 89 implants (22 patients). A comparison of the clinical parameters showed that the ARA group had significantly higher variations in their maximum iPPD and iBoP values over time than those in the control group. Risk factors for peri-implantitis as objective variables were the use of ARAs (aOR: 3.91; 95% confidence interval [CI]: 1.29-11.9) and the change in the maximum iPPD over time (aOR: 1.86; 95% CI: 0.754-4.58). Conclusions: During long-term implant maintenance treatment, patients' health and medication status change. Monitoring peri-implantitis, the presumed cause of peri-implant MRONJ, is essential, especially in patients who started ARA treatment after implant placement, and special attention should be paid to changes in implant pocket depth.

This study aimed to longitudinally investigate the temporal relationship between tongue pressure and malnutrition in older adults with dysphagia and to determine the antecedent factors. This is a retrospective cohort study. In total, 177 participants aged ≥65 years with dysphagia who visited a specialized dysphagia rehabilitation clinic between 2014 and 2018 were enrolled. Malnutrition was assessed based on the phenotypic criteria (unintentional weight loss, low body mass index, and reduced skeletal muscle mass) from the Global Leadership Initiative on Malnutrition framework. Tongue pressure was measured using a tongue pressure measuring device. The bidirectional association between tongue pressure and malnutrition was examined, adjusting for age, sex, cognitive function, occlusal support status, and comorbidities. In the Cross-Lagged Panel Model, a significant cross-lagged effect was observed from tongue pressure to malnutrition at 6 months (β = -0.135, p < 0.001) and 12 months (β = -0.112, p = 0.028). However, the pathway from malnutrition to tongue pressure was not significant. Logistic regression analysis also revealed that baseline tongue pressure was significantly associated with malnutrition at 6 months (odds ratio [OR] = 0.91, 95% confidence interval [CI]: 0.86-0.95) and 12 months (OR = 0.89, 95% CI: 0.84-0.94). During the follow-up period, tongue pressure improved; however, the prevalence of malnutrition increased. Decreased tongue pressure may precede malnutrition in older adults with dysphagia; however, a reverse relationship was not observed. The findings suggest the importance of incorporating oral function assessment as part of the risk assessment for malnutrition.

Receiving home care improves the quality of life of older adults. Nonetheless, limited studies have examined factors influencing pneumonia onset and home care discontinuation in older adults living at home. To clarify the factors associated with home care discontinuation in older adults receiving home care for dysphagia and to identify risk factors for home care discontinuation. This study included 162 adults (≥ 65 years) with dysphagia who were receiving home care. Nutritional status, history of pneumonia, swallowing function, activities of daily living, and comorbidities were assessed. The study participants were followed up for 2 years. Factors associated with home care discontinuation (death and hospitalisation) were analysed using the Kaplan-Meier method and Cox proportional hazards model. During the 2-year follow-up, 110 (67.9%) participants discontinued home care (35 due to pneumonia, 75 due to other causes). Severe dysphagia was the strongest risk factor for pneumonia-induced discontinuation (HR = 3.25, 95% CI: 1.35-7.83). Malnutrition (HR = 2.32, 95% CI: 0.93-5.76) and pneumonia history (HR = 2.00, 95% CI: 1.00-4.35) elevated pneumonia-related risk. Severe dysphagia (HR = 1.52, 95% CI: 0.65-3.55) and malnutrition (HR = 1.58, 95% CI: 0.95-2.64) were potential risk factors for non-pneumonia-induced discontinuation. In older adults receiving home care, severe dysphagia was a major risk factor for home care discontinuation, with malnutrition and a history of pneumonia suggested as potential contributing factors. These findings indicate that improving nutritional status, maintaining and enhancing swallowing function and providing appropriate management for individuals with a history of pneumonia are crucial for ensuring continuous home care.

The patient was a 51-year-old woman. A left breast tumor was detected during a health checkup and the patient was referred to our hospital. Upon arrival, a mobile mass measuring 17 mm in diameter was palpable in the CD region of the left breast. The mammogram showed a sawtooth mass. Ultrasonography revealed a hypoechoic mass with abundant blood flow. Needle biopsy revealed invasive ductal carcinoma. Systemic examination revealed masses in both thyroid lobes, and a fine-needle aspiration cytology diagnosis showed it to be benign. A left circular mastectomy and sentinel lymph node biopsy were performed. Pathological examination revealed a resection margin negative, ER negative, PgR negative, HER2 negative invasive ductal carcinoma, with a tumor diameter of 20 mm and 17.2% Ki-67 positivity. Thirty months after surgery, the left thyroid tumor showed a tendency to grow, and fine-needle aspiration cytology was performed again, which revealed a papillary carcinoma. A left thyroid lobectomy and lymph node dissection were performed. Pathological examination revealed that the patient had papillary thyroid cancer, T1aN0M0=Stage Ⅰ(<55y). Currently, 3 years after surgery, there is no evidence of metastasis or recurrence of either cancer.

Environmental stress induces an arrest of the cell cycle. Thus, release from this arrest is essential for cell survival. The cell-cycle-arrest occurs via the down regulation of the cyclins that drive the main cyclin dependent kinase, CDK1/Cdc28. However, it was not clear how cells escape this potentially fatal arrest. Here we show that prior to the restoration of CDK1/Cdc28 cyclins, a non-canonical CDK, Pho85, initiates a cascade to restart the cell cycle. We demonstrate that following stress, Pho85 phosphorylates the Sch9 kinase, which in turn directly phosphorylates the transcriptional inhibitor Whi5, the yeast analog of RB1/retinoblastoma, and a CDK1 target. This promotes Whi5 translocation from the nucleus, and the release of the stress-induced arrest at G 1 phase. In addition, we find that in parallel with Pho85, CDK1/Cdc28 also plays a role in the control of Whi5. Together, these findings provide insights into how cells re-enter the cell cycle during recovery from stress and reveal that a non-canonical CDK and cyclin takes on essential roles and acts via a pathway that functions in parallel with CDK1/Cdc28.

The study aimed to compare the performance of four pre-trained convolutional neural networks in recognizing seven distinct prosthodontic scenarios involving the maxilla, as a preliminary step in developing an artificial intelligence (AI)-powered prosthesis design system. Seven distinct classes, including cleft palate, dentulous maxillectomy, edentulous maxillectomy, reconstructed maxillectomy, completely dentulous, partially edentulous, and completely edentulous, were considered for recognition. Utilizing transfer learning and fine-tuned hyperparameters, four AI models (VGG16, Inception-ResNet-V2, DenseNet-201, and Xception) were employed. The dataset, consisting of 3541 preprocessed intraoral occlusal images, was divided into training, validation, and test sets. Model performance metrics encompassed accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC), and confusion matrix. VGG16, Inception-ResNet-V2, DenseNet-201, and Xception demonstrated comparable performance, with maximum test accuracies of 0.92, 0.90, 0.94, and 0.95, respectively. Xception and DenseNet-201 slightly outperformed the other models, particularly compared with InceptionResNet-V2. Precision, recall, and F1 scores exceeded 90% for most classes in Xception and DenseNet-201 and the average AUC values for all models ranged between 0.98 and 1.00. While DenseNet-201 and Xception demonstrated superior performance, all models consistently achieved diagnostic accuracy exceeding 90%, highlighting their potential in dental image analysis. This AI application could help work assignments based on difficulty levels and enable the development of an automated diagnosis system at patient admission. It also facilitates prosthesis designing by integrating necessary prosthesis morphology, oral function, and treatment difficulty. Furthermore, it tackles dataset size challenges in model optimization, providing valuable insights for future research.

Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1-4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.