Tissue regeneration is defined as regenerating the lost or damaged tissue, by various reasons inc... more Tissue regeneration is defined as regenerating the lost or damaged tissue, by various reasons including trauma and diseases, to original tissue structure. However the detailed mechanism of tissue regeneration is still not fully understood. The contribution of many types of cells in tissue regeneration might be a major reason why regeneration processes are complicated. In this article, we will introduce correlation between mesenchymal stem cells and immune cells in bone regeneration with our previous data.
The accurate transfer of the morphology of a provisional restoration to that of a definitive rest... more The accurate transfer of the morphology of a provisional restoration to that of a definitive restoration is an essential process that contributes to sufficient function, cleanability, and esthetics, especially in implant treatment; it is clinically important[1-3]. To date, the customized impression transfer coping (conventional) technique reported by Buskin et al. has been widely used to reproduce the definitive restoration morphology. This technique involves replicating the subgingival contour of the provisional restoration onto an impression transfer coping using acrylic resin; subsequently, impressions for the definitive restoration are obtained using this customized impression transfer coping[4]. Buskin's conventional technique enables reproduction of the subgingival contour of the provisional restoration to the definitive restoration. However, even with this technique, the morphology of the coronal part of the provisional restoration cannot be copied, resulting in patient and clinician dissatisfaction. Recently, we reported a case managed with a novel digital workflow (tooth morphology fusion [TMF] digital technique) . Briefly, three types of surface morphology data scanned by an intraoral scanner (IOS) were superimposed using a computer-aided design (CAD)
The purpose of the study was to compare the long-term performance of three prostheses for partial... more The purpose of the study was to compare the long-term performance of three prostheses for partial edentulism: implant-supported, fixed denture (IFD), fixed partial denture (FPD), and removable partial denture (RPD), in terms of prosthesis survival and oral health-related quality of life (OHRQoL). Methods: The 138 patients in our previous study received one of the three prosthetic treatments and answered a validated OHRQoL questionnaire before and immediately after treatment. In the present study, the patients were followed up six years after treatment using medical records and OHRQoL examinations to evaluate prosthesis survival and change in OHRQoL. The cumulative survival rates were calculated using the Kaplan-Meier analysis. The Steel-Dwass test was used to compare the median OHRQoL scores at the three time points. Results: For the 105 patients (66.8 ± 10.8 years, IFD/FPD/RPD: 58/27/20 patients) who successfully completed the follow-up assessments, the six-year estimated cumulative survival rates of the IFDs, FPDs, and RPDs were 94.7%, 77.4%, and 33.3%, respectively. The log-rank tests indicated that the survival curves were significantly different (IFDs vs. FPDs: p = 0.01; RPDs vs. IFDs, FPDs: p < 0.01). The median OHRQoL scores of the IFD group immediately after treatment and six years after treatment were significantly higher than those observed before treatment (p < 0.01). There was no significant difference in the median OHRQoL scores among the three time points in the RPD or FPD groups. Conclusions: IFDs showed significantly longer survival rates than FPDs and RPDs in partially edentulous patients. Only in the IFD patients was the OHRQoL level six years after treatment significantly higher than that before treatment.
Development of human bodies, organs, and tissues contains numerous steps of cellular differentiat... more Development of human bodies, organs, and tissues contains numerous steps of cellular differentiation including an initial zygote, embryonic stem (ES) cells, three germ layers, and multiple expertized lineages of cells. Induced pluripotent stem (iPS) cells have been recently developed using defined reprogramming factors such as Nanog, Klf5, Oct3/4 (Pou5f1), Sox2, and Myc. This outstanding innovation is largely changing life science and medicine. Methods of direct reprogramming of cells into myocytes, neurons, chondrocytes, and osteoblasts have been further developed using modified combination of factors such as N-myc, L-myc, Sox9, and microRNAs in defined cell/tissue culture conditions. Mesenchymal stem cells (MSCs) and dental pulp stem cells (DPSCs) are also emerging multipotent stem cells with particular microRNA expression signatures. It was shown that miRNA-720 had a role in cellular reprogramming through targeting the pluripotency factor Nanog and induction of DNA methyltransferases (DNMTs). This review reports histories, topics, and idea of cellular reprogramming.
Inappropriate dietary intake and low dietary diversity are widely known to cause various medical ... more Inappropriate dietary intake and low dietary diversity are widely known to cause various medical diseases, including malnutrition, sarcopenia, heart disease, stroke, and type 2 diabetes . In addition to physical health, cognitive function can be affected by dietary diversity. For instance, higher dietary diversity decreases brain aging and the risk of cognitive decline in older adults by preventing the decrease in hippocampal volume . Therefore, high dietary diver-
MicroRNAs (miRNAs) are small RNA molecules of 21-25 nucleotides that regulate cell behavior throu... more MicroRNAs (miRNAs) are small RNA molecules of 21-25 nucleotides that regulate cell behavior through inhibition of translation from mRNA to protein, promotion of mRNA degradation and control of gene transcription. In this study, we investigated the miRNA expression signatures of cell cultures undergoing osteoblastic and osteocytic differentiation from mesenchymal stem cells (MSC) using mouse MSC line KUSA-A1 and human MSCs. Ninety types of miRNA were quantified during osteoblastic/osteocytic differentiation in KUSA-A1 cells utilizing miRNA PCR arrays. Coincidently with mRNA induction of the osteoblastic and osteocytic markers, the expression levels of several dozen miRNAs including miR-30 family, let-7 family, miR-21, miR-16, miR-155, miR-322 and Snord85 were changed during the differentiation process. These miRNAs were predicted to recognize osteogenic differentiation-, stemness-, epinegetics-, and cell cycle-related mRNAs, and were thus designated OstemiR. Among those OstemiR, the miR-30 family was classified into miR-30b/c and miR-30a/d/e groups on the basis of expression patterns during osteogenesis as well as mature miRNA structures. In silico prediction and subsequent qRT-PCR in stable miR-30d transfectants clarified that context-dependent targeting of miR-30d on known regulators of bone formation including osteopontin/spp1, lifr, ccn2/ctgf, ccn1/cyr61, runx2, sox9 as well as novel key factors including lin28a, hnrnpa3, hspa5/grp78, eed and pcgf5. In addition, knockdown of human OstemiR miR-541 increased Osteopontin/SPP1 expression and calcification in hMSC osteoblastic differentiation, indicating that miR-541 is a negative regulator of osteoblastic differentiation. These observations indicate stage-specific roles of OstemiR especially miR-541 and the miR-30 family on novel targets in osteogenesis.
Aging tissues present a progressive decline in homeostasis and regenerative capacities, which has... more Aging tissues present a progressive decline in homeostasis and regenerative capacities, which has been associated with degenerative changes in tissue-specific stem cells and stem cell niches. We hypothesized that amino acids could regulate the stem cell phenotype and differentiation ability of human bone marrow-derived mesenchymal stromal cells (hBMSCs). Thus, we performed a screening of 22 standard amino acids and found that D-tryptophan (10 µM) increased the number of cells positive for the early stem cell marker SSEA-4, and the gene expression levels of OCT-4, NANOG, and SOX-2 in hBMSCs. Comparison between D-and L-tryptophan isomers showed that the latter presents a stronger effect in inducing the mRNA levels of Oct-4 and Nanog, and in increasing the osteogenic differentiation of hBMSCs. On the other hand, L-tryptophan suppressed adipogenesis. The migration and colony-forming ability of hBMSCs were also enhanced by L-tryptophan treatment. In vivo experiments delivering L-tryptophan (50 mg/kg/day) by intraperitoneal injections for three weeks confirmed that L-tryptophan significantly increased the percentage of cells positive for SSEA-4, mRNA levels of Nanog and Oct-4, and the migration and colony-forming ability of mouse BMSCs. L-kynurenine, a major metabolite of L-tryptophan, also induced similar effects of L-tryptophan in enhancing stemness and osteogenic differentiation of BMSCs in vitro and in vivo, possibly indicating the involvement of the kynurenine pathway as the downstream signaling of L-tryptophan. Finally, since BMSCs migrate to the wound healing site to promote bone healing, surgical defects of 1 mm in diameter were created in mouse femur to evaluate bone formation after two weeks of L-tryptophan or L-kynurenine injection. Both L-tryptophan and L-kynurenine accelerated bone healing compared to the PBS-injected control group. In summary, L-tryptophan enhanced the stemness and osteoblastic differentiation of BMSCs and may be used as an essential factor to maintain the stem cell properties and accelerate bone healing and/or prevent bone loss.
Dental implant therapy is currently a common treatment option for patients with missing teeth bec... more Dental implant therapy is currently a common treatment option for patients with missing teeth because of its overall good treatment outcome. After implant placement, attention must be paid to not only the establishment of osseointegration but also the esthetics of the surrounding area, particularly the anterior maxillary area. The implant is usually placed after tooth extraction; this action changes the contour of the hard and soft tissue in the surrounding area and the pontic area[1-3]. Regarding hard tissue, there is more alveolar ridge resorption on the buccal aspect than on the lingual aspect; therefore, alveolar bone support is required to achieve esthetically pleasing soft tissue contours . To achieve a natural appearance of emergence of the prosthesis, it is necessary to attain sufficient hard and soft tissue dimensions via the
ABSTRACT Background / Purpose: Peripheral administration of Botulinum toxin type A (BoNT/A) decre... more ABSTRACT Background / Purpose: Peripheral administration of Botulinum toxin type A (BoNT/A) decreases trigeminal neuropathic pain behaviours and reverses neuropathy-induced gene expression changes in trigeminal ganglia by decreasing exaggerated neurotransmitter release in trigeminal sensory neurons. Peripheral administration of BoNT/A decreases exaggerated neurotransmitter release in neuropathic trigeminal neurons thereby decreasing neuropathic pain behaviours and reversing neuropathy-induced gene expression changes in trigeminal ganglia.We recently reported that neuropathic trigeminal sensory neurons exhibit exaggerated neurotransmitter release. This present study confirmed that peripheral administration of BoNT/A decreases exaggerated neurotransmitter release and that peripheral of BoNT/A decreases trigeminal neuropathic pain behaviours measured by mechanical and thermal stimulation of the facial area. It was also demonstrated that BoNT/A administration reverses neuropathy-induced gene expression changes in trigeminal ganglia.Trigeminal neuropathy was induced by infraorbital nerve constriction (IoNC) in male Sprague-Dawley rats (220-250g). Pain behaviour was measured by facial mechanical stimulation or thermal stimulation. Neurotransmitter release was measured by measuring the fluorescence intensity of the membrane-uptake marker (FM4-64). Gene expression changes in trigeminal ganglia after peripheral BoNT/A administration were measured with DNA microarray. Main conclusion: IoNC produced long-lasting (&gt;14 days) pain behaviours and post-treatment with BoNT/A (intradermal injection) alleviated these pain behaviours. Peripheral BoNT/A injection reduced the exaggerated FM4-64 release from cell bodies of TRG neurons extracted from neuropathic rats. BoNT/A reversed neuropathy-induced gene expression changes in trigeminal ganglia extracted from neuropathic rats.This study suggests that targeting exaggerated neurotransmitter release of neuropathic sensory neurons may represent an attractive alternative to alleviating neuropathic pain symptoms in patients for whom centrally-acting medications do not provide adequate relief. Thus, BoNT/A, which does not exhibit appreciable centrally-mediated side effects may represent one of the key drugs for treating neuropathic pain patients.
Patient: A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to ... more Patient: A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to a connective tissue graft (CTG) for esthetic improvement before rehabilitation with a fixed partial denture. Palate-harvested connective tissue was used as a graft after extra-oral removal of the epithelium. Unexpectedly, complete wound healing was not observed. Moreover, 6 months post-surgery, a white discharge was detected at the grafted site. The adjacent tooth showing a root fracture was initially associated with the symptoms and was then extracted. Concomitantly, the unhealed tissue at the grafted site was also excised, leading to temporary symptom resolution. However, the white discharge reappeared after 2 months. The excision area was expanded to remove the grafted tissue entirely, and the wound was completely healed. Since the alveolar ridge resorption had become larger compared to the preoperative condition, the patient was subjected to a second CTG, now using a connective tissue harvested from the palate by a single incision technique. The wound healed uneventfully, and the final prosthesis was delivered 6 months after soft tissue stabilization. The patient has been followed-up for more than 28 months without any recurrence of white discharge. Discussion: Histopathological and cytological examination detected keratinized epithelial tissues and cells, respectively, in excised tissues and white discharge specimens. Consequently, a possible relationship between white discharge and residual epithelium in the harvested graft was strongly suspected. Conclusions: Success of the CTG procedure requires careful method selection for tissue transplantation and treatment execution.
Tissue regeneration is defined as regenerating the lost or damaged tissue, by various reasons inc... more Tissue regeneration is defined as regenerating the lost or damaged tissue, by various reasons including trauma and diseases, to original tissue structure. However the detailed mechanism of tissue regeneration is still not fully understood. The contribution of many types of cells in tissue regeneration might be a major reason why regeneration processes are complicated. In this article, we will introduce correlation between mesenchymal stem cells and immune cells in bone regeneration with our previous data.
The accurate transfer of the morphology of a provisional restoration to that of a definitive rest... more The accurate transfer of the morphology of a provisional restoration to that of a definitive restoration is an essential process that contributes to sufficient function, cleanability, and esthetics, especially in implant treatment; it is clinically important[1-3]. To date, the customized impression transfer coping (conventional) technique reported by Buskin et al. has been widely used to reproduce the definitive restoration morphology. This technique involves replicating the subgingival contour of the provisional restoration onto an impression transfer coping using acrylic resin; subsequently, impressions for the definitive restoration are obtained using this customized impression transfer coping[4]. Buskin's conventional technique enables reproduction of the subgingival contour of the provisional restoration to the definitive restoration. However, even with this technique, the morphology of the coronal part of the provisional restoration cannot be copied, resulting in patient and clinician dissatisfaction. Recently, we reported a case managed with a novel digital workflow (tooth morphology fusion [TMF] digital technique) . Briefly, three types of surface morphology data scanned by an intraoral scanner (IOS) were superimposed using a computer-aided design (CAD)
The purpose of the study was to compare the long-term performance of three prostheses for partial... more The purpose of the study was to compare the long-term performance of three prostheses for partial edentulism: implant-supported, fixed denture (IFD), fixed partial denture (FPD), and removable partial denture (RPD), in terms of prosthesis survival and oral health-related quality of life (OHRQoL). Methods: The 138 patients in our previous study received one of the three prosthetic treatments and answered a validated OHRQoL questionnaire before and immediately after treatment. In the present study, the patients were followed up six years after treatment using medical records and OHRQoL examinations to evaluate prosthesis survival and change in OHRQoL. The cumulative survival rates were calculated using the Kaplan-Meier analysis. The Steel-Dwass test was used to compare the median OHRQoL scores at the three time points. Results: For the 105 patients (66.8 ± 10.8 years, IFD/FPD/RPD: 58/27/20 patients) who successfully completed the follow-up assessments, the six-year estimated cumulative survival rates of the IFDs, FPDs, and RPDs were 94.7%, 77.4%, and 33.3%, respectively. The log-rank tests indicated that the survival curves were significantly different (IFDs vs. FPDs: p = 0.01; RPDs vs. IFDs, FPDs: p < 0.01). The median OHRQoL scores of the IFD group immediately after treatment and six years after treatment were significantly higher than those observed before treatment (p < 0.01). There was no significant difference in the median OHRQoL scores among the three time points in the RPD or FPD groups. Conclusions: IFDs showed significantly longer survival rates than FPDs and RPDs in partially edentulous patients. Only in the IFD patients was the OHRQoL level six years after treatment significantly higher than that before treatment.
Development of human bodies, organs, and tissues contains numerous steps of cellular differentiat... more Development of human bodies, organs, and tissues contains numerous steps of cellular differentiation including an initial zygote, embryonic stem (ES) cells, three germ layers, and multiple expertized lineages of cells. Induced pluripotent stem (iPS) cells have been recently developed using defined reprogramming factors such as Nanog, Klf5, Oct3/4 (Pou5f1), Sox2, and Myc. This outstanding innovation is largely changing life science and medicine. Methods of direct reprogramming of cells into myocytes, neurons, chondrocytes, and osteoblasts have been further developed using modified combination of factors such as N-myc, L-myc, Sox9, and microRNAs in defined cell/tissue culture conditions. Mesenchymal stem cells (MSCs) and dental pulp stem cells (DPSCs) are also emerging multipotent stem cells with particular microRNA expression signatures. It was shown that miRNA-720 had a role in cellular reprogramming through targeting the pluripotency factor Nanog and induction of DNA methyltransferases (DNMTs). This review reports histories, topics, and idea of cellular reprogramming.
Inappropriate dietary intake and low dietary diversity are widely known to cause various medical ... more Inappropriate dietary intake and low dietary diversity are widely known to cause various medical diseases, including malnutrition, sarcopenia, heart disease, stroke, and type 2 diabetes . In addition to physical health, cognitive function can be affected by dietary diversity. For instance, higher dietary diversity decreases brain aging and the risk of cognitive decline in older adults by preventing the decrease in hippocampal volume . Therefore, high dietary diver-
MicroRNAs (miRNAs) are small RNA molecules of 21-25 nucleotides that regulate cell behavior throu... more MicroRNAs (miRNAs) are small RNA molecules of 21-25 nucleotides that regulate cell behavior through inhibition of translation from mRNA to protein, promotion of mRNA degradation and control of gene transcription. In this study, we investigated the miRNA expression signatures of cell cultures undergoing osteoblastic and osteocytic differentiation from mesenchymal stem cells (MSC) using mouse MSC line KUSA-A1 and human MSCs. Ninety types of miRNA were quantified during osteoblastic/osteocytic differentiation in KUSA-A1 cells utilizing miRNA PCR arrays. Coincidently with mRNA induction of the osteoblastic and osteocytic markers, the expression levels of several dozen miRNAs including miR-30 family, let-7 family, miR-21, miR-16, miR-155, miR-322 and Snord85 were changed during the differentiation process. These miRNAs were predicted to recognize osteogenic differentiation-, stemness-, epinegetics-, and cell cycle-related mRNAs, and were thus designated OstemiR. Among those OstemiR, the miR-30 family was classified into miR-30b/c and miR-30a/d/e groups on the basis of expression patterns during osteogenesis as well as mature miRNA structures. In silico prediction and subsequent qRT-PCR in stable miR-30d transfectants clarified that context-dependent targeting of miR-30d on known regulators of bone formation including osteopontin/spp1, lifr, ccn2/ctgf, ccn1/cyr61, runx2, sox9 as well as novel key factors including lin28a, hnrnpa3, hspa5/grp78, eed and pcgf5. In addition, knockdown of human OstemiR miR-541 increased Osteopontin/SPP1 expression and calcification in hMSC osteoblastic differentiation, indicating that miR-541 is a negative regulator of osteoblastic differentiation. These observations indicate stage-specific roles of OstemiR especially miR-541 and the miR-30 family on novel targets in osteogenesis.
Aging tissues present a progressive decline in homeostasis and regenerative capacities, which has... more Aging tissues present a progressive decline in homeostasis and regenerative capacities, which has been associated with degenerative changes in tissue-specific stem cells and stem cell niches. We hypothesized that amino acids could regulate the stem cell phenotype and differentiation ability of human bone marrow-derived mesenchymal stromal cells (hBMSCs). Thus, we performed a screening of 22 standard amino acids and found that D-tryptophan (10 µM) increased the number of cells positive for the early stem cell marker SSEA-4, and the gene expression levels of OCT-4, NANOG, and SOX-2 in hBMSCs. Comparison between D-and L-tryptophan isomers showed that the latter presents a stronger effect in inducing the mRNA levels of Oct-4 and Nanog, and in increasing the osteogenic differentiation of hBMSCs. On the other hand, L-tryptophan suppressed adipogenesis. The migration and colony-forming ability of hBMSCs were also enhanced by L-tryptophan treatment. In vivo experiments delivering L-tryptophan (50 mg/kg/day) by intraperitoneal injections for three weeks confirmed that L-tryptophan significantly increased the percentage of cells positive for SSEA-4, mRNA levels of Nanog and Oct-4, and the migration and colony-forming ability of mouse BMSCs. L-kynurenine, a major metabolite of L-tryptophan, also induced similar effects of L-tryptophan in enhancing stemness and osteogenic differentiation of BMSCs in vitro and in vivo, possibly indicating the involvement of the kynurenine pathway as the downstream signaling of L-tryptophan. Finally, since BMSCs migrate to the wound healing site to promote bone healing, surgical defects of 1 mm in diameter were created in mouse femur to evaluate bone formation after two weeks of L-tryptophan or L-kynurenine injection. Both L-tryptophan and L-kynurenine accelerated bone healing compared to the PBS-injected control group. In summary, L-tryptophan enhanced the stemness and osteoblastic differentiation of BMSCs and may be used as an essential factor to maintain the stem cell properties and accelerate bone healing and/or prevent bone loss.
Dental implant therapy is currently a common treatment option for patients with missing teeth bec... more Dental implant therapy is currently a common treatment option for patients with missing teeth because of its overall good treatment outcome. After implant placement, attention must be paid to not only the establishment of osseointegration but also the esthetics of the surrounding area, particularly the anterior maxillary area. The implant is usually placed after tooth extraction; this action changes the contour of the hard and soft tissue in the surrounding area and the pontic area[1-3]. Regarding hard tissue, there is more alveolar ridge resorption on the buccal aspect than on the lingual aspect; therefore, alveolar bone support is required to achieve esthetically pleasing soft tissue contours . To achieve a natural appearance of emergence of the prosthesis, it is necessary to attain sufficient hard and soft tissue dimensions via the
ABSTRACT Background / Purpose: Peripheral administration of Botulinum toxin type A (BoNT/A) decre... more ABSTRACT Background / Purpose: Peripheral administration of Botulinum toxin type A (BoNT/A) decreases trigeminal neuropathic pain behaviours and reverses neuropathy-induced gene expression changes in trigeminal ganglia by decreasing exaggerated neurotransmitter release in trigeminal sensory neurons. Peripheral administration of BoNT/A decreases exaggerated neurotransmitter release in neuropathic trigeminal neurons thereby decreasing neuropathic pain behaviours and reversing neuropathy-induced gene expression changes in trigeminal ganglia.We recently reported that neuropathic trigeminal sensory neurons exhibit exaggerated neurotransmitter release. This present study confirmed that peripheral administration of BoNT/A decreases exaggerated neurotransmitter release and that peripheral of BoNT/A decreases trigeminal neuropathic pain behaviours measured by mechanical and thermal stimulation of the facial area. It was also demonstrated that BoNT/A administration reverses neuropathy-induced gene expression changes in trigeminal ganglia.Trigeminal neuropathy was induced by infraorbital nerve constriction (IoNC) in male Sprague-Dawley rats (220-250g). Pain behaviour was measured by facial mechanical stimulation or thermal stimulation. Neurotransmitter release was measured by measuring the fluorescence intensity of the membrane-uptake marker (FM4-64). Gene expression changes in trigeminal ganglia after peripheral BoNT/A administration were measured with DNA microarray. Main conclusion: IoNC produced long-lasting (&gt;14 days) pain behaviours and post-treatment with BoNT/A (intradermal injection) alleviated these pain behaviours. Peripheral BoNT/A injection reduced the exaggerated FM4-64 release from cell bodies of TRG neurons extracted from neuropathic rats. BoNT/A reversed neuropathy-induced gene expression changes in trigeminal ganglia extracted from neuropathic rats.This study suggests that targeting exaggerated neurotransmitter release of neuropathic sensory neurons may represent an attractive alternative to alleviating neuropathic pain symptoms in patients for whom centrally-acting medications do not provide adequate relief. Thus, BoNT/A, which does not exhibit appreciable centrally-mediated side effects may represent one of the key drugs for treating neuropathic pain patients.
Patient: A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to ... more Patient: A 54-year-old woman presenting with anterior alveolar ridge resorption was submitted to a connective tissue graft (CTG) for esthetic improvement before rehabilitation with a fixed partial denture. Palate-harvested connective tissue was used as a graft after extra-oral removal of the epithelium. Unexpectedly, complete wound healing was not observed. Moreover, 6 months post-surgery, a white discharge was detected at the grafted site. The adjacent tooth showing a root fracture was initially associated with the symptoms and was then extracted. Concomitantly, the unhealed tissue at the grafted site was also excised, leading to temporary symptom resolution. However, the white discharge reappeared after 2 months. The excision area was expanded to remove the grafted tissue entirely, and the wound was completely healed. Since the alveolar ridge resorption had become larger compared to the preoperative condition, the patient was subjected to a second CTG, now using a connective tissue harvested from the palate by a single incision technique. The wound healed uneventfully, and the final prosthesis was delivered 6 months after soft tissue stabilization. The patient has been followed-up for more than 28 months without any recurrence of white discharge. Discussion: Histopathological and cytological examination detected keratinized epithelial tissues and cells, respectively, in excised tissues and white discharge specimens. Consequently, a possible relationship between white discharge and residual epithelium in the harvested graft was strongly suspected. Conclusions: Success of the CTG procedure requires careful method selection for tissue transplantation and treatment execution.
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Papers by Takuo Kuboki