学術論文|抜かない歯|とみなが歯科医院

学術論文

EMAT (Electro-Magnetic Apical Treatment)―Application of Electrical stimulation to apical periodontitis-
歯と歯茎の断面図
論文掲載雑誌名:日本歯内療法学会雑誌 2017年 38巻 1号
著者、共著者 :富永 敏彦, 北池 光希, 多田 瑛一朗, 高比良 一輝, 坂東 直樹, 平尾 早希, 林 邦彦, 横山 昌憲, 吉永 仁

Disinfection of the root canal system is essential in endodontic therapy. However, due to the complex anatomical morphology, it is impossible to completely eliminate infecting microorganisms. We have reported that electromagnetic stimulation has an activating effect on osteoblastic cells as well as a bactericidal effect and suggested that direct electromagnetic stimulation may be applicable for refractory apical periodontitis. Consequently, we developed Electro-Magnetic Apical Treatment (EMAT), with the aim of promoting rapid healing of periodontal tissue. The purpose of this study was to assess the efficacy of EMAT for apical periodontitis.
Methods:74 maxillary anterior teeth with periapical lesions (>5.0 mm in diameter) were treated. 37 teeth were stimulated by the EMAT device, and 37 teeth were not stimulated. Radiographic follow-up was performed to evaluate the healing effect at 12 months postoperatively.
Results : The success rate (97.3%) in the EMAT group was statistically higher (p<0.01) than that in the non-stimulated group (73.0%). In the successful cases, the average reduction rate of periapical lesions was 9.7±5.2%/month in the EMAT group, which was significantly higher (p<0.01) compared with the non-stimulated group (4.9±1.7%/month).
Conclusions : These results suggest that EMAT accelerates the healing process of periodontal tissue.

Electromagnetic Wave Irradiation Promotes Osteoblastic Cell Proliferation and Up-Regulates Growth Factors via Activation of the ERK1/2 and p38 MAPK Pathways
歯と歯茎の断面図
論文掲載雑誌名:Cellular Physiology and Biochemistry 2015年 35巻 2号
著者、共著者 :Hiromichi Yumoto, Kouji Hirao, Toshihiko Tominaga, Naoki Bando, Kanako Takahashi, Takashi Matsuo

Periodontitis with bone resorption is caused by inflammatory reactions to bacterial infection. We recently reported that electromagnetic wave irradiation (EMWI) has bactericidal effects. However, the effects of EMWI on periodontal tissues remain unclear. This study was aimed to investigate the effects of EMWI on osteoblasts. Methods: Osteoblastic cells MC3T3-E1 were treated with EMWI (500-1,000 kHz, 5 times, 1 sec/time). Cell growth and cytotoxicity were determined by cell proliferation assays and measurement of lactate dehydrogenase release, respectively. Gene expression and protein production of growth factors were analyzed using real-time PCR and ELISA, respectively. EMWI-activated cellular signal transduction pathways were investigated by immunoblotting and blocking assay with specific inhibitors. Results: Osteoblasts proliferation was significantly enhanced 3 days after EMWI and no cytotoxicity was observed. EMWI up-regulated various growth factors, such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). EMWI induced ERK1/2, p38 MAPK and SAPK/JNK phosphorylation within 5 min, and the production of PDGF-ΑΑ and VEGF was partially reduced by MAPK-specific inhibitor. Conclusion: These findings demonstrated that EMWI increases osteoblastic cell activity and the expression of growth factors via ERK1/2 and p38 MAPK pathways and suggested that EMWI may be beneficial to bone tissue repair such as periodontitis.

Bactericidal activity and oral pathogen inactivation by electromagnetic wave irradiation
歯と歯茎の断面図
論文掲載雑誌名:Journal of Applied Microbiology 2012年 113巻 1号
著者、共著者 :H. Yumoto, T. Tominaga, K. Hirao, T. Kimura, K. Takahashi, T. Sumitomo, N. Bando and T. Matsuo

Aims: The aim of this work was to clarify the effects of electromagnetic waveirradiation (EMWI) on oral bacterial pathogens.
Methods and Results: A Gram-negative (Porphyromonas gingivalis) or Grampositive(Streptococcus mutans, S. intermedius,Enterococcus faecalis) bacterial suspension was irradiated by EMW apparatus (500?1000 kHz, 5?15 times, 1s time)1). Quantification of survival bacteria by CFU counting revealed that EMWI exhibited marked bactericidal activity against all tested bacteria and bactericidal activity at 500 kHz increased in an irradiation number-dependent manner. After EMWI at 500 kHz, scanning electron microscopic observations showed that the chain of S. mutans cells was shortened after 5 irradiations and the outlines of bacterial cells (S. mutans and P. gingivalis) were unclear after 5? 10 irradiations. EMWI inhibited the inductive effect of S. mutans on proinflammatory cytokine production in human monocytes and this inhibitory effect was comparable with that of heat-killed bacteria. Furthermore, using an enzyme activity assay, EMWI partially inactivated the activities of gingipains from P. gingivalis.
Conclusions: These findings demonstrated that EMWI has inactivation and bactericidal activities against single microbial species among four kinds of oral pathogens.
Significance and Impact of the Study: Electromagnetic wave irradiation may be applicable for medical disinfection and sterilization, such as refractory periapical periodontitis.

Application with Electro-Magnetic wave to periapical lesion~EMAT (Electro-Magnetic Apical Treatment)~
歯と歯茎の断面図
論文掲載雑誌名:日本歯内療法学会雑誌 2011年 32巻 3号
著者、共著者 :坂東 直樹, 富永 敏彦, 湯本 浩通, 住友 孝史, 平尾 早希, 平尾 功治, 松尾 敬志

Periapical periodontitis is considered to be caused by infectious agents persisting in the root canal system triggering the host immune reaction. Disinfection is the key point for endodontic treatment, but it is difficult to completely remove all causal agents from the root canal system because of the morphological complexities. In this study, we focused on the potential usefulness of electro-magnetic wave irradiation (EMWI) for clinical application to promote healing. The aims of this study were : 1) to determine the characteristics of EMW and 2) to evaluate the clinical application of EMWI to endodontic treatment. The analysis of EMW characteristics demonstrated that it is important to make the diameter of the active electrode tip smaller and to keep the insertion depth within 5 mm for effective generation of Joule heat, and revealed that Joule heat conduction spreads 1.0-1.5 mm wide in the horizontal direction. The success rate of clinical application of EMWI was 99.1%, which is higher than that of the EMWI-untreated group (95.1%). Moreover, the reduction rate of the diameter of periapical lesion in the EMWI-treated group (75.62%) was significantly increased. These findings demonstrate that EMWI accelerates healing of periapical lesions and suggest that it may be useful for clinical application to refractory periapical periodontitis as non-surgical treatment.

Application of electro-magnetic wave to endodontic treatment?EMAT (Electro-Magnetic Apical Treatment)
歯と歯茎の断面図
論文掲載雑誌名:四国歯学会雑誌 2011年 24巻 1号
著者、共著者 :富永 敏彦

Periapical periodontitis has been considered to be a host immune reaction triggered by infectious agents persisting in root canal system. Disinfection within the root canal system is the most important procedure in endodontic treatment; however, it is quite difficult to completely remove bacteria and all causal agents from the root canal system because of its anatomical and morphological complexities. Therefore, it is necessary to develop new control techniques against infected root canal-associated bacteria. Here, we focused on the potent of electro-magnetic wave irradiation (EMWI) as a disinfection apparatus against pathogens localized in the root canal as well as clinical application to promote the healing of bony defects around dental roots. The aims of this work were 1) to determine the characteristics of EMW, 2) to clarify the effects of EMWI on oral bacterial pathogens and 3) to evaluate the clinical application of EMWI to endodontic treatment.
The analysis of EMW demonstrated that it is important to make the diameter of active electrode tip smaller and keep the insertion depth within 5 mm for effective generation of Joule heat, and revealed that Joule heat conduction spreads 1.0-1.5 mm wide in a horizontal direction, not vertical direction.
Bacterial suspension was irradiated by the EMW apparatus (500-1,000 kHz, 5-15 times, 1 sec/time). The enumeration of survival bacteria revealed that the EMWI exhibited great bactericidal activity to kill all tested bacteria and this bactericidal activity at 500 kHz increased in an irradiation times-dependent manner. After 5-10 times EMWI at 500 kHz, scanning electron microscopic observations showed that a chain of Streptococcus mutans cells was shortened and the outer layer or shape of S. mutans and Porphyromonas gingivalis cells were unclear. EMWI inhibited the induction of pro-inflammatory cytokine production in human monocytes by S. mutans. Furthermore, EMWI partially inactivated the activity of gingipains from P. gingivalis.
The success rate of EMAT clinical application was 99.0%, which is significantly higher than that of EMAT-untreated the control group (94.9%). Both the diameter and area of periapical lesion in EMAT group had markedly reduced throughout the entire follow-up period of 6 month. The changes per month in diameter and area of periapical lesion in EMAT group were much bigger than those in the control group.
These findings demonstrated that EMWI has inactivative and bactericidal activities against oral bacteria and accelerates healing of periapical lesion, and suggest that it is useful for the clinical application to refractory periapical periodontitis as a non-surgical treatment.

書籍等

感染根管治療 Retreatment
感染根管治療 Retreatment
発刊日:2019年9月
著者、共著者:富永 敏彦、多田 瑛一朗、高比良 一輝、菅谷 勉
書籍タイトル:感染根管治療 Retreatment :木ノ本 喜史先生編著(ヒョーロン・パブリッシャーズ)内

冒頭部分一部抜粋
電磁波や超音波などの物理的刺激は治癒を促進することが報告されており、高周波電流も根尖病変の治癒を促進できる可能性がある。
そこで、高周波電流を根管と根尖部歯周組織に直接作用させ、治癒を活性化する「電磁波根尖療法(electromagnetic apical treatment:EMAT)(2~4) を考案した。本稿では、EMATの術式ならびに臨床応用例について解説する。

日本歯科評論No.916(日本歯科評論)
日本歯科評論No.916(日本歯科評論)
発刊日:2019年2月
著者、共著者:富永 敏彦、多田 瑛一朗、高比良 一輝、菅谷 勉
書籍タイトル:日本歯科評論No.916(日本歯科評論)

冒頭部分一部抜粋
電磁波や超音波などの物理的刺激は治癒を促進することが報告されており、高周波電流も根尖病変の治癒を促進できる可能性がある。
そこで、高周波電流を根管と根尖部歯周組織に直接作用させ、治癒を活性化する「電磁波根尖療法(electromagnetic apical treatment:EMAT)(2~4) を考案した。本稿では、EMATの術式ならびに臨床応用例について解説する。

はつらつ元気7月号
はつらつ元気7月号
発刊日:2012年6月
著者、共著者:富永 敏彦
書籍タイトル:はつらつ元気7月号(芸文社)

冒頭部分一部抜粋
歯槽骨が溶けた場合、一般的にその再生は不可能とされ、外科手術による治療ないしは抜歯という方法が採られています。ところが2006年、そのどちらの方法にも依らない画期的な治療法が誕生し、注目を集めています。

季刊・歯科医療秋号
季刊歯科医療秋号
発刊日:2011年11月
著者、共著者:富永 敏彦
書籍タイトル 季刊・歯科医療秋号(第一歯科出版)

冒頭部分一部抜粋
電磁波を直接応用する「電磁波骨再生療法Electro-Magnetic Apical Treatment(EMAT)」は、in vitro.in vivoでの研究結果より最近の増殖を抑制し、さらに炎症性サイトカインの産生誘導も減少させることが認められている。

季刊・歯科医療夏号
季刊・歯科医療夏号
発刊日:2011年7月
著者、共著者:富永 敏彦
書籍タイトル:季刊・歯科医療夏号(第一歯科出版)

冒頭部分一部抜粋
2005年に考案した「電磁波骨再生療法Electro-Magnetic Apical Treatment(EMAT)」は難治性根尖病変に対して、電磁波(500~1000kHz)を直接応用することにより、根管内および根尖周囲における病原体の殺菌や骨芽細胞の活性化を惹起し、歯周組織の治癒を加速化させることを目的としている。

季刊・歯科医療春号
季刊・歯科医療 春号
発刊日:2011年4月
著者、共著者:富永 敏彦
書籍タイトル:季刊・歯科医療春号(第一歯科出版)天然歯を残す新しい治療法-

冒頭部分一部抜粋
本連載では、「電磁波骨再生療法、Electro-Magnetic Apical Treatment(EMAT)における細菌および骨芽細胞様細胞に対する影響ならびに臨床結果からみられた有用性、将来的な応用方法について解説する。

アポロニア21:205号
アポロニア21   205号
発刊日:2011年1月
著者、共著者:富永 敏彦
書籍タイトル:アポロニア21:205号

冒頭部分一部抜粋
2005年に考案され、外科処置でしか対応困難であった難治性根尖病変に対して良好な成果を上げている「EMAT(電磁波骨再生療法)」について解説する本連載。最終回となる第3回目は、EMAT開発経緯を振り返り、今後の発展性について展望したい。

アポロニア21:204号
アポロニア21   204号
発刊日:2010年12月
著者、共著者:富永 敏彦
書籍タイトル:アポロニア21:204号

冒頭部分一部抜粋
2005年に考案され、外科的処置でしか対応困難であった難治性根尖病変に対して良好な成果を上げている「EMAT(電磁波骨再生療法)」について解説する本連載。
第2回目は、日常臨床にて、疼痛・腫脹・排膿が持続する「難治性根尖性歯周炎」に対してEMATを行った2症例をご紹介します。

アポロニア21:203号
アポロニア21 :203号
発刊日:2010年11月
著者、共著者:富永 敏彦
書籍タイトル:アポロニア21:203号

冒頭部分一部抜粋
近年の歯内療法は、マイクロスコープや歯科用CTの登場により、盲目的に行われてきた手技からより計画的に行える治療方法に変化しつつあります。しかし、根管系の複雑な解剖学的形態により、起炎因子を機械的清掃や化学的清掃で完全に取り除くことは不可能であり、日常臨床において、長期間治療しない症例に遭遇することがあります。
本連載では、外科的処置でしか対応困難であった難治性根尖病変に対して良好な成果を上げている、2005年に考案された「EMAT(電磁波骨再生療法)」についてご紹介します。

とみなが歯科小冊子
とみなが歯科小冊子
発刊日:2009年9月
著者、共著者:富永 敏彦
書籍タイトル:とみなが歯科小冊子

冒頭部分一部抜粋
「美味しく食事ができる」我々にとって非常に大切なことです。歯科医師になって20年…。いつもポリシーとして、思い続けてきたことは…。
「自分がして欲しい医療を患者さんにする!」誰でも「歯を削る」のはイヤですよね。
まして、「歯を抜く」はもっとイヤだと思います。
私も全く同感です。もう二度と生えてこないのだから、歯を減らしたくありません。「天然の歯に勝るものはない。どうにかこの揺れている歯を残すことはできないか?」 そればかり考えてきました。