14:55～15:15

包括的矯正歯科治療マスターコース第１期生
篠塚 有希

Biological Optimized Occlusion Concept（BOOC）とは、咬合適応力と咬合反応力を評価し、個々の患者に最適化された包括的矯正治療を戦略的に構築するためのコンセプト（綿引淳一, 2024）である。包括的矯正治療において考慮すべき5つの項目；①全身状態および生活習慣、②歯周組織状態、③顎口腔系の特徴、④補綴デザイン、⑤矯正装置の種類に加え、評価すべき2つの項目；①咬合適応力、②咬合反応力の合計7項目を診査診断の際に評価し、治療計画に反映させることにより、リスクヘッジを図ることで、実現可能性を高めることが期待される。
私が現在研修を受けている包括的矯正歯科治療マスターコース（3年制）の1年目はタイポドント実習が主であったが、1年目後半から矯正治療の臨床実習が始まり、２年目においては綿引淳一先生の指導の下で包括的矯正歯科治療を行ってきた。本発表では、臨床実習症例の中から、BOOCおよびDual Incisal Planning (DIP)法に基づき診査診断と治療計画を立案し、矯正治療を開始した症例を供覧させていただく。なお、今回の発表は、包括的矯正歯科治療マスターコースの2年目カリキュラムの修了判定を兼ねたプレゼンテーションである。

〈症例〉

患者	35歳 女性 非喫煙者 全身疾患なし
主訴	叢生と顎のズレ
上顎アーチ	レングスディスクレパンシー −4mm
下顎アーチ	レングスディスクレパンシー −2mm
診断	Angle Class II division 2 限局型慢性歯周炎 Stage I Grade A Watahikiのペリオ分類：上下顎 P1 両側顎関節症
BOOC評価	全身状態：Moderate 歯周組織：Moderate 顎口腔系の特徴：Low 補綴治療：なし → High 矯正装置：ブラケット矯正（抜歯） → High
治療計画	歯周基本治療、MFT（TCH是正）、抜歯矯正
治療経過	歯周基本治療の後に、矯正治療を開始した。矯正検査時に顎関節症状を認め、MRI検査にて顎関節症と診断された。上顎レベリング後に顎位の変化が生じうる可能性があったため、まずは非抜歯にて上顎のレベリングを先行し、顎位が変わらないことを確認後に予定通り抜歯矯正を行った。レベリング後にバイトレイズを行いながらの犬歯のリトラクション、その後、アンテリアリトラクションに移行した。顎間ゴムを使用したバイトレイズ時期の矯正治療施行時に開口障害の顎関節症状を発症したため、顎間ゴムの使用を中止する対応をとり、その後開口量は改善した。

〈考察〉

過蓋咬合は咬合適応力が高い一方で、咬合反応力が低いという特徴がある。今回の症例においては、初診検査において顎関節症の診断に至っていたことから、顎口腔系の特徴はLoｗであると評価し、患者への事前説明（顎関節症の急性症状の発症リスク、マッサージなどのセルフケアの重要性、矯正期間が予想以上にかかりうること）を十分に行った。加えて、ブラケット矯正を選択し、起こりうる顎位の変化に備えた慎重な矯正治療を行い、顎間ゴム使用時の顎関節周囲への負担に十分留意しながら矯正治療を進めた。それにも関わらず、実際の臨床においては、歯科治療に伴う長時間の開口により一時的な開口障害を発症した。今後はより一層の顎関節症症状の慎重な経過観察と、顎間ゴムの使用中止や使用時間の短縮、使用ゴムのサイズ変更などの適切な対応が重要である。あらかじめBOOC評価と説明をしていたことによって、患者も術者も慌てることなく、対応することができたと考える。

BOOCを用いて評価することで、包括的矯正治療の適応か否かの慎重判断と難易度の高さに対する工夫・リスクマネージメントの重要性が明確になる。これは術者だけでなく、患者側にとっても、患者自身の理解と生活習慣の見直し、セルフケアへの取り組みを含め、非常に有用なものであると考える。
本症例はまだ治療途中ではあるが、今回の臨床実習を通じて、BOOCとDIP法を用いた患者個々に合わせた戦略的な治療計画の立案の有効性を実感するとともに、１年目のタイポドント実習などで学んだブラケットセレクションやメカニカルフォースシステム、矯正治療の基本手技の習得の重要性を理解できた。

日本包括的矯正歯科学会の皆様にもBOOCとDIP法の有用性を知っていただき、これらを積極的に活用していただけたら幸いである。

〈略歴〉

２０１１年	新潟大学歯学部歯学科 卒業
２０１９年	うめむら歯科医院　勤務
２０２３年	包括的矯正歯科治療マスターコース（３年コース）第一期生

〈所属〉

• 日本包括的矯正⻭科学会
• ⽇本顕微鏡歯科学会　認定医
• 日本有病者歯科医療学会 認定医
• ⽇本歯周病学会
• 日本臨床歯周病学会
• 日本歯内療法学会
• 日本口腔インプラント学会

［Member Presentation: a presentation of a practical training case for second-year-development-test of master course of interdisciplinary orthodontic treatment］

14:55～15:15

“A Case of Angle Class II Division 2 Treated with Diagnosis and Orthodontic Treatment Based on the Biologically Optimized Occlusion Concept and the DIP Planning”

Aki Shinozuka (First Cohort of the Master Course in Comprehensive Orthodontic Treatment)

The Biological Optimized Occlusion Concept (BOOC) is a treatment framework proposed by Junichi Watahiki in 2024. It aims to strategically construct comprehensive orthodontic treatment plans optimized for each individual patient by evaluating two key factors: occlusal adaptability and occlusal reactivity.
In comprehensive orthodontic treatment, five clinical aspects must be considered: (1) the patient’s general health and lifestyle habits, (2) periodontal condition, (3) maxillofacial morphology, (4) prosthetic design, and (5) type of orthodontic appliance. Additionally, two evaluative items — (1) occlusal adaptability and (2) occlusal reactivity — should be assessed. By evaluating these seven items during diagnosis and reflecting them in the treatment plan, risk hedging becomes possible, which is expected to improve the feasibility of treatment.
In the first year of the three-year Master Course in Comprehensive Orthodontics that I am currently attending, typodont training was the primary focus. In the latter half of the first year, I began clinical orthodontic practice under the supervision of Dr. Junichi Watahiki, applying comprehensive orthodontic treatment principles.
In this presentation, I will showcase an ongoing clinical case that were diagnosed and treatment-planned based on the BOOC and the Dual Incisal Planning (DIP) method. This presentation also serves as an evaluation for the completion of the second-year curriculum of the Master Course in Comprehensive Orthodontics.

Case
Patient: 35-year-old female, non-smoker, no systemic disease
Chief complaint: Dental crowding and jaw misalignment
Findings: Maxillary arch length discrepancy: -4 mm
Mandibular arch length discrepancy: -2 mm
Diagnosis: Angle Class II division 2, localized chronic periodontitis Stage I Grade A, Watahiki’s periodontal classification: P1 in both arches, temporomandibular disorder
BOOC assessment:
General Condition: Evaluated as Moderate due to the patient being an adult.
Periodontal Condition: Evaluated as Moderate based on a diagnosis of Stage I Grade A periodontitis.
Characteristics of the Stomatognathic System: Evaluated as Low due to the presence of a deep overbite and temporomandibular joint symptoms.
Treatment Characteristics: Evaluated as High in the absence of prosthetic treatment; in cases involving bracket (extraction) orthodontic treatment, also evaluated as High.

Treatment plan: Basic periodontal therapy, MFT (correction of TCH), extraction orthodontic treatment
Treatment progress: Orthodontic treatment was initiated after completing basic periodontal therapy. Due to the diagnosis of TMD and the potential for mandibular positional changes after maxillary leveling, leveling of the maxillary arch was performed without extraction first. Once it was confirmed that there was no change in mandibular position, extraction-based orthodontic treatment proceeded as planned. After leveling, canine retraction was performed with bite-raising, followed by anterior retraction. During the period of orthodontic treatment involving bite-raising with intermaxillary elastics, the patient developed TMJ symptoms characterized by limited mouth opening. In response, the use of intermaxillary elastics was discontinued, which led to recovery of the mouth opening range.

Discussion:
Deep overbite cases are characterized by high occlusal adaptability but low occlusal tolerance. In the present case, the patient had already been diagnosed with temporomandibular joint disorder at the initial examination, suggesting a low adaptive capacity of the stomatognathic system. Accordingly, we provided thorough pre-treatment counseling, including the risk of acute TMD symptom onset, the importance of self-care such as massage, and the possibility that the treatment duration could be longer than expected. Furthermore, fixed appliance therapy (bracket system) was selected, and cautious orthodontic treatment was carried out to accommodate any potential changes in mandibular position. Special care was taken to minimize the load on the TMJ during the use of intermaxillary elastics. Despite these precautions, the patient developed limited mouth opening during orthodontic procedures. Moving forward, it will be critical to closely monitor TMJ symptoms and implement appropriate measures such as discontinuation or reduction of elastic wear time, or changing the size of the elastics. Thanks to the prior BOOC assessment and explanation, both the patient and me were able to respond calmly and appropriately to the situation.

By applying the BOOC framework to patient evaluation, it becomes clear whether orthodontic treatment is indicated, as well as the importance of planning strategies and risk management in relation to the level of treatment difficulty. This approach is highly beneficial not only for the clinician but also for the patient, as it promotes better understanding, encourages lifestyle modifications, and supports engagement in self-care.
Although the treatment is still in progress, this clinical practicum has deepened my understanding of orthodontic diagnostics using the BOOC and DIP methods. It has also made me realize the importance of developing strategic treatment plans tailored to each individual patient, making timely referrals to specialists when necessary, and implementing risk management both before treatment intervention and throughout the course of treatment.
I hope that members of the Comprehensive Orthodontic Study Group will recognize the value of the BOOC and DIP methods and consider actively applying them in clinical practice.

Brief Biography

2011- Graduated from department of dentistry of Niigata University
2019- Umemura Dental Clinic, Tokyo
2023- Master course of interdisciplinary orthodontic treatment
Japanese Interdisciplinary Orthodontic Society
Japan Association of Microscopic Dentistry
Japanese Society of Dentistry for Medically Compromised Patient
Japanese Society of Periodontology
Japanese Academy of Clinical Periodontology
Japan Endodontic Association
Japanese Society of Oral Implantology

15:30～16:00

医療法人社団歯門会 神山歯科医院 神山 剛史

厚生労働省の「令和5年 簡易生命表」によれば、現在の日本人の平均寿命は男性が81.09歳、女性が87.14歳である。永久歯列完成期が12歳頃と考えると、われわれ歯科医師は約70年以上先を見越した包括的な歯科治療を考慮しなければならない。それは、現在の患者の口腔内の状況と年齢とを照らし合わせ、長い時間軸の中で今何が最善なのかをつねに考えて治療計画を立てる必要があることを意味する。

包括的歯科臨床は、一口腔単位で診査診断し天然歯の保全、欠損拡大防止、機能回復、審美性の改善などさまざまな目的があるが、同じ口腔内の状態でもライフステージ別に達成するべきポイントの優先順位が異なってくると感じている。例えば、20〜40歳の比較的若いステージでは、天然歯列の保全を第一に歯列矯正の必要性と審美性の改善の優先順位が高くなるだろう。また、50〜70歳代では、欠損拡大防止、機能回復を第一に患者のQOL向上を目指すことが重要となってくるためインプラント治療を用いた咬合再構成が主流となる。いずれのステージにおいてもわれわれ歯科医師は、最小の介入で最大の治療効果を得られるよう、今その治療介入することが最善なのかを長い時間軸で考え治療計画を立ていかねばならない。

今回、ライフステージを考慮し包括的な歯科治療を行なった症例を供覧いただく。ご意見ご指導いただけると幸いである。

〈略歴〉

1999.3	北海道医療大学歯学部卒業
1999.4	東京医科歯科大学歯周病科入局
2004.5	神山歯科医院　開設

〈所属学会・スタディーグループ〉

• 日本歯周病学会
• 日本臨床歯周病学会 認定医
• 日本顎咬合学会
• JIADS
• IPRT
• JIOS
• 情熱会
• POP
• 川口ペリオ研究会
• k-project
• COKI.TOKYO
• ROUTE DH

［Member Presentation］

15:30～16:00

Title: “A Case of Comprehensive Dental Treatment Considering the Patient’s Life Stage”

Takeshi Kamiyama (Kamiyama Dental Clinic, Fukaya City, Saitama Prefecture)

According to the “2023 Abridged Life Tables” published by the Ministry of Health, Labour and Welfare of Japan, the current average life expectancy is 81.09 years for men and 87.14 years for women. Given that the permanent dentition is typically completed around the age of 12, dental professionals must consider comprehensive treatment plans that span more than 70 years into the future. This requires formulating treatment strategies that align the current oral condition and age of the patient with what is optimal over a long-term timeline.

Comprehensive dental care involves examining and diagnosing the patient on a full-mouth basis, aiming to preserve natural teeth, prevent the progression of tooth loss, restore function, and improve esthetics. However, the priorities of these objectives may vary depending on the patient’s life stage, even if the oral conditions appear similar.

For instance, during the younger life stages—typically between the ages of 20 and 40—the highest priorities may include the preservation of the natural dentition, the need for orthodontic treatment, and esthetic improvement. On the other hand, for patients in their 50s to 70s, the focus tends to shift toward preventing further tooth loss and restoring function to enhance quality of life. In such cases, occlusal reconstruction using implant therapy becomes the mainstay of treatment.

Regardless of the life stage, dental professionals must always consider whether a particular intervention is truly optimal at that point in time and aim to achieve the greatest treatment effect with the least invasive approach, keeping a long-term perspective in mind.

In this presentation, I will share a case in which comprehensive dental treatment was performed with careful consideration of the patient’s life stage. I would be grateful for your feedback and guidance.

Profile

March 1999: Graduated from Hokkaido University School of Dentistry
April 1999: Joined the Department of Periodontology, Tokyo Medical and Dental University
May 2004: Opened Kamiyama Dental Clinic

Affiliations & Study Groups

The Japanese Society of Periodontology
The Japanese Clinical Periodontology Association (Certified Dentist)
The Japanese Academy of Occlusion
JIADS
IPRT
JIOS
Jonetsukai
POP
Kawaguchi Periodontal Study Group
K-Project
COKI.TOKYO
ROUTE DH