[SL2-2] Back to the Future: Periodontics Through the Looking Glass
研修コード：2504
略歴
Professor Greg Seymour is currently an Emeritus Professor at the University of Queensland and an Honorary Professor at Griffith University in Australia. He was formerly Dean of the Faculty of Dentistry and Professor of Periodontology at the University of Otago in New Zealand. He graduated from the University of Sydney in 1971, did his specialist training in Periodontics also at the University of Sydney in Australia and his PhD in basic Immunology at the University of London in the UK. He has authored over 370 papers and book chapters and has over 16,000 citations. He has received numerous Fellowships and awards including a Distinguished Scientist Award of the IADR in 1997, Honorary Life Membership of the British Society for Periodontology in 2003 and Fellowship of the Royal Society of New Zealand in 2008.
Professor Greg Seymour is currently an Emeritus Professor at the University of Queensland and an Honorary Professor at Griffith University in Australia. He was formerly Dean of the Faculty of Dentistry and Professor of Periodontology at the University of Otago in New Zealand. He graduated from the University of Sydney in 1971, did his specialist training in Periodontics also at the University of Sydney in Australia and his PhD in basic Immunology at the University of London in the UK. He has authored over 370 papers and book chapters and has over 16,000 citations. He has received numerous Fellowships and awards including a Distinguished Scientist Award of the IADR in 1997, Honorary Life Membership of the British Society for Periodontology in 2003 and Fellowship of the Royal Society of New Zealand in 2008.
While it is virtually impossible to predict the future of periodontics, there is no doubt that it will be determined by the need for the profession to provide safe and reliable periodontal care which, in turn, will be shaped by current research. Over the past two decades clinical periodontics has been dominated by implants. However, it is now becoming apparent that the initial promise of an almost 100% success rate is not being fulfilled and that some 15-20% of implants are failing due to varying degrees of peri-implant mucositis and peri-implantitis. This failure is often as a result of inappropriate placement in patients with existing untreated periodontitis. Worldwide the population is aging and due to advances in dentistry over the past 50 years, these people will expect greater personalised care to ensure that they keep their teeth (and implants) as they get older and move into aged care facilities. Hence, in the future, a greater focus on more effective treatment of periodontitis and maintenance of periodontal health will be required, not only to maintain a healthy functioning dentition in the aging population, but also to ensure greater success of implants.
In this context, future periodontal care will need to be more tailored to the individual. Current research using next generation sequencing (NGS) is showing that plaques vary from individual to individual and that it is likely that a dysbiosis in an individual’s plaque rather than specific organisms per se results in disease progression. And, while plaque control will remain the backbone of periodontal care, the use of specific oral probiotics to restore the balance in the oral microbiota is likely to assume greater importance. It is now firmly established that the progressive periodontal lesion (and probably the peri-implantitis lesion) is a B cell / plasma cell lesion and that anti-B cell therapies are effective in controlling its progression. In the future, the use of targeted, anti-inflammatory therapies locally, in conjunction with plaque based therapies, are also likely to be integral treatment modalities. Here pharmacogenomics will become essential in informing the clinician as to which host modulating agent is most suited to an individual patient. Epigenetic factors, such as smoking and stress, are also recognised to have a significant influence on disease progression and cannot be ignored by the treating clinician. Unravelling the complexities of bacterial, host and epigenetic interactions will lead to enhanced individual risk profiling and more targeted treatment in the future.
Equally, future periodontal care cannot ignore the young as recent data on the natural history of untreated periodontal disease has highlighted the importance of treating early disease in the young in order to ensure a functioning dentition over the age of sixty.
Finally, the association between periodontal disease and overall health is increasingly being recognised such that a strong working relationship with medical practitioners will further define periodontics in the future.