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SPECIALREPORT

His father was a dentist before him. His brother too. But many
of his colleagues agree that no one since the legendary G. V
Black has had a greater impact on restorative dental care than
Dr. Takao Fusayama of Japan, recipient of the 1997 ADA Gold
Medal Awardfor Excellence in Dental Research.
_~ ven across an 8,000-mile telephone connection, Dr. Takao Fusayama
comes through as what he is: a gentleman, in the most literal sense
\ ,J of the term.
Dr. Fusayama, the recipient of the 1997 ADA Gold Medal Award for
Excellence in Dental Research, is cordial and soft-spoken, pausing often to choose
just the right word in English. A clatter of voices and dishes in the background
makes it clear that the caller has intruded on a midday family meal at the
Fusayama household in Tokyo. Still, the good doctor is gracious to the caller. He
says he is honored to receive the award and is looking forward to visiting the United
States. Then he politely asks whether it would be all right if he responded to ques-
tions by fax, rather than by telephone. He says his written English is better.
From his manner, you might not take Dr. Fusayama for a revolutionary, but
that is what he is-a man who changed the field of restorative dentistry forever
and for good. The 81-year-old retired chairman of operative dentistry at Tokyo
Medical and Dental University is a true innovator, a man ahead of his time.

I F3 v J U L I E.t >A J C o* |

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And like an innovator who of Dr. Fusayama. "What's more, support the family, a traditional
challenges conventional wisdom, they worked. In my estimation, duty ofthe eldest son in Japanese
Dr. Fusayama had his early he ranks among the all-time top society.
detractors. At first, his ideas five greats in our profession." Dr. "I could return to academic life,
were met with skepticism and Cox is professor of restorative leaving to him the care ofmy par-
resistance from his colleagues dentistry and biomaterials at the ents, brothers and sisters," says
around the world. Today, though, University of Alabama, Dr. Fusayama ofhis brother.
his techniques of caries detection, Birmingham, dental school. After four years' teaching at
dentin acid etching and dentin Born in Mino, Japan, Dr. Tokyo Women's Dental College,
bonding are considered standard Fusayama was the eldest son of a Dr. Fusayama joined the staff at
procedure. dentist. As a young man, his aca- Tokyo Medical and Dental
His emphasis on preserving as demic promise was recognized University, where he would
much tooth tissue as possible is early: on graduating from Tokyo remain for the rest of his career.
the very foundation of restora- Medical and Dental University in In 1955, he received his doctor-
tive dentistry in the 1990s. 1938, he received a special prize ate and spent a year at Indiana
In receiving the ADA's Gold for having the highest test scores University on a Fulbright schol-
Medal award, Dr. Fusayama in the school's history. arship. Returning to Japan, he
joins an illustrious, exclusive was appointed professor and
club that includes Dr. Harald fter graduation, Dr. chair of operative dentistry at
Loe, Dr. Irwin D. Mandel, Dr. A\ Fusayama's professors the university. He held that post
Robert J. Genco and Dr. Basil encouraged him to pur- until his retirement in 1982. He
G. Bibby. sue an academic career is now a professor emeritus of
"I have no doubt that Dr. and offered him a post as a teach- the university.
Fusayama's research will rank ing assistant at the university. Dr. Fusayama's research cen-
in importance with that of G.V. Then came the grim reality of tered on finding better ways to
Black, once the dental commu- World War II. Like millions of oth- adhere restoratives to teeth
nity realizes what he has done," ers, Dr. Fusayama's career was using acid etching of both enamel
says Dr. Raymond L. put on hold. and dentin. His techniques pre-
Bertolotti, professor of He served for seven serve more tooth structure than
biomaterials at the years in the G.V. Black's method, which
University of Japanese anny, requires removal of healthy
California, San eventually earn- dentin and enamel to adhere the
Francisco, who ing the rank of restorative to the tooth mechani-
nominated Dr. captain. During cally.
Fusayama for the the fighting, Dr. Fusayama first developed
ADA award. his father lost a technique using a red dye to
"Without Dr. track ofhim distinguish infected, unmineral-
Fusayama's persis- and feared the izable parts of carious lesions
tent efforts in the worst. To carry on from remineralizable lesions.
face of resistance and his career, the This process allowed dentists to
disbelief in the United father sent Dr. be more precise when removing
States and elsewhere, den- Fusayama's younger brother carious lesions, preserving a
tistry would not be what it is to dental school. That decision higher volume of healthy tooth
today." proved fortunate for Dr. tissue. He then turned his atten-
Dr. Charles Cox echoes those Fusayama when at last he tion to finding a way to bond
words. "His concepts were real- returned from his military service. restoratives directly to dentin by
ly ahead of their time," he says It relieved him ofthe obligation to using acid etching.

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At the time Dr. Fusayama "I fondly recall the many dis- to the Japanese researcher and
began his clinical research, acid cussions we have had, the corre- asked to visit with him the next
etching was used only on enamel. spondence and the honor of hav- time he was in the United States.
Conventional wisdom insisted ing had him as a guest in our Not long afterward, the two men
that dentin etching caused pulp home," says Dr. Bowen. "I admire met over dinner in Washington,
irritation. But Dr. Fusayama dis- Dr. Fusayama's devotion to den- D.C., during an ADA/FDI World
covered that by using the iright tal research and steadfast teach- Dental Congress held there in
bonding materials, dentin etching ing of his findings. 1988.
was a safe, effective way to pre- "He has put special emphasis As Dr. Bertolotti recalls, Dr.
pare dentin tissue for bonding to on improving the means of saving Fusayama impressed him that
restoratives. the structurally sound portions of evening as a friendly, modest
"I confirmed pathohistological- tooth crowns during restorative man-but one who was firm in
ly the harmlessness of dentin procedures," continues Dr. his convictions about the validity
etching," he recalls. "The curious Bowen. "Takao Fusayama is cer- of his research.
taboo of dentin etching was thus tainly a worthy recipient of the "He said that if people didn't
revealed to be a kind of supersti- American Dental Association's believe his research, he would
tion. Total etching of both enamel Gold Medal Award." keep telling the truth," recalls Dr.
and dentin at once is the simplest Bertolotti. "He does not give up
and most effective way for secur- r_ r. Fusayama's findings easily. He's stubborn. He said'I
ing maximum adhesion." contradicted other U.S. want you to try this and see if it
Using phosphoric acid to etch research that showed works. You will be convinced."'
the dentin is the key to success in dentin acid etching Dr. Bertolotti did just that and
bonding restoratives to dentin, he irritated the pulp. Researchers was won over by the impressive
says. "Phosphoric acid was essen- now know that the irritation results. "Dr. Fusayama influenced
tial before applying the bonding observed in those studies was my dentistry more than anyone
agent to remove the smear plug in caused by bonding agents that else," he says. "I went on to teach
tubule aperture and to make the did not properly seal the his techniques worldwide."
dentin surface porous, facilitating dentin-not by the phos- The Japanese scien-
penetration." phoric acid etching. tist's early research
During his 37-year career, Dr. California's Dr. papers on his
Fusayama published roughly 150 Bertolotti remem- dentin-etching
papers and wrote 25 books, includ- bers reading Dr. technique were
ing his landmark English-language Fusayama's land- widely rejected
text, "New Concepts in Operative mark text shortly by scientific
Dentistry," published in 1980. His after its publica- joumals. He
most recent book, "A Simple Pain- tion in 1980. "My acknowledges
Free Adhesive Restorative System reaction to the that this caused
by Minimal Reduction and Total book was that it him some embar-
Etching," summarizes his body of was very well- rassment. But he
research. It was published in researched and that it never gave up. With
English in 1993. all made sense," he says. confidence in himself and
Dr. Rafael L. Bowen, distin- "But all the major speakers at his work and the support of his
guished scientist with the the major meetings at that time friends in Japan and the United
Paffenbarger Research Center, were saying it wouldn't work." States, he persisted. Looking back
has counted himself among Dr. Intrigued by the conflict, Dr. over his career today, he is philo-
Fusayama's friends for many Bertolotti sought a personal meet- sophical about the early rejection
years. ing with Dr. Fusayama. He wrote of his work.

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"It is natural for a fundamen- turning point, says Dr. Bertolotti, as dean of students at Tokyo
tal innovation to meet a serious came in 1990, when Bisco intro- Medical and Dental University.
resistance," he says. "I was quite duced its "All Etch" dentin and In retirement, he spent 11 years
self-confident because the idea enamel acid-etching material. as president of the Japanese
had been well-confirmed by a Other manufacturers quickly chapter of the Indiana
variety of basic research tech- introduced similar products. University Alumni Club and 12
niques as well as by clinical test- years as chief director of a stu-
ing. My strategy was to take There's no question that dent dormitory. "I've always
another way when one way was Dr. Fusayama has had loved people," he says, "particu-
blocked." a major impact on the larly young people."
A philosophy of quiet persis- restorative techniques Today, he keeps active giving
tence, says Dr. Fusayama, has taught in dental schools today, lectures and working on a book
g-uided him throughout his career says Dr. Dominick DePaola, about his philosophy of science.
and served him well. Despite presi'dent of Baylor College of He enjoys golf, tennis and judo,
early skepticism about his work, Dentistry in Dallas. but his family, which now
he has long been respected as a "Bonded amalgams and adhe- includes seven grandchildren, is
research scientist. sive products have been intro- the focal point of his life.
In 1975, the ADA awarded duced into the nation's dental Summing up his contribu-
him honorary membership. school clinics and ultimately into tions to dentistry, Dr.
Seven years later, he received practice in a major way, largely Fusayama says simply, "I am
the Wilmer Souder Award for through the research findings of extremely pleased that my life
dental research from the Dr. Fusayama," Dr. DePaola effort could contribute to
International Association for wrote in his letter supporting human welfare, that I could
Dental Research. He served as Dr. Fusayama' s nomination for minimize sacrifice of dental tis-
vice president of the FDI World the ADA's Gold Medal Award, sue to restoration, which led to
Dental Congress for seven years one of many letters received. technical simplicity, painless
and chaired the scientific pro- The Japanese researcher operation and maximum
gram for the FDI's 1983 meeting says he is gratified that his longevity of restored teeth."
in Tokyo. In 1987, he was induct- techniques are now widely Adds Dr. Bertolotti, "4Dr.
ed into the Japan Academy, the accepted and used. "I do feel Fusayama totally changed
only dentist ever accepted into validated now," he says, "and I American dentistry. If it
the prestigious scientific organi- owe this to the support of my weren't for him, we would still
zation. good friends." be using techniques of 20 years
Gradually, his techniques Beyond his busy research ago. He is an amazing man." .
became accepted in the United career, Dr. Fusayama has dedi-
Ms. Jacob is a free-lance writer based in
States and elsewhere as more and cated himself to encouraging Chicago.
more dentists tried them. The and helping students. He served

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