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* |

1456 JADA, Vol. 128, October 1997

-SPECIAL BEPOBI
And like an innovator who
challenges conventional wisdom,
Dr. Fusayama had his early
detractors. At first, his ideas
were met with skepticism and
resistance from his colleagues
around the world. Today, though,
his techniques of caries detection,
dentin acid etching and dentin
bonding are considered standard
procedure.
His emphasis on preserving as
much tooth tissue as possible is
the very foundation of restora-
tive dentistry in the 1990s.
In receiving the ADA's Gold
Medal award, Dr. Fusayama
joins an illustrious, exclusive
club that includes Dr. Harald
Loe, Dr. Irwin D. Mandel, Dr.
Robert J. Genco and Dr. Basil
G. Bibby.
"I have no doubt that Dr.
Fusayama's research will rank
in importance with that of G.V.
Black, once the dental commu-
nity realizes what he has done,"
says Dr. Raymond L.
Bertolotti, professor of
biomaterials at the
University of
California, San
Francisco, who
nominated Dr.
Fusayama for the
ADA award.
"Without Dr.
Fusayama's persis-
tent efforts in the
face of resistance and
disbelief in the United
States and elsewhere, den-
tistry would not be what it is
today."
Dr. Charles Cox echoes those
words. "His concepts were real-
ly ahead of their time," he says
1458 JADA, Vol. 128, October 1997
of Dr. Fusayama. "What's more,
they worked. In my estimation,
he ranks among the all-time top
five greats in our profession." Dr.
Cox is professor of restorative
dentistry and biomaterials at the
University of Alabama,
Birmingham, dental school.
Born in Mino, Japan, Dr.
Fusayama was the eldest son of a
dentist. As a young man, his aca-
demic promise was recognized
early: on graduating from Tokyo
Medical and Dental University in
1938, he received a special prize
for having the highest test scores
in the school's history.
fter graduation, Dr.
A\ Fusayama's professors
encouraged him to pur-
sue an academic career
and offered him a post as a teach-
ing assistant at the university.
Then came the grim reality of
World War II. Like millions of oth-
ers, Dr. Fusayama's career was
put on hold.
He served for seven
years in the
Japanese anny,
eventually earn-
ing the rank of
captain. During
the fighting,
his father lost
track ofhim
and feared the
worst. To carry on
his career, the
father sent Dr.
Fusayama's younger brother
to dental school. That decision
proved fortunate for Dr.
Fusayama when at last he
returned from his military service.
It relieved him ofthe obligation to
support the family, a traditional
duty ofthe eldest son in Japanese
society.
"I could return to academic life,
leaving to him the care ofmy par-
ents, brothers and sisters," says
Dr. Fusayama ofhis brother.
After four years' teaching at
Tokyo Women's Dental College,
Dr. Fusayama joined the staff at
Tokyo Medical and Dental
University, where he would
remain for the rest of his career.
In 1955, he received his doctor-
ate and spent a year at Indiana
University on a Fulbright schol-
arship. Returning to Japan, he
was appointed professor and
chair of operative dentistry at
the university. He held that post
until his retirement in 1982. He
is now a professor emeritus of
the university.
Dr. Fusayama's research cen-
tered on finding better ways to
adhere restoratives to teeth
using acid etching of both enamel
and dentin. His techniques pre-
serve more tooth structure than
G.V. Black's method, which
requires removal of healthy
dentin and enamel to adhere the
restorative to the tooth mechani-
cally.
Dr. Fusayama first developed
a technique using a red dye to
distinguish infected, unmineral-
izable parts of carious lesions
from remineralizable lesions.
This process allowed dentists to
be more precise when removing
carious lesions, preserving a
higher volume of healthy tooth
tissue. He then turned his atten-
tion to finding a way to bond
restoratives directly to dentin by
using acid etching.

At the time Dr. Fusayama
began his clinical research, acid
etching was used only on enamel.
Conventional wisdom insisted
that dentin etching caused pulp
irritation. But Dr. Fusayama dis-
covered that by using the iright
bonding materials, dentin etching
was a safe, effective way to pre-
pare dentin tissue for bonding to
restoratives.
"I confirmed pathohistological-
ly the harmlessness of dentin
etching," he recalls. "The curious
taboo of dentin etching was thus
revealed to be a kind of supersti-
tion. Total etching of both enamel
and dentin at once is the simplest
and most effective way for secur-
ing maximum adhesion."
Using phosphoric acid to etch
the dentin is the key to success in
bonding restoratives to dentin, he
says. "Phosphoric acid was essen-
tial before applying the bonding
agent to remove the smear plug in
tubule aperture and to make the
dentin surface porous, facilitating
penetration."
During his 37-year career, Dr.
Fusayama published roughly 150
papers and wrote 25 books, includ-
ing his landmark English-language
text, "New Concepts in Operative
Dentistry," published in 1980. His
most recent book, "A Simple Pain-
Free Adhesive Restorative System
by Minimal Reduction and Total
Etching," summarizes his body of
research. It was published in
English in 1993.
Dr. Rafael L. Bowen, distin-
guished scientist with the
Paffenbarger Research Center,
has counted himself among Dr.
Fusayama's friends for many
years.
"I fondly recall the many dis-
cussions we have had, the corre-
spondence and the honor of hav-
ing had him as a guest in our
home," says Dr. Bowen. "I admire
Dr. Fusayama's devotion to den-
tal research and steadfast teach-
ing of his findings.
"He has put special emphasis
on improving the means of saving
the structurally sound portions of
tooth crowns during restorative
procedures," continues Dr.
Bowen. "Takao Fusayama is cer-
tainly a worthy recipient of the
American Dental Association's
Gold Medal Award."
r_ r. Fusayama's findings
contradicted other U.S.
research that showed
dentin acid etching
irritated the pulp. Researchers
now know that the irritation
observed in those studies was
caused by bonding agents that
did not properly seal the
dentin-not by the phos-
phoric acid etching.
California's Dr.
Bertolotti remem-
bers reading Dr.
Fusayama's land-
mark text shortly
after its publica-
tion in 1980. "My
reaction to the
book was that it
was very well-
researched and that it
all made sense," he says.
"But all the major speakers at
the major meetings at that time
were saying it wouldn't work."
Intrigued by the conflict, Dr.
Bertolotti sought a personal meet-
ing with Dr. Fusayama. He wrote
-SPECIAL DEPODI
to the Japanese researcher and
asked to visit with him the next
time he was in the United States.
Not long afterward, the two men
met over dinner in Washington,
D.C., during an ADA/FDI World
Dental Congress held there in
1988.
As Dr. Bertolotti recalls, Dr.
Fusayama impressed him that
evening as a friendly, modest
man-but one who was firm in
his convictions about the validity
of his research.
"He said that if people didn't
believe his research, he would
keep telling the truth," recalls Dr.
Bertolotti. "He does not give up
easily. He's stubborn. He said'I
want you to try this and see if it
works. You will be convinced."'
Dr. Bertolotti did just that and
was won over by the impressive
results. "Dr. Fusayama influenced
my dentistry more than anyone
else," he says. "I went on to teach
his techniques worldwide."
The Japanese scien-
tist's early research
papers on his
dentin-etching
technique were
widely rejected
by scientific
joumals. He
acknowledges
that this caused
him some embar-
rassment. But he
never gave up. With
confidence in himself and
his work and the support of his
friends in Japan and the United
States, he persisted. Looking back
over his career today, he is philo-
sophical about the early rejection
of his work.
JADA, Vol. 128, October 1997 1459
 "It is natural for a fundamen-
tal innovation to meet a serious
resistance," he says. "I was quite
self-confident because the idea
had been well-confirmed by a
variety of basic research tech-
niques as well as by clinical test-
ing. My strategy was to take
another way when one way was
blocked."
A philosophy of quiet persis-
tence, says Dr. Fusayama, has
g-uided him throughout his career
and served him well. Despite
early skepticism about his work,
he has long been respected as a
research scientist.
In 1975, the ADA awarded
him honorary membership.
Seven years later, he received
the Wilmer Souder Award for
dental research from the
International Association for
Dental Research. He served as
vice president of the FDI World
Dental Congress for seven years
and chaired the scientific pro-
gram for the FDI's 1983 meeting
in Tokyo. In 1987, he was induct-
ed into the Japan Academy, the
only dentist ever accepted into
the prestigious scientific organi-
zation.
Gradually, his techniques
became accepted in the United
States and elsewhere as more and
more dentists tried them. The
1460 JADA, Vol. 128, October 1997
turning point, says Dr. Bertolotti,
came in 1990, when Bisco intro-
duced its "All Etch" dentin and
enamel acid-etching material.
Other manufacturers quickly
introduced similar products.
There's no question that
Dr. Fusayama has had
a major impact on the
restorative techniques
taught in dental schools today,
says Dr. Dominick DePaola,
presi'dent of Baylor College of
Dentistry in Dallas.
"Bonded amalgams and adhe-
sive products have been intro-
duced into the nation's dental
school clinics and ultimately into
practice in a major way, largely
through the research findings of
Dr. Fusayama," Dr. DePaola
wrote in his letter supporting
Dr. Fusayama' s nomination for
the ADA's Gold Medal Award,
one of many letters received.
The Japanese researcher
says he is gratified that his
techniques are now widely
accepted and used. "I do feel
validated now," he says, "and I
owe this to the support of my
good friends."
Beyond his busy research
career, Dr. Fusayama has dedi-
cated himself to encouraging
and helping students. He served
as dean of students at Tokyo
Medical and Dental University.
In retirement, he spent 11 years
as president of the Japanese
chapter of the Indiana
University Alumni Club and 12
years as chief director of a stu-
dent dormitory. "I've always
loved people," he says, "particu-
larly young people."
Today, he keeps active giving
lectures and working on a book
about his philosophy of science.
He enjoys golf, tennis and judo,
but his family, which now
includes seven grandchildren, is
the focal point of his life.
Summing up his contribu-
tions to dentistry, Dr.
Fusayama says simply, "I am
extremely pleased that my life
effort could contribute to
human welfare, that I could
minimize sacrifice of dental tis-
sue to restoration, which led to
technical simplicity, painless
operation and maximum
longevity of restored teeth."
Adds Dr. Bertolotti, "4Dr.
Fusayama totally changed
American dentistry. If it
weren't for him, we would still
be using techniques of 20 years
ago. He is an amazing man." .
Ms. Jacob is a free-lance writer based in
Chicago.