Trotz einer großen Auswahl wirksame Medikamente: Psoriatiker scheinen immer noch untertherapiert zu sein.

HINTERGRUND UND ZIELE: Durch die Entwicklung neuer anti-psoriatischer Medikamente und verbesserte Strukturen zu deren flächendeckender Einführung hat sich die medizinische Versorgung von Psoriasis-Patienten deutlich verbessert. In dieser Studie haben wir die tatsächliche Inanspruchnahme des Gesundheitswesens untersucht und Gründe für die Unzufriedenheit der Betroffenen ermittelt. PATIENTEN UND METHODIK: Diese nicht-interventionelle Querschnittsstudie wurde als anonyme Online-Befragung von 12/2018 bis 01/2019 in Deutschland durchgeführt. Teilnehmer mit einer selbstberichteten, von einem Arzt gestellten Psoriasis-Diagnose und Symptomen beantworteten Fragen zu ihrer Erkrankung, deren Einfluss auf das tägliche Leben und ihrer medizinischen Versorgung. ERGEBNISSE: 649 Teilnehmer mit einem mittleren Alter von 42,5 ± 13,7 Jahren und ausgewogener Geschlechterverteilung (männlich: 50,2 %) wurden ausgewertet. 54,1 % waren zum Zeitpunkt der Studie in ärztlicher Behandlung, 45,9 % nicht. Von den Teilnehmern mit medizinischer Versorgung waren 59,3 % nur mäßig oder weniger zufrieden mit ihrer Behandlung. Gründe für die Unzufriedenheit mit der Medikation waren unter anderem mangelnde Wirksamkeit und Nebenwirkungen. Von den nicht in ärztlicher Behandlung befindlichen Teilnehmern wurde "Zeitmangel des Arztes" als Hauptgrund für die Nichtinanspruchnahme ärztlicher Hilfe angegeben. SCHLUSSFOLGERUNGEN: Trotz der Verfügbarkeit effizienter Therapieoptionen in Deutschland sind viele Betroffene mit Psoriasis unzufrieden. Diese unterbehandelte Gruppe wurde als neue Zielgruppe identifiziert.

Despite large choice of effective therapies: Individuals with psoriasis still seem undertreated.

BACKGROUND AND OBJECTIVES: Due to the development of new anti-psoriatic drugs in combination with improved structures for implementation throughout Germany, the medical care of psoriasis patients has markedly improved. In this study we investigated the real-life utilization of the health care system and identified reasons for dissatisfaction in affected individuals. PATIENTS AND METHODS: This non-interventional cross-sectional study was conducted as an anonymous online survey from 12/2018 to 01/2019 in Germany. Participants with a self-reported physician-confirmed diagnosis of psoriasis and symptoms answered questions about their disease, its influence on daily life and their medical care. RESULTS: 649 participants with a mean age of 42.5 ± 13.7 years and equal gender distribution (male: 50.2 %) were evaluated. 54.1 % received medical treatment at the time of the study, 45.9 % did not. Among the participants with medical care, 59.3 % were only moderately or less satisfied with their treatment. Reasons for dissatisfaction with the medication included lack of efficacy and side effects. Participants without medical treatment specified a physician's lack of time as a main reason for not seeking medical help. CONCLUSIONS: Despite the availability of efficient therapeutic options in Germany, many individuals with psoriasis are not satisfied. This under-treated group was identified as a new target population.

Patient satisfaction and oral health-related quality of life 10 years after implant placement.

BACKGROUND: Implant survival and implant success (freedom of biologic complications) are important factors in assessing the success of implant therapy. However, these factors are not the only determinants. Patients' satisfaction also plays a very important role in daily practice. Therefore, the aim of this study was to assess patients' satisfaction regarding function (phonetics, chewing comfort, stability, cleanability) and aesthetics in patients treated with XiVE and Frialite implants in a private periodontal practice ten years after implant placement. Furthermore, oral health-related quality of life (OHRQoL) was evaluated. METHODS: Patient-reported outcome measures (PROMs) regarding overall satisfaction, phonetics, chewing comfort, stability, cleanability, and aesthetics were examined on a Visual Analog Scale (VAS) 10 years ± 6 months after implant placement in a cross-sectional survey. OHRQoL and psychological impact were assessed via the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Potential influence of patient-related factors (age, gender, smoking, peri-implantitis, implant position, type of restoration) on VAS, OHRQoL and PIDAQ were investigated using regression analyses. RESULTS: High satisfaction with implant-supported restorations was seen in all 95 patients ten years after implant placement. Mean VAS-score for general satisfaction with implant-supported restoration was 93.0% (SD ± 9.4, median: 96.3%, range 50.0-100%). Mean OHIP score was 11.3 (SD ± 10.8, median: 9.0, range 0-45), mean PIDAQ score 20.5 (SD ± 11.37, median: 17.0, range 0-52). A slight tendency that presence of a moderate/severe peri-implantitis lowers satisfaction could be detected (overall satisfaction: ordinal, p = 0.012, VAS, p = 0.026). Also, the factors age, implant position and type of restoration might have an impact on patient's satisfaction. CONCLUSIONS: Patients restored with mostly fixed implant-supported restorations showed a very high patient satisfaction regarding function and aesthetics 10-year after implant placement. The presence of a moderate/severe peri-implantitis showed a slight tendency for influencing patient satisfaction. Due to the cross-sectional design results have to be interpreted with care.

Evaluation of Two Protocols to Measure the Accuracy of Fixed Dental Prostheses: An In Vitro Study.

PURPOSE: The aim of this in vitro study was to compare two measurement protocols of the internal and marginal fit of three-unit zirconia fixed dental prostheses (FDPs). MATERIALS AND METHODS: Forty-four FDPs were fabricated for standardized dies by two laboratory CAD/CAM systems: Cercon (n = 22) and Ceramill (n = 22). The fitting was tested using a replica technique (RT = technique 1) with a light-body silicone stabilized with heavy-body material. After producing the replicas, cross-sections were made in the buccolingual and mesiodistal directions. FDPs were cemented on definitive dies, embedded, and sectioned (CST = technique 2). The marginal and internal fits were measured under an optical microscope at 50x magnification with a special software program. Data evaluation was performed according to prior studies at a level of significance of 5%. RESULTS: The mean internal gap width was 51 ± 36 µm for the RT and 52 ± 35 µm for the cross-section technique (CST) (p = 0.74). The mean marginal gap width was 27 ± 18 µm for RT and 30 ± 19 µm for CST (p = 0.19). Statistical tests showed no significant differences (p > 0.05). CONCLUSIONS: Both techniques can be used for fit evaluation; however, the noninvasive RT is suitable for clinical use.

Socket Shield Technique for immediate implant placement - clinical, radiographic and volumetric data after 5 years.

OBJECTIVES: Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes. MATERIAL AND METHODS: This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs). RESULTS: All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded. CONCLUSION: Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.

Marginal and internal fit of posterior three-unit fixed zirconia dental prostheses fabricated with two different CAD/CAM systems and materials.

OBJECTIVES: The purpose of this in vitro study was to compare the precision of fit of frameworks milled from semi-sintered regular zirconia and high-translucent (HT) zirconia blanks, fabricated with two different CAD/CAM systems. MATERIAL AND METHODS: Three-unit, posterior fixed dental prostheses (FDP) frameworks were fabricated for standardized dies (n = 11) with two different laboratory computer-aided design (CAD)/computer-aided manufacturing (CAM) systems (Cercon/Ceramill). The replica technique was used to evaluate the marginal and internal fit under an optical microscope. Evaluation of the data was performed according to prior studies at a level of significance of 5%. RESULTS: The systems showed a statistically significant influence on the internal fit of the frameworks (p ≤ 0.001) and on the marginal fit (p < 0.001). The type of material showed no influence on the marginal fit for the Cercon system (p = 0.636) and on the marginal fit (p = 0.064) and the internal fit (p = 0.316) for the Ceramill system, while regular zirconia from Cercon showed higher internal values than HT zirconia (p = 0.016). CONCLUSIONS AND CLINICAL RELEVANCE: Both investigated systems showed clinically acceptable values within the limitations of this in vitro study. However, one showed less internal accuracy when regular zirconia was used.

Replacement of mandibular central incisors with implant-supported crowns: a case report.

Anterior teeth are often affected by accidental dental trauma and may eventually be lost. When the neighboring teeth are unharmed, implant-supported crowns are often the preferred treatment choice. When not only the teeth but also the supporting hard and soft tissue has been lost, surgical reconstruction may be needed. However, in combined horizontal and vertical class III defects, the available augmentation techniques are often not predictable. In this case report, two neighboring mandibular central incisors were replaced by two implants after soft and hard tissue augmentation with the cortical bone plate method. The interdental soft tissue was reconstructed with remarkable success, making this an example of what can be achieved in cases such as this.

The socket-shield technique: first histological, clinical, and volumetrical observations after separation of the buccal tooth segment ­ a pilot study.

BACKGROUND: The "socket-shield technique" has shown its potential in preserving buccal tissues. However, front teeth often have to be extracted due to vertical fractures in buccolingual direction. It has not yet been investigated if the socket-shield technique can only be used with intact roots or also works with a modified shield design referring to vertical fracture lines. PURPOSE: The aim of this study was to assess histologically, clinically, and volumetrically the effect of separating the remaining buccal root segment in two pieces before immediate implant placement. MATERIAL AND METHODS: Three beagle dogs were selected in the study. The third and fourth premolars on both sides of the upper jaw were hemisected and the clinical crown of the distal root was removed. Then, the implant bed preparation was performed into the distal root so that a buccal segment of healthy tooth structure remained. This segment was then separated in a vertical direction into two pieces and implants placed lingual to it. After 4 months of healing, the specimens were processed for histological diagnosis. In a clinical case, the same technique was applied and impressions taken for volumetric evaluation by digital superimposition. RESULTS: The tooth segments showed healthy periodontal ligament on the buccal side. New bone was visible between implant surface and shield as well as inside the vertical drill line. No osteoclastic remodeling of the coronal part of the buccal plate was observed. The clinical volumetric analysis showed a mean loss of 0.88 mm in labial direction with a maximum of 1.67 mm and a minimum of 0.15 mm. CONCLUSION: The applied modification seems not to interfere with implant osseointegration and may still preserve the buccal plate. It may offer a feasible treatment option for vertically fractured teeth.

The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution.

Soft tissue replacement grafts have become a substantial element to increase tissue volume in plastic periodontal and implant surgery. Autogenous subepithelial connective tissue grafts are increasingly applied in aesthetic indications like soft tissue thickening, recession treatment, ridge preservation, soft tissue ridge augmentation and papilla re-construction. For the clinical performance of connective tissue graft harvesting and transplantation, a fundamental understanding of the anatomy at the donor sites and a sound knowledge of tissue integration and re-vascularization processes are required. Possible donor sites are the anterior and posterior palate including the maxillary tuberosity, providing grafts of distinct geometric shape and histologic composition. The selective clinical application of different grafts depends on the amount of required tissue, the indication and the personal preference of the treating surgeon. One of the main future challenges is to volumetrically evaluate and compare the efficacy and long-term stability of soft tissue autografts and their prospective substitutes. The aim of this review was to discuss the advantages and shortfalls of different donor sites, substitute materials and harvesting techniques. Although standardized recommendations regarding treatment choice and execution can hardly be given, guidelines for predictable and successful treatment outcomes are provided based on clinical experience and the available scientific data.

Opposing effects of Notch-signaling in maintaining the proliferative state of follicle cells in the telotrophic ovary of the beetle Tribolium.

INTRODUCTION: Establishment of distinct follicle cell fates at the early stages of Drosophila oogenesis is crucial for achieving proper morphology of individual egg chambers. In Drosophila oogenesis, Notch-signaling controls proliferation and differentiation of follicular cells, which eventually results in the polarization of the anterior-posterior axis of the oocyte. Here we analyzed the functions of Tribolium Notch-signaling factors during telotrophic oogenesis, which differs fundamentally from the polytrophic ovary of Drosophila. RESULTS: We found Notch-signaling to be required for maintaining the mitotic cycle of somatic follicle cells. Upon Delta RNAi, follicle cells enter endocycle prematurely, which affects egg-chamber formation and patterning. Interestingly, our results indicate that Delta RNAi phenotypes are not solely due to the premature termination of cell proliferation. Therefore, we monitored the terminal/stalk cell precursor lineage by molecular markers. We observed that upon Delta RNAi terminal and stalk cell populations were absent, suggesting that Notch-signaling is also required for the specification of follicle cell populations, including terminal and stalk precursor cells. CONCLUSIONS: We demonstrate that with respect to mitotic cycle/endocycle switch Notch-signaling in Tribolium and Drosophila has opposing effects. While in Drosophila a Delta-signal brings about the follicle cells to leave mitosis, Notch-signaling in Triboliumis necessary to retain telotrophic egg-chambers in an "immature" state. In most instances, Notch-signaling is involved in maintaining undifferentiated (or preventing specialized) cell fates. Hence, the role of Notch in Tribolium may reflectthe ancestral function of Notch-signaling in insect oogenesis.The functions of Notch-signaling in patterning the follicle cell epithelium suggest that Tribolium oogenesis may - analogous to Drosophila - involve the stepwise determination of different follicle cell populations. Moreover, our results imply that Notch-signaling may contribute at least to some aspects of oocyte polarization and AP axis also in telotrophic oogenesis.

JAK-STAT signalling is required throughout telotrophic oogenesis and short-germ embryogenesis of the beetle Tribolium.

In Drosophila, the JAK-STAT signalling pathway regulates a broad array of developmental functions including segmentation and oogenesis. Here we analysed the functions of Tribolium JAK-STAT signalling factors and of Suppressor Of Cytokine Signalling (SOCS) orthologues, which are known to function as negative regulators of JAK-STAT signalling, during telotrophic oogenesis and short-germ embryogenesis. The beetle Tribolium features telotrophic ovaries, which differ fundamentally from the polytrophic ovary of Drosophila. While we found the requirement for JAK-STAT signalling in specifying the interfollicular stalk to be principally conserved, we demonstrate that these genes also have early and presumably telotrophic specific functions. Moreover, we show that the SOCS genes crucially contribute to telotrophic Tribolium oogenesis, as their inactivation by RNAi results in compound follicles. During short-germ embryogenesis, JAK-STAT signalling is required in the maintenance of segment primordia, indicating that this signalling cascade acts in the framework of the segment-polarity network. In addition, we demonstrate that JAK-STAT signalling crucially contributes to early anterior patterning. We posit that this signalling cascade is involved in achieving accurate levels of expression of individual pair-rule and gap gene domains in early embryonic patterning.