[Lutetium-177-PSMA radioligand therapy : Consensus within the framework of GKV-funded care between the university hospitals in Aachen, Bonn, Düsseldorf, Essen, and Cologne and the MDK Nordrhein]. / Lutetium-177-PSMA-Radioligandentherapie : Konsensus im Rahmen der GKV-finanzierten Versorgung zwischen den Hochschulkliniken in Aachen, Bonn, Düsseldorf, Essen und Köln und dem MDK Nordrhein.

In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance. The goals of this article are to help treating physicians understand how this new therapy option works, to integrate it in the overall therapy concept for castration-resistant metastatic prostate cancer, and, above all, to use Lu-177-PSMA-RLT-based on the current data-at the right place in the therapy sequence of castration-resistant metastatic prostate cancer.

Effect of age on gingival crevicular fluid concentrations of MIF and PGE2.

We used an experimental gingivitis study design to compare crevicular fluid concentrations of Migration Inhibitory Factor (MIF) and Prostaglandin E(2) (PGE(2)) in younger (18 to 30 yrs) and older (46 to 77 yrs) healthy adults. PGE(2) increased after 1 wk in younger participants, whereas it decreased in older individuals after 1 wk of plaque accumulation. A significant interaction between age and time was observed for PGE(2) (p = 0.04). High concentrations of MIF were identified in both age groups at baseline. MIF increased in the younger participants, whereas in the older individuals a decrease over time was observed. MIF concentration was positively correlated with plaque index and gingival index in the older age group. Total counts of bacteria, Parvimonas micra and Prevotella intermedia, were significantly correlated with MIF concentration in older participants. In conclusion, MIF and PGE(2) production in response to bacterial accumulation seems to be modified by age.

The effect of age on prostaglandin-synthesizing enzymes in the development of gingivitis.

BACKGROUND AND OBJECTIVE: The aim of this study was to identify the expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 in young and elderly subjects. MATERIAL AND METHODS: Periodontally healthy subjects were divided into young (18-30 years, n = 7) and elderly (46-77 years, n = 7). A gingival biopsy was taken at baseline. After experimental gingivitis, clinical examination was repeated and a second biopsy was taken. The expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 was analyzed by means of immunohistochemistry. RESULTS: In both healthy age groups, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed in epithelial cells, endothelial cells and fibroblast-like connective tissue cells. Cyclooxygenase-1 was found in Langerhans' cells of the epithelium. Cyclooxygenase-2 expression was observed in cells exhibiting the morphology of epithelial mitosis cells, and the expression of cyclooxygenase-2 in periodontally healthy elderly subjects was significantly lower (p < or = 0.05). Following experimental gingivitis, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 expression did not change. However, the expression of cyclooxygenase-2 was significantly increased in both age groups (p < or = 0.05). Cyclooxygenase-3 was not detected in any group investigated. CONCLUSION: Cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed constitutively in gingival tissue, and expression was unaffected by age or inflammation states. In contrast, the expression of cyclooxygenase-2 was weaker in elderly subjects. In the course of experimental gingivitis, cyclooxygenase-2 was induced in both age groups.

Osseointegrated implants in patients treated for generalized chronic periodontitis and generalized aggressive periodontitis: 3- and 5-year results of a prospective long-term study.

BACKGROUND: The successful use of osseointegrated implants in periodontally healthy patients has been documented in numerous longitudinal studies in recent years. However, the extent to which these positive results apply to periodontally diseased patients remains unclear. The aim of the present prospective longitudinal study of partially edentulous patients treated for generalized chronic periodontitis and generalized aggressive periodontitis was a clinical, microbiological, and radiographic comparison of teeth and implants and assessment of the implant success rate. METHODS: Five partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and 5 treated for generalized chronic periodontitis (GCP) were enrolled in this study. The GAgP patients received 36 implants, and the GCP patients 12 implants. The teeth were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline), and 3 weeks after insertion of the final abutments (second examination). All further examinations were performed during a 3-month recall schedule over a 5-year period for the GAgP patients and over a 3-year period for the GCP patients. At each session clinical parameters were recorded at teeth and implants and the composition of the subgingival microflora was determined by dark-field microscopy and DNA analysis. Intraoral radiographs of the teeth and implants were taken for control purposes at baseline; after insertion of the superstructure; and 1, 3, and 5 years later. RESULTS: The clinical findings indicated healthy periodontal and peri-implant conditions in both patient groups throughout the study. However, an increased probing depth and an attachment loss were recorded in the GAgP patients after the third year (P<0.001). The distribution of the microorganisms revealed no significant differences between the patient groups or between implants and teeth. Moderate bone loss at teeth and implants was registered in both groups. The success rates recorded were 100% in the GCP patients and 88.8% (maxilla: 85.7%; mandible: 93.3%) in the GAgP patients. CONCLUSIONS: The 3-year and 5-year follow-ups show that osseointegrated implants may be successful in oral rehabilitation of partially edentulous patients treated for generalized aggressive periodontitis and generalized chronic periodontitis. However, as no significant differences were recorded between conditions at teeth and at implants, progression of the disease cannot be ruled out.

An in vitro study of the treatment of implant surfaces with different instruments.

The aim of this in vitro study using implants and abutments was to examine traces left by various cleaning instruments and to determine the quantity of substance removal. The implants and relevant abutments were Screw-Vent implants (Dentsply), titanium plasma-coated full-screw implants (Straumann), and standard Brånemark implants (Nobel Biocare). The instruments used were titanium curettes, Gracey curettes, plastic curettes, rubber cups with Zircate prophy paste, the Cavitron Jet ultrasonic scaler with universal inserts and airpolishing nozzles with Prophy-Jet cleaning powder, and the Densonic sonic scaler with SofTip disposable prophy tips and universal tips. Two test fields (2 x 2 mm) on the respective implant head and abutment underwent standard treatment with each instrument. With the full-screw implants, an additional two test fields were examined from the transition of the titanium plasma coating to the implant head. Untreated implants and abutment surfaces served as controls. The treated and untreated surfaces were examined by scanning electron microscopy for work traces and by optical laser profilometry for substance removal. The results showed that the Cavitron Jet ultrasonic unit, the Densonic sonic scaler with universal tips, and the Gracey curette left pronounced traces and induced high substance removal. The titanium curette and the Densonic sonic scaler with SofTip disposable prophy tips left virtually no traces and removed very little substance. The rubber cup, the plastic curette, and the Cavitron Jet airpolishing system left the implant surfaces unchanged. All instruments apart from the rubber cup and Cavitron Jet airpolishing system left pronounced traces at the transition of the implant head to the titanium plasma coating of the full-screw implants. The Cavitron Jet airpolishing system, the rubber cup, the plastic curette, and, with some reservations, the Densonic sonic scaler with SofTip plastic fittings and the titanium curette, appear to be suitable for cleaning implant surfaces.

Desquamative gingivitis and balanitis--linear IgA disease or cicatricial pemphigoid?

A 38-year-old man presented with gingival inflammation together with erosions of the penis. Direct immunofluorescence demonstrated linear deposits of IgA at the basement membrane zone; indirect immunofluorescence and immunoblotting were negative. Linear IgA disease (LAD) was therefore suspected and treatment with dapsone initiated but this was changed to sulfamethoxy-pyridazine and systemic corticosteroids because of methaemoglobinaemia. During 1-year follow-up the lesions continued to wax and wane although they were never as extensive as before. Eighteen months after disease onset there was scarring of the penis together with suspected fibrosis of the inflamed gingival region. In addition the patient was HLA DQ7(3) positive, a haplotype thought to be increased in patients with cicatricial pemphigoid (CP); LAD with scarring or CP with solely linear IgA deposits are possible diagnoses of his condition.

An in vitro study of various instruments for root planing.

Rotating instruments are becoming increasingly significant in the scaling and planing of the root surface. The objective of this in vitro study was to test various root-planing instruments on extracted teeth and then to compare the treated surfaces using scanning electron microscopy. Two manual instruments (scaler and curette) and five mechanically rotating instruments (Desmo-Clean; Perio-Set; Viking-Set; and 40-microns and 15-microns diamond finishers) were investigated. From a total of 42 teeth, six root surfaces were treated with each instrument. The results confirm the clear superiority of the manual instruments (especially the curette). The manual instruments permit good root planing with minimum ablation from the root surface and only a thin smear layer (a compound of grinding dust, dentinal fluid, and water). The best planing results by rotating instruments were achieved with the Desmo-Clean and the 15-microns diamond finisher, whose performance was almost equal to that of the manual instruments. The rotating instruments, however, were associated with higher ablation and a marked smear layer. Manual instruments remain the media of choice on easily accessible root surfaces; however, rotating instruments are of advantage in inaccessible areas (eg, furcations) because of their handling properties.

Osseointegrated implants in patients treated for generalized severe adult periodontitis. An interim report.

This study presents oral rehabilitation with osseointegrated implants in partially edentulous patients treated for generalized severe adult periodontitis. Five female patients aged between 31 and 44 received a total of 36 implants and were observed for 1 year after insertion of the superstructure. Three months before implantation, venous blood samples were taken from the patients and five periodontally healthy controls, and the serum examined with highly sensitive ELISA test kits for interleukin 1 beta (IL-1 beta) and interleukin 6 (IL-6). Clinical examination covered the plaque index (PI) and gingival index (GI) at teeth and implants plus probing depth (PD) and clinical attachment level (CAL) at the teeth. Microbiological evaluation of teeth and implants was performed by dark-field analysis, and DNA analysis was performed in addition 1 year after insertion of the superstructure. Radiological controls of the teeth were carried out with standard single-tooth films in the 2 years preceding implantation and at baseline. Following implantation, further controls of the teeth and implants were undertaken immediately after insertion of the superstructure and 1 year thereafter. The immunological examination revealed that the IL-1 beta (0.22 +/- 0.2 pg/ml) (means +/- SD) and IL-6 (2.27 +/- 2.8 pg/ml) level was slightly, but not significantly, higher in the patients than in the control group (IL-1 beta: 0.06 +/- 0.06 pg/ml and IL-6: 0.64 +/- 0.2 pg/ml) (P > 0.05). The clinical results show that the GI at the teeth rose slightly from 0.0 to 0.2, and at the implants from 0.3 to 0.4. The PI rose slightly from 0.3 to 0.7 at the teeth and from 0.2 to 0.9 at the implants. Neither the GI nor the PI revealed any significant difference between teeth and implants. Clinical attachment loss at the teeth was minimal at 4.7 to 4.8 mm. Comparison between the teeth and the implants revealed no essential difference in bacterial flora; neither Actinobacillus actinomycetemcomitans nor Porphyromonas gingivalis was recorded at any location. Small quantities of Prevotella intermedia were detected at the teeth and implants of one patient. Radiological evaluation 1 year after insertion of the superstructure revealed a mean bone loss of 0.62 mm at the implants. The bone loss at the teeth during the same period was 0.3%, whereas it had been 1.5% in each of the 2 previous years. These results suggest that there is only a slight difference between the periodontal and peri-implant areas in patients with generalized severe adult periodontitis. The full potential for implants in these patients, however, needs to be shown in controlled longitudinal studies.

Periodontal status of a subject sample of Yemen.

From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with reference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0), whereas bleeding on probing and calculus (CPITN 1 + 2) were registered in 86.2%. In the 35-44 year age group, 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2 + 3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.

Comparative study of plaque and gingivitis prevention by AmF/SnF2 and NaF. A clinical and microbiological 9-month study.

This comparative clinical 9-month study was designed to examine the efficacy of amine/stannous fluoride (AmF/SnF2) (Meridol) and sodium fluoride (NaF). 150 probands with chronic gingivitis or early signs of periodontitis were divided into 3 randomised groups. Group 1 was given a NaF toothpaste and an NaF mouthrinse, group 2 AmF/SnF2 toothpaste and mouthrinse, and group 3 AmF/SnF2 toothpaste and NaF mouthrinse. The probands were examined at intervals (0, 1, 3 and 9 months) under conditions of a clinical double-blind study. The parameters recorded were the plaque index (PlI), the approximal plaque index (API), the gingival index (GI) and the mod. sulcus bleeding index (SBI). The probing depths (PD) were also measured. The composition of the supragingival plaque was evaluated by dark-field microscopy. A highly significant reduction in all clinical parameters was recorded in all 3 groups in the course of the study. The most pronounced reduction in PlI, API, SBI and PD was recorded in group 2. In the group comparison, however, no significant differences were recorded. Microbiological examination revealed a highly significant increase in cocci and a decrease in rods in all 3 groups. There was also a significant reduction in spirochetes, filaments and fusiforms in groups 2 and 3. In group 1, there was a significant fall only in fusiforms and small spirochetes. Overall, no significant difference in clinical parameters was recorded in the group comparison. However, the use of AmF/SnF2 toothpaste and mouthrinse (group 2) and, to a lesser degree, the combined use of AmF/SnF2 toothpaste and NaF mouthrinse display a favorable microbiological effect. The results from the present double-blind study reveal a reduction in gingival inflammation and supragingival plaque accumulation with a positive change in plaque flora in all groups. The reduction in potentially gingivopathogenic bacteria was slightly higher in the amine/stannous fluoride group.

An in vitro study of oscillating instruments for root planing.

The objective of this in vitro study was to test PER-IO-TOR instruments on the Profin Directional System angle piece (Dentatus-Sweden), using extracted human teeth. In the 1st part of the study, 6 root surfaces were treated with the instruments TOR 1, TOR 2, TOR 3 and TOR 4. For comparison purposes, half the samples treated with each instrument were then subjected to further treatment with a Gracey curette. All samples were then examined by SEM. In the 2nd part of the study, 4 root surfaces were given standardized treatment with each PER-IO-TOR instrument and the amount of substance removed was determined with a mechanical profilometer. For this purpose, the treated root surface was scanned with a microneedle and the profile depth recorded. The study showed that the PER-IO-TOR instruments were efficient with respect to surface planning and protective abrasion. Instrument TOR 3 (spatula with eyelet) in particular yielded similar results to those obtained with a curette. The overall results confirm that the PER-IO-TOR instruments have similar planing properties to manual instruments, causing minimum abrasion from the root surface. They thus represent an alternative to manual instruments, not only in inaccessible areas but also on smooth tooth surfaces.

Periodontal health of the population in eastern Germany (former GDR).

The periodontal status of 1688 inhabitants of eastern Germany (former GDR) was investigated between July 1991 and March 1992, using the CPITN. The results show that only 1.4% of those examined have a healthy periodontal apparatus, whereas 40.1% had some signs of severe periodontitis (CPITN 4). This implies a very high therapy requirement in all age-groups, with 93.1% of 15- to 19-year-olds in need of peridontal treatment (CPITN 1 + 2 + 3 + 4). A comparison between educational qualifications and frequency of brushing or routine dental checks reveals a better level of prophylaxis in the more educated classes. As expected, the CPITN code with good oral hygiene and regular dental checks was significantly lower than with poor oral hygiene and infrequent dental checks. The high prevalence of periodontal disease lends urgency to the development of an extensive prevention concept introduced in childhood.

Impaired regulation of surfactant phospholipid metabolism in the isolated rat lung after nitrogen dioxide inhalation.

Various drugs have been shown to stimulate surfactant phospholipid metabolism. Particularly beta-adrenergic agonists play an important role under physiologic conditions. For the first time we have studied whether nitrogen dioxide (NO2) inhalation alters beta-adrenergic regulation of surfactant phospholipid metabolism in the model of the isolated lung. Rats were continuously exposed in vivo to a 5 ppm NO2-containing atmosphere for 48 hr. The lungs were isolated and perfused in presence of the beta-adrenergic agonist dopexamine and surfactant metabolism was studied in three lung compartments: (1) lung lavage, (2) lung tissue, and (3) lavagable free alveolar cells. We found that (1) in normal rat lungs dopexamine increased the incorporation of palmitate and choline from the perfusate into lung lavage phospholipids. In nitrogen dioxide exposed rat lungs beta-adrenergic stimulation did not cause an increase in precursor incorporation. No significant difference in unstimulated precursor incorporation was found for normal and NO2-exposed rat lungs. (2) Lung tissue from rats exposed to NO2 showed a decreased precursor incorporation into disaturated phosphatidylcholine due to an augmented cellular pool size. (3) Lavagable alveolar cells showed an increased palmitate uptake after nitrogen dioxide inhalation and by beta-adrenergic stimulation. From these data we conclude that nitrogen dioxide inhalation impairs the beta-adrenergic regulation of surfactant phospholipid metabolism. Moreover these data underline the importance of beta-adrenergic agonists in surfactant metabolism.

CPITN application in regular dental practice.

The periodontal status of 8862 dentulous and partially dentulous inhabitants of the Federal Republic of Germany was investigated in various dental practices, using the CPITN, developed by the World Health Organization. The results show that a total of only 4.3% of those examined have a healthy periodontal apparatus and thus require no periodontal treatment. At least detailed oral hygiene instruction needs to be given to 95.7% of all subjects. Furthermore, 80% patients with periodontal disease require scaling or root planing, and 10% of them require periodontal surgery. The treatment of shallow gingival pocketing (CPITN 3) is predominant in every age group, and every fifth patient aged 35 years or more is need of periodontal surgery. This high frequency rate of periodontal disease illustrates the urgent necessity in regular dental practice for each and every patient to undergo periodontal screening. Such screening, based on the time saving CPITN, is to be recommended as it ensures fast, reliable determination of the periodontal status of each individual patient and the treatment needs involved.

[Periodontal status in Rio de Janeiro city (Brazil)]. / Parodontalzustand in Rio de Janeiro City (Brasilien).

The periodontal status and the treatment needs were investigated in 1854 residents of Rio de Janeiro City (Brazil) by means of the CPITN. The results of the study showed that 2.5% of the examined individuals were healthy (CPITN 0), 8.1% displayed an increased tendency towards bleeding on probing (CPITN 1) and 23.2% presented with calculus and bleeding on probing (CPITN 2). Shallow pocketing (CPITN 3) was observed in 51.4% and deep pocketing (CPITN 4) in 14.7% of the examined subjects. Since 97.5% of the examined population were in need of periodontal therapy, the necessity for organizing an oral health program with emphasis on prevention and treatment of periodontal disease is strongly indicated.

[Clinical indices in periodontal diagnosis. A review]. / Klinische Indizes in der parodontologischen Diagnostik. Eine Ubersicht.

In this review, are described the most common clinical indices. Further, is discussed and criticized their application as well as usefulness in the clinical diagnosis and patient management. Although, there exists a variety of clinical indices, only a few of them could be sufficient for monitoring diagnosis and treatment in the general practice.