Die Belastung einer Gesellschaft durch Krankheiten wird als „Burden of disease“ bezeichnet. Neurologische Erkrankungen sind hier führend. Schlaganfall, Demenz, Epilepsie, MS, Parkinson, Polyneuropathie etc. führen für gewöhnlich nicht zum Tode, sondern ohne eine adäquate Behandlung zu einer progredienten Behinderung. Diese endet viel zu oft in einer sehr kostenintensiven Pflegebedürftigkeit.

Summary: Periodontitis is associated with numerous systemic diseases, and it has been shown that these associations are partly causal in nature. It is assumed that such interactions between periodontal and systemic diseases are also mediated via adipokines. Apelin, an adipokine about which there is little research in the dental field, is also produced together with its receptor in periodontal cells. The aim of this review was to summarize the currently available literature on the apelin-APJ system to better understand the pathomechanistic relationship between periodontitis and obesity and to determine the potential clinical relevance of apelin for diagnostics and therapy. In vitro studies suggest that apelin can enhance bacterial-induced synthesis of proinflammatory and proteolytic molecules, indicating a significant etiopathogenic role of this adipokine. Since serum levels of apelin are elevated in diabetes and/or obesity, it is possible that such systemic diseases promote the development and progression of periodontitis via apelin. On the other hand, it is also conceivable that apelin from the periodontium influences such systemic diseases. Further research is needed to better understand the role of apelin in the periodontium and the entire oral cavity, but also in the interactions between periodontal and systemic diseases. In particular, clinical intervention studies are needed to further decipher the etiopathogenic role of apelin in periodontitis. Schlagwörter: apelin, adipocytokine, adipokine, periodontitis, periodontium

Purpose: Dental students learn knowledge and practical skills to provide oral health care to the population. Practical skills must be maintained or continuously developed throughout a professional career. This cross-sectional survey aimed to evaluate the perception of practical skills of dental students and dental-school graduates by national dental associations (NDAs) in international comparison in the European Regional Organization of the FDI World Dental Federation (ERO-FDI) zone. Materials and Methods: A questionnaire of 14 items collected information on pre-/postgraduate areas. Results: A total of 25 countries participated (response rate: 69.4%), with 80.0% having minimum requirements for practical skills acquisition and 64.0% starting practical training in the 3rd year of study. In countries where clinical practical work on patients begins in the 2nd year of study, practical skills of graduates are perceived as average, starting in the 3rd year of study as mainly good, starting in the 4th as varying widely from poor to very good. In total, 76.0% of respondents feel that improvements are needed before entering dental practice. Improvements could be reached by treating more patients in dental school (32.0%), increasing the quantity of clinical training (20.0%), or having more clinical instructors (12.0%). In 56.0% of the countries, it is possible to open one’s own dental practice immediately after graduation, and in 16.0%, prior vocational training is mandatory. Conclusions: All participating countries in the ERO-FDI zone reported practical training in dental school, most starting in the 3rd year of study. The perception of practical skills of dental students and dental-school graduates among NDAs is very heterogeneous. Reasons for the perceived deficiencies should be further explored. Schlagwörter: dental association, graduate, international, practical skills, student

Purpose: Hypersensitivity is a frequent complaint in children with molar incisor hypomineralisation (MIH). This double-blind randomised controlled trial aimed to evaluate non-inferiority in hypersensitivity relief of a toothpaste containing microcrystalline hydroxyapatite compared to amine fluoride in children with MIH. Materials and Methods: Children were randomised into 2 groups: either hydroxyapatite (intervention) or amine fluoride toothpaste (control). The primary endpoint was pain sensation in response to tactile stimulus (Wong-Baker FACES Pain Rating Scale) 56 days after randomisation and analysed by mixed effects linear regression analysis. Non-inferiority was inferred if the upper limit of the one-sided 95% confidence interval (CI) of the difference between intervention and control group was below the non-inferiority margin of 1 in the ITT (intention-to-treat) and PP (per protocol) population. Results: Twenty-one children were randomised and 14 children finished the study per protocol. In the ITT population, hydroxyapatite was non-inferior to amine fluoride (mean difference: -0.75 95%CI [-∞;0.49]). In the PP population, non-inferiority could not be shown (-0.62 [-∞;1.08]). Conclusions: Overall non-inferiority in hypersensitivity relief of a toothpaste containing hydroxyapatite compared to amine fluoride could not be shown. However, the hydroxyapatite group tended to be less hypersensitive in both populations. Attrition of the PP population due to the COVID-19 pandemic led to loss of statistical power. Schlagwörter: children, hydroxyapatite, hypersensitivity, fluoride, molar incisor hypomineralisation (MIH)

Parodontitis ist eine chronische Erkrankung des Parodonts, die unbehandelt zu Zahnlockerung und Zahnausfall führen kann. Seit Längerem ist bekannt, dass Parodontitis in einem engen Zusammenhang mit Erkrankungen des Gesamtorganismus, zum Beispiel Diabetes mellitus und kardiovaskulären Erkrankungen, steht. Zahlreiche Studien belegen nun, dass Parodontitis auch mit Adipositas assoziiert ist. Die Wahrscheinlichkeit, an einer Parodontitis zu erkranken, ist bei Übergewichtigkeit um das 1,3-Fache und bei Adipositas um das 1,8-Fache erhöht, wie eine Meta-Analyse kürzlich zeigte. Außerdem scheint Adipositas die parodontale Heilung nach einer Parodontitistherapie negativ zu beeinflussen. Bisher ist noch weitgehend ungeklärt, ob es sich bei der Assoziation zwischen Adipositas und Parodontitis um eine kausale und/ oder non-kausale Beziehung handelt. Zahlreiche Pathomechanismen, die dieser Assoziation zugrunde liegen könnten, stehen derzeit im Fokus der parodontalen Forschung. Aufgrund der komplexen Interaktionen zwischen Parodontitis und Erkrankungen des Gesamtorganismus, kommt der interdisziplinären Zusammenarbeit eine herausragende Bedeutung zu. Schlagwörter: Parodontitis, Parodontium, Adipositas, Adipokine

Periodontitis is a chronic inflammatory disease associated with loss of periodontal attachment, collagen, and alveolar bone. Regeneration of periodontal tissues can be supported by the local application of enamel matrix derivative (EMD). However, periodontal regeneration remains a major and often unpredictable challenge as the result of a number of unknown factors. The authors' in vitro studies revealed that EMD stimulated the wound fill rate, proliferation, and adhesion of periodontal ligament (PDL) cells. However, in the presence of an inflammatory environment or biomechanical loading, the beneficial effects of EMD decreased significantly. EMD also stimulated the synthesis of growth factors and collagen, as well as calcium deposition, in PDL cell cultures. These beneficial effects of EMD on PDL cells were also significantly diminished by inflammation and biomechanical forces, respectively. The findings suggest that critical PDL cell functions pertinent to periodontal regeneration are reduced in an inflammatory environment and under biomechanical loading. Therefore, effective anti-infectious and anti-inflammatory periodontal treatment before the application of EMD may be critical to ensure the full regenerative capacity of the PDL tissue. Furthermore, occlusal loading of EMD-treated teeth, at least immediately following surgery, should be minimized to obtain optimal regenerative healing results. A better understanding of the interactions of growth factors and biomechanical signals will result in more powerful regenerative therapeutic strategies.

Die Regeneration verlorengegangener parodontaler Gewebe kann durch die intraoperative Applikation von Schmelzmatrixproteinen (EMD) unterstützt werden. Insgesamt zeigen zahlreiche In-vitro-Studien, dass EMD die Proliferation, Adhäsion und Migration von parodontalen Ligament- (PDL)-Zellen fördert. EMD führt in diesen Zellen auch zu einer verstärkten Synthese von Wachstumsund Differenzierungsfaktoren, Matrixmolekülen und Osteogenese-assoziierten Faktoren, zu vermehrten Kalziumablagerungen sowie zu einer beschleunigten In-vitro-Wundheilung. Ähnliche positive Effekte übt EMD auch auf Osteoblasten bzw. osteoblastenartige Zellen, Zementoblasten und deren Vorläuferzellen aus. Mehrere Studien belegen zudem, dass EMD die Synthese von Entzündungsmediatoren hemmt, also antiinflammatorische Effekte ausübt. Lokale und systemische Faktoren könnten jedoch die regenerationsfördernden Effekte von EMD beeinflussen und sollten daher so gut wie möglich kontrolliert werden. Schlagwörter: Schmelzmatrixderivat (EMD), Schmelzmatrixproteine, Amelogenin, Regeneration, Entzündung, parodontale Ligamentzellen