Implantatkonstruktionen und alternative Versorgungsmöglichkeiten im Vergleich (Dental Basics 1) (German Edition) eBook: Wolfgang Kohlbach: leondumoulin.nl
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Feasabilitity and safety of transfer from racemic methadone to R -methadone in primary care: Clinical results from a open study. World J Biol Psych 10 3 , Zur pharmakologischen Wirkung der optischen Isomeren des Methadons; Dtsch Apothekerzeitung 17, Der Kassenarzt 12, Psychische Befindlichkeit in der Substitutionsbehandlung mit Levomethadon und d-l- Methadon — eine doppelt randomisierte cross-over-Studie.
Sucht 53 1 , Wittchen HU et al. Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in patients. Drug and Alcohol Depend 95 3 , Auch als File fuer bessere Graphiken: In Frankreich ist Buprenorphin vorherrschend. Wichtige politische Themen auf einen Blick 1. Die Substitutionstherapie ist wesentlicher Bestandteil eines umfassenden Ansatzes zur Drogentherapie.
Die derzeit verwendeten Substanzen sind u. In nahezu allen EU-Mitgliedstaaten ist eine Substanz vorherrschend. Um optimale Ergebnisse zu erzielen, sollte sowohl die Auswahl der Substanz als auch deren Dosierung auf den jeweiligen Betroffenen abgestimmt werden. Der Zugang zur Substitutionstherapie ist in der EU sehr unterschiedlich. Ihr Nutzen ist unter Beweis gestellt worden. Gesundheitsproblemen sowie sozialer Verelendung ausgesetzt sind [6]. Welche Ersatzsubstanzen werden verwendet?
Nahezu alle EU-Mitgliedstaaten verwenden eine vorherrschende Ersatzsubstanz anstatt einer breiten Palette von Substanzen [7]. Die Ersatzsubstanzen haben unterschiedliche Eigenschaften. Neugeborenen weniger Probleme als Methadon zu verursachen. Trotz einer allgemeinen Ausweitung der Substitutionstherapie in den letzten zehn Jahren ist der Zugang zu ihr innerhalb der EU weiterhin uneinheitlich. Die Zulassungskriterien unterscheiden sich von einem EU-Land zum anderen erheblich. Januar 4 — Spanien 83 72 erhielten Methadon Frankreich 71 62 erhielten Buprenorphin und 8 erhielten Methadon Dezember 4 Irland 4 5 Januar 4 Portugal 18 6 1.
Januar Finnland 1 6 Buprenorphin und 70 Methadon Schweden 1 6 Beides hat seine Vorteile: In nahezu allen EU-Mitgliedstaaten konzentriert sich die Therapie jedoch auf die eine oder andere Alternative. Eine Kombination aus beiden. Beides hat auch seine Nachteile: Letztere schwanken erheblich zwischen den Mitgliedstaaten. Das Angebot sollte eine breitere und diversifiziertere Palette von Substanzen und Dosierungen umfassen, um dem Profil des sich in Therapie begebenden Klienten zu entsprechen.
Addictive Behaviors, 23, Nr. Ich habe das auch als File fuer die Tabellen: Hibbard stopped dispensing the highly addictive painkiller last July, after two robbers in ski goggles demanded it at knifepoint one afternoon as shocked customers looked on. It was one in a rash of armed robberies at Maine drugstores last year, a sharp increase that has rattled pharmacists and put the police on high alert. Hibbard said of OxyContin, which the authorities say is the most common target of pharmacy robberies here.
In at least one case, a tiny tracking device affixed to a bottle let the police easily track a thief after a robbery. More than 1, pharmacy robberies have taken place nationally over the last three years, typically conducted by young men seeking opioid painkillers and other drugs to sell or feed their own addictions. The most common targets are oxycodone the main ingredient in OxyContin , hydrocodone the main ingredient in Vicodin and Xanax. The robbers are brazen and desperate.
In Satellite Beach, Fla. The crime wave has spurred pharmacists to tighten security measures and add ones they may never have imagined. Many have upgraded their surveillance cameras; some have installed bulletproof glass and counters high enough to keep would-be robbers from jumping them, giving these pharmacies the aesthetic of an urban liquor store.
Meanwhile, the police are quietly experimenting with new tools. They gathered evidence there, arrested the suspect a few days later and indicted him last month. But some local law enforcement officials have been overwhelmed enough by the incidents to seek help. Thomas Delahanty II, the United States attorney in Maine, announced recently that the federal authorities would help investigate the heists from now on and prosecute some of the cases. Federal charges could bring more prison time, Mr. Police officers there got free training in how to investigate pharmacy heists last month from Purdue Pharma, the maker of OxyContin.
The company also trains pharmacists on how to prevent robberies and what to do should they fall victim to one, said Rick Zenuch, its director of law enforcement liaison and education. In Washington State, where more than pharmacy robberies have taken place over the last three years, law enforcement officials say the penalty for second-degree robbery, when the pharmacist may be threatened but no weapon is shown, is too weak. Dan Satterberg, the King County prosecutor, said he had submitted a bill to the Legislature to increase the minimum jail time to three years from three months.
Satterberg and other law enforcement officials said, and the most popular pill is 80 milligrams. Many pharmacies in Washington have deterred would-be robbers by putting time-release locks on the safes where they store narcotics and staggering their inventory, Mr. Perhaps as a result, the number of armed robberies at pharmacies there dropped to 23 in from 49 in , according to the D.
Satterberg said, the threat of robbery has made it difficult for retail chains in the state to recruit enough pharmacists in recent years. In sheer numbers, Florida, Indiana, California, Ohio and Washington have had the most armed robberies of pharmacies since January , according to the D. But Maine, Oklahoma and Oregon had the sharpest increases last year. All but a handful of the Maine robberies took place at Rite Aid and CVS stores, some of which were hit multiple times.
Robbers there often demand Xanax, an anti-anxiety drug, along with opioids, said Sgt. Dave Walker, who runs the robbery unit of the Tulsa Police Department. In Bingham, a remote town of about 1,, the men who robbed Mr. Hibbard and his employees still jump when the place is quiet and they hear footsteps coming up the ramp, they said. Hibbard, Rite Aid has chosen to keep stocking the drugs that are popular with robbers, said Eric Harkreader, a spokesman. But the company now limits the amount of certain drugs in stores at any given time.
In Biddeford, a Rite Aid that was robbed twice last year was struck again last week. The suspect, who demanded OxyContin and fled into the night, remains at large. According to Solomon, et. They say that most of the time, study subjects are healthy, unlike the people for whom the drug is meant. Two studies evaluating health risks associated with taking pain meds made the news recently.
The news reports I read focused on the findings that giving opioids narcotic pain medications to people over the age of 80 increased their risk of complications, health problems and even death. Of course, conventional pain doctors who commented in the news reports tried to refute the results by saying the study had serious problems with confounding. Little information about exactly what skewed the results was given in the news reports. Confounding happens when a researcher observes people to find out what causes or at least is associated with a particular effect. Investigators may hypothesize that one characteristic is responsible for a disease or condition.
But another characteristic, related to the one they are evaluating, emerges as a possible cause during the course of the study. So the hypothesis just got more complicated. In the two recent studies, confounders included any possible role that obesity, smoking, drinking and the use of over the counter pain meds NSAIDs may have played in the safety of those who took opioids or Cox-2 inhibitors.
The study authors talked about this problem in their report, acknowledging the possibility that something other than the medication was at work here. They described the way in which they created comparable groups of pain med taking seniors. And as it turns out, these remaining factors smoking, drinking, being overweight and taking NSAID s occupied only a small fraction of the overall possible causes of the health risks identified in the two studies. As with most studies, the authors end by saying more studies are necessary before we can definitely know the best course of action for patients.
It revealed a historical detail that is very difficult to swallow: Some of the most respected business families today owe their fortune to that vile practice. So what was this Opium Trade? To pay shareholders, the company had to make huge profits. So the Company forced Indian peasants to grow opium, instead of grain. This opium was sold in China in exchange for highly profitable tea.
So India became poor, an entire generation of Chinese became opium addicts, to make the Company, and later the Empire, rich. Many now respectable Indian business families allegedly and apparently, for everyone denies it now participated in this lucrative trade and made huge fortunes. I imagine Chinese students being taught this history: How the West abused it for its profit and how Indian business families participated in their downfall. This could be the reason why the Chinese do not have a great relationship with India, and look at everyone with suspicion.
How does one rectify it? They say children inherit the sins of the father. The Mahabharata refers to this concept again and again. How crimes committed in an earlier generation end up affecting a later generation. The epic begins with the story of Janamejaya angry that his father has been killed by a snake, until he is told that his great grand parents destroyed an entire forest that was home to thousands of snakes.
Even the horrific war at Kurukshetra, like the World Wars, is not merely the fight of cousins, but the outburst of several generations of rage and denial and frustration and envy. That is why these stories look not at one generation but at several. So long is the history and so deep is the wound that everyone assumes they are the victims and no one is prepared to take the responsibility of the villain.
There are no heroes or villains, just people who choose to exploit, people who seek retribution, people who cannot forgive and people who yearn shy away from responsibility but yearn for nobility. But a UN drugs forecast released on Monday says that poppy growing will increase elsewhere in Afghanistan. Forecasting the Afghan crop is a tricky business, and the groundwork for this UN survey is based on the sample of only a few villages in each province.
And that spread this year will even extend into provinces that had become poppy-free in recent years. The United Nations Office on Drugs and Crime UNODC has expressed concern in particular about a predicted increase in Nangahar, a large province bordering Pakistan where poppy growing had been all but eradicated in recent years. The UN survey predicts more planting across a wide swathe of central Afghanistan — from Herat and Ghor in the west to the provinces east of Kabul along the Pakistan border.
Their forecast for the northern region will come out later in the year, as the season starts later in the north. The predicted rise in poppy planting tallies with other evidence suggesting that the Taliban insurgency has spread across a wider region of the country. That is why we continue saying this is not business as usual. The surge of US troops along with British troops in the main population centres in Helmand played a big part, as did weather conditions — too cold and dry at the time farmers wanted to plant. But the deputy head of the British mission in Helmand, Leo Tomlin, said the forecast showed that a set of policies were working.
They include public information, strong leadership from the Governor Gulab Mangal, tougher policing and better job opportunities. Even these predicted reductions will leave more than 65, hectares under cultivation for poppies in Helmand and some 25, hectares in Kandahar. It may have been pushed onto marginal land, out of sight, but it still remains a potent threat to stability and security in Afghanistan.
Kabul — The United Nations said Monday in a report that the increasing price of opium had not boosted its cultivation in the main producing provinces of southern Afghanistan. The current high price of opium did not produce an increase in opium cultivation in the biggest producing provinces of Helmand and Kandahar, the report titled Afghanistan: Opium Survey said.
The opium winter assessment report prepared by the United Nations Office on Drugs and Crime and the Afghan Counter Narcotics Ministry also predicted a decrease in the opium cultivation in the two southern provinces in In other parts of Afghanistan, mainly the western, eastern and central provinces, the report observed an increase. The price went up by per cent in The total harvest was nearly halved due to bad weather conditions and a plant disease. For the Taliban insurgents, poppy production is one of the main sources of income which funds their insurgency. Planted poppy seeds start to germinate in winter in the main opium producing provinces in the southern, western and eastern areas of Afghanistan, while sowing takes place later in the north, according to UNODC.
The expected decline in opium cultivation, as well as prolonged drought in the south may lead to another year of reduced opium production, the agency said. An outbreak of opium blight last year cut production by half and caused prices to soar. The survey once again highlighted the direct correlation between insecurity, lack of agricultural aid and opium cultivation, UNODC noted. Villages considered insecure and lacking agricultural assistance are more likely to grow poppy this year than those with better security and assistance.
An estimated 90 per cent of insecure villages are involved in opium cultivation, while those targeted by anti-poppy awareness campaigns are significantly less likely to grow poppy, the agency reported. Im Buprenorphin-Arm gab es keine Therapieversager: Individuals recovering from opiate dependence have long reported that while the acute withdrawal symptoms from opiates may pass relatively quickly, they do not feel quite right for several weeks or even months thereafter.
New data in animals, reported in Biological Psychiatry , now implicates the serotonin system in this phenomenon. French researchers found that mice with chronic morphine exposure showed decreasing physical dependence during a period of abstinence, with no physical withdrawal symptoms after 4 weeks. In contrast, low sociability and despair behavior clearly developed after 4 weeks of abstinence. Remarkably, treatment during the abstinence period with the antidepressant fluoxetine prevented the development of both social aversion and despair behavior.
This is important because fluoxetine targets the serotonin system, which is known to influence mood. John Krystal, Editor of Biological Psychiatry. These findings should foster novel research along serotonergic pathways in drug abuse. It is hoped that these findings can lead to real-world clinic use, since serotonergic medication is already broadly available.
Self-injurious behavior SIB is a primary reason that individuals with neurodevelopmental disabilities NDD are either retained in restrictive environments or are administered psychotropic medication. There are no known causes and no universally accepted treatments for this complex behavior among individuals with NDD. There is developing evidence, however, that individuals exhibiting SIB have a disturbance of the opiate-mediated pain and pleasure system. One hypothesis is that SIB reflects insensitivity to pain and general sensory depression hypoalgesia , perhaps related to chronic elevation of endogenous opiates.
Moreover, for some individuals the addictive properties of elevated endogenous opiates euphoria may be responsible for maintaining their SIB. Reports that levels of endogenous opiates at rest and after SIB episodes predict positive responses to opiate blockers e. Although the long term effects of opiate blockers on SIB are unknown, reduction in SIB following acute treatment provides support that a specific biological system may be dysregulated in a subgroup of patients. It is concluded that naltrexone produces a clinically significant reduction in the serious and life-threatening behavior of self injury for individuals who have not been responsive to any other type of treatment.
Several suggestions and cautions are provided for regimens of naltrexone treatment of SIB. Introduction Despite considerable research effort, self-injurious behavior SIB continues to be a primary reason, together with aggression toward others, that individuals are either retained in institutional restrictive environments or are administered psychotropic medication. Intentional acts of harm to self, evident in many species, a have no known cause and b no agreed upon treatment [4]. The apparent absence of visible progress in understanding or treating SIB is not because of a lack of interest or effort.
Studies of self-injury have increased exponentially over the past 30 years, rising from just 60 published studies between and to over 1, studies reported between and Figure 1. Number of studies of self-injurious behavior SIB conducted in 5-year intervals from to the present.
One major obstacle in understanding the mechanisms of SIB and developing coherent treatment plans is the absence of distinctive behavioral phenotypes. Despite the consensus that SIB has variable expression with no known cause, the group of NICHD experts agreed that SIB could be defined, perhaps with greater precision than most complex human behaviors. SIB is a directly observable. The NICHD group argued that data collection and analysis had advanced so that complex patterns of SIB should replace or supplement measures of rate and frequency [5,6].
Two distinct patterns of SIB were proposed as possible guides. One pattern consists of bouts that are most likely maintained by environmental contingencies. The second pattern involves protracted periods of SIB that are most likely under the primary influence of biological factors.
The vast majority of existing studies, however, have reported frequencies or rates of occurrence of SIB often linked to a single environmental manipulation. It is a significant advantage that many forms of SIB can be counted and time-stamped enabling contemporary studies to use sequential and time series procedures to define their structure and their relations with other behaviors and the environment. We subjected extensive and lengthy observations of maladaptive behavior in its natural environmental context to time series analysis and discovered unique temporal and sequential patterns of these severe maladaptive behaviors [2,3,].
Specifically, we found for a large majority of the individuals studied, SIB was predicted only by its own recent history. Application of time-series methods of analysis that controlled for chance pairings of events indicated that the contagious patterns of SIB were independent from frequency and rate of occurrence. That is, the temporally dependent patterns we observed were not a function of high rates of occurrence.
Moreover, and surprisingly, SIB was not associated consistently with other behaviors or with the several staff activities or environmental conditions recorded in these studies. Thus, in a significant majority of these individuals, SIB episodes were self-perpetuating and not related to antecedent or subsequent environmental circumstances, events, or other recorded behaviors. This novel and surprising finding was consistent with conclusions of the NICHD group that some expressions of SIB may have an underlying biological basis because a solely self-perpetuating behavior is most parsimoniously explained by internal i.
The vast majority of individuals in our cohort exhibited the most primitive level of internally regulated behavioral patterns despite years of behavioral interventions and treatment with various medications [8,9]. Anecdotal and clinical observations of these individuals also strongly suggested a biological basis for their behavior and specifically involvement of the pain and pleasure systems. Typically, SIB is repetitious consisting of hourly, daily, weekly, monthly, or even yearly cycles [14]. Some individuals who repeatedly injure themselves appear immune to the normal experience of pain [12].
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They abuse and injure their bodies, hitting or biting themselves, hurling themselves to the ground, and banging their head against solid objects resulting in broken bones, disfigurement, blindness, and even loss of life [2,15,16]. They often work to overcome interventions designed to decrease self-injury in a manner that is consistent with seeking positive reward. For instance, protective devices such as helmets may result in individuals exerting greater effort and exhibiting greater rates of behavior to hit and harm themselves [17].
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Because many medications that treat pain or induce pleasure are addicting, it is interesting that SIB, in addition to the obvious involvement of pain systems, shares features of addiction such as compulsive and ritualistic or stereotypic patterns that either comprise or surround the self-injuring acts. One biological system that has been implicated in SIB and the modulation of pain and pleasure is Pharmaceuticals , 4 the hypothalamic-pituitary-adrenal HPA stress axis and specifically the proopiomelanocortin POMC molecule [3,18,19].
This was not surprising because there was little consistency among studies regarding the rigor of diagnosis, the molecule measured, the tissue assayed, or the conditions assessed []. Despite inflicting serious physical damage to their bodies, many of these individuals do not grimace, cry, or show other symptoms that they are experiencing pain.
It has been suggested that this absence of response to self-inflicted injury reflects insensitivity to pain and general sensory depression induced either by elevated endogenous opiates or by supersensitive opiate receptors [11,]. This possibility is supported by classical findings that opiate receptor blockers a reverse congenital insensitivity to pain [30]; b normalize hypothalamic-peptide dysfunction coexisting with elevated pain threshold [31]; and c increase brain responses to sensory information [32].
These observations are consistent with a venerable animal literature proving that opiate blockers lower pain threshold [33]. Pleasure Addiction and the Endogenous Opioid System It also is possible that the addictive properties of elevated endogenous opiates are responsible for maintaining SIB. If it is presumed SIB does result in pain and that the experience of pain results in the release of opiates, then it can be argued that individuals commit self-inflicted harm to receive the euphoric pleasurable effects of increased circulating opiates.
The repetitive, often compulsive, and ritualistic patterns of SIB i. The addiction hypothesis maintains that individuals with SIB may endure the pain to enjoy the pleasure it produces as well as to avoid a withdrawal effect. The addiction hypothesis predicts that SIB may be reinforced both positively and negatively because it gains the individual access to the narcotic effect of endorphins while simultaneously allowing the individual to escape the unpleasant sensory consequences commonly associated with the absence of opiates following chronic and sustained access.
Stress and the Endogenous Opioid System The endogenous opioid system is tightly coupled with the general stress response. Evidence from several laboratories indicates that functioning and processing of a stress-related molecule POMC in the HPA axis may be perturbed among subgroups of individuals exhibiting SIB [15,19,21,]. In humans, most POMC is produced in the pars distalis of the anterior pituitary but also by hypothalamic neurons and neurons in the amygdala and pituitary stalk.
POMC is a well-characterized K dalton, bioinactive protein-like molecule that is post-translationally converted by enzymes e. This suggests that one consequence of SIB is the disregulation of the arousal system. Acute Effects of Naltrexone In a review of pre studies [49], six of eight published studies reported that injectable naloxone significantly reduced SIB. In these eight studies, naloxone was tested in a total of ten individuals with SIB. A decrease in SIB was reported for seven individuals. Most of the studies either were case studies or were studies with very small samples.
A separate review of 13 studies including several in the Sandman review [49] concluded that about one-third of the patients tested with Naltrexone had a decrease in their SIB [50]. Several studies in this later review included juvenile patients under the age of 8 years [51] and patients with primary behavioral problems related to aggression and agitation [52]. Aggression toward others and agitation are not equivalent to SIB on any obvious dimension except, perhaps, exertion, and the fact that opiate blockers were ineffective in the control of these behaviors adds inferential support to the argument that the opioid system is uniquely implicated in SIB and not in other maladaptive behaviors.
The effects of opiate blockers in children who self-injure may be similar to the effects observed in adults but there are too few reports to make that conclusion. More recently, a thorough review of the scientific literature employing stringent and appropriate criteria for inclusion concluded that the effects of opiate blockers on SIB could be evaluated in a total of 86 patients [53]. Eighty percent of the subjects were reported to improve relative to baseline i.
In studies reporting dose levels in milligrams, males were more likely than females to respond. No significant relations were found between treatment outcomes and autism status or form of self-injury. Two relatively large, placebo-controlled studies [16,54] included in this review of naltrexone came to very similar conclusions. In a double-blind, placebo-controlled, dose-finding study, Sandman et al. Acute treatment 1 week at each of three doses with naltrexone reduced the frequency of SIB without major side-effects.
Activity, stereotypy, involuntary movement, and neurological status were not influenced by naltrexone. There were two central findings. Six of these eight patients also responded at the 0. Second, subjects with the most frequent SIB were the most positive responders to higher doses of naltrexone, consistent with earlier reports [55,56].
A small minority of subjects responded most favorably to lower doses. Another double-blind, placebo-controlled, fixed-dose study of eight, severe to profoundly retarded adults included in the review [16], reported that treatment with naltrexone reduced head hitting, head banging, and self-biting. The eight individuals evaluated displayed 18 forms of SIB.
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Episodes of high frequency SIB also were more sensitive to treatment with naltrexone. The mg high dose was more effective than the mg low dose in reducing SIB. For several individuals, some forms of SIB decreased after naltrexone e. Four of the subjects in this trial received concomitant treatment with clonidine alphaadrenergic agonist but no effects on SIB or interactions with naltrexone were observed. These findings compliment previous studies and caution that although naltrexone is effective in reducing SIB, not all forms of self-inflicted harm may be controlled by blocking the opioid system.
These two relatively large studies of acute treatment with naltrexone came to very similar conclusions. Opiate blockers appear to be an effective treatment for a significant number of individuals exhibiting SIB. Administration of naltrexone reduces high frequency SIB and some, but not all, selfdestructive behavior. Both studies acknowledged that not all individuals expressing SIB were positive responders and that a small minority may increase SIB see also Barrett [57]. In the single study that has evaluated the effects of naltrexone using time-series analysis, Symons et al.
Second, and most interesting, they discovered that in addition to the improvement with naltrexone, there was an alteration in the sequential dependencies between staff behavior and the manifestation of SIB. One possible conclusion from these findings is that naltrexone exerts its effects on SIB, in part by the opioid-mediated reinforcing influences of social interactions.
Alternatively, Symons et al. Long-Term Effects of Naltrexone Treatments The long-term effects and consequences of continued treatment with naltrexone is not completely known because most studies reporting treatment of individuals with SIB have been short-term demonstrations or acute trials. Most published long-term studies have been either case studies or openlabel designs and they have generated mixed results. Two types of studies comprise the long-term evaluations of naltrexone, either prolonged treatment with naltrexone or extended observations following brief periods of treatment.
With these procedures, investigators have reported that about six of eight patients examined in several studies exhibited long-term benefits in varying degrees from treatment with naltrexone []. In the first report, a total of 24 days of naltrexone treatment resulted in elimination of SIB in a year-old girl that persisted for at least 22 months [57]. A similar finding was reported after 1 year of continuous treatment with naltrexone in a year-old woman with severe SIB.
Not only did treatment eliminate SIB but also the near-zero rate persisted through placebo and nodrug phases of the study [59]. In their retrospective study of 56 patients, Casner et al. We [61] examined the long-term 12 month effects following acute treatment with naltrexone and then we assessed the effects of subsequent long-term treatment with naltrexone.
To accomplish this, we enrolled 15 subjects in a double-blind, placebo-controlled acute dose-finding study. Each acute dose was evaluated for a 1-week period with placebo weeks interspersed. Subjects were followed for a month period and then they were enrolled in a multiple baseline design with a single most effective dose determined in the acute phase administered to each subject for 2-, 3-month periods over an month interval with placebo periods appropriately separating the treatment phases.
Again, timesampled video records were scored using a computer-assisted program [62]. The primary finding from our study was that a subgroup of patients exhibited persisting effects decreased SIB in the 12 months after acute treatment with naltrexone. The largest decrease in SIB was observed in patients who had a brief exposure to naltrexone, were given a month hiatus during which they showed an increase in SIB, and then were readministered naltrexone several times in the month double-blind, placebo-controlled study.
Endogenous Opioid Levels Predict Response to Opiate Blockers In our initial study to examine the relation between circulating endogenous opioids and response to naltrexone, we collected blood samples from ten patients within 2—5 min of a self-injuring act and during a control period [18]. At least 1 month later patients were administered three different doses of naltrexone in a double-blind, placebo-controlled crossover study over a week period.
All patients were videotaped during the study and behavior was coded with a computer-assisted program. Patients with the highest change in plasma levels of BE after SIB had the most and statistically significant positive response to naltrexone. These results were consistent with several other reports.
First, Ernst et al. Second, Bouvard et al. Third, Scifo et al. Fourth, Cazzullo et al. In a follow-up study of nine additional patients total of nineteen , we [3] found that plasma BE was uncoupled from the usually coreleased ACTH [] after an episode of SIB. This unusual pattern was not a function of time of day that blood was sampled, and it confirmed our earlier observations [7,18] and provided additional support for this specific biological marker among a diverse group of subjects who share a behavioral aberration.
In addition, stronger support was generated for the effectiveness of naltrexone in reducing SIB. Positive responses to low doses of naltrexone were observed in subjects who did not exhibit increased BE after SIB. The relation between BE and response to the lowest dose of naltrexone was consistent with our earlier results, and statistically significant with the addition of nine subjects.
Previously we [3] suggested that SIB had functional significance because it increased endogenous opiates and thereby delivered positive consequences i. We argued that the highest dose of naltrexone most effectively blocked this mechanism in subjects with the highest levels of BE after SIB. The results from the follow-up study suggested an alternative possibility related to baseline levels of, or baseline relations between, POMC peptides. Because the lowest dose of naltrexone was most effective in subjects with the highest morning baseline relative to post-SIB levels, we speculated that the association between baseline ACTH and BE could influence the response to naltrexone based on evidence that supported reciprocal functions of BE and ACTH [72]].
If our speculations were accurate, subjects with the greatest difference between morning BE and ACTH levels would be the most responsive to low doses of naltrexone because there would be less attenuation of the opioid influence. The test of this possibility confirmed our speculations because we found that subjects with high levels of morning chronic BE and low levels of ACTH were associated with positive responses to the low dose of naltrexone. This possibility may be compatible with findings that chronic exposure to opioids resulted in supersensitivity to the effects of low doses of opiate antagonists [73,74].
These findings have since been extended using a fundamentally different method for quantifying changes in the temporal patterning of SIB following treatment with naltrexone. The THEME method developed by Magnusson [75,76] has been used to detect highly significant, nonrandom, hierarchical patterns in the temporal organization of SIB with respect to other observed behaviors.
In the subgroup of subjects receiving naltrexone discussed above , the percent change in these T-patterns of SIB between weeks the subjects were receiving placebo and weeks they were receiving naltrexone was found to be significantly correlated with post-SIB i. These results are shown in Table 1. We have made similar observations in our long-term studies of naltrexone and SIB [19].
POMC fragments were measured in twelve self-injurious patients before and after long-term 3-month treatment with naltrexone. POMC fragments were sampled from blood collected at the end of the baseline and placebo-controlled treatment phases of the study. One group responders displayed persisting improvement in SIB and lower relative levels of BE after initial exposure to naltrexone.
Chronic administration of naltrexone to this group was associated with increased SIB and elevated relative levels of BE. Return to placebo improved their behavior reduced SIB and their levels of BE returned to basal levels. The second group nonresponders was characterized by absence of persisting improvement after acute treatment with naltrexone and by elevated basal BE levels.
Chronic treatment with naltrexone improved their behavior but did not alter their BE levels. Conclusions When it was established that the body had its own opiate system [77], the endogenous opiates became prime suspects responsible for maintaining SIB. Perhaps individuals who self-injure have elevated thresholds for pain or derive pleasure from painful stimulation. Exposure to, or levels of, endogenous opiates could explain these possibilities. Reduction in SIB following treatment with opiate blockers would provide evidence for the opiate hypothesis of self-injury.
Results from studies to test these possibilities, however, are complex. The complexity is related primarily to the fact that patients exhibiting SIB and evaluated after treatment comprise a mixture of etiologies, pathologies, and motivations. Despite the tremendous amount of error introduced with a heterogeneous population, there is substantial evidence that opiate blockers are efficacious in reducing SIB. First, naltrexone produces a clinically significant reduction in a serious and life-threatening behavior for some individuals typically who have not been responsive to any other type of treatment.
We have observed startling improvements in individuals who have failed all rational treatments. Some adults in our studies have had protective headgear discontinued for the first time since early childhood. Others have developed adaptive skills and have acquired the ability or the privilege to leave institutions for the first time in their lives after treatment with naltrexone.
Second, the results with naltrexone are important because they suggest that a specific biological system may be disregulated in a subgroup of patients. Because the opiate blockers have few effects in the absence of opiates [78], effective treatment with these drugs must engage the endogenous opioid system.
Reports that resting levels of endogenous opiates or levels of endorphin after an SIB episode predict positive responses to opiate blockers provide support for this assumption and the foundation for rational treatment strategies based on biological criteria. From the current review we can draw several conclusions.
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Inserting implants of reduced length might be useful in order to avoid vertical bone augmentation prior to implantation. To the present day, no official guidelines exist as to the optimal length for these implants. It is nevertheless well known that the stability of an implant depends primarily on its osseointegration, which could otherwise be influenced by modifying implant surface texture.
The aim of our study was to evaluate osseointegration in correlation with implant length and surface texture. Eight weeks after unloaded healing, bone tissue specimens containing the implants were processed, stained with Masson Goldner-trichrome and analyzed histologically. Regardless of implant length and surface texture, new bone formation with no signs of inflammation could be detected in the area of the threads. Implants with a modified surface showed no statistically significant difference in boneimplant-contact BIC tiologic ST Shorty, Surface modification could positively influence osseointegration as well as contribute to overcoming the adverse effects of length reduction.
In systematischen Simulationen wurden die numerischen Modelle zur Implantateinheilung entwickelt, optimiert und mit Hilfe experimentell ermittelter Daten validiert und so konnte ein vergleichbares Verhalten erzielt werden. Der dabei entstandene Kausimulator bringt diese Belastungen als periodische Intervalle mittels eines Druckstempels auf ein im Rentiergeweih inseriertes dentales Implantat auf. Sein hochgradig optimierter Stromverbrauch erlaubt auch langfristige autonome Untersuchungen an frei laufenden Tieren.
Dabei wird ebenfalls der Kausimulator angebracht und in Betrieb genommen. Der Kausimulator konnte erfolgreich an zwei Tieren getestet und die gewonnenen Daten ausgewertet werden. This study sought to evaluate platform-switched implants for immediate placement. A total of implants were placed in 58 patients using either an immediate or delayed implant protocol. Bone level changes of the implants were measured mesially and distally and statistically analyzed with linear mixed models.
No implant was lost. Subsequent bone resorption was negligible in both groups.
Int J Periodontics Restorative Dent ; Moreover, the displacements of the new implants were even smaller than the current implants and the biomechanical properties of the analysed implants were positively improved by integrating the self-tapping threads. A clinical study Annals of Anatomy November 6: To compare the reaction of the alveolar bone to the preservation of the extraction socket by Bio- Oss Collagen with and without combination of implant treatment.
To evaluate whether early implant insertion 8 10 weeks thereafter could be a suitable time point for long term bone stability around the implant. A total of 25 patients were divided into three groups: The first group seven patients received Bio-Oss Collagen after extraction and 8 10 weeks later an implant, the second group eight patients received only Bio-Oss Collagen without implantation thereafter, while the third group was considered as a control eleven patients , where the sockets healed without any treatment.
The change in the vertical bone level of the alveolar crests were measured from panoramic radiographs and statistically analysed. Bone level preservation of extraction sockets using Bio-Oss Collagen with implantation is significantly better compared to using Bio-Oss Collagen only and untreated sockets. Implant insertion 8 10 weeks after extraction is a suitable time point after socket augmentation. The aim of the present study was to investigate experimentally and numerically the influence of a fine threaded- against a roughened-cervical region of immediately loaded dental implants in combination with straight and angled abutments on the implant primary stability.
A total of 30 implants were inserted in bovine rib-segments, 14 cervically roughened implants and 16 implants with fine cervical threads. Each implant system received two abutments, straight and angled. Implant displacements and rotations were measured using a biomechanical measurement system. Subsequently, eight samples were selected for geometrical reconstruction and numerical investigation of stress and strain distributions in the bone by means of the finite element method.
Experimentally, both implant systems showed similar behaviour with the straight abutments concerning displacements and rotations. However, fine threaded implants showed much less displacement and rotation against roughened implants when angled abutments were considered. Numerically, stresses were within MPa in the cortical bone for both implant systems.
The strains showed highest values within the spongious bone with the roughened implants connected to angled abutments. The results indicate that implants with fine cervical threads could be recommended in particular with angled abutments. The outcomes of this study are currently confirmed by long-term clinical investigations.
To improve osseointegration, different possible dental implant surface modifications, e. The purpose of this study was to examine the in vitro biocompatibility of newly designed zirconium implants with different surface modifications in comparison with commercially available zirconium and titanium implants. Therefore, cell viability and proliferation were measured after 21 days and correlated with surface structures. The cell viability findings correlate with the results of the cell cytotoxicity assay.
The etched implants showed a surface with high roughness and heterogeneity, whereas the mds and blasted implants showed a similar, very rough-textured homogenate surface. The in vitro biocompatibility of two new ceramic implants was significantly better in comparison with the tested reference ceramic and titanium implants. The good biocompatibility may be attributed to the homogenous surface of these implants, and these surfaces might hasten osseointegration.
The effect of bone remodeling on the long-time success of dental implants is becoming critical for implant design and presurgical assessments. This study applies a previously presented remodeling simulation scheme on a computer tomography CT -based finite element model. The CT data of a dental implant at the upper right central incisor region 6 years after implant insertion was used.
The time-dependent density change of the trabecular bone after osseointegration was studied.
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The trabecular structure, by means of density distribution, around the implant showed similarities to the CT images at many regions. In recent years, mini and short dental implants have become increasingly popular as treatment alternatives for patients in whom the bone is unsuitable for a standard implant.
As yet, no detailed scientific analysis of the mechanical and biomechanical impact of the reduced diameter and length of these implants has been published. We analysed 21 commercially available implants 13 mini, eight short with respect to material behaviour and load transfer to the alveolar bone, using finite element FE analysis. Mini implants were analysed in the anterior mandibular jaw region at a force of N under immediate loading, using a contact analysis in the FE software package Marc Mentat Short implants were inserted in posterior bone segments and analysed in the osseointegrated state at an occlusal force of N.
Von Mises stresses up to MPa in mini implants partly exceeded the ultimate strength. Implant diameter and geometry had a pronounced effect on stresses in the cortical plate up to MPa. Strains in spongy bone and stresses in cortical bone around short implants were markedly increased compared to those in standard implants. An increased risk of bone damage or implant failure may be assumed in critical clinical situations. The oral cavity along with the teeth and the surrounding gingival epithelium is open to the oral environment and is thus exposed to multiple microbiological and pathogenic influences.
To prevent permanent inflammatory processes such as gingivitis or parodontitis, an efficient defense system is necessary to sustain the physiological function of the oral cavity. Surfactant proteins SPs , originally known from pulmonary tissue, are important players of the immune system and, beyond this, support the stability and rheology of gas or fluid interphases.
The distribution of all four SPs was further determined with monoclonal antibodies using Western blot analyses and immunohistochemistry in healthy and pathologically changed tissues samples obtained during biopsies and in saliva of volunteers. Based on the known direct and indirect antimicrobial effects, SP-A and SP-D appear to be involved in immune defense within the oral cavity especially in direct proximity of teeth. Gingiva affected by bacterial inflammation gingivitis seems to increase expression of SPs.
As a result, the rheology of saliva may be changed especially at the crest of the gingival epithelium to support the function of antimicrobial substances present in saliva. Furthermore, SPs could assist in pellicle formation on teeth, which needs to be determined in further experiments.
To determine the lingual surface morphology of central and lateral upper incisors evaluating constant morphological regions for better adhesion of industrial prefabricated lingual brackets. A total of randomly selected patients at the end of the first phase of second dentition with intact central and lateral upper incisors participated in this study. After impression taking and cast model preparation, 3D laser scans of the lingual surface of the upper central and lateral incisors were taken Laserscan 3D, Willytec, Munich, Germany , digitalised, and transferred into CAD software to analyse the surface morphology by superimposition.
For better comparison of morphological variations and determination of the most constant lingual regions, the surface was divided into five parts: Statistical analysis was performed by the paired t -test. Statistically significant differences were found in all surfaces, with cingulum as the most inconstant region. The most constant region was the medial sector and the mesial ridge.
As expected, the lingual surface underlies a high intra-individual variation complicating industrial prefabricated lingual brackets adhesion. However, the mesial ridge and the medial sector seem to be the most constant regions within intra-individual morphological variations.
The influence of abutment design on bone resorption around immediately loaded and osseointegrated implants used to support fixed partial prostheses was investigated in a 1-year study. One hundred ten implants were placed in 24 anterior partially edentulous maxillae. The probing depths of each implant were measured 6 and 12 months after abutment placement and analyzed statistically. Total probing depth was 1. There were significant differences between non- and submerged implants with angled abutments and between submerged implants with straight and angled abutments.
No significant differences were observed between non- and submerged implants with straight abutments and between nonsubmerged implants with straight and angled abutments. Bone resorption around dental implants is influenced by the abutment design and the associated implantation protocol Abstract Bone resorption and peri-implantitis are some of the most important problems of dental implantology. The implant macrodesign might decrease initial bone loss.
The aim of this longitudinal study was to investigate crestal bone loss around screw type, tapered implants showing a fine threaded neck and platform switching design. In 32 patients of a dental practice, maxillary implants with a diameter of 3. Immediate loading was exclusively performed in 3. The remaining implants were loaded delayed. The bone level change was measured mesially and distally of the implant shoulder using follow-up X-rays and calculated per year in a linear mixed model.
Bone resorption was low in all groups 3. Based on the results of this study, it can be concluded that this implant macrodesign showed negligible bone resorption for all loading times. Immediate loading seems to be a reliable treatment option in the maxilla when clinical criteria are considered. Short and mini dental implants have been widely used as treatment alternatives in certain selected clinical situations. However, a profound scientific analysis of the mechanical and biomechanical impact of the reduced length and diameter of these implant geometries has not been published until now.
Using finite element analysis, a series of different experimentally designed short and mini implants have been analysed with regard to their load transfer to the alveolar bone and have been compared to respective standard commercial implants. Mini implants have been inserted in an idealised bone bed representing the anterior mandibular jaw region and loaded with a force of N.
An immediate loading condition was assumed and analysed using the contact analysis option of the FE package MSC. Short implants were inserted in an idealised posterior bone segment and loaded in osseointegrated state with forces of N. Clearly increased bone loading was observed for the short and mini dental implants compared with standard implants, clearly exceeding the physiological limit of MPa.
The determined biomechanical characteristics could explain the slightly increased failure rate of short and mini dental implants. Finite element models of a four-unit FPP were generated. An extreme condition was simulated, using only two immediately loaded implants in order to derive recommendations for possible clinical application. Straight and 20 degrees-angled abutments and bonded or sliding contact between the bridge and abutment were simulated.
In addition, two models were generated with two completely osseointegrated implants. A N load to the prosthesis at a 45 degrees angle to the long axis of each implant was applied. Minor differences were observed in implant displacements, stress and strain distributions of the two abutment designs. However, bone loading exceeded the physiological limits, including a risk of bone atrophy. A considerable decrease in implant displacements and bone loading was observed in the osseointegrated cases. An FPP supported by only two implants cannot be recommended for immediate loading.
Journal of Physiology and Pharmacology December, 60 Suppl 8: The aim of the study was the investigation of the survival rate of immediate implants in addition to the evaluation of the level of the alveolar bone around the neck region of immediately placed implants of different macrodesigns. To address the question whether the biological, highly polished area of the implant neck is more associated with crestal resorption than the rough neck region, the influence of the surface characters of the implant cervical region was studied.
The survival rate of implants from 52 patients was evaluated on different time points after immediate implantation.
The level of peri-implant bone contacts to the implant border from 24 implants, which included implants types Tiolox, NobelReplace Tapered and PrimaConnex Tapered, was measured radiographically in seven patients who received immediate implants followed by a healing period of months. Various periods from the time of insertion were considered for the measurement depending on the clinically available data. No differences in the status of the alveolar crest around highly polished and roughened cervical-implant regions were observed in the seven patients.
The most noticeable resorption was detected in the distal margin of the alveolar crest. The present study shows that highly polished- or roughened neck implants are inserted into a fresh extraction socket do not differ significantly in the clinical and radiographical outcomes after various post-operative periods. Heinemann F, Mundt T, Biffar R, Gedrange T, Goetz W A 3-year clinical and radiographic study of implants placed simultaneously with maxillary sinus floor augmentations using a new nanocrystalline hydroxyapatite.
The aims of this case series was to evaluate the success rate of implants and their restorations, the sinus bone graft resorption, and the marginal bone loss around the implants when nanocristalline HA embedded in a silica matrix was exclusively used as grafting material. After 6 to 9 months 37 implants were restored with fixed dental prostheses.
The clinical evaluation included peri-implant parameters, periotest measurements and the restorations. The radiographic bone heights over time were estimated with linear mixed models. The periotest values between -7 and -6 after implant abutment connection indicated a solid osseointegration. The mean rates of the marginal bone loss over the first year were higher mesial: The prosthodontic and esthetic evaluation revealed a successful outcome. Osseointegration of dental implants up-to-date is a well-confirmed phenomenon, however the long-term stability and integrity of the bone and soft tissue collar is under discussion.
A homogenous distribution of the bone loading is a prerequisite for bone modelling and preservation in the neck area while overload must be avoided. Based on the finite element method FEM models of implants without and with a fine thread implant types Tiolox and tiologic with surrounding bone were generated and analysed using the FE program system MSC. The alveolar bone was considered to be an idealized segment with a cortical bone thickness of 2 or 3 mm, respectively with an enclosed spongy bone. The implants were loaded with forces up to N in two different directions, in the first case with a purely vertical force and in other case with an additional lateral force component with an angle of 45 degrees with respect to the occlusal plane.
The deflections of the implants ranged from to mm in the load direction, depending on the implant diameter and the cortical bone thickness. When considering a physiological vertical load of a maximum of N, the highest strains were about micro strain in the spongy bone. The improvement of implant anchorage in the cortical bone reduced the strains in the spongious bone, at the same time there were no additional stress peaks visible at the fine thread region. News Dezember, 3 9: This multicenter prospective study was aimed to clinically evaluate implant behavior inserted in severely resorbed maxillae and restored 3 months after sinus grafting.
In three clinical centers, 67 totally rough wide diameter implants were inserted during 30 consecutive sinus lifts. Computed tomography and panoramic analysis were preoperatively requested for each patient. Sinus grafting was performed using a nano-crystalline hydroxyapatite sole bone filler; no membrane was used to cover the buccal window. Preoperative residual bone height ranged between 1 4 mm mean value: Uncovering procedure was carried out following 3 months of healing; 2 weeks later, a definitive restoration was seated using platform switching concept. To monitor stability changes, resonance frequency analysis was performed and implant stability quotient ISQ values were collected at the first surgery baseline, T0 , at the abutment connection T1 , and at 2-year follow-up T2.
To measure bone changes, patients underwent panoramic analysis after 2-year follow-up.
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The image analysis software calculated the grafted bone height changes at level of implant site comparing pre-operative and follow-up panoramic films; the software compensated for eventual radiographic distortion. Mean ISQ value was After 24 months of functional loading, only two implants were lost cumulative survival rate: Within the limits of this study, despite of preoperative residual bone height ranging 1 to 4 mm and absence of the membrane covering the buccal bone wall, maxillary sinus lift restoration 14 weeks after first surgery seems to be a reliable procedure using totally-rough surfaced implants restored using platform switching concept and nano-structured hydroxyapatite as sole bone filler.
This indicates that the fine thread increases the load transmission in the cortical bone. This should have a positive impact on the biomechanical properties and healing process. News Oktober, 1 7: News September, 1 6: Die Implantate werden von Dr. Von den einbestellten Patienten waren inzwischen 20 verstorben du 33 unbekannt verzogen. Insgesamt wurden Tiolox -Implantate inseriert, davon im Oberkiefer und im Unterkiefer. Die Implantathygiene war insgesamt gut Grad Das Symptom Blutung auf Sondierung war nur bei 26 von Implantaten negativ.
Der Knochenabbau im ersten Jahr liegt danach mit einem Median von 0,14 mm bzw. Teilweise wurde sogar eine Knochenapposition gemessen. Dabei ist im jeweiligen Kiefer der Seitenzahnbereich mehr betroffen als der Frontzahnbereich.
Die Art der Suprakonstruktion spielt eine untergeordnete Rolle. Das Tiolox -Implantat stellt sich innerhalb der Studie als ein sehr stabiles und erfolgreiches System dar. METHODS Dental fixtures Tiolox implants GmbH, Germany were implanted and crown and bridgework applied in a private practice between and Copings made of pure gold or titanium were permanently cemented onto the prepared teeth. Removal and re-attaching without damage of the dentures was undertaken for the following reasons: Journal of Oral and Maxillofacial Implants August, 21 4: PURPOSE The aims of this study were to examine the long-term survival and the prosthetic treatment outcome of screw-type, tapered implants placed in a private practice setting and to explore potential risk factors of implant failures.
An oral examination was also conducted. Cumulative survival rates were estimated through Kaplan-Meier methods. Comparisons between subgroups of patients were made using the log-rank statistical test. The association between several factors and implant failures was analyzed using Cox regression analyses random and dependent models.
The failure rates for implants were The differences between nonsmokers, former smokers, and current smokers were significant nonsmokers versus former smokers: