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  • 1.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Bisphosphonates and implants in the jaw bone2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Insertion of metal implants in bone is one of the commonest of all surgical procedures. The success of these operations is dependent on the fixation of the implants, which, in turn, depends on the strength of the bone that holds them. If the quality of the bone holding the implant could be improved locally, surgical procedures would become simpler and rehabilitation would become faster. Bisphosphonates are anti-resorptive drugs that act specifically on osteoclasts, thereby maintaining bone density and strength. Once released from the surface of a coated implant, bisphosphonates reduce osteoclast activity, thereby changing the balance of bone turnover in favor of bone formation, leading to a net gain in local bone density. During the last decades, the effects of bisphosphonate treatment on the stability of implants have been tested in several clinical and animal studies, but not in human jaws. This may be because it has been suggested that there is a link between the use of bisphosphonates (especially those given intravenously) and a condition called osteonecrosis of the jaw (ONJ). The pathophysiology and treatment of ONJ is controversial. The difficulty in treating ONJ has highlighted the importance of prevention.

    The overall aim of the present thesis was to evaluate the effect of local and systemic use of bisphosphonates on bone tissue. Could a thin, bisphosphonate-eluting fibrinogen coating improve the fixation of metal implants in the human jaw? Would it be possible to reproduce ONJ and prevent the development of this condition in an animal model?

    In two clinical studies, a total number of 96 implants were inserted in 21 patients. In a randomized trial with a paired design, one implant in each pair was coated with a thin fibrinogen layer containing two bisphosphonates (pamidronate and ibandronate). The bisphosphonate-coated implants showed better stability as measured by resonancefrequency analysis. Radiographic intraoral films also showed less bone loss. Three animal models were developed. In a study comparing local and systemic effects of bisphosphonates, zoledronate-coated screws inserted in rats showed better fixation in spite of a drug treatment that is known to induce ONJ-like lesions when given systemically. In another rat model, ONJ-like lesions were reproducibly induced at sites of tooth extraction whereas there were no signs of bone cell death in uninjured sites. Finally, rat experiments showed that the development of ONJ-like lesions after tooth extraction could be prevented by early mucoperiosteal coverage.

    In conclusion, a thin, bisphosphonate-eluting fibrinogen coating can improve the fixation of dental implants in human bone. This may lead to new possibilities in orthopaedic surgery and dentistry. The pathophysiology of ONJ is strongly linked to bone exposure in combination with drugs that reduce resorption.

    List of papers
    1. Bisphosphonate coating might improve fixation of dental implants in the maxilla: A pilot study
    Open this publication in new window or tab >>Bisphosphonate coating might improve fixation of dental implants in the maxilla: A pilot study
    2010 (English)In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 39, no 7, p. 673-677Article in journal (Refereed) Published
    Abstract [en]

    This pilot study evaluates the clinical stability of bisphosphonate-coated dental implants placed using a two-stage surgical procedure in five patients. Each patient received seven regular Branemark implants, one of which was coated with bisphosphonate in a fibrinogen matrix. The coated implant was inserted where the bone was expected to have the least favourable quality. The level of the marginal bone around each implant was measured by intraoral periapical radiographs and implant stability was recorded using resonance frequency measurements. Frequency values (ISQ) were obtained peroperatively before flap closure and after 6 months at abutment connection. At abutment connection the bisphosphonate-coated implants were removed en bloc in two patients for histological examination. An animal experiment had previously confirmed that gamma-sterilization did not reduce bioactivity of the bisphosphonate coating. In each patient, the bisphosphonate-coated implant showed the largest improvement in ISQ level of all implants. Their values at the start tended to be lower, and the absolute value at 6 months did not differ. No complications occurred with the coated implants. Histology showed no abnormalities. Improvement in ISQ values was an expected effect of the bisphosphonate coating, but could be due to the choice of insertion site. This finding warrants a randomized blinded study.

    Place, publisher, year, edition, pages
    Elsevier Science B.V., Amsterdam, 2010
    Keywords
    bisphosphonate coating; dental implants; fixation
    National Category
    Orthopaedics Other Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-58193 (URN)10.1016/j.ijom.2010.04.002 (DOI)000279972500007 ()
    Available from: 2010-08-11 Created: 2010-08-09 Last updated: 2018-01-12
    2. A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants
    Open this publication in new window or tab >>A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants
    2012 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 50, no 5, p. 1148-1151Article in journal (Refereed) Published
    Abstract [en]

    Many surgical procedures use metal implants in bone. The clinical results depend on the strength of the bone holding these implants. Our objective was to show that a drug released from the implant surface can improve parameters reflecting the quality or amount of this bone. Sixteen patients received paired dental titanium implants in the maxilla, in a randomized, double-blinded fashion. One implant in each pair was coated with a thin fibrinogen layer containing 2 bisphosphonates. The other implant was untreated. Fixation was evaluated by measurement of resonance frequency (implant stability quotient; ISQ) serving as a proxy for stiffness of the implant-bone construct. Increase in ISQ at 6 months of follow-up was the primary variable. None of the patients had any complications. The resonance frequency increased 6.9 ISQ units more for the coated implants (p = 0.0001; Cohens d = 1.3). The average difference in increase in ISQ and the effect size, suggested a clinically relevant improvement. X-ray showed less bone resorption at the margin of the implant both at 2 months (p = 0.012) and at 6 months (p = 0.012). In conclusion, a thin, bisphosphonate-eluting fibrinogen coating might improve the fixation of metal implants in human bone. This might lead to new possibilities for orthopedic surgery in osteoporotic bone and for dental implants.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    Keywords
    Bone healing, Dental implant, Drug delivery, Mechanical test, Osseointegration bisphosphonates
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77527 (URN)10.1016/j.bone.2012.02.001 (DOI)000303274400018 ()
    Note

    Funding Agencies|Swedish Research Council|VR 2009-6725|

    Available from: 2012-05-28 Created: 2012-05-22 Last updated: 2017-12-07
    3. Bisphosphonate-induced osteonecrosis of the jaw in a rat model arises first after the bone has become exposed. No primary necrosis in unexposed bone
    Open this publication in new window or tab >>Bisphosphonate-induced osteonecrosis of the jaw in a rat model arises first after the bone has become exposed. No primary necrosis in unexposed bone
    2012 (English)In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 41, no 6, p. 494-499Article in journal (Refereed) Published
    Abstract [en]

    J Oral Pathol Med (2012) 41: 494499 Background: Bisphosphonate-related osteonecrosis of the jaw was first described to start with sterile osteocyte death, similar to osteonecrosis in other parts of the skeleton. The typical chronic osteomyelitis was thought to develop when the dead bone was exposed to the oral cavity. An alternative explanation would be that the chronic osteomyelitis is a result of a bisphosphonate-related inability of infected bony lesions to heal. We tested the hypothesis that primary osteocyte death is not necessary for the development of jaw osteonecrosis. Material and methods: Forty rats were randomly allocated to four groups of 10. All animals underwent unilateral molar extraction and received the following drug treatments: Group I, controls with no drug treatment; Group II, 200 mu g/kg per day alendronate; Groups III and IV, 200 mu g/kg per day alendronate and 1 mg/kg of dexamethasone. All rats were euthanized after 14 days. Presence of osteonecrosis was determined by clinical and histological observations for groups IIII. For group IV, osteocyte viability at the contralateral uninjured site was examined using lactate dehydrogenase histochemistry (LDH). Results: All animals in the alendronate plus dexamethasone groups developed large ONJ-like lesions. Lactate dehydrogenase staining showed viable osteocytes in the contralateral jaw with no tooth extraction. No signs of osteonecosis were seen in the other groups. Conclusion: Bisphosphonates and dexamethasone caused no osteocyte death in uninjured bone, but large ONJ-like lesions after tooth extraction. Osteonecrosis of the jaw appears to arise first after the bone has been exposed. Possibly, bisphosphonates hamper the necessary resorption of bone that has become altered because of infection.

    Place, publisher, year, edition, pages
    John Wiley and Sons, 2012
    Keywords
    bisphosphonates; bisphosphonate associated osteonecrosis of the jaw; osteonecrosis; rat
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79679 (URN)10.1111/j.1600-0714.2011.01125.x (DOI)000305961100010 ()
    Available from: 2012-08-14 Created: 2012-08-13 Last updated: 2017-12-07
    4. Effect of Local vs. Systemic Bisphosphonate Delivery on Dental Implant Fixation in a Model of Osteonecrosis of the Jaw
    Open this publication in new window or tab >>Effect of Local vs. Systemic Bisphosphonate Delivery on Dental Implant Fixation in a Model of Osteonecrosis of the Jaw
    2013 (English)In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no 3, p. 279-283Article in journal (Refereed) Published
    Abstract [en]

    Locally applied bisphosphonates may improve the fixation of metal implants in bone. However, systemic bisphosphonate treatment is associated with a risk of osteonecrosis of the jaw (ONJ). We hypothesized that local delivery of bisphosphonate from the implant surface improves the fixation of dental implants without complications in a setting where systemic treatment induces ONJ. Forty rats were randomly allocated to 4 groups of 10. All groups received a titanium implant inserted in an extraction socket. Group I received the implants only. Group II received dexamethasone (0.5 mg/kg). Group III received dexamethasone as above plus alendronate (200 µg/kg). Group IV received zoledronate-coated implants and dexamethasone as above. The animals were sacrificed 2 weeks after tooth extraction. All 10 animals with systemic alendronate treatment developed large ONJ-like changes, while all with local treatment were completely healed. Implant removal torque was higher for the bisphosphonate-coated implants compared with the other groups (p < 0.03 for each comparison). Micro-computed tomography of the maxilla showed more bone loss in the systemic alendronate group compared with groups receiving local treatment (p = 0.001). Local bisphosphonate treatment appears to improve implant fixation in a setting where systemic treatment caused ONJ.

    Place, publisher, year, edition, pages
    Sage Publications, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-89667 (URN)10.1177/0022034512472335 (DOI)000314914100013 ()23264610 (PubMedID)
    Available from: 2013-03-01 Created: 2013-03-01 Last updated: 2017-12-06Bibliographically approved
    5. Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model
    Open this publication in new window or tab >>Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model
    2013 (English)In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 42, no 5, p. 632-636Article in journal (Refereed) Published
    Abstract [en]

    There is evidence for a link between the use of systemic bisphosphonates and osteonecrosis of the jaw (ONJ). This condition has the appearance of chronic osteomyelitis, and antibiotics prevent the development of ONJ in animal models. Clinically, ONJ can sometimes be successfully treated by mucoperiosteal coverage. If ONJ is indeed primarily caused by bacterial infection, immediate coverage of the extraction alveolus might reduce the risk of ONJ development in risk patients. Therefore, we studied whether immediate mucoperiosteal coverage after tooth extraction could prevent ONJ development in a rat model. Thirty rats were randomly allocated to three groups of 10. Group I (controls): extraction, no drug treatment; Group II (non-coverage): extraction, dexamethasone plus alendronate; Group III (coverage): dexamethasone plus alendronate, plus coverage by a mucoperiosteal flap. Rats were examined for macroscopic ONJ-like wounds after 2 weeks. All animals in the non-coverage group developed large ONJ-like changes. The coverage and control groups showed an intact overlying mucosa in all rats. Findings were confirmed with histology. Bisphosphonates and dexamethasone caused ONJ-like lesions after tooth extraction in a rat model. This was prevented by immediate mucoperiosteal coverage. The risk of ONJ in patients using bisphosphonates might be reduced by mucoperiosteal coverage after tooth extraction.

    Keywords
    Bisphosphonates, osteonecrosis, jaw, rat, mucoperiosteal flap, antibiotics
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-89668 (URN)10.1016/j.ijom.2013.02.007 (DOI)000318132600014 ()
    Available from: 2013-03-01 Created: 2013-03-01 Last updated: 2017-12-06Bibliographically approved
  • 2.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Agholme, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Prevention of osteonecrosis of the jaw by mucoperiosteal coverage in a rat model2013In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 42, no 5, p. 632-636Article in journal (Refereed)
    Abstract [en]

    There is evidence for a link between the use of systemic bisphosphonates and osteonecrosis of the jaw (ONJ). This condition has the appearance of chronic osteomyelitis, and antibiotics prevent the development of ONJ in animal models. Clinically, ONJ can sometimes be successfully treated by mucoperiosteal coverage. If ONJ is indeed primarily caused by bacterial infection, immediate coverage of the extraction alveolus might reduce the risk of ONJ development in risk patients. Therefore, we studied whether immediate mucoperiosteal coverage after tooth extraction could prevent ONJ development in a rat model. Thirty rats were randomly allocated to three groups of 10. Group I (controls): extraction, no drug treatment; Group II (non-coverage): extraction, dexamethasone plus alendronate; Group III (coverage): dexamethasone plus alendronate, plus coverage by a mucoperiosteal flap. Rats were examined for macroscopic ONJ-like wounds after 2 weeks. All animals in the non-coverage group developed large ONJ-like changes. The coverage and control groups showed an intact overlying mucosa in all rats. Findings were confirmed with histology. Bisphosphonates and dexamethasone caused ONJ-like lesions after tooth extraction in a rat model. This was prevented by immediate mucoperiosteal coverage. The risk of ONJ in patients using bisphosphonates might be reduced by mucoperiosteal coverage after tooth extraction.

  • 3.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Agholme, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Sandberg, Olof
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Aspenberg, Per
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Bisphosphonate-induced osteonecrosis of the jaw in a rat model arises first after the bone has become exposed. No primary necrosis in unexposed bone2012In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 41, no 6, p. 494-499Article in journal (Refereed)
    Abstract [en]

    J Oral Pathol Med (2012) 41: 494499 Background: Bisphosphonate-related osteonecrosis of the jaw was first described to start with sterile osteocyte death, similar to osteonecrosis in other parts of the skeleton. The typical chronic osteomyelitis was thought to develop when the dead bone was exposed to the oral cavity. An alternative explanation would be that the chronic osteomyelitis is a result of a bisphosphonate-related inability of infected bony lesions to heal. We tested the hypothesis that primary osteocyte death is not necessary for the development of jaw osteonecrosis. Material and methods: Forty rats were randomly allocated to four groups of 10. All animals underwent unilateral molar extraction and received the following drug treatments: Group I, controls with no drug treatment; Group II, 200 mu g/kg per day alendronate; Groups III and IV, 200 mu g/kg per day alendronate and 1 mg/kg of dexamethasone. All rats were euthanized after 14 days. Presence of osteonecrosis was determined by clinical and histological observations for groups IIII. For group IV, osteocyte viability at the contralateral uninjured site was examined using lactate dehydrogenase histochemistry (LDH). Results: All animals in the alendronate plus dexamethasone groups developed large ONJ-like lesions. Lactate dehydrogenase staining showed viable osteocytes in the contralateral jaw with no tooth extraction. No signs of osteonecosis were seen in the other groups. Conclusion: Bisphosphonates and dexamethasone caused no osteocyte death in uninjured bone, but large ONJ-like lesions after tooth extraction. Osteonecrosis of the jaw appears to arise first after the bone has been exposed. Possibly, bisphosphonates hamper the necessary resorption of bone that has become altered because of infection.

  • 4.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Agholme, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Sandberg, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Effect of Local vs. Systemic Bisphosphonate Delivery on Dental Implant Fixation in a Model of Osteonecrosis of the Jaw2013In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no 3, p. 279-283Article in journal (Refereed)
    Abstract [en]

    Locally applied bisphosphonates may improve the fixation of metal implants in bone. However, systemic bisphosphonate treatment is associated with a risk of osteonecrosis of the jaw (ONJ). We hypothesized that local delivery of bisphosphonate from the implant surface improves the fixation of dental implants without complications in a setting where systemic treatment induces ONJ. Forty rats were randomly allocated to 4 groups of 10. All groups received a titanium implant inserted in an extraction socket. Group I received the implants only. Group II received dexamethasone (0.5 mg/kg). Group III received dexamethasone as above plus alendronate (200 µg/kg). Group IV received zoledronate-coated implants and dexamethasone as above. The animals were sacrificed 2 weeks after tooth extraction. All 10 animals with systemic alendronate treatment developed large ONJ-like changes, while all with local treatment were completely healed. Implant removal torque was higher for the bisphosphonate-coated implants compared with the other groups (p < 0.03 for each comparison). Micro-computed tomography of the maxilla showed more bone loss in the systemic alendronate group compared with groups receiving local treatment (p = 0.001). Local bisphosphonate treatment appears to improve implant fixation in a setting where systemic treatment caused ONJ.

  • 5.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Tengvall, Pentti
    Gothenburg University.
    Aspenberg, Per
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants2012In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 50, no 5, p. 1148-1151Article in journal (Refereed)
    Abstract [en]

    Many surgical procedures use metal implants in bone. The clinical results depend on the strength of the bone holding these implants. Our objective was to show that a drug released from the implant surface can improve parameters reflecting the quality or amount of this bone. Sixteen patients received paired dental titanium implants in the maxilla, in a randomized, double-blinded fashion. One implant in each pair was coated with a thin fibrinogen layer containing 2 bisphosphonates. The other implant was untreated. Fixation was evaluated by measurement of resonance frequency (implant stability quotient; ISQ) serving as a proxy for stiffness of the implant-bone construct. Increase in ISQ at 6 months of follow-up was the primary variable. None of the patients had any complications. The resonance frequency increased 6.9 ISQ units more for the coated implants (p = 0.0001; Cohens d = 1.3). The average difference in increase in ISQ and the effect size, suggested a clinically relevant improvement. X-ray showed less bone resorption at the margin of the implant both at 2 months (p = 0.012) and at 6 months (p = 0.012). In conclusion, a thin, bisphosphonate-eluting fibrinogen coating might improve the fixation of metal implants in human bone. This might lead to new possibilities for orthopedic surgery in osteoporotic bone and for dental implants.

  • 6.
    Aspenberg, Per
    et al.
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial with internal controls in BONE, vol 50, issue , pp S56-S562012In: BONE, Elsevier , 2012, Vol. 50, p. S56-S56Conference paper (Refereed)
    Abstract [en]

    n/a

  • 7.
    Aspenberg, Per
    et al.
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Agholme, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Sandberg, Olof
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Bisphosphonate-induced osteonecrosis of the jaw in a rat model arises first after the bone has become exposed. no primary necrosis in unexposed bone in BONE, vol 50, issue , pp S173-S1732012In: BONE, Elsevier , 2012, Vol. 50, p. S173-S173Conference paper (Refereed)
    Abstract [en]

    n/a

  • 8.
    Aspenberg, Per
    et al.
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Agholme, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Sandberg, Olof
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Dental implants in a rat model: Bisphosphonate coating improved fixation while systemic treatment caused osteonecrosis in BONE, vol 50, issue , pp S173-S1742012In: BONE, Elsevier , 2012, Vol. 50, p. S173-S174Conference paper (Refereed)
    Abstract [en]

    n/a

  • 9.
    Bergendal, B.
    et al.
    National Oral Disability Centre, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Ahlborg, B.
    Mun-H-Center, National Orofacial Resource Center for Rare Disorders, Gothenburg, Sweden.
    Knudsen, E.
    Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Marcusson, Agneta
    Linköping University, Department of Neuroscience and Locomotion, Dental Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Nyberg, J.
    Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Wallenius, E.
    Swedish Association of Rare Disorders, Sundbyberg, Sweden.
    Gustafsson-Bonnier, K.
    Habilitation Services, Stockholm County Council, Stockholm, Sweden.
    Living with facial disfigurement- Strategies for individuals and care management2011In: Special Care in Dentistry, ISSN 0275-1879, Vol. 31, no 6, p. 216-219Article in journal (Refereed)
    Abstract [en]

    Individuals and families affected by craniofacial disorders have expressed dissatisfaction with their experiences in the healthcare system, with day care, and in school situations. To capture their views, focus group encounters were done in a group of young individuals with these disorders and in a group of parents whose children were affected. The aim was to synthesize their attitudes and experiences into improved strategies for parents, teenagers, and professionals in the healthcare system. Their views were compiled into a document that emphasizes the responsibilities of persons with craniofacial disorders and their parents to actively seek information on diagnosis and treatment options and to participate in decisions on therapy. The conclusion was that it is not lack of specific knowledge but rather a lack of implementation of existing recommendations that makes living with facial disfigurement difficult for many individuals and their families. © 2011 Special Care Dentistry Association and Wiley Periodicals, Inc.

  • 10.
    Hultcrantz, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Ericsson, Elisabeth
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
    Hemlin, Claes
    Aleris specialistvård Sabbatsberg, Stockholm.
    Eggertsen, Robert
    Avd. för Samhällsmedicin och folkhälsa/allmänmedicin, Göteborgs Universitet.
    Lundeborg-Hammarström, Inger
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Marcusson, Agneta
    Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Proczkowska-Björklund, Marie
    Barn- och ungdomspsykiatri, Psykiatriska kliniken, Höglandet Eksjö/Nässjö.
    Stjernquist-Desatnik, Anna
    Öron-näsa-hals-kliniken, Universitetssjukhuset Lund.
    Zettergren-Wijk, Lena
    Avdelningen för tandreglering, Folktandvården Gävleborg AB, Gävle.
    Moa, Gunnar
    Projektledare Nationella medicinska indikationer.
    Törnqvist, Helene
    Projektledare Nationella medicinska indikationer.
    Indikation för tonsillotomi på barn och ungdomar2011Report (Other academic)
  • 11.
    John, M.T.
    et al.
    Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States.
    Larsson, Pernilla
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Nilner, K.
    Department of Oral Prosthetics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Bandyopadhyay, D.
    Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States.
    List, T.
    Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Validation of the Orofacial Esthetic Scale in the general population2012In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 10, article id 135Article in journal (Refereed)
    Abstract [en]

    Background: The Orofacial Esthetic Scale (OES) is an eight-item instrument to assess how patients perceive their dental and facial esthetics. In this cross-sectional study we investigated dimensionality, reliability, and validity of OES scores in the adult general population in Sweden.Methods: In a random sample of the adult Swedish population (response rate: 39%, N=1159 subjects, 58% female, mean age (standard deviation): 49.2 (17.4) years), dimensionality of OES was investigated using factor analytic methods to determine how many scores are needed to characterize the construct. Reliability of scores was calculated using Cronbachs alpha. Score validity was determined by correlating the OES summary score with a global indicator of orofacial esthetics (OE).Results: Factor analyses provided support that a single score can sufficiently characterize OE. A Cronbachs alpha of 0.93 indicated excellent reliability. A validity coefficient of r=0.89 (95% confidence interval: 0.87-0.90) indicated that OES summary scores correlated highly with a global OE assessment.Conclusions: The OES is a promising instrument to measure the construct OE. Factor analyses supported that this construct can be assessed with one score, offering a feasible and acceptable standardized assessment of OE. The present study extends the OES use to the general population, an important target population for assessment of orofacial esthetics. © 2012 John et al.; licensee BioMed Central Ltd.

  • 12.
    Kallunki, Jenny
    et al.
    Östergötlands Läns Landsting, Public Dental Health Care.
    Marcusson, Agneta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Ericsson, Elisabeth
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Tonsillotomy versus tonsillectomy--a randomized trial regarding dentofacial morphology and post-operative growth in children with tonsillar hypertrophy2014In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 36, no 4, p. 471-478Article in journal (Refereed)
    Abstract [en]

    Objectives:The primary aim of this study was to analyse two different methods of tonsil surgery, tonsillectomy (TE) and tonsillotomy (TT), regarding post-operative dentofacial growth in children with tonsillar hypertrophy. A secondary aim was to analyse these results in relation to cephalometric standards.Material and methods:The study group consisted of 64 subjects (39 boys and 25 girls), mean age 4.8 years ± 4 months. They were randomized to a complete removal of the pharyngeal tonsil, TE, (n = 31) or a partial removal, TT, (n = 33). Pre-operative and 2 years post-operative study material were obtained and analysed. The results were compared with cephalometric standards.Results:Pre-operative, children with hypertrophic tonsils displayed an increased vertical relation (P < 0.05) compared with cephalometric standards. Post-operative, no significant difference could be detected between the two surgical procedures regarding dentofacial growth. Mandibular growth with an anterior inclination was significant (P < 0.001/TE, P < 0.01/TT) for both groups. An increased upper and lower incisor inclination was noted (P < 0.01/TE,TT). The vertical relation decreased (P < 0.001/TE, P < 0.05/TT) as well as the mandibular angle (P < 0.01/TE, P < 0.001/TT). Reduction was also significant for the sagittal intermaxillar (P < 0.001/TE,TT) relation. These post-operative results, together with a more prognatic mandible (P < 0.05/TE,TT) and chin (P < 0.001/TE, P < 0.01/TT), might indicate a more horizontal direction of mandibular growth.Conclusion:TE and TT yielded equal post-operative dentofacial growth in children treated for hypertrophic tonsils. This result should be considered when deciding upon surgical technique.

  • 13.
    Lindgren, Christer
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    On healing of titanium implants in biphasic calcium phosphate2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Previously, autogenous bone was considered the gold standard for grafting procedures in implant surgery. Today, the use of bone graft substitutes is an alternative for sinus lift procedures. Nevertheless, only a few bone substitutes are well documented and can be recommended as an alternative to autogenous bone grafts. Both deproteinized bovine bone (DBB) and tricalcium phosphate (TCP) are materials that are frequently used and well documented. During the last years a novel biphasic calcium phosphate (BCP) has been introduced to the market. Until now only a few studies have been published.

    Aims: Studies I, II, III and IV. The overall aim of the present thesis was to evaluate a new biphasic calcium phosphate for bone augmentation of the maxillary sinus. Deproteinized bovine bone was used as a control.Study V. The aim of this in vitro study was to evaluate the response of human osteoblast-like cells (HOB) to nano-crystalline-diamond-particle-modified (nDP-modified) and un-modified (control) deproteinized bovine bone (DBB) and biphasic calcium phosphate (BCP) scaffolds.

    Materials and Methods: Studies I, II, III and IV. The studies were based on 11 patients (six women, five men) with a mean age of 67 years (range; 50 to 79 years). All patients showed severe maxillary resorption with less than 5mm of residual alveolar bone in the floor of the maxillary sinus, which excluded conventional implant treatment. Twenty-two maxillary sinuses were augmented with BCP on one side and with DBB acting as a control at the contralateral side. Simultaneously with the augmentation procedure 22 microimplants were placed inside the augmented materials. After 8 months of graft healing the microimplants and a surrounding bone core were retrieved for histomorphometrical analysis (Paper I) and for energy dispersive spectroscopy (Paper II). After retrieval of the microimplants, 62 conventional implants were placed and left to heal for 8 weeks before rehabilitation with fixed prosthetic constructions. The conventional implants were evaluated clinically at baseline, after 1- and 3 years of loading (Papers III and IV). After 3 years of graft healing 18 biopsies were harvested from 9 patients for histomorphometrical analysis (Paper IV).

    Computerized tomography (CT) of the maxillary sinuses was performed after 3 years of graft healing to allow examination of the recipient sites.

    Study V. Nano-crystalline-diamond particle-modification of DBB and BCP particles was carried out through different steps of preparation including grinding and ultrasonic techniques. Scanning electron microscopy (SEM) was carried out after 24 hours and 3 days. Real time-polymerase chain reaction (PCR) was carried out after 3 days, 1 week and 2 weeks of incubation. The following osteoblast differentiation markers were analyzed: alkaline phosphatase (ALP), osteocalcin (OC), bone morphogenetic protein type 2 (BMP-2) and integrin alpha 10 (ITGA 10).

    Results: In paper I, the results revealed a similar degree of bone formation and bone-to-implant contact around sandblasted and acid-etched microimplants placed in sinuses augmented with BCP or DBB. No obvious signs of resorption of the BCP and DBB particles were noticed. There was a significantly higher amount of DBB particles in contact with newly formed bone compared to BCP (p=.007).

    In paper II, the median Ca/P ratios (atomic %), determined from >200 discreet sites within residual graft particles and adjacent bone were analysed. The difference between the median values for BCP and DBB and for BCP-augmented bone compared with DBB-augmented bone were statistical significant (p=.028 in each case). The reduction in Ca/P ratio for BCP over the healing period is consistent with the dissolution of β-TCP and reprecipitation on the surface of calcium-deficient hydroxyapatite.

    In paper III, the results revealed that no implant placed in residual bone was lost, one implant placed in BCP was lost after 3 months of functional loading due to infection, and one implant placed in DBB was lost only a few weeks after insertion due to lack of initial instability. The overall implant survival rate was 96.8%. Success rates for implants placed in BCP and DBB were 91.7% and 95.7% respectively. No significant differences in marginal bone loss were found around implants placed in BCP, DBB or residual bone respectively.

    In paper IV, it was shown that after 36 months (range; 36 to 37 months) of functional loading the overall implant survival rate was 96.8%. Success rates for implants placed in BCP, DBB and residual bone were 91.7%, 95.7% and 86.7% respectively. No significant difference was found between implants placed in BCP, DBB and residual bone. The corresponding histological evaluation after 3 years of graft healing showed BCP particles under different levels of dissolution. Dissolution was mostly observed on the edges of the BCP particles but in some cases the entire particle was dissolving. In contrast, DBB particles showed no signs of resorption. The percentage of graft particles in contact with newly formed bone was not significantly different after 3 years of healing for BCP and DBB.

    In paper V, cellular responses were evaluated in terms of attachment and differentiation. SEM after 24 hours and 3 days of incubation disclosed similar cell attachment and spreading for nDP-modified and non-modified DBB and BCP particles. Real-time PCR revealed significant up-regulation of mRNA expression of ALP and OC and by HOB grown on nDP-modified DBB and BCP-particles after 1 and 2 weeks compared to non-modified particles. A significant down-regulation of BMP-2 on nDP-modified DBB and a significant up-regulation of BMP-2 on DP-modified BCP was disclosed for HOB in relation to un-modified particles. Cell adhesion marker ITGA 10 showed significant down-regulation in the mRNA level for both nDP-modified groups after 2 weeks of incubation (mDP-BCP (p<.01) and nDP-DBB (p<.05) compared to the non-modified materials.

    Conclusion: It is concluded that BCP can be used for maxillary floor augmentation and later placement of dental implants producing equal results to those for DBB. Nevertheless, the initial HA/β-TCP ratio in BCP might not be optimized for cell adhesion, which can affect the early healing phase. Furthermore, the results indicate that BCP is not optimized for gene expression in its present form and that nDP-modified BCP enhances the osteoblast phenotype suggesting that these scaffolds are appropriate cell carriers, superior to non-modified BCP particles. Surface modification of bone substitutes is a new interesting field in bone tissue engineering (BTE). Nevertheless, it´s still unclear if the modification will have any clinical impact.

    List of papers
    1. Clinical Histology of Microimplants Placed in Two Different Biomaterials
    Open this publication in new window or tab >>Clinical Histology of Microimplants Placed in Two Different Biomaterials
    2009 (English)In: INTERNATIONAL JOURNAL OF ORAL and MAXILLOFACIAL IMPLANTS, ISSN 0882-2786, Vol. 24, no 6, p. 1093-1100Article in journal (Refereed) Published
    Abstract [en]

    Purpose: This randomized, controlled study was designed to compare bone formation around microimplants with a sandblasted, acid-etched surface placed at the time of maxillary sinus floor augmentation with a synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB). Materials and Methods: Nine completely edentulous patients and two partially edentulous patients (six women, five men) with a mean age of 67 years (range, 50 to 79 years) requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) in one side and DBB (control) in the contralateral side. At the time of augmentation, one microimplant on each side was placed vertically from the top of the alveolar crest, penetrating the residual bone and the grafting material. After 8 months of graft healing, at the time of ordinary implant placement, all 22 microimplants were retrieved with a surrounding bone core for histologic analyses. Results: The bone-to-implant contact in the BCP group was 64.6% +/- 9.0%, versus 55.0% +/- 16.0% for the DBB group. The difference was not significant. The corresponding values for the area of newly formed bone in the biopsies were 41.1% +/- 9.8% and 41.6% +/- 14.0% for BCP and DBB, respectively. There were significantly more DBB particles in contact with newly formed bone than BCP particles (87.9 +/- 18.2% versus 53.9 +/- 26.1%; Wilcoxon rank sum test; P = .007). Conclusion: In this randomized, controlled clinical trial, new bone formation and bone-to-implant contact around microimplants with a sandblasted, acid-etched surface was found to be equivalent between sinuses augmented with BCP or DBB. Significantly more DBB particles than BCP particles were in contact with newly formed bone, but the clinical relevance of this has yet to be established.

    Keywords
    biphasic calcium phosphate, bone substitutes, deproteinized bovine bone, histology, microimplants, sinus floor augmentation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-53440 (URN)000273295800014 ()20162114 (PubMedID)
    Available from: 2010-01-22 Created: 2010-01-22 Last updated: 2011-12-12
    2. Back-scattered electron imaging and elemental analysis of retrieved bone tissue following sinus augmentation with deproteinized bovine bone or biphasic calcium phosphate
    Open this publication in new window or tab >>Back-scattered electron imaging and elemental analysis of retrieved bone tissue following sinus augmentation with deproteinized bovine bone or biphasic calcium phosphate
    2010 (English)In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 21, no 9, p. 924-930Article in journal (Refereed) Published
    Abstract [en]

    Objectives To compare resorption of a synthetic biphasic calcium phosphate (BCP) bone-graft substitute with deproteinized bovine bone (DBB) used for human maxillary sinus augmentation. Materials and methods Eleven patients underwent bilateral maxillary sinus floor augmentation with DBB in one side and a BCP (40% beta-tricalcium phosphate (beta-TCP) and 60% hydroxyapatite) in the contralateral side. Simultaneously, with the augmentation on each side a microimplant was placed vertically from the top of the alveolar crest penetrating the residual bone and the grafting material. Eight months after initial surgery the microimplants were retrieved with a surrounding bone core. The composition of residual graft material and surrounding bone was analysed by scanning electron microscopy and energy dispersive X-ray spectroscopy. Results Residual graft material of both types was present as 10-500 mu m particles in direct contact with, or completely surrounded by, newly formed bone; smaller particles were also present in non-mineralized tissue. In the case of BCP the bone-graft substitute interface showed evidence of superficial disintegration of particles into individual grains. Median Ca/P ratios (at.%), determined from andgt; 200 discreet sites within residual graft particles and adjacent bone, were: DBB: 1.61 (confidence interval [CI] 1.59-1.64); BCP: 1.5 (CI 1.45-1.52); DBB-augmented bone: 1.62 (CI 1.59-1.66); BCP-augmented bone: 1.52 (CI 1.47-1.55); P=0.028 for DBB vs. BCP and DBB- vs. BCP-augmented bone. The reduction in Ca/P ratio for BCP over the healing period is consistent with the dissolution of beta-TCP and reprecipitation on the surface of calcium-deficient hydroxyapatite. Conclusion The beta-TCP component of BCP may be gradually substituted by calcium-deficient hydroxyapatite over the healing period. This process and superficial degranulation of BCP particles may influence the progress of resorption and healing. To cite this article:Lindgren C, Hallman M, Sennerby L, Sammons R. Back-scattered electron imaging and elemental analysis of retrieved bone tissue following sinus augmentation with deproteinized bovine bone or biphasic calcium phosphate.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    bone implant interactions, bone substitutes, sinus elevation
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-58655 (URN)10.1111/j.1600-0501.2010.01933.x (DOI)000280630200007 ()
    Available from: 2010-08-22 Created: 2010-08-20 Last updated: 2017-12-12Bibliographically approved
    3. A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone
    Open this publication in new window or tab >>A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone
    2012 (English)In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 1, p. 41-50Article in journal (Refereed) Published
    Abstract [en]

    Background: The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking. Purpose: This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control. Material and Methods: Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, <5 mm residual bone in the floor of the sinus and a crestal width ≥4 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading. Results: After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB). Conclusion: In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB.

    Place, publisher, year, edition, pages
    Wiley, 2012
    Keywords
    augmentation, Bio-Oss®sinuslift, bone substitutes, BoneCeramic®, dental implants
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-66971 (URN)10.1111/j.1708-8208.2010.00224.x (DOI)000299412900003 ()20491816 (PubMedID)
    Available from: 2011-03-23 Created: 2011-03-23 Last updated: 2017-12-11Bibliographically approved
    4. A 3-year clinical follow-up of implants placed in 2 differentbiomaterials used for sinus augmentation
    Open this publication in new window or tab >>A 3-year clinical follow-up of implants placed in 2 differentbiomaterials used for sinus augmentation
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) used for maxillary sinus floor augmentation (MSFA) in a split mouth design, and to perform a clinical follow-up of placed dental implants.

    Material and Methods: Nine completely edentulous patients and two partially edentulous patients with a mean age of 67 years requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive® surface (Strauman®, Basel, Switzerland) were placed. After 3 years of graft healing core biopsies were obtained from the grafted areas for histological and histomorphometrical analysis. After 3 years of functional implant loading, implant survival/success rate, clinical indexes, radiographical examination and resonance frequency analysis (RFA) wereperformed.

    Results: The mean values of the area of newly formed bone in the biopsies was 29% ±14.3% and 32% ± 18.0% for BCP and DBB respectively and graft particles in contact with bone in the BCP group was 38% ± 10.9% compared to 44% ± 12.1% for the DBB group, showing no significant differences between the groups. The mean values of the area of BCP particles and DBB particles were 20% ± 7.5% and 24% ± 13.5% respectively (non-significant).

    Irrespective of particles used, one dental implant was lost from each group, giving an overall implant survival rate of 96.8% after 3-years of loading. Conclusion: The results of this prospective 3-year clinical and histological follow up demonstrated a similar amount of newly formed bone irrespectively of the used biomaterial. The choice of biomaterial does not seem to influence the survival rates of the implants.

    Keywords
    Biphasic calcium phosphate, deproteinized bovine bone, histology, implants, sinus floor augmentation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-72936 (URN)
    Available from: 2011-12-12 Created: 2011-12-12 Last updated: 2011-12-12Bibliographically approved
    5. Surface modified biphasic calcium phosphate-particles enhance expression of bone markers in osteoblast-like cells
    Open this publication in new window or tab >>Surface modified biphasic calcium phosphate-particles enhance expression of bone markers in osteoblast-like cells
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: The aim of the present in vitro study was to evaluate the response of human osteoblast-like cells (HOB) to nano-crystalline-diamond-particle-modified (nDP-modified) and un-modified (control) deproteinized bovine bone (DBB) and biphasic calcium phosphate (BCP) scaffolds.

    Materials and methods: nDP-modification of DBB and BCP- particles was carried out through different steps of preparation including grinding and  ultrasonic technique. In each experiment, 100 mg materials from each of the 4 groups (nDP-modified DBB, nDP-modified BCP, un-modified DBB and un-modified BCP) were plated into a 48 well cell culture plate and 200.000 cells/well were seeded onto the materials. Scanning electron microscopy (SEM) was carried out after 24 hours and 3 days. Real time-polymerase chain reaction (PCR) was carried out after 3 days, 1 week and 2 weeks of incubation. The following markers were analyzed; alkaline phosphatase (ALP), osteocalcin (OC), bone morphogenetic protein type 2 (BMP-2) and integrin alpha 10 (ITGA 10). The general tendency of DBB and BCP was compared.

    Results: Cellular responses were evaluated in terms of attachment and differentiation. SEM after 24 hours and 3 days of incubation disclosed similar cell attachment and spreading for nDP-modified and non-modified DBB and BCP particles. Real-time PCR revealed significant up-regulation of mRNA expression of ALP and OC by HOB grown on nDP-modified DBB and BCP-particles after 1 and 2 weeks compared to non-modified  particles. A significant down-regulation of BMP-2 on nDP-modified DBB and a significant up-regulation of BMP-2 on nDP-modified BCP were disclosed for HOB in relation to un-modified particles. Cell adhesion marker ITGA 10 showed significant down-regulated in the mRNA level for both nDP-modified groups after 2 weeks of incubation (nDP-BCP (p<.01) and nDP-DBB (p<.05) compared to the non-modified materials.

    Conclusion: nDP-modified BCP-particles seem to enhance the expression of osteogenic markers in HOB in vitro. The results indicate that nDP-modified BCP enhance the osteoblast phenotype and suggest that these scaffolds might be appropriate cell carriers, superior to nonmodified BCP-particles. The osteogenic markers of OC and ALP were increased for nDPmodified DBB particles but BMP-2 was down regulated in relation to non-modified DBB particles.

    Keywords
    Tissue engineering, scaffolds, gene expression, human osteoblast-like cells, biphasic calcium phosphate, deproteinized bovine bone
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-72937 (URN)
    Available from: 2011-12-12 Created: 2011-12-12 Last updated: 2011-12-12Bibliographically approved
  • 14.
    Lindgren, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Mordenfeld, Arne
    Department of Oral and Maxillofacial Surgery, Gävle, County Hospital, Sweden.
    Hallman, Mats
    Department of Oral and Maxillofacial Surgery, Gävle, County Hospital, Sweden.
    A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 1, p. 41-50Article in journal (Refereed)
    Abstract [en]

    Background: The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking. Purpose: This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control. Material and Methods: Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, <5 mm residual bone in the floor of the sinus and a crestal width ≥4 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading. Results: After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB). Conclusion: In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB.

  • 15.
    Lindgren, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Mordenfeld, Arne
    Gävle County Hospital, Sweden Gothenburg University, Sweden .
    Johansson, Carina B
    University of Örebro, Sweden .
    Hallman, Mats
    Gävle County Hospital, Sweden Umeå University, Sweden Uppsala University, Sweden .
    A 3-Year Clinical Follow-up of Implants Placed in Two Different Biomaterials Used for Sinus Augmentation2012In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 27, no 5, p. 1151-1162Article in journal (Refereed)
    Abstract [en]

    Purpose: The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) for maxillary sinus floor augmentation in a split-mouth design and to perform a clinical follow-up of dental implants placed in the augmented sinuses. Materials and Methods: Partially or completely edentulous patients requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. Eight months after grafting, dental implants were placed. After 3 years of graft healing, core biopsy specimens were obtained from the grafted areas for histologic and histomorphometric analyses. After 3 years of functional implant loading, implant survival/success rates and clinical indices were assessed and radiographic examination and resonance frequency analysis were performed. Results: Nine completely edentulous patients and two partially edentulous patients (mean age, 67 years) who required bilateral sinus augmentation were included in the study, and 62 implants were placed. The mean values for the area of newly formed bone in the retrieved specimens were 29% +/- 14.3% and 32% +/- 18.0% for BCP and DBB, respectively; the percentage of graft particles in contact with bone was 38% +/- 10.9% in the BCP group and 44% +/- 12.1% in the DBB group (no statistical significant differences between groups). The mean values for the area of BCP particles and DBB particles were 20% +/- 7.5% and 24% +/- 13.5%, respectively (difference not significant). One dental implant was lost from each group, resulting in an overall implant survival rate of 96.8% after 3 years of loading. Conclusion: After 3 years, a similar amount of newly formed bone was present regardless of the biomaterial used. The choice of biomaterial did not seem to influence implant survival rates.

  • 16.
    Lindgren, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Mordenfeld, Arne
    Department of Oral and Maxillofacial Surgery, Gävle, County Hospital, Sweden/Dept of Biomaterials, Institute of Clinical Sciences, Göteborg University, Sweden.
    Johansson, CB
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hallman, Mats
    Department of Oral and Maxillofacial Surgery, Gävle, County Hospital, Sweden/Department of Oral & Maxillofacial Surgery, Umeå University, Umeå Sweden and Center for Research and Development, Uppsala University/Gävleborg County Council, Sweden.
    A 3-year clinical follow-up of implants placed in 2 differentbiomaterials used for sinus augmentationManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: The aims of the present study were to compare a novel biphasic calcium phosphate (BCP) with deproteinized bovine bone (DBB) used for maxillary sinus floor augmentation (MSFA) in a split mouth design, and to perform a clinical follow-up of placed dental implants.

    Material and Methods: Nine completely edentulous patients and two partially edentulous patients with a mean age of 67 years requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) and DBB (control) in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive® surface (Strauman®, Basel, Switzerland) were placed. After 3 years of graft healing core biopsies were obtained from the grafted areas for histological and histomorphometrical analysis. After 3 years of functional implant loading, implant survival/success rate, clinical indexes, radiographical examination and resonance frequency analysis (RFA) wereperformed.

    Results: The mean values of the area of newly formed bone in the biopsies was 29% ±14.3% and 32% ± 18.0% for BCP and DBB respectively and graft particles in contact with bone in the BCP group was 38% ± 10.9% compared to 44% ± 12.1% for the DBB group, showing no significant differences between the groups. The mean values of the area of BCP particles and DBB particles were 20% ± 7.5% and 24% ± 13.5% respectively (non-significant).

    Irrespective of particles used, one dental implant was lost from each group, giving an overall implant survival rate of 96.8% after 3-years of loading. Conclusion: The results of this prospective 3-year clinical and histological follow up demonstrated a similar amount of newly formed bone irrespectively of the used biomaterial. The choice of biomaterial does not seem to influence the survival rates of the implants.

  • 17.
    Lindgren, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Sennerby, Lars
    Sahlgrens Acad, Department Biomat, Institute Surg Science, Gothenburg, Sweden .
    Mordenfeld, Arne
    Gavle County Hospital, Department Oral and Maxillofacial Surg, SE-80107 Gavle, Sweden Gothenburg University, Institute Clin Science, Department Biomat, Gothenburg, Sweden .
    Hallman, Mats
    Gavle County Hospital, Department Oral and Maxillofacial Surg, SE-80107 Gavle, Sweden Umea University, Department Oral and Maxillofacial Surg, Umea, Sweden Uppsala University, Centre Research and Dev, Gavleborg County Council, Uppsala, Sweden .
    Clinical Histology of Microimplants Placed in Two Different Biomaterials2009In: INTERNATIONAL JOURNAL OF ORAL and MAXILLOFACIAL IMPLANTS, ISSN 0882-2786, Vol. 24, no 6, p. 1093-1100Article in journal (Refereed)
    Abstract [en]

    Purpose: This randomized, controlled study was designed to compare bone formation around microimplants with a sandblasted, acid-etched surface placed at the time of maxillary sinus floor augmentation with a synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB). Materials and Methods: Nine completely edentulous patients and two partially edentulous patients (six women, five men) with a mean age of 67 years (range, 50 to 79 years) requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) in one side and DBB (control) in the contralateral side. At the time of augmentation, one microimplant on each side was placed vertically from the top of the alveolar crest, penetrating the residual bone and the grafting material. After 8 months of graft healing, at the time of ordinary implant placement, all 22 microimplants were retrieved with a surrounding bone core for histologic analyses. Results: The bone-to-implant contact in the BCP group was 64.6% +/- 9.0%, versus 55.0% +/- 16.0% for the DBB group. The difference was not significant. The corresponding values for the area of newly formed bone in the biopsies were 41.1% +/- 9.8% and 41.6% +/- 14.0% for BCP and DBB, respectively. There were significantly more DBB particles in contact with newly formed bone than BCP particles (87.9 +/- 18.2% versus 53.9 +/- 26.1%; Wilcoxon rank sum test; P = .007). Conclusion: In this randomized, controlled clinical trial, new bone formation and bone-to-implant contact around microimplants with a sandblasted, acid-etched surface was found to be equivalent between sinuses augmented with BCP or DBB. Significantly more DBB particles than BCP particles were in contact with newly formed bone, but the clinical relevance of this has yet to be established.

  • 18.
    Lindgren, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Xue, Ying
    Department of Clinical Dentistry, Center for Clinical Dental Research, Faculty of Medicine and Dentistry, University of Bergen, Bergen 5009, Norway.
    Hallman, Mats
    Department of Oral& Maxillofacial Surgery, Gävle, County Hospital, Sweden/Department of Oral & Maxillofacial Surgery, Umeå University, Umeå Sweden/Center for Research and Development, Uppsala University/Gävleborg County Council, Sweden.
    Steinmueller-Nethl, Doris
    KOMET RHOBEST GmbH, Exlgasse 20a, 6020 Innsbruck, Austria.
    Waag, Thilo
    PhD, KOMET RHOBEST GmbH, Exlgasse 20a, 6020 Innsbruck, Austria.
    Krüger, Anke
    Institut für Organische Chemie, Julius-Maximilians-Universität, Am Hubland, 97074 Würzburg, Germany.
    Babikeir Eln Mustafa, Kamal
    Department of Clinical Dentistry, Center for Clinical Dental Research, Faculty of Medicine and Dentistry, University of Bergen, Bergen 5009, Norway.
    Surface modified biphasic calcium phosphate-particles enhance expression of bone markers in osteoblast-like cellsManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: The aim of the present in vitro study was to evaluate the response of human osteoblast-like cells (HOB) to nano-crystalline-diamond-particle-modified (nDP-modified) and un-modified (control) deproteinized bovine bone (DBB) and biphasic calcium phosphate (BCP) scaffolds.

    Materials and methods: nDP-modification of DBB and BCP- particles was carried out through different steps of preparation including grinding and  ultrasonic technique. In each experiment, 100 mg materials from each of the 4 groups (nDP-modified DBB, nDP-modified BCP, un-modified DBB and un-modified BCP) were plated into a 48 well cell culture plate and 200.000 cells/well were seeded onto the materials. Scanning electron microscopy (SEM) was carried out after 24 hours and 3 days. Real time-polymerase chain reaction (PCR) was carried out after 3 days, 1 week and 2 weeks of incubation. The following markers were analyzed; alkaline phosphatase (ALP), osteocalcin (OC), bone morphogenetic protein type 2 (BMP-2) and integrin alpha 10 (ITGA 10). The general tendency of DBB and BCP was compared.

    Results: Cellular responses were evaluated in terms of attachment and differentiation. SEM after 24 hours and 3 days of incubation disclosed similar cell attachment and spreading for nDP-modified and non-modified DBB and BCP particles. Real-time PCR revealed significant up-regulation of mRNA expression of ALP and OC by HOB grown on nDP-modified DBB and BCP-particles after 1 and 2 weeks compared to non-modified  particles. A significant down-regulation of BMP-2 on nDP-modified DBB and a significant up-regulation of BMP-2 on nDP-modified BCP were disclosed for HOB in relation to un-modified particles. Cell adhesion marker ITGA 10 showed significant down-regulated in the mRNA level for both nDP-modified groups after 2 weeks of incubation (nDP-BCP (p<.01) and nDP-DBB (p<.05) compared to the non-modified materials.

    Conclusion: nDP-modified BCP-particles seem to enhance the expression of osteogenic markers in HOB in vitro. The results indicate that nDP-modified BCP enhance the osteoblast phenotype and suggest that these scaffolds might be appropriate cell carriers, superior to nonmodified BCP-particles. The osteogenic markers of OC and ALP were increased for nDPmodified DBB particles but BMP-2 was down regulated in relation to non-modified DBB particles.

  • 19.
    Magnusson, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Maxillofacial Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment: Effects on dental, skeletal and nasal structures and rhinological findings2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue.

    The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs.

    The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time.

    The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009.

    In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 – 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months).

    In Papers III–IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 – 43.9). Helical CT-images were taken pre-treatment and eighteen months’ post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II–IV, the treatment groups constituted their own control groups.

    The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a shortterm, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pre-treatment nasal obstruction reported a lasting sensation of improved nasal function.

    SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base.

    The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.

    List of papers
    1. Surgically assisted rapid maxillary expansion: long-term stability
    Open this publication in new window or tab >>Surgically assisted rapid maxillary expansion: long-term stability
    2009 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 31, no 2, p. 142-149Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to evaluate treatment outcomes and long-term stability in patients treated by surgically assisted rapid maxillary expansion (SARME) and to compare the results with a matched, untreated control group. The sample comprised consecutive study models from 31 subjects (17 males and 14 females) with a mean pre-treatment age of 25.9 years [standard deviation (SD) 9.6]. The mean follow-up time was 6.4 years (SD 3.3). The transverse distances between the maxillary canines and maxillary first molars were measured with digital sliding callipers before treatment (T0), after treatment (T1), and at follow-up (T2). The data were analysed with a Mann-Whitney U, Spearman's rho, and Wilcoxon signed-rank tests. At T1, all posterior crossbites were corrected and the expansions were statistically significant. At T2, despite some reduction in the transverse measurements, the posterior crossbites remained corrected. There were no statistically significant differences between the treatment and control groups at T2 regarding transverse measurements, except for the distance between the mesio-buccal cusp tips of the maxillary first molars. In the treatment group, there was no significant difference in terms of reductions in the transverse dimensions over the short- or long-term, no significant correlations between age or gender and the decrease in transverse dimensions or between the degree of anterior and posterior expansion. There were no significant correlations between the degree of expansion and subsequent post-treatment decrease. The results indicate that SARME normalizes the transverse discrepancies and is stable a mean of 6 years post-treatment. The decreases in the transverse dimensions are most pronounced during the first 3 years post-treatment. 

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-44691 (URN)10.1093/ejo/cjn074 (DOI)77308 (Local ID)77308 (Archive number)77308 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
    2. Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: A prospective longitudinal study
    Open this publication in new window or tab >>Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: A prospective longitudinal study
    Show others...
    2011 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 140, no 5, p. 641-651Article in journal (Refereed) Published
    Abstract [en]

    Introduction: The aims of this study were to measure changes in nasal minimum cross-sectional area and nasal airway resistance after surgically assisted rapid maxillary expansion and to explore a possible correlation with the subjective sensation of nasal obstruction. Methods: Minimum cross-sectional area and nasal airway resistance were measured in 39 consecutive patients treated with surgically assisted rapid maxillary expansion. Subjective nasal obstruction was assessed by a questionnaire at pretreatment and at 3 and 18 months postoperatively. Results: Subjective nasal obstruction had improved significantly by 3 months postoperatively. Minimum cross-sectional area increased and nasal airway resistance decreased. No correlations were found. In subjects with pretreatment subjective nasal obstruction and initially narrow anterior minimum cross-sectional area, there was a significant correlation between a moderate increase in anterior minimum cross-sectional area and improvement in perceived nasal obstruction. Eighteen months postoperatively, no changes were found from pretreatment values for subjective nasal obstruction, minimal cross-sectional area, or nasal airway resistance, and there were no correlations. Subjects with a sensation of nasal obstruction at treatment start reported a lasting significant subjective improvement. Conclusions: The postoperative effects of surgically assisted rapid maxillary expansion did not persist in the long term. No correlation was found between objective and subjective findings. Subjects with pretreatment nasal obstruction, however, reported a lasting sensation of improved nasal function after surgically assisted rapid maxillary expansion.

    Place, publisher, year, edition, pages
    Elsevier Masson, 2011
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-73101 (URN)10.1016/j.ajodo.2010.11.024 (DOI)000296745100017 ()
    Note
    Funding Agencies|Futurum-The Academy for Healthcare, County Council, Jonkoping Sweden||Medical Research Council of Southeast Sweden||Available from: 2011-12-16 Created: 2011-12-16 Last updated: 2017-12-08
    3. Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study
    Open this publication in new window or tab >>Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study
    Show others...
    2012 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 142, no 6, p. 825-833Article in journal (Refereed) Published
    Abstract [en]

    Introduction: The aim of this prospective longitudinal study was to evaluate transverse skeletal changes after surgically assisted rapid maxillary expansion. The changes were registered by using a 3-dimensional computerized tomography technique based on superimposition on the anterior base of the skull. Methods: The subjects comprised 35 patients (mean age, 19.7 years; range, 16.1-43.9 years). Low-dose, helical computerized tomography images were taken at treatment start and after orthodontic treatment. The 3-dimensional models were registered and superimposed at the anterior cranial base. Results: Surgically assisted rapid maxillary expansion had a significant transverse skeletal treatment effect, significantly greater posteriorly than anteriorly. The expansion was parallel anteriorly, but posteriorly there was significant transverse tipping. Although there was no statistically significant difference between the changes at the corresponding landmarks, the range of standard deviations was marked. Conclusions: The results showed that, for registering transverse skeletal changes after surgically assisted rapid maxillary expansion, 3-dimensional superimposition is a reliable method, circumventing projection and measurement errors. Surgically assisted rapid maxillary expansion had a significant but nonuniform skeletal treatment effect. Despite careful surgical separation, pronounced posterior tipping occurred. No correlation was found between the severity of tipping and the patients age. (Am J Orthod Dentofacial Orthop 2012;142:825-33)

    Place, publisher, year, edition, pages
    Elsevier Masson, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87201 (URN)10.1016/j.ajodo.2012.08.015 (DOI)000311635800011 ()
    Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2017-12-06
    4. Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study
    Open this publication in new window or tab >>Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study
    Show others...
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: The aim of this prospective, longitudinal study was toe valuate changes to the external shape and form of the nose after Surgically Assisted Rapid Maxillary Expansion (SARME) and orthodontic treatment. The changes were registered using a three-dimensional (3-D) computer tomography technique, based on superimposition on the anterior base of the skull.

    Method: The subjects comprised 35 patients, mean age 19.7 years (16.1-43.9). Lowdose, helical Computerized Tomography (CT) was taken at treatment start and after completed orthodontic treatment, about 18months post-surgery. The 3-D models were registered and superimposed on the anterior cranial base.

    Results: There was in general significant widening and overall anterior and inferior displacement of the nasal soft tissue. The changes varied in size and direction. No correlation was found between the initial and final widths of the nose, or between the initial and final widths of the nostrils.

    Conclusion: After SARME, the most obvious changes to the external features of the nose  are at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. Patients with narrow and constrained nostrils can benefit from these changes. The 3-D superimposition applied in this study is a reliable method, circumventing projection and measurement errors.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-91699 (URN)10.1016/j.ajodo.2013.04.013 (DOI)
    Available from: 2013-04-29 Created: 2013-04-29 Last updated: 2014-11-19
  • 20.
    Magnusson, Anders
    et al.
    Institute Postgrad Dent Educ, Sweden .
    Bjerklin, Krister
    Institute Postgrad Dent Educ, Sweden .
    Kim, Hyungmin
    Harvard University, USA .
    Nilsson, Peter
    Institute Postgrad Dent Educ, Sweden .
    Marcusson, Agneta
    Linköping University, Department of Neuroscience and Locomotion, Dental Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
    Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study2012In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 142, no 6, p. 825-833Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of this prospective longitudinal study was to evaluate transverse skeletal changes after surgically assisted rapid maxillary expansion. The changes were registered by using a 3-dimensional computerized tomography technique based on superimposition on the anterior base of the skull. Methods: The subjects comprised 35 patients (mean age, 19.7 years; range, 16.1-43.9 years). Low-dose, helical computerized tomography images were taken at treatment start and after orthodontic treatment. The 3-dimensional models were registered and superimposed at the anterior cranial base. Results: Surgically assisted rapid maxillary expansion had a significant transverse skeletal treatment effect, significantly greater posteriorly than anteriorly. The expansion was parallel anteriorly, but posteriorly there was significant transverse tipping. Although there was no statistically significant difference between the changes at the corresponding landmarks, the range of standard deviations was marked. Conclusions: The results showed that, for registering transverse skeletal changes after surgically assisted rapid maxillary expansion, 3-dimensional superimposition is a reliable method, circumventing projection and measurement errors. Surgically assisted rapid maxillary expansion had a significant but nonuniform skeletal treatment effect. Despite careful surgical separation, pronounced posterior tipping occurred. No correlation was found between the severity of tipping and the patients age. (Am J Orthod Dentofacial Orthop 2012;142:825-33)

  • 21.
    Magnusson, Anders
    et al.
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bjerklin, Krister
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Kim, Hyungmin
    Harvard University, USA .
    Nilsson, Peter
    Institute Postgrad Dent Educ, Sweden .
    Marcusson, Agneta
    Linköping University, Department of Neuroscience and Locomotion, Dental Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study2013Manuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: The aim of this prospective, longitudinal study was toe valuate changes to the external shape and form of the nose after Surgically Assisted Rapid Maxillary Expansion (SARME) and orthodontic treatment. The changes were registered using a three-dimensional (3-D) computer tomography technique, based on superimposition on the anterior base of the skull.

    Method: The subjects comprised 35 patients, mean age 19.7 years (16.1-43.9). Lowdose, helical Computerized Tomography (CT) was taken at treatment start and after completed orthodontic treatment, about 18months post-surgery. The 3-D models were registered and superimposed on the anterior cranial base.

    Results: There was in general significant widening and overall anterior and inferior displacement of the nasal soft tissue. The changes varied in size and direction. No correlation was found between the initial and final widths of the nose, or between the initial and final widths of the nostrils.

    Conclusion: After SARME, the most obvious changes to the external features of the nose  are at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. Patients with narrow and constrained nostrils can benefit from these changes. The 3-D superimposition applied in this study is a reliable method, circumventing projection and measurement errors.

  • 22.
    Magnusson, Anders
    et al.
    Institute for Postgraduate Dental Education, Jönköping.
    Bjerklin, Krister
    Institute for Postgraduate Dental Education, Jönköping.
    Nilsson, Peter
    Institute for Postgraduate Dental Education, Jönköping.
    Jonsson, Fredrik
    Ryhov County Hospital, Jönköping.
    Marcusson, Agneta
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL. Linköping University, Department of Clinical and Experimental Medicine, Maxillofacial Surgery.
    Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: A prospective longitudinal study2011In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 140, no 5, p. 641-651Article in journal (Refereed)
    Abstract [en]

    Introduction: The aims of this study were to measure changes in nasal minimum cross-sectional area and nasal airway resistance after surgically assisted rapid maxillary expansion and to explore a possible correlation with the subjective sensation of nasal obstruction. Methods: Minimum cross-sectional area and nasal airway resistance were measured in 39 consecutive patients treated with surgically assisted rapid maxillary expansion. Subjective nasal obstruction was assessed by a questionnaire at pretreatment and at 3 and 18 months postoperatively. Results: Subjective nasal obstruction had improved significantly by 3 months postoperatively. Minimum cross-sectional area increased and nasal airway resistance decreased. No correlations were found. In subjects with pretreatment subjective nasal obstruction and initially narrow anterior minimum cross-sectional area, there was a significant correlation between a moderate increase in anterior minimum cross-sectional area and improvement in perceived nasal obstruction. Eighteen months postoperatively, no changes were found from pretreatment values for subjective nasal obstruction, minimal cross-sectional area, or nasal airway resistance, and there were no correlations. Subjects with a sensation of nasal obstruction at treatment start reported a lasting significant subjective improvement. Conclusions: The postoperative effects of surgically assisted rapid maxillary expansion did not persist in the long term. No correlation was found between objective and subjective findings. Subjects with pretreatment nasal obstruction, however, reported a lasting sensation of improved nasal function after surgically assisted rapid maxillary expansion.

  • 23.
    Rasmusson, Lars
    et al.
    Department Oral and Maxillofacial Surgery, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,.
    Abtahi, Jahan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Bisphosphonate associated osteonecrosis of the jaw: an update on pathophysiology, risk factors, and treatment.2014In: International Journal of Dentistry, ISSN 1687-8728, E-ISSN 1687-8736, article id 71035Article, review/survey (Refereed)
    Abstract [en]

    Osteonecrosis of the jaw in patients treated with bisphosphonates is a relatively rare but well known complication at maxillofacial units around the world. It has been speculated that the medication, especially long-term i.v. bisphosphonate treatment, could cause sterile necrosis of the jaws. The aim of this narrative review of the literature was to elaborate on the pathological mechanisms behind the condition and also to gather an update on incidence, risk factors, and treatment of bisphosphonate associated osteonecrosis of the jaw. In total, ninety-one articles were reviewed. All were published in internationally recognized journals with referee systems. We can conclude that necrotic lesions in the jaw seem to be following upon exposure of bone, for example, after tooth extractions, while other interventions like implant placement do not increase the risk of osteonecrosis. Since exposure to the bacterial environment in the oral cavity seems essential for the development of necrotic lesions, we believe that the condition is in fact chronic osteomyelitis and should be treated accordingly.

  • 24.
    Schüttert, Eva Maria
    et al.
    Malmö University, Sweden .
    Alstad, Vera
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Eriksson, Lars
    Malmö University, Sweden .
    Orthognathic surgery - postoperative clinical and radiographic follow-up routines at Swedish oral and maxillofacial surgery departments2012In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 3, p. 109-114Article in journal (Refereed)
    Abstract [en]

    Orthognathic surgery is a frequent procedure at Swedish Oral and Maxillofacial Surgery Departments. The number of clinical and radiographic postoperative follow-up examinations and the choice of radiographic methods seem to vary. The intention with this study was to find out when postoperative clinical and radiographic follow-up was performed following orthognathic surgery and the type of radiographic examinations that were used. less thanbrgreater than less thanbrgreater thanIn 2009, all Swedish Oral and Maxillofacial Surgery Departments in the Public Health Service (25 centres) were given a form containing standardized questions on the time for clinical follow-up after orthognathic surgery and the radiographic examinations used. A pilot study on 49 consecutive patients at one of the centres was performed to determine if the postoperative radiographic examinations added additional information, leading to further procedures compared to the clinical observations only. less thanbrgreater than less thanbrgreater thanA one-year follow-up was the most frequently used clinical control reported by 15 centres, and a six-month follow-up, the next most frequent. At 14 of the 15 centres, radiographic examinations were included at the one-year follow-up. A five-year clinical and radiographic follow-up was reported by two centres. One or, at the most, two postoperative radiographic follow-up sessions were reported by 68% of the centres. Profile and panoramic imaging were most often used. In the evaluation of the postoperative handling of the 49 consecutive patients in the pilot study, a radiolucency around a fixation screw noted radiographically was the only additional postoperative radiological finding that resulted in a surgical procedure. less thanbrgreater than less thanbrgreater thanPostoperative clinical and radiographic follow-up routines following orthognathic surgery vary considerably between the Swedish Oral and Maxillofacial Surgery Departments. There appears to be a need for studies on the value of the information, which repeated postoperative clinical and radiographic follow-up controls add in routine medical attendance.

1 - 24 of 24
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