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  • 1.
    Bryndahl, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Warfvinge, G
    Eriksson, L
    Isberg, A
    Cartilage changes link retrognathic mandibular growth to TMJ disc displacement in a rabbit model2011In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 40, no 6, p. 621-627Article in journal (Refereed)
    Abstract [en]

    Recent experimental research demonstrated that non-reducing temporomandibular joint (TMJ) disc displacement in growing rabbits impaired mandibular growth. TMJ disc displacement is also shown to induce histological changes of the condylar cartilage. The authors hypothesized that the severity of these changes would correlate to the magnitude of mandibular growth. Bilateral non-reducing TMJ disc displacement was surgically created in 10 growing New Zealand White rabbits. Ten additional rabbits constituted a sham operated control group. Aided by tantalum implants, growth was cephalometrically determined for each mandibular side during a period equivalent to childhood and adolescence in man. At the end of the growth period, histologically classified cartilage features were correlated with the assessed ipsilateral mandibular growth. Non-reducing displacement of the TMJ disc during the growth period induced histological reactions of the condylar cartilage in the rabbit model. The severity of cartilage changes was inversely correlated to the magnitude and the direction of mandibular growth, which resulted in a retrognathic growth pattern.

  • 2.
    Emanuelsson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Allen, Carl M.
    Rydin, Katarina
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Department of Odontology.
    Osteoblastoma of the temporal articular tubercle misdiagnosed as a temporomandibular joint disorder2017In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 46, no 5, p. 610-613Article in journal (Refereed)
    Abstract [en]

    This is a case report of a benign osteoblastoma in the temporomandibular joint of a 17-year-old female. The patient had a two-and-a-half-year history of reduced mouth opening accompanied by tenderness and swelling in the left temporomandibular joint (TMJ). Initial treatment included stabilization of occlusion with a splint, jaw exercise and analgesics. At first symptoms decreased, but then increased 18 months later, prompting evaluation by a cone beam computed tomography (CBCT) scan of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications. The lesion was removed under general anesthesia and sent for histopathological examination. At 12-month follow-up the patient had normal function in the TMJ without clinical symptoms. CBCT examination showed a small recurrence of 3 millimeter. Another 12 months later CBCT showed a 1 mm increase of the recurrence. Function was normal with a subtle tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annually follow-up. The present case illustrates the importance of radiographic examination of patients with temporomandibular dysfunction when conservative treatment of symptoms does not relieve pain or swelling.

  • 3.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Lindhagen, O
    Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.1997In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 26, no 6, p. 428-434Article in journal (Refereed)
    Abstract [en]

    This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (Brånemark) were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.

  • 4.
    Lundgren, Stefan
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Sjöström, Mats
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Simultaneous or delayed placement of titanium implants in free autogenous iliac bone grafts: Histological analysis of the bone graft-titanium interface in 10 consecutive patients1999In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 28, no 1, p. 31-37Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to histologically analyse the bone graft-titanium implant interface after six and twelve months of healing for a simultaneous approach and after six months for a delayed approach. For this purpose, screw-shaped c.p. titanium microimplants, 2 mm in diameter and 5 mm long, were placed and retrieved at different time intervals in ten consecutive patients with severely resorbed maxillae and treated with iliac cortico-cancellous bone grafts and titanium implants in a two-stage procedure. The histomorphometrical analyses of ground sections of the specimens showed a higher degree of bone-implant contact and more bone filling the implant threads in the delayed approach microimplants. This was probably due to the partly revascularized grafted bone in the delayed approach being able to respond to the surgical trauma, resulting in interfacial bone formation. It is concluded that the results from the present study favour the use of a delayed approach when using free autogenous bone grafts and titanium implants for reconstruction of the severely atrophied maxilla.

  • 5.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Ahlqvist, Jan
    Kahnberg, K E
    Rosenquist, J B
    Autogenous onlay bone grafts fixed with screw implants for the treatment of severely resorbed maxillae. Radiographic evaluation of preoperative bone dimensions, postoperative bone loss, and changes in soft-tissue profile.1996In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 25, no 5, p. 351-359Article in journal (Refereed)
    Abstract [en]

    Thirty patients with severely resorbed edentulous maxillae underwent combined treatment of iliac bone onlay graft and titanium implants. The patients were followed for 3 years. They were radiographically examined before surgery to evaluate the bone volume at the intended implant sites. Only 13/156 implant sites were suitable for implant insertion. The bone level at the implant surfaces was evaluated after 6 months and 1, 2, and 3 years, respectively. There was a continuing decrease of the bone level throughout the follow-up period with a mean loss of 4.9 mm after 3 years and with no difference between sexes. Twenty-six implants were radiographically examined before removal, and only three of these implant sites showed radiographic signs of failure. The soft-tissue profile was analyzed cephalometrically by the subtraction technique. The upper lip generally moved inward and the apex of the nose and the columella downward and inward. The anterior facial height increased in most of the patients, resulting in a downward and inward change of the lower lip, the mentolabial sulcus, the soft-tissue pogonion, and the soft-tissue gnathion.

  • 6.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Legrell, Per Erik
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Kahnberg, K E
    Bone graft remodelling and implant success rate in the treatment of the severely resorbed maxilla: a 5-year longitudinal study.2002In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 31, no 2, p. 158-164Article in journal (Refereed)
    Abstract [en]

    A total of 30 patients, 10 in a developmental group and 20 in a routine group, with extremely resorbed maxillae were treated with bone grafting from the hip and implant placement in a one-stage procedure. All patients were followed for a minimum of 5 years and were examined regarding the long-term success rate of the implants and marginal bone level. The implant success rate was 74.6% for the whole patient group and 85.8% for the routine group, after 5 years. The marginal bone along the implant surface decreased continuously, up to 3 years and thereafter the bone level stabilized. In the routine group, changes in bone graft dimensions over time were also evaluated by computerized tomography. The mean height of the bone graft postoperatively at all implant sites was 8.3 mm. The total mean bone height, including bone graft and residual alveolar crest, was 12.4 mm. After 5 years the total bone height had decreased to a mean of 10 mm. The mean width of the bone graft was 12 mm postoperatively and 8.7 mm at the 5-year examination. A substantial amount of bone can be gained in patients with extremely resorbed maxillae, when treated with bone graft according to the procedure described in this study.

  • 7.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Legrell, P E
    Forssell, A
    Kahnberg, K E
    Combined use of bone grafts and implants in the severely resorbed maxilla. Postoperative evaluation by computed tomography.1995In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 24, no 1 Pt 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    Combined horseshoe-shaped iliac bone grafts and Brånemark fixtures were used to rehabilitate patients with severely resorbed maxillae. Twenty patients were followed-up by computed tomography (CT) examination with axial slices to assess the fixture sites and to study the changes in height and width of the bone graft 3 weeks and 3, 6, 12, and 24 months postoperatively. The mean height of the bone graft at the 3-week postoperative examination was 8.2 mm; after 2 years the mean value had decreased to 6.2 mm. The height reduction occurred mainly between the 3-month and 1-year examinations. The mean width of the bone graft at the 3-week postoperative examination was 12.2 mm, and it decreased to 8.6 mm after 2 years. Most of the width reduction took place during postoperative months 1-3. From 1 year after the grafting procedure, the rate of reduction of both height and width was very low.

  • 8.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Odontology, Prosthetic Dentistry.
    Interpositional bone grafting and Le Fort I osteotomy for reconstruction of the atrophic edentulous maxilla. A two-stage technique.1997In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 26, no 6, p. 423-427Article in journal (Refereed)
    Abstract [en]

    This study presents the results from ten consecutive patients who, because of insufficient bone volume for conventional implant placement in the maxilla, were treated with an interpositional bone graft and Le Fort I osteotomy. The endosteal implants were placed six months after the osteotomy. A total of 60 screw-shaped titanium implants (Brånemark) were placed, of which three failed to integrate during the six-month healing period. No further implants were lost during the follow-up period, ranging from 15 to 39 months after placement of the implants. All patients received fixed bridges and all have continued to function efficiently.

  • 9.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    A 9-14 year follow-up of onlay bone grafting in the atrophic maxilla.2009In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 38, no 2, p. 111-116Article in journal (Refereed)
    Abstract [en]

    Treatment of the atrophic edentulous maxilla is challenging especially when bone graft procedures are necessary. In this study an onlay bone graft, a saddle or veneer, with or without maxillary sinus floor inlay graft, harvested from the anterior iliac crest, in combination with implants was used in the reconstruction of patients with extreme atrophy in their maxillae. The aim was to investigate treatment outcome, and the impact of gender and smoking, in 44 patients in a prospective, long-term, follow-up study concerning implant survival rate and marginal bone loss adjacent to the surfaces of the implant. Mean follow-up time was 11 years. Of 334 inserted Brånemark implants, with machined surface, 27 failed. Estimated implant survival rate was 90%. Marginal bone loss was 1.8 mm 1 year after implant surgery; 2.3 mm after 5 years; and 2.4 mm after 10 years. There was a significant difference between genders in implant survival. Marginal bone loss differed significantly between smokers and non-smokers up to the 5-year examination and between genders after the 4-year examination. The onlay bone graft, with or without a maxillary inlay graft, results in high implant survival rate, good oral function and stabilised marginal bone. All patients are still wearing their original fixed bridges.

  • 10.
    Nyström, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Gunne, Johan
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Reconstruction of the atrophic maxilla with interpositional bone grafting/Le Fort I osteotomy and endosteal implants: A 11-16 year follow-up.2009In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 38, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    A Le Fort I osteotomy and interpositional bone graft in combination with implants was used in the reconstruction of patients with extreme atrophy in their maxillae. Surgery was performed in a two-stage procedure. The patients in this study had conditions with reversed intermaxillary relationships with or without increased vertical intermaxillary distance. The aim of the study was to investigate treatment outcome for patients in a prospective, long-term, follow-up with a mean of 13 years (range 11-16 years), concerning implant survival rate and marginal bone loss adjacent to the surfaces of the implant. The impact of gender and smoking was also investigated. Twenty-six patients were included in the study. Of 167 implants, 24 failed. The implant estimated survival rate was 85% at the end of the follow-up. There was no significant difference between smokers and non-smokers or genders concerning implant survival. Marginal bone loss was 2.5, 2.9, 3.0 and 3.1mm from the implant-abutment junction, after 1, 2, 5 and 10 years, respectively. The bone level stabilised after 2 years. This technique results in good facial morphology, good oral function and aesthetics. All patients are still wearing their original fixed bridges.

  • 11. Rosenquist, J B
    et al.
    Nyström, Elisabeth
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Surgery.
    Occlusion of the incisal canal with bone chips. A procedure to facilitate insertion of implants in the anterior maxilla.1992In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 21, no 4, p. 210-211Article in journal (Refereed)
    Abstract [en]

    In 4 patients, who had lost one or both central maxillary incisors due to trauma, the incisal canals were filled with autogenous cancellous bone harvested from the chin. After a healing period of 4-5 months implants were inserted. At the time of implant surgery in all cases the canal appeared to be replaced by cancellous bone and the implants were placed partially into the grafted area. After another 6 months abutments were connected and crowns made. After follow-up of between 12 and 15 months no fixture has been lost.

  • 12.
    Sjöström, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Nilson, Hans
    Umeå University, Faculty of Medicine, Department of Odontology, Prosthetic Dentistry.
    Sennerby, Lars
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Monitoring of implant stability in grafted bone using resonance frequency analysis: A clinical study from implant placement to 6 months of loading.2005In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 34, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    The aim of this prospective study was to compare implants placed in grafted and normal non-grafted maxilla by means of resonance frequency analysis (RFA), clinical stability and implant failure. Twenty-nine patients with severe atrophy of the edentulous maxilla were treated with autogenous bone grafts as onlay (24 patients) or as interpositional grafts in conjunction with a Le Fort I osteotomy (five patients) 6 months prior to placement of 222 implants. Ten non-grafted patients treated with 75 Brånemark implants in the edentulous maxillae served as a control group. RFA was performed at implant placement, abutment connection and after 6 months of bridge loading. Seventeen (8%) implants were lost in the grafted bone and one (1%) in normal bone. RFA revealed a similar pattern in both grafted and normal maxillae, i.e. increasing resonance frequency (RF) with time (Wilcoxon Signed Rank test for paired data). Twenty implants that were rotation mobile (low primary stability) at the time of insertion showed a significantly lower value at implant placement according to RFA (Mann-Whitney U-test, P = 0.020). The RF for the failed implants revealed a tendency towards lower values (Mann-Whitney U-test, P = 0.072), compared to the successful implants. It is concluded that implants placed in grafted bone when using a two-stage technique achieve a stability similar to that of implants placed in normal non-grafted bone.

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