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  • 201. Hultin, Margareta
    et al.
    Davidson, Thomas
    Gynther, Goran
    Helgesson, Gert
    Jemt, Torsten
    Lekholm, Ulf
    Nilner, Krister
    Nordenram, Gunilla
    Norlund, Anders
    Rohlin, Madeleine
    Sunnegårdh-Grönberg, Karin
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Tranaeus, Sofia
    Oral Rehabilitation of Tooth Loss: A Systematic Review of Quantitative Studies of OHRQoL2012In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, no 6, p. 543-552Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). Materials and Methods: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. Results: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. Conclusions: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.

  • 202.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Fält, Anna
    Hägg, Mary
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Swallowing dysfunction as risk factor for undernutrition in older people admitted to Swedish short-term care: a cross-sectional study2019In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 31, no 1, p. 85-94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Swallowing dysfunction and risk of undernutrition increase the risk of pneumonia, morbidity, and mortality. Short-term care is an unexplored care context, where many older people stay yearly.

    AIM: This cross-sectional study aimed to describe and analyze the relationship between swallowing dysfunction and risk of undernutrition among older people in short-term care, including potential gender-related differences.

    METHODS: In total, 391 people (209 women), aged ≥ 65 years (median age 84 years) and admitted to short-term care in five Swedish counties participated. They went through a timed water swallow test to assess swallowing dysfunction, including abnormal swallowing capacity and signs of aspiration (i.e., cough and voice change). Risk for undernutrition was assessed using the Minimal Eating Observation and Nutrition Form-version II.

    RESULTS: Swallowing dysfunction was observed in 248 of 385 (63%) participants, including abnormal swallowing capacity in 213 of 385 (55%) and aspiration signs in 127 of 377 (34%). Abnormal swallowing capacity was more frequent among women (p = 0.030), whereas men with normal swallowing capacity exhibited signs of aspiration more frequently (cough p = 0.038, voice change p = 0.004). Risk of undernutrition was found in 91 of 390 (23%) participants, more frequently among women (p = 0.007). A logistic regression model revealed an increased risk of undernutrition among older people with abnormal swallowing capacity (OR 1.74, 95% CI 1.04-2.92, p = 0.034).

    CONCLUSIONS: The high prevalence of swallowing dysfunction and risk of undernutrition highlight the need for a systematic screening program and feasible treatment to improve swallowing function for adequate and safe food intake among older people in short-term care.

    CLINICAL TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov on July 4, 2016, under NCT02825927.

  • 203.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Olai, Lena
    Ståhlnacke, Katri
    Persenius, Mona
    Hagg, Mary
    Andersson, Maria
    Koistinen, Susanne
    Carlsson, Eva
    Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 78Article in journal (Refereed)
    Abstract [en]

    Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia).

    Methods/Design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality.

    Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT <10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups.

    Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

  • 204.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Susanne, Koistinen
    Olai, Lena
    Ståhlnacke, Katri
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Older people with swallowing dysfunction and poor oral health are at greater risk of early death2019In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528Article in journal (Refereed)
    Abstract [en]

    Objectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

    Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).

    Results: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02‐2.75; P = .041 and aHR: 1.98, 95% CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).

    Conclusions: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.

  • 205.
    Hägglund, Paul
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Segerdal, Staffan
    Forsberg, Carl-Magnus
    The integrated Herbst appliance-treatment effects in a group of adolescent males with Class II malocclusions compared with growth changes in an untreated control group2008In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 30, no 2, p. 120-127Article in journal (Refereed)
    Abstract [en]

    In this study, the effect of the integrated Herbst appliance (IHA) was examined in 30 Swedish males (mean age 14.2 +/- 0.96 years) with a Class II malocclusion. An evaluation of hand-wrist radiographs showed that the patients were in the maturation stages MP3-F, MP3-FG, or MP3-G at the start of treatment. The average treatment time with the Herbst mechanics was 0.7 years. Dentoskeletal and soft tissue parameters were analysed on lateral radiographic head films taken at the start and end of the IHA treatment. The pre- and post-Herbst values of a number of skeletal and dental variables in the treatment group were compared with the corresponding values in a group of untreated age-matched males with Class II malocclusions. Differences in the cephalometric measurements pre- and post-Herbst treatment were determined using paired t-tests. In general, the control group exhibited only minor or no changes during the period of observation, whereas treatment with the IHA resulted in statistically significant and favourable changes of the recorded variables. In the IHA patients, ANB angle was reduced on average by 2.1 degrees. However, a skeletal post-normality (ANB = 3.9 degrees) remained even though a Class I dental relationship had been obtained. In comparison with treatment effects achieved with other designs of Herbst appliances, some minor differences in the changes of the variables SNA and ML/NSL were noted in the present study. These differences could probably be attributed to the particular treatment protocol which was applied in the IHA treatments.

  • 206.
    Häggman Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö; Faculty of Odontology, Health Technology Assessment – Odontology (HTA-O), Malmö.
    Alstergren, P.
    Davidson, T.
    Högestätt, E. D.
    Östlund, P.
    Umeå University, Faculty of Medicine, Department of Odontology. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm.
    Tranaeus, S.
    Umeå University, Faculty of Medicine, Department of Odontology. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm.
    Vitols, S.
    List, T.
    Pharmacological treatment of oro-facial pain: health technology assessment including a systematic review with network meta-analysis2017In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, no 10, p. 800-826Article, review/survey (Refereed)
    Abstract [en]

    This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients >= 18 years with chronic (>= 3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [ temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

  • 207.
    Häggman Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Grönqvist, Johan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Eriksson, Per-Olof
    Umeå University, Faculty of Medicine, Department of Odontology.
    Frequent jaw-face pain in chronic Whiplash-Associated Disorders2011In: Swedish Dental Journal, ISSN 0347-9994, Vol. 35, no 3, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Chronic Whiplash-Associated Disorders (WAD) present with frequent pain in the neck, head and shoulder regions but the presence of frequent jaw-face pain is unclear. The aim of the study was to investigate the frequency of jaw-face pain in other regions, and general symptoms in chronic WAD patients. Fifty whiplash-patients  and 50 healthy age- and sex-matched controls were examined by qustionnaire for pain in the jaw-face, pain in other regions and other symptoms.

    In contrast to healthy, a majority of the WAD patients (88%) reported frequent pain in the jaw-face, in addition to frequent pain in the neck (100%), shoulders (94%), head (90%) and back (72%). The WAD patients also reported stiffness and numbness in the jaw-face region, and frequent general symptoms such as balance problems, stress and sleep disturbances.

    The result suggests that frequent pain in the jaw-face can be part of the spectrum of symptoms in chronic WAD. The finding of self-reported numbness in the jaw-face indicates disturbed trigeminal nerve function and merits further investigation. We conclude that assessment of WAD should include pain in the jaw-face region. A multidisciplinary rehabilitation program including dentists, preferably specialized in the area of orofacial pain, should be advocated after whiplash injury.

  • 208.
    Häggman Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    List, Thomas
    Westergren, Hans
    Axelsson, Susanna
    Temporomandibular Disorder Pain After Whiplash Trauma: A Systematic Review2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 3, p. 217-226Article, review/survey (Refereed)
    Abstract [en]

    Aims: To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether treatment modalities commonly used for TMD are equally effective in patients with solely TMD pain and those with TMD/whiplash-associated disorders (WAD) pain. Methods: A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012. The systematic search identified 125 articles. After an initial screening of abstracts, 45 articles were reviewed in full text. Two investigators evaluated the methodological quality of each identified study. Results: Eight studies on prevalence/incidence of TMD pain in WAD and four studies on interventions in TMD pain and WAD met the inclusion criteria. The reported median prevalence of TMD pain after whiplash trauma was 23% (range 2.4% to 52%) and the incidence ranged from 4% to 34%. For healthy controls, the reported median prevalence was 3% (range 2.5% to 8%) and the incidence ranged from 4.7% to 7%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect (median improvement rate of 48%, range 13% to 68%) compared to TMD patients without a whiplash injury (75%, range 51% to 91%). Conclusion: There is some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region.

  • 209.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
    Lampa, Ewa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Marklund, Susanna
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Pain and Disability in the Jaw and Neck Region following Whiplash Trauma2016In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 10, p. 1155-1160Article in journal (Refereed)
    Abstract [en]

    The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain.

  • 210.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lampa, Ewa
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders2013In: International Journal of Oral Science, ISSN 1674-2818, Vol. 5, no 3, p. 150-154Article in journal (Refereed)
    Abstract [en]

    There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury. Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma. The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders (WADs) with both a qualitative method and quantitative sensory testing (QST). Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women. Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits. Seven test sites in the facial skin (overlying each trigeminal branch bilaterally, and the midpoint of the chin) were examined. The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds. For the WAD patients, the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy, whereas QST systematically showed significantly higher detection thresholds (i.e., decreased sensitivity) for both cold and warm stimuli. For the individuals who were assessed as having increased sensitivity in the qualitative assessment, the QST displayed either normal or higher thresholds, i.e., decreased sensitivity. The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method. The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

  • 211.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Eriksson, Per-Olof
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Increased sternocleidomastoid, but not trapezius, muscle activity in response to increased chewing load2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 5, p. 443-449Article in journal (Refereed)
    Abstract [en]

    Previous findings, during chewing, that boluses of larger size and harder texture result in larger amplitudes of both mandibular and head-neck movements suggest a relationship between increased chewing load and incremental recruitment of jaw and neck muscles. The present report evaluated jaw (masseter and digastric) and neck [sternocleidomastoid (SCM) and trapezius] muscle activity during the chewing of test foods of different sizes and textures by 10 healthy subjects. Muscle activity was recorded by surface electromyography and simultaneous mandibular and head movements were recorded using an optoelectronic technique. Each subject performed continuous jaw-opening/jaw-closing movements whilst chewing small and large boluses of chewing gum and rubber silicone (Optosil). For jaw opening/jaw closing without a bolus, SCM activity was recorded for jaw opening concomitantly with digastric activity. During chewing, SCM activity was recorded for jaw closing concomitantly with masseter activity. Trapezius activity was present in some, but not all, cycles. For the masseter and SCM muscles, higher activity was seen with larger test foods, suggesting increased demand and recruitment of these muscles in response to an increased chewing load. This result reinforces the previous notion of a close functional connection between the jaw and the neck motor systems in jaw actions and has scientific and clinical significance for studying jaw function and dysfunction.

  • 212.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neurophysiology.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Eriksson, Per-Olof
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Head Immobilization can Impair Jaw Function2006In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 85, no 11, p. 1001-1005Article in journal (Refereed)
    Abstract [en]

    Findings that jaw-opening/-closing relies on both mandibular and head movements suggest that jaw and neck muscles are jointly activated in jaw function. This study tested the hypothesis that rhythmic jaw activities involve an active repositioning of the head, and that head fixation can impair jaw function. Concomitant mandiular and head-neck movements were recorded during rhythmic jaw activities in 12 healthy adults, with and without fixation of the head. In four participants, the movement recording was combined with simultaneous registration of myoelectric activity in jaw and neck muscles. The results showed neck muscle activity during jaw opening with and without head fixation. Notably, head fixation led to reduced mandibular movements and shorter duration of jaw-opening/-closing cycles. The findings suggest recruitment of neck muscles in jaw activities, and that head fixation can impair jaw function. The results underline the jaw and neck neuromuscular relationship in jaw function.

  • 213.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial Pain and Jaw Function, Malmö University, Malmö.
    Rezvani, M.
    Department of Orofacial Pain and Jaw Function, Malmö University, Malmö.
    List, T.
    Department of Orofacial Pain and Jaw Function, Malmö University, Malmö and Department of Rehabilitation Medicine, Skåne University Hospital, Lund,.
    Prevalence of whiplash trauma in TMD patients: a systematic review2014In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 1, p. 59-68Article, review/survey (Refereed)
    Abstract [en]

    The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 84% to 70% (median 35%) in TMD populations, compared with 17-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.

  • 214.
    Häggman-Henrikson, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orofacial pain and Jaw function, Malmö University, Malmö, Sweden.
    Wiesinger, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Research and Development, Västernorrland County Council, Umeå University, Umeå, Sweden.
    Wänman, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 1, p. 6-12Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effect of a supervised exercise program in patients with localized/regional temporomandibular disorder (TMD) pain and with TMD associated with generalized pain.

    Material and methods: Consecutively referred patients with localized/regional TMD pain (n = 56; 46 women and 10 men, mean age 44 years) and TMD associated with generalized pain (n = 21; 21 women, mean age 41 years) participated. Patients underwent a 10-session structured supervised exercise program over 10-20 weeks that included relaxation, and coordination and resistance training of the jaw and neck/shoulders. The outcomes were jaw pain intensity on the Numerical Rating Scale, endurance time for jaw opening and protrusion against resistance and chewing, and effect of pain on daily activities.

    Results: After the exercise program, a reduction in jaw pain was reported by the local (p = .001) and general (p = .011) pain groups. There were no significant differences in jaw pain intensity between the groups, before (p = .062) or after treatment (p =.121). Endurance time increased for both groups for jaw opening/protrusion (both p <. 001) and chewing (both p = .002). The effect of jaw pain on daily activities decreased after exercise compared to baseline for both the local (p < .001) and general (p = .008) pain groups.

    Conclusions: Supervised exercise can reduce TMD pain and increase capacity in patients with TMD. The results suggest that activation of the jaw motor system with exercise has a positive effect in patients with localized/regional TMD pain and TMD associated with generalized pain.

  • 215. Hänsel Petersson, G
    et al.
    Fure, S
    Twetman, Svante
    Umeå University, Faculty of Medicine, Odontology, Pediatric Dentistry.
    Bratthall, D
    Comparing caries risk factors and caries risk profiles in children and elderly.2004In: Swedish dental journal, Vol. 28, no 3, p. 119-128Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors. Another aim was to find out if there were gender differences among the participants. The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the ‘percent chance of avoiding caries’ in the future. Methods: The Cariogram was earlier evaluated in two longitudinal studies for its capacity to assess caries risk. One study comprised about 400 children, 10-11 years of age and the other study included about 150 elderly (age 55, 65 and 75). At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and the participants were divided into five groups according to the calculated Cariogram risk profiles. After two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Results: The Cariogram risk predictions were statistically in agreement with the actual caries increment. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26.4% belonged to the highest caries risk group versus 3.1% of the children. The median value ‘chance of avoiding caries’ was 44% for the elderly and 80% for the children. The main Cariogram sectors contributing to the observed higher caries risk among elderly was the bacterial components in combination with higher susceptibility. Individual factors contributing significantly to the higher risk profiles for the adults compared to the children were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Conclusion: comparing the risk profiles of the children and the elderly showed that the elderly were at a higher risk developing caries lesions. Overall one may say that the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.

  • 216.
    Hänström, Lennart
    Umeå University, Faculty of Medicine, Department of Odontology.
    The effect of diphenylhydantoin on the metabolism of connective tissue macromolecules in oral mucosa and bone in vitro: a biochemical study1981Doctoral thesis, comprehensive summary (Other academic)
  • 217.
    Höglund Åberg, Carola
    Umeå University, Faculty of Medicine, Department of Odontology.
    Exotoxins of Aggregatibacter actinomycetemcomitans and periodontal attachment loss in adolescents2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aggregatibacter actinomycetemcomitans is an oral bacterium that is mainly associated with aggressive forms of periodontitis, which most often starts at an early age. Amongst the virulence factors of A. actinomycetemcomitans, two exotoxins, the leukotoxin (LtxA) and the cytolethal distending toxin (Cdt), are suggested to play an important role in the pathogenicity of aggressive periodontitis. There is also a genetic diversity of the different strains of A. actinomycetemcomitans, and a variation in the ability of different strains to express and release exotoxins has been suggested. Of the different genotypes of A. actinomycetemcomitans, the highly leukotoxic JP2 genotype, which is prevalent in individuals of African origin, seems to be the genotype that is most strongly associated with localized aggressive periodontitis.

    This thesis is built upon studies of a West African adolescent population. The aim was to study the virulence characteristics of A. actinomycetemcomitans genotypes with a specific focus on the LtxA and the Cdt in relation to the progression of attachment loss (AL). The specific aim was first, to investigate cross-sectionally the presence of the JP2 and non-JP2 genotypes of A. actinomycetemcomitans in relation to the prevalence of AL and then prospectively to assess the progression of AL in a Ghanaian adolescent population. Second, in clinical isolates of A. actinomycetemcomitans obtained from the participants of the study, the serotypes and the virulence characteristics related to the two exotoxins were studied and associated with the progression of AL at the individual level.

    In Paper I, based on the study population consisting of 500 adolescents (mean age 13.2 years; SD ±1.5), it was shown that the overall carrier rate of A. actinomycetemcomitans was high (54.4%) and that the presence of this bacterium was associated with AL ≥ 3 mm. The JP2 genotype was prevalent (8.8%) in this population. In Paper II, 397 (79.4%) of the study participants were periodontally examined again at a 2-year follow-up. The presence of the JP2 genotype of A. actinomycetemcomitans in subgingival plaque was strongly associated with the progression of AL. This study also provided support for an enhanced estimated risk (odds ratio, OR=3.4), though less pronounced, for the progression of AL in individuals positive for the non-JP2 genotypes of A. actinomycetemcomitans.

    In Paper III, all three cdt genes (a, b and c) were detected in 79% of the examined A. actinomycetemcomitans isolates, all of which expressed an active toxin. The distribution of the cdt genes showed a serotype-dependent pattern. In particular, the presence of the b serotypes (both JP2 and non-JP2 genotypes) was associated with the disease progression, whereas the expression of Cdt was not particularly related to the disease progression.  In Paper IV, it was shown that the presence of of A. actinomycetemcomitans isolates with high leukotoxicity, also those of the non-JP2 genotypes of A. actinomycetemcomitans, were associated with an increased risk of the progression of AL in relation to the reference group. The main proportion of the serotype b isolates was distributed in the category of highly leukotoxic isolates. The analyses of the non-JP2 genotypes of serotype b indicated a diversity linked to the level of leukotoxicity.

    In conclusion, A. actinomycetemcomitans in general was associated with the progression of AL. Individuals with an increased risk of developing progression of AL mainly harboured isolates of A. actinomycetemcomitans with a high leukotoxicity, which suggests that the LtxA is an important virulence factor. Of the two exotoxins, the pathogenic potential was mainly associated with the LtxA, while the role of the Cdt is unclear.

  • 218.
    Höglund Åberg, Carola
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology.
    Antonoglou, Georgios
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology.
    Haubek, Dorte
    Section for Pediatric Dentistry, Department of Dentistry, Health, Århus University, Århus, Denmark.
    Kwamin, Francis
    Dental School University of Ghana, Accra, Ghana.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Cytolethal distending toxin in isolates of Aggregatibacter actinomycetemcomitans from Ghanaian adolescents and association with serotype and disease progression 2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, p. e65781-Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: The cytolethal distending toxin (Cdt) is a highly conserved exotoxin that are produced by a number of Gram negative bacteria, including Aggregatibacter actinomycetemcomitans, and affects mammalian cells by inhibiting cell division and causing apoptosis. A complete cdt-operon is present in the majority of A. actinomycetemcomitans, but the proportion of isolates that lack cdt-encoding genes (A, B and C) varies according to the population studied. The objectives of this study were to examine serotype, Cdt-genotype, and Cdt-activity in isolates of A. actinomycetemcomitans collected from an adolescent West African population and to examine the association between the carrier status of A. actinomycetemcomitans and the progression of attachment loss (AL).

    Material and Methods: A total of 249 A. actinomycetemcomitans isolates from 200 Ghanaian adolescents were examined for serotype and cdt-genotype by PCR. The activity of the Cdt-toxin was examined by DNA-staining of exposed cultured cells and documented with flow cytometry. The periodontal status of the participants was examined at baseline and at a two-year follow-up.

    Results: Presence of all three cdt-encoding genes was detected in 79% of the examined A. actinomycetemcomitans isolates. All these isolates showed a substantial Cdt-activity. The two different cdt-genotypes (with and without presence of all three cdt-encoding genes) showed a serotype-dependent distribution pattern. Presence of A. actinomycetemcomitans was significantly associated with progression of AL (OR = 5.126; 95% CI = [2.994 - 8.779], p < 0.001).

    Conclusion: A. actinomycetemcomitans isolated from the Ghanaian adolescents showed a distribution of serotype and cdt-genotype in line with results based on other previously studied populations. Presence of A. actinomycetemcomitans was significantly associated with disease progression, in particular the b serotype, whereas the association with disease progression was not particularly related to cdt-genotype, and Cdt-activity.

  • 219.
    Höglund Åberg, Carola
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Haubek, Dorte
    Århus University.
    Kwamin, Francis
    Ghana University.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Leukotoxic activity of Aggregatibacter actinomycetemcomitans and periodontal attachment loss2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 8, p. e104095-Article in journal (Refereed)
    Abstract [en]

    Aggregatibacter actinomycetemcomitans is a Gram-negative periodontitis-associated bacterium that expresses a toxin that selectively affects leukocytes. This leukotoxin is encoded by an operon belonging to the core genome of this bacterial species. Variations in the expression of the leukotoxin have been reported, and a well-characterized specific clonal type (JP2) of this bacterium with enhanced leukotoxin expression has been isolated. In particular, the presence of the JP2 genotype significantly increases the risk for the progression of periodontal attachment loss (AL). Based on these findings we hypothesized that variations in the leukotoxicity are linked to disease progression in infected individuals. In the present study, the leukotoxicity of 239 clinical isolates of A. actinomycetemcomitans was analysed with different bioassays, and the genetic peculiarities of the isolates were related to their leukotoxicity based on examination with molecular techniques. The periodontal status of the individuals sampled for the presence of A. actinomycetemcomitans was examined longitudinally, and the importance of the observed variations in leukotoxicity was evaluated in relation to disease progression. Our data show that high leukotoxicity correlates with an enhanced risk for the progression of AL. The JP2 genotype isolates were all highly leukotoxic, while the isolates with an intact leukotoxin promoter (non-JP2 genotypes) showed substantial variation in leukotoxicity. Genetic characterization of the non-JP2 genotype isolates indicated the presence of highly leukotoxic genotypes of serotype b with similarities to the JP2 genotype. Based on these results, we conclude that A. actinomycetemcomitans harbours other highly virulent genotypes besides the previously described JP2 genotype. In addition, the results from the present study further highlight the importance of the leukotoxin as a key virulence factor in aggressive forms of periodontitis.

  • 220.
    Höglund Åberg, Carola
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Kwamin, Francis
    Ghana University.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlén, Gunnar
    Göteborgs Universitet.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Haubek, Dorte
    Århus Universitet, Danmark.
    Progression of attachment loss is strongly associated with presence of the JP2 genotype of Aggregatibacter actinomycetemcomitans: a prospective cohort study of a young adolescent population2014In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 41, no 3, p. 232-241Article in journal (Refereed)
    Abstract [en]

    AIM: To assess the progression of attachment loss (AL) during a two-year period according to the presence of JP2 and non-JP2 genotypes of A. actinomycetemcomitans in a Ghanaian adolescent population.

    METHODS: A total of 500 adolescents (mean age 13.2 years, SD± 1.5) were enrolled in the study. After two years, 397 (79.4%) returned for a periodontal re-examination, including the measurement of AL. The carrier status of the JP2 and non-JP2 genotypes of A. actinomycetemcomitans was evaluated in a baseline examination two years earlier.

    RESULTS: Individuals who carried the JP2 genotype of A. actinomycetemcomitans had a significantly increased risk (relative risk (RR) = 7.3) of developing AL ≥ 3 mm. The mean AL at the follow-up and the mean two-year progression of AL was significantly higher in the JP2 genotype-positive group (n=38) compared with the group positive for the non-JP2 genotypes of A. actinomycetemcomitans (n=169), and the group of A. actinomycetemcomitans-negative individuals (n=190). The JP2 genotype was strongly associated with the progression of AL ≥ 3 mm (OR= 14.3). The non-JP2 genotypes of A. actinomycetemcomitans were also, however less pronounced, associated with the progression of AL ≥ 3 mm (OR=3.4).

    CONCLUSION: The JP2 genotype of A. actinomycetemcomitans is strongly associated with the progression of AL.

  • 221.
    Ihalin, Riikka
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Biochemistry, University of Turku, Turku, Finland.
    Eneslatt, Kjell
    Umeå University, Faculty of Medicine, Department of Odontology.
    Asikainen, Sirkka
    Umeå University, Faculty of Medicine, Department of Odontology.
    Peptidoglycan-associated lipoprotein of Aggregatibacter actinomycetemcomitans induces apoptosis and production of proinflammatory cytokines via TLR2 in murine macrophages RAW 264.7 in vitro2018In: Journal of Oral Microbiology, ISSN 2000-2297, E-ISSN 2000-2297, Vol. 10, article id 1442079Article in journal (Refereed)
    Abstract [en]

    Peptidoglycan-associated lipoprotein (PAL) is a conserved pro-inflammatory outer membrane lipoprotein in Gram-negative bacteria. Compared to systemic pathogens, little is known about the virulence properties of PAL in Aggregatibacter actinomycetemcomitans (AaPAL). The aims of this study were to investigate the cytolethality of AaPAL and its ability to induce pro-inflammatory cytokine production in macrophages. Mouse macrophages were stimulated with AaPAL, and the production of IL-1β, IL-6, TNF-α, and MCP-1 was measured after 6, 24, and 48 h. To investigate which receptor AaPAL employs for its interaction with macrophages, anti-toll-like receptor (TLR)2 and anti-TLR4 antibodies were used to block respective TLRs on macrophages. Metabolic activity and apoptosis of the macrophages were investigated after stimulation with AaPAL. AaPAL induced the production of MCP-1, TNF-α, IL-6, and IL-1β from mouse macrophages in order of decreasing abundance. The pre-treatment of macrophages with an anti-TLR2 antibody significantly diminished cytokine production. Under AaPAL stimulation, the metabolic activity of macrophages decreased in a dose-and time-dependent manner. Furthermore, AaPAL induced apoptosis in 56% of macrophages after 48 h of incubation. Our data suggest that AaPAL can kill macrophages by apoptosis. The results also emphasize the role of AaPAL as a potent pro-inflammatory agent in A. actinomycetemcomitans-associated infections.

  • 222.
    Isberg, A
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring-Jäghagen, E
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlström, M
    Dahlqvist, A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function.1998In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 118, no 6, p. 870-874Article in journal (Refereed)
    Abstract [en]

    In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

  • 223.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    The life-threatening TMD2009In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, Vol. 27, no 1, p. 1-2Article in journal (Refereed)
  • 224.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Kreiner, Marcelo
    Craniofacial pain: authors' response2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 4, p. 440-441Article in journal (Refereed)
  • 225.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Salé, Hanna
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Recalling pain: author's response2011In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 142, no 1, p. 24-24Article in journal (Refereed)
  • 226.
    Isberg, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Salé, Hanna
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    TMJ and whiplash: reply2007In: The Journal of the American Dental Association (1939), ISSN 0002-8177, E-ISSN 1943-4723, Vol. 138, no 11, p. 1422-1422Article in journal (Other academic)
  • 227.
    Isehed, Catrine
    Umeå University, Faculty of Medicine, Department of Odontology. Folktandvården Gävleborg AB, Region Gävleborg.
    Peri-implantitis: treatment and effects of enamel matrix derivative2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Biological complications affecting osseointegrated dental implants are a growing treatment problem in clinical practice. Since the number of implant carriers has increased in recent decades, this is an urgent topic in dentistry. Peri-implantitis, inflammatory degradation of the implant-supporting jawbone, affects approximately 20% of all implant carriers and approximately 10% of all implants.

    Implant surfaces are colonised by microbes that may cause an inflammatory process in the soft tissue around the implant. In some sensitive individuals, the inflammatory response leads to disturbed jawbone remodelling, with increased recruitment and activity of bone-resorbing osteoclasts, which could ultimately lead to implant loss. The corresponding degradation of the bone supporting the teeth is denoted as periodontitis. The current view is that factors such as proinflammatory cytokines and prostaglandins, produced by leukocytes and cells of mesenchymal origin in the inflamed connective tissue, are responsible for local osteoclast recruitment and activation. Pro-inflammatory factors and tissue degradation products will leak into the exudate in the peri-implant sulci and the gingival pockets around the teeth. Analysis of the exudate could be of use for predicting and monitoring peri-implantitis, as well as identifying new targets for treatment.

    The standard treatment for peri-implantitis is surgery in combination with mechanical cleaning of the implant surface and optimisation of oral hygiene, with the goal of achieving infection control and pocket reduction. This treatment has a moderate effect on healing of the peri-implantitis lesion around the dental implant. The use of adjunctive bone grafts, membranes and antimicrobials has thus far not been shown to achieve a more successful outcome. Adjunctive treatment with enamel matrix derivative (EMD) during regenerative periodontal surgery contributes to wound healing and increased tissue support, but the adjunctive effect of EMD during surgical treatment of peri-implantitis remains unknown.

    The overall aim of this thesis was to investigate the outcome of a regenerative surgical treatment approach with and without adjunctive EMD treatment from the short- and long-term perspectives and to increase our knowledge of microbial flora and biomarkers in the peri-implant sulci before and after treatment. Furthermore, an additional aim of this work was to investigate whether EMD could directly affect osteoclast formation and activity.

    We performed a randomised controlled clinical trial of a surgical intervention for peri-implantitis with and without EMD. In multivariate modelling, an increased marginal bone level at the implant site 12 months after surgery was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a gram-positive/aerobic microbial flora, whereas a reduced bone level was associated with a gram-negative/anaerobic microbial flora and the presence of bleeding and pus, with a cross-validated predictive capacity (Q2) of 36.4%. Similar trends were observed for bone level, pocket depth, plaque, pus and bleeding, but these associations were statistically non-significant in the univariate analysis. Five years after treatment, no significant differences in bone level changes were observed between groups, but fewer implants were lost to follow-up due to reinfections in the EMD-treated group.

    We used mass spectrometry to analyse the protein content in peri-implant crevicular fluid (PICF) before and up to 12 months after treatment. The total protein amount and diversity displayed decreasing trends 3, 6 and 12 months after treatment. Multivariate analysis of the PICF protein content revealed two major groups, cluster 2 and cluster 3, of which cluster 2 was associated with an increased risk of implant loss. EMD treatment was associated with cluster 3, which was in turn associated with increased implant survival.

    To test whether EMD affects osteoclast formation or bone resorption, we added purified EMD to RANKL-stimulated mouse bone marrow macrophage cultures in plastic dishes and counted the number of osteoclasts. We also cultured the cells on bone slices and measured the secretion of TRAP5b and the release of CTX-1 into the culture medium as biomarkers of osteoclast numbers and bone resorption, respectively, but no effect of EMD was observed.

    In conclusion, adjunctive EMD during surgical treatment of peri-implantitis changed the microbial flora to a less pathogenic microbiota, and similar changes in the inflammatory protein profile of PICF were observed; these effects were associated with implant survival. However, the trend toward a positive healing response after EMD treatment was not associated with a significant radiographic bone gain in this study and needs to be further explored. In addition, our finding that EMD did not affect osteoclast formation or bone resorption in vitro indicates that the effect of EMD on bone regeneration, as seen in periodontitis treatment, does not seem to depend on a direct inhibitory effect on osteoclast formation or bone resorption.

  • 228.
    Isehed, Catrine
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Periodontology, Gävle County Hospital, Gävle, Sweden; Center for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Holmlund, Anders
    Renvert, Stefan
    Svenson, Bjorn
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis: A randomized controlled trial2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 10, p. 863-873Article in journal (Refereed)
    Abstract [en]

    Objective: This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD).

    Methods: Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months.

    Results: In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram-/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q(2)) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis.

    Conclusion: Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.

  • 229.
    Isehed, Catrine
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Periodontology, Public Dental Health County Council of Gävleborg, Gävle County Hospital, Gävle, Sweden; Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Svenson, Björn
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Holmlund, Anders
    Surgical treatment of peri-implantitis using enamel matrix derivative, an RCT: 3-and 5-year follow-up2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 6, p. 744-753Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the clinical and radiographic outcomes 3 and 5years after the surgical treatment of peri-implantitis per se or in combination with an enamel matrix derivative (EMD).

    Materials and Methods: At baseline, 29 patients were randomized to surgical treatment with adjunctive EMD or no EMD. One year after the surgical treatment of peri-implantitis, 25 patients remained eligible for survival analyses at the 3- and 5-year follow-up. The primary outcomes were implant loss and bone level (BL) change measured on radiographs, and the secondary outcomes, bleeding on probing, pus and plaque at each implant were analysed in 18 and 14 patients at the 3- and 5-year follow-up, respectively.

    Results: After exclusion of four patients who discontinued the study, at the 3-year follow-up, 13 (100%) implants survived in the EMD group, and 10 of 12 (83%) in the non-EMD group. At the 5-year follow-up, 11 of 13 (85%) implants in the EMD group and nine of 12 (75%) in the non-EMD group survived. In multivariate modelling, BL changes and EMD treatment were positively associated with implant survival. Similarly, the same trend was seen in univariate analysis.

    Conclusions: An exploratory analysis suggests that adjunctive EMD is positively associated with implant survival up to 5 years, but larger studies are needed.

  • 230.
    Jajo, Merna
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Sjöblom, Nikolina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Analysis of selected virulence properties of Filifactor alocis2018Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    Filifactor alocis is a gram-positive rod-shaped bacterium, and several studies have demonstrated that the species is associated with periodontal disease. It has several proteins and properties that makes it a potential partner in crime in a disease process. Here we studied a small collection of 10 isolates of F. alocis, sampled for routine analysis at Oral Microbiology. One of the main questions of this exam project was to investigate if there was any genotypic and/or phenotypic differences between those isolates with potential association with virulence. To examine that we used a selection of laboratory methods, including PCR, SDS-PAGE, Silver-staining, extraction of membrane vesicles, Western immunoblotting and cytotoxicity assays on human macrophages. Our results show that there were both genotypic and phenotypic differences among the 10 strains. For example, they could be divided in two genotypes, based on carriage of gene (here denoted rtx) encoding a protein with similarity to Leukotoxin.  There were also differences in their protein content. Of the two tested F. alocis strains, frozen whole cell extracts from them both showed a similar dose-dependent cytotoxic effect on macrophages.  It also showed that the cytotoxicity did not depend on the rtx gene product since this study was conducted on two F. alocis strains, one with the rtx gene and the other without. In conclusion, our study could come in use in characterizing different F. alocis strains and their virulence factors in order to find future ways to reduce its virulence.

     

  • 231.
    Jashari, Fisnik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Jäghagen, Eva Levring
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT2015In: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 16, no 8, p. 19978-19988Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT).

    METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations.

    RESULTS: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8-35; 36-70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients.

    CONCLUSION: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

  • 232.
    Jensen, Anne B.
    et al.
    Aarhus University, Denmark.
    Haubek, Dorte
    Aarhus University, Denmark.
    Claesson, Rolf
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nørskov-Lauritsen, Niels
    Aarhus University, Denmark.
    Comprehensive antimicrobial susceptibility testing of a large collection of clinical strains of Aggregatibacter actinomycetemcomitans does not identify resistance to amoxicillin2019In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 46, no 8, p. 846-854Article in journal (Refereed)
    Abstract [en]

    AIM: The present study aims to determine the susceptibility of Aggregatibacter actinomycetemcomitans to amoxicillin by investigating a large collection of oral strains of diverse geographical origin.

    METHODS: Two hundred and fifty-seven A. actinomycetemcomitans strains were serotyped using a multiplex polymerase chain reaction, and minimal inhibitory concentration (MIC) values of amoxicillin were determined using the agar dilution method (range 0.25 to 8.0 mg/L). The plates were spot-wise inoculated with approximately 104 colony-forming units, incubated in 5% CO2 at 37 C°, and visually inspected after 24 and 48 hours. A MIC ≤ 2.00 mg/L was categorised as susceptible using EUCAST interpretative criteria for Haemophilus species.

    RESULTS: Amoxicillin MIC-values varied from 0.25 mg/L to 2.00 mg/L, and all tested strains, including strains previously reported as resistant, were susceptible to amoxicillin. The MIC50 was 1.00 mg/L and the MIC90 was 2.00 mg/L.

    CONCLUSION: Meticulous investigation of strains including isolates previously reported as resistant could not confirm the emergence of resistance to β-lactams in A. actinomycetemcomitans. Based on the present in vitro results, amoxicillin can be considered a key oral antimicrobial agent for treatment of A. actinomycetemcomitans. This article is protected by copyright. All rights reserved.

  • 233.
    Johansson, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Buhlin, Kåre
    Sorsa, Timo
    Pussinen, Pirkko J
    Systemic Aggregatibacter Actinomycetemccomitans Leukotoxin-Neutralizing Antibodies in Periodontitis2017In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 88, no 1, p. 122-129Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The leukotoxin expressed by Aggregatibacter actinomycetemcomitans is a powerful exotoxin, which can cause imbalance in the host response. Immunoreactivity to the leukotoxin is a marker for the presence of leukotoxic A. actinomycetemcomitan, a presence that may modify the disease pattern of the colonized individuals. The aim of the present study was to examine the presence of systemic immunoreactivity to A. actionmycetemcomitans leukotoxin in relation to clinical and inflammatory findings in individuals with or without periodontitis (n = 88).

    METHODS: The periodontal status was examined in a population of cases (n = 49) and controls (n = 39), and the cases received periodontal treatment. Systemic biomarkers associated with inflammation and infections, as well as the clinical parameters, were analyzed at baseline, three months after treatment and six months after.

    RESULTS: The presence of immunoreactivity against leukotoxin was associated with impaired remission of the disease after periodontal treatment. This immunoreactivity was also significantly associated with increased systemic levels of A. actinomycetemcomtans-specific immunoglobulins and increasing age.

    CONCLUSION: The presence and levels of systemic immunoreactivity against A. actinomycetemcomitans leukotoxin are associated with a decreased remission after otherwise successful periodontal treatment.

  • 234.
    Johansson, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlén, Gunnar
    Odontologi, Göteborgs Universitet.
    Bacterial virulence factors that contributes to periodontal disease2017In: Pathogenesis of periodontal disease: biological concepts for clinicians / [ed] Nagihan Bostanci, Georgios N. Belibasakis, Cham: Springer Berlin/Heidelberg, 2017, p. 31-49Chapter in book (Refereed)
    Abstract [en]

    In this chapter, the role of different microbial virulence factors in relation to the pathogenesis of periodontal diseases is addressed. These factors are molecules produced by pathogens and contribute to their pathogenicity by promoting colonization and affecting host response. The importance of different virulence factors in the life of the oral biofilm and the interplay with the host’s response is exemplified here by two of the major, and most well studied, periodontal pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Both of these microbes have great genetic intraspecies diversity and express a number of different virulence factors, which have the capacity to cause imbalance in the host’s response. A. actinomycetemcomitans is the major pathogen in aggressive forms of periodontitis (Fig. 4.1) that affect young individuals, while P. gingivalis is frequently detected in periodontal pockets of individuals with the chronic forms of the disease (Fig. 4.2). However, the role of these two bacteria in periodontal breakdown is still not entirely clear.

  • 235.
    Johansson, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Molecular Periodontology.
    Kalfas, Sotos
    Aristotle University, Thessaloniki, Greece.
    Virulence Mechanisms of Leukotoxin from Aggregatibacter actinomycetemcomitans2012In: Oral Health Care: Prosthodontics, Periodontology, Biology, Research and Systemic Conditions / [ed] Mandeep Singh Virdi, Zagreb: InTech, 2012, p. 165-192Chapter in book (Refereed)
  • 236. Johansson, Björn
    et al.
    Friberg, Bertil
    Nilson, Hans
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science. Stockholm Dental Implant Centre, Stockholm, Sweden.
    Digitally planned, immediately loaded dental implants with prefabricated prostheses in the reconstruction of edentulous maxillae: a 1-year prospective, multicenter study2009In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 11, no 3, p. 194-200Article in journal (Refereed)
    Abstract [en]

    Background: The introduction of digital planning programs has made it possible to place dental implants in preplanned positions and being immediately functionally loaded by using prefabricated prostheses.

    Purpose: The aim of this multicenter study was to describe the 1-year results of digitally planned, immediately loaded edentulous maxillae.

    Materials and Methods: A total of 312 implants (Branemark System (R), TiUnite RP, Nobel Biocare, Goteborg, Sweden) in 52 patients from eight Scandinavian clinics were digitally planned, surgically as well as prosthetically, by using the NobelGuide (R) (Nobel Biocare AB, Goteborg, Sweden) and received prefabricated, immediately loaded fixed prosthetic constructions in the maxillae. Individual implant stability was manually tested at 1-year follow-up.

    Results: All patients received a Procera Implant Bridge (R) (Nobel Biocare AB); however, in two cases, the bridges were reconstructed due to misfit. In five patients, difficulties in getting the surgical guide completely in position, and in five patients, getting the prostheses completely seated, were noted. All but four patients fulfilled the 1-year follow-up. Two implants were lost during the study period, resulting in a cumulative survival rate of 99.4%. The mean marginal bone resorption from implant placement to the 1-year follow-up was 1.3 mm (SD 1.28). More than 2 mm of marginal resorption was noted in 19% of the implants at this instant. The most frequently reported complications during the first year were gingival hyperplasia and prosthesis-related problems (prosthesis screw loosening, occlusal fractures, and occlusal adjustments).

    Conclusion: The 1-year results in this multicenter are promising regarding implant and bridge stability; however, the study is planned to be running for at least 3 years.

  • 237.
    Johansson, Elisabeth
    Umeå University, Faculty of Medicine, Department of Odontology.
    Effect of ozone on dental caries and on cariogenic microorganisms2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There are a number of unanswered questions regarding new caries preventive methods such as ozone treatment as well as novel caries detection methods that monitor and evaluate these preventive methods. This thesis seeks answers to some of these questions.

    Aims: Paper I investigates the in vitro sealing capacity of a novel ozone delivery system and its re-suction capacity. Paper II studies the in vitro antibacterial effect of ozone on cariogenic bacterial species with and without the presence of saliva and its possible effect on the saliva proteins. Paper III assesses the in vitro validity of laser-induced fluorescence (LF) measurements, visual inspection (colour), and tactile examination (surface texture) on root caries lesions and correlates these with histopathological measurements of lesion depths.  In addition, Paper III investigates how inter-device, inter-examiner, and intra-examiner levels influence LF reading agreements and whether lesion colour and surface texture influences LF readings. Paper IV evaluates the in vivo effect of ozone and fluoride varnish treatments on occlusal caries in primary molars.

    Material and methods: Paper I: Full ozone application cycles, including the re-suction period, and interrupted cycles with displacement of the cup during the delivery cycle were studied using an ozone air analyser. Paper II: Ozone gas was exposed to the bacteria in the solution’s buffer and saliva via a tube connected to the ozone generator for 10, 30, and 60 seconds. Paper III: Calibrated examiners assessed lesion colour and surface texture and performed measurements with two LF devices for three separate one-week intervals.  Sections (300µm thick) of 64 out of 93 teeth were obtained and examined under a microscope. Lesion depth was assessed with two references: from the delineated borderline of the original exposed root surface (ref I) or, if loss of surface continuity, the absolute lesion depth (ref II). Paper IV: The split mouth study was conducted in two parts. The participants in part A were children (mean age 4.8 years) with medium-high caries risk. Inclusion criteria were bilateral matched pairs of cavitated or non-cavitated occlusal lesions in primary molars (Ekstrand index score ≤ 3). Children in part B (mean age 4.5 years) with low-medium caries risk had pairs of non-cavitated lesions only (Ekstrand index score ≤ 2a). The assessments and treatments with ozone and fluoride varnish were performed at baseline and at three, six, and nine months. At the 12-month follow-up, only assessments were performed.

    Results: Paper I: Ozone leakage levels varied between 5.2 and 9.8 µg/m3. Paper II: In the salt buffer, 92%, 73%, and 64% of the initial numbers of A. naeslundii, S. mutans, and L. casei, respectively, were killed after 10 s ozone exposure and approximately 99.9% of the bacteria were dead after a 60 s exposure. After 10 and 30 s but not after 60 s exposure to ozone, S. mutans and L. casei were less efficiently killed in saliva compared to in the salt buffer. Various saliva proteins were degraded by ozone after the 60 s exposure. Paper III: The correlation between LF readings and histological depth was low with values ranging from 0.22 (p ˃ 0.05) to 0.31 (p < 0.05). The LF devices were significantly correlated with discolouration and with a surface texture denoted as hard. A significant correlation was found between colour and histological depth. No significant correlation was found between surface texture and histological depth. The reliability, evaluated as intra-class correlation coefficient, was 0.99 for intra-examiner, 0.97 for inter-examiner, and 0.98 inter-device level. Large differences were found between two consecutive measurements and high measurement errors indicated considerable deviation of individual measurements.Paper IV: In the first 15 pairs of part A, eight lesions treated with ozone and nine treated with fluoride, including all cavitated lesions, progressed to failure, i.e., required operative treatment during the study time. Due to non-acceptable results, the sample collection was discontinued because of ethical reasons. In part B, of 35 pairs, one of the ozone treated lesions failed at 12 months. A small shift towards increased VI scores was recorded for both ozone and fluoride lesions in this second part.

    Conclusions:

    - The ozone delivery system can be considered a safe system with low leakage levels in air, also with accidental displacements.

    - The cariogenic species S. mutans, L. casei, and A. naeslundii were sensitive to ozone gas treatment. The presence of saliva hampered the antibacterial effect of ozone.

    A low correlation between the LF readings and the histopathological depth of root caries lesions was shown. The LF device was found not to be appropriate for application to root caries diagnosis.

    - Neither ozone nor fluoride varnish treatments arrested the progression of cavitated occlusal caries lesions. In low and medium caries risk children non-cavitated occlusal lesions remained mainly unchanged during the study period.  No difference in the effect of ozone and fluoride varnish treatments on occlusal caries in primary molars was seen.

  • 238.
    Johansson, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    van Dijken, Jan W V
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Hygiene.
    Karlsson, Lena
    Division of Cariology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Andersson-Wenckert, Ingrid
    Umeå University, Faculty of Medicine, Department of Odontology.
    Treatment effect of ozone and fluoride varnish application on occlusal caries in primary molars: a 12-month study2014In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 18, no 7, p. 1835-1843Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study is to evaluate the effect of ozone and fluoride varnish on occlusal caries in primary molars in a split-mouth study.

    MATERIALS AND METHODS: Caries risk was estimated by treating Public Dental Health Service dentists. Children with occlusal caries with Ekstrand index scores ≤3 (VI ≤3) were included. Selection of caries lesions was discontinued for ethical reasons due to non-acceptable clinical results during the follow-up. In the continued evaluation pairs of teeth with non-cavitated caries lesions, Ekstrand score ≤2a (VI ≤2) were selected. Fifty pairs of carious primary molars were included, 18 boys and 15 girls (mean 4.7 years, range 3-8). At baseline, the lesions were assessed by visual inspection (VI) and laser-induced fluorescence (LF), in each pair to treatment with 40 s ozone (HealOzone(TM), 2,100 ppm) or fluoride varnish Duraphat®. The treatments and evaluations were repeated at 3, 6 9 months and evaluations only at 12 months.

    RESULTS: Medium-high caries risk was observed in VI ≤3 children and low-medium risk in VI ≤2a children. In the 15 pairs VI ≤3 lesions, 8 treated with ozone and 9 with fluoride progressed to failure. In the 35 pairs VI ≤2a lesions, one lesion failed. Median baseline LF values in the VI ≤3 group were 76 and 69, for ozone and fluoride lesions, respectively, and 21 and 19 in the VI ≤2a group. At 12 months, LF values in the VI ≤2a group were 15 and 18. No improvement or difference in LF values was found over time between the caries lesions treated with ozone or fluoride.

    CONCLUSIONS: Neither ozone nor fluoride varnish treatments stopped the progression of caries in cavitated lesions. In low and medium caries risk children, non-cavitated lesions following both treatments showed slight or no progression. The use of ozone or fluoride varnish treatments in this regime as caries preventive method, added to the daily use of fluoridated toothpaste, to arrest caries progression in primary molars must therefore be questioned.

  • 239.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Esberg, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Eriksson, Linda
    Umeå University, Faculty of Medicine, Department of Odontology.
    Haworth, Simon
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Self-reported bovine milk intake is associated with oral microbiota composition2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 3, article id e0193504Article in journal (Refereed)
    Abstract [en]

    Bovine milk intake has been associated with various disease outcomes, with modulation of the gastro-intestinal microbiome being suggested as one potential mechanism. The aim of the present study was to explore the oral microbiota in relation to variation in self-reported milk intake. Saliva and tooth biofilm microbiota was characterized by 16S rDNA sequencing, PCR and cultivation in 154 Swedish adolescents, and information on diet and other lifestyle markers were obtained from a questionnaire, and dental caries from clinical examination. A replication cohort of 31,571 adults with similar information on diet intake, other lifestyle markers and caries was also studied. Multivariate partial least squares (PLS) modelling separated adolescents with low milk intake (lowest tertile with <0.4 servings/day) apart from those with high intake of milk (≥3.7 servings/day) based on saliva and tooth biofilm, respectively. Taxa in several genera contributed to this separation, and milk intake was inversely associated with the caries causing Streptococcus mutans in saliva and tooth biofilm samples by sequencing, PCR and cultivation. Despite the difference in S. mutans colonization, caries prevalence did not differ between milk consumption groups in the adolescents or the adults in the replication cohort, which may reflect that a significant positive association between intake of milk and sweet products was present in both the study and replication group. It was concluded that high milk intake correlates with different oral microbiota and it is hypothesized that milk may confer similar effects in the gut. The study also illustrated that reduction of one single disease associated bacterial species, such as S. mutans by milk intake, may modulate but not prevent development of complex diseases, such as caries, due to adverse effects from other causal factors, such as sugar intake in the present study.

  • 240.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Holgerson, Pernilla Lif
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Kressin, NR
    Nunn, ME
    Tanner, AC
    Snacking habits and caries in young children2010In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 44, no 5, p. 421-430Article in journal (Refereed)
    Abstract [en]

    Dental caries is caused by a combination of infection and diet. This disease, if left untreated, may lead to pain, and impair the quality of life, nutritional status and development of young children. The objective was to investigate the association between snacking and caries in a population at high risk of dental caries. American preschool children (n = 1,206) were recruited in the offices of paediatricians. Data on sociodemographic characteristics, oral hygiene, breast-feeding, use of bottle and snacking were collected by questionnaire. Plaque presence, the number of teeth and their caries status (deft) were scored. The children sampled were 61% Black, 27% White and 10% Asian. Of the 1- to 2-, 2- to 3- and 3- to 4-year-old children, 93.8, 82.4 and 77.3% were caries free, and their mean caries scores were 0.16, 0.58 and 0.93, respectively. Multivariate partial least squares (PLS) modelling revealed plaque presence, lowest income, descriptors for tooth exposure time (number of teeth and age) and cariogenic challenge (total intake of sugar-containing snacks and chips/crisps, and chips intake with a sugar-containing drink) to be associated with more caries. These differences were also found in univariate analyses; in addition, children who continued breast-feeding after falling asleep had significantly higher deft values than those who did not. PLS modelling revealed that eating chips clustered with eating many sweet snacks, candies, popcorn and ice cream. We conclude that, in addition to the traditional risk indicators for caries - presence of plaque, sugar intake and socioeconomic status -, consumption of chips was associated with caries in young children.

  • 241.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Milk and oral health2011In: Milk and Milk Products in Human Nutrition / [ed] Clemens R.A., Hernell O., Michaelsen K.F., S. Karger, 2011, Vol. 67, p. 55-66Conference paper (Refereed)
    Abstract [en]

    Oral health includes freedom from disease in the gums, the mucosa and the teeth. There has been a striking reduction in dental caries and periodontitis in industrialized countries, although the proportion with severe disease has remained at 10-15%, and the prevalence increases in less developed countries. If left untreated, these diseases may lead to pain, and impaired quality of life and nutritional status. Prevention and treatment need, besides traditional implementation of proper oral hygiene, sugar restriction and use of fluoride, newer cost-effective strategies. Non-sweetened dairy products, which are proven non-cariogenic, or specific bioactive components from alike sources might prove to be part of such strategies. Thus, milk proteins, such as bovine and human caseins and lactoferrin, inhibit initial attachment of cariogenic mutans streptococci to hydroxyapatite coated with saliva or purified saliva host ligands. In contrast, both bovine and human milk coated on hydroxyapatite promotes attachment of commensal Actinomyces naeslundii and other streptococci in vitro, and phosphorylated milk-derived peptides promote maintenance of tooth minerals, as shown for the β-casein-derived caseino-phosphate peptide. Observational studies are promising, but randomized clinical trials are needed to reveal if dairy products could be a complementary treatment for oral health.

  • 242.
    Johansson, Ingegerd
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Witkowska, Emilia
    Umeå University, Faculty of Medicine, Department of Odontology.
    Kaveh, Babak
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Tanner, A. C. R.
    The Microbiome in Populations with a Low and High Prevalence of Caries2016In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 1, p. 80-86Article in journal (Refereed)
    Abstract [en]

    The oral microbiota was compared between Romanian adolescents with a high prevalence of caries and no dental care and Swedish caries-active and caries-free adolescents in caries prevention programs and with a low prevalence of caries. Biofilm samples were analyzed by FLX+ pyrosequencing of the V1 to V4 hypervariable regions of the 16S rRNA gene and polymerase chain reaction (PCR)/quantitative PCR (qPCR) for Streptococcus mutans and Streptococcus sobrinus. Sequences obtained blasted to 9 phyla, 66 genera, and 401 human oral taxa (HOT) in the 16S rRNA Human Oral Microbiome Database, of which 295 were represented by >= 20 sequences. The Romanian adolescents had more sequences in Firmicutes and fewer in Actinobacteria phyla and more sequences in the genera Bacteroidetes [G-3], Porphyromonas, Abiotrophia, Filifactor, Peptostreptococcaceae [11][G-4], Pseudoramibacter, Streptococcus, and Neisseria and fewer in Actinomyces, Selenomonas, Veillonella, Campylobacter, and TM7 [G-1] than the Swedish groups. Multivariate modeling employing HOT, S. sobrinus and S. mutans (PCR/qPCR), and sugar snacks separated Romanian from Swedish adolescents. The Romanian adolescents' microbiota was characterized by a panel of streptococci, including S. mutans, S. sobrinus, and Streptococcus australis, and Alloprevotella, Leptotrichia, Neisseria, Porphyromonas, and Prevotella. The Swedish adolescents were characterized by sweet snacks, and those with caries activity were also characterized by Prevotella, Actinomyces, and Capnocytophaga species and those free of caries by Actinomyces, Prevotella, Selenomonas, Streptococcus, and Mycoplasma. Eight species including Streptococcus mitis and Streptococcus species HOT070 were prevalent in Romanian and Swedish caries-active subjects but not caries-free subjects. In conclusion, S. mutans and S. sobrinus correlated with Romanian adolescents with caries and with limited access to dental care, whereas S. mutans and S. sobrinus were detected infrequently in Swedish adolescents in dental care programs. Swedish caries-active adolescents were typically colonized by Actinomyces, Selenomonas, Prevotella, and Capnocytophaga. Hence, the role of mutans streptococci as a primary caries pathogen appears less pronounced in populations with prevention programs compared to populations lacking caries treatment and prevention strategies.

  • 243. Jorkjend, Lars
    et al.
    Bergenholtz, Axel
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Ann-Katrin
    Johansson, Anders
    Effect of Pilocarpine on impaired salivary secretion in patients with Sjogren's Syndrome2008In: Swedish Dental Journal, ISSN 0347-9994, Vol. 32, no 2, p. 49-56Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze resting whole saliva (RWS) and stimulated whole saliva (SWS) flow rates before and after administration of Pilocarpine in secondary Sjogren's Syndrome patients. Fifty-one patients (49 women, 2 men, ;mean age 61 years, range 38-85), all with a resting saliva <= 0.1ml/min, participated. Volumes of RWS and SWS collected over periods of 15 and 5 min, respectively, using standardized protocols were measured and the same procedure was repeated after oral administration of Pilocarpine (0.7 mg per 10 kg body weight). The sample was then divided into two groups, according to those in whom Pilocarpine stimulation had caused RWS flow to reach >0.1 ml/min (responders) and those who remained at values <= 0.1 ml/min (non-responders). All participants completed a questionnaire related to general and oral health status, as well as their subjective intraoral complaints before and after administration of Pilocarpine. Thirteen patients (25%) were classified as non-responders and the remaining 38 (75%) as responders. No statistically significant differences between the non-responders and responders were detected as regards general health parameters or intake of medicines with anticholinergic affect. As regards intraoral subjective complaints, no difference between the groups was found before Pilocarpine administration. After administration of Pilocarpine, complaints were significantly fewer among the responders (p<0.01). Both groups exhibited a significant decrease of intraoral symptoms after administration of Pilocarpine (responders P<0.001 and non-responders P<0.05) compared to baseline. For the whole group, more severe intraoral complaints were significantly associated with a lower SWS (P<0.05), but not a RWS, rate at baseline. It is concluded that a subgroup of Sjogren patients do not respond to Pilocarpine stimulation. The clinical implications of this finding need further investigation.

  • 244. Jorkjend, Lars
    et al.
    Johansson, Anders
    Johansson, Ann-Katrin
    Bergenholtz, Axel
    Umeå University, Faculty of Medicine, Department of Odontology.
    Resting and stimulated whole salivary flow rates in Sjogren's syndromepatients over time: a diagnostic aid for subsidized dental care?2004In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 62, no 5, p. 264-268Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate Swedish and Norwegian criteria currently applied in the assessment of eligibility for subsidized dental care of Sjogren's syndrome (SS) patients. These criteria are partly based on a single salivary test showing a resting whole salivary secretion rate of less than or equal to0.1 mL/min. Thirty secondary Sjogren (SSS) patients (29 F and 1 M) participated for the duration of the study, in which resting (RWS) and stimulated (SWS) whole salivary flow rates were collected in the morning and afternoon, over 3 consecutive weeks, once per week, as well as at different times over a 5-year period. Twenty patients presented levels of RWS flow rates of less than or equal to 0.1 mL/min on one or more occasions over a 3-week period, while 8 of these also exceeded, on one or more occasions, the cut-off level of 0.1 mL/min, indicating that salivary flow rates varied over time. Six patients showed consistently low secretion rates of RWS as well as of SWS, estimated as less than or equal to0.1 mL/min and less than or equal to0.7 mL/min, respectively. Based on the results, salivary tests that are to be used as a diagnostic aid for SS diagnosis, and thus as a basis for inclusion within the subsidy net for dental care, must be taken on several occasions in order to more accurately give information about salivary gland function. In line with this, current regulations governing the eligibility of SS patients within subsidized dental care programs should be reviewed.

  • 245.
    Jungner, Måns
    Umeå University, Faculty of Medicine, Department of Odontology.
    Healing of endosseous implants with different surface characteristics in grafted and non-grafted bone: clinical and experimental studies2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aims: This study uses radiological and clinical evaluations of the healing of endosseous titanium implants presented with different surface characteristics in the clinical situation (paper I-III) and experimentally to describe the early bone healing in maxillary sinus membrane elevation with and without the use of grafting material (paper IV).

    Material and methods: In paper I, 136 patients were treated with 394 dental implants – 199 were oxidized titanium implants (Nobel Biocare TiUnite) and 195 were turned titanium surface implants (Nobel Biocare Mark III). Implant survival rates were retrospectively investigated after a minimum of five months after functional loading of the implants. At the five-year follow-up (paper II), eight patients were deceased and 128 were invited. Twenty-five patients refrained from participating in the study. The remaining 103 patients (287 implants – 133 with a turned surface and 154 with an oxidized surface) were examined after at least five years of functional loading. Clinical examinations of bleeding on probing (BoP) and pocket depth (PD) were performed. Intraoral radiographs were used to assess marginal bone levels (MBLs). In paper III, 28 patients were subjected to autologous bone graft and delayed implant placement, with a total of 92 dental implants. Thirteen patients received 47 implants with a turned surface and 15 patients received 45 implants with an oxidized surface. After a minimum of five years of functional loading, all patients were clinically examined regarding PD and BoP. The MBL was measured in intraoral radiographs. Cone beam computed tomography (CBCT) was used to evaluate the apical bone level (ABL) of the implants and intra-sinus conditions. The experimental study (paper IV) used nine adult male tufted capuchin primates (Cebus apella). Eight animals were subjected to bilateral maxillary sinus membrane elevation using a lateral replaceable bone window technique. One oxidized dental implant was placed in the residual bone of the sinus floor, protruding into the maxillary sinus cavity on both sides. In four animals, one sinus was left without any additional treatment, while the contralateral sinus was filled with autologous bone grafts from the tibia. In two animals, the implants were inserted under the elevated sinus membrane on both sides. In two animals, the sinus membrane was totally removed bilaterally before placement of implants. The animals were euthanized after 10 (n=4) or 45 (n=4) days. One non-operated animal representing pristine tissue conditions served as the control. The maxillary sinuses with implants were retrieved and further processed to prepare light microscopic ground sections or decalcified sections for immunohistochemical analyses. Results: In paper I seven implants were lost in five patients – six in the maxilla and one in the mandible. All failed implants were Mark III turned implants. The overall implant survival rate was 98.2% with a survival rate of 96.4% for implants with turned surface after a minimum of five months after functional loading. In paper II, one additional oxidized implant failed, giving an overall cumulative survival rate of 94.7 and 99.4%, respectively, after at least five years of functional loading. There was no difference for BoP, PD, or MBL between turned and oxidized implants. A total of two implants, three oxidized and one turned, showed a PD > 3 mm, MBL > 4 mm, and BoP. However, none of these were associated with suppurative infection on examination. In paper III no difference was found between the two implants surfaces used in terms of PD, BoP, MBL, or ABL. Pathological reactions to the sinus membrane were seen in four of the patients (14%). Radiographic signs of sinus pathology were not correlated to either survival rate of the implants or any of the investigated parameters. In the experimental paper IV, bone formation started from the bottom of the sinus floor, sprouting into the granulation tissue along the implant surface under the elevated membrane irrespective of time and surgical technique. Bone formation was not seen in direct conjunction with the sinus membrane. A distinct expression of osteopontin was observed in the serous glands of deeper portion of the lamina propria in direct connection with the elevated sinus membrane and close to the implant within all groups.

    Conclusion: After more than five years of function in non-grafted patients, oxidized implants had a survival rate higher than turned implants, although this was not statistically significant. No difference was found in MBL, PD, or BoP. Grafting of the maxillary sinus floor with intra- orally harvested bone and delayed placement of either turned or oxidized implants resulted in equally high long-term survival rates, MBL, ABL, and BoP. Pathological findings in the maxillary sinus cavity, in terms of sinus membrane health, are few and not correlated to any of the other investigated parameters. In the experimental study bone formation after sinus membrane elevation with or without additional bone grafts started at the sinus floor and sprouted into the elevated space along the implant surface. Removal of the membrane resulted in less bone formation. The sinus membrane did not seem to present osteoinductive potential in sinus membrane elevation procedures.

  • 246.
    Jungner, Måns
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Cricchio, Giovanni
    Umeå University, Faculty of Medicine, Department of Odontology.
    Salata, Luiz A
    Department of Oral & Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
    Sennerby, Lars
    Department of Oral and Maxillofacial Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lundqvist, Carina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hultcrantz, Malou
    Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology.
    On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, no 6, p. 1092-1102Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown predictable bone formation in the maxillary sinus after membrane elevation. However, how and where the bone is formed is not well understood.

    Purpose: The aim of the study was to histologically and immunohistochemically study the early bone formation events in primates after membrane elevation in the maxillary sinus.

    Materials and Methods: Nine adult male tufted capuchin primates (Cebus apella) were included in the study. Eight animals were subjected to bilateral maxillary sinus membrane elevation using a lateral replaceable bone window technique. One oxidized dental implant was placed into the maxillary sinus cavity on both sides. In four animals, one sinus was left without any additional treatment, whereas the contralateral sinus was filled with autologous bone grafts from the tibia. In two animals, the implants were inserted under the elevated sinus membrane on both sides. In two animals, the sinus membrane was totally removed. The animals were euthanized after 10 or 45 days. One nonoperated animal representing pristine tissue conditions served as control. The maxillary sinuses with implants were retrieved and further processed for light microscopic ground sections or decalcified sections for immune-histochemical analyses.

    Results: Bone formation started from the bottom of the sinus floor, sprouting into the granulation tissue along the implant surface under the elevated membrane irrespective of time and surgical technique. Bone formation was not seen in direct conjunction with the sinus membrane. A distinct expression of osteopontin was observed in the serous glands of the lamina propria close to the implant within all groups.

    Conclusion: Bone formation after sinus membrane elevation with or without additional bone grafts starts at the sinus floor and sprouts into the elevated space along the implant surface. The sinus membrane does not seem to present osteoinductive potential in sinus membrane elevation procedures in this study.

  • 247.
    Jungner, Måns
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery. Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Legrell, Per Erik
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Surgery.
    Follow-up study of implants with turned or oxidized surfaces placed after sinus augmentation2014In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 29, no 6, p. 1380-1387Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare long-term survival and clinical outcomes of endosseous implants with different surface characteristics in patients with sinus elevation procedures, autologous bone grafting, and delayed implant placement. Materials and Methods: Implant survival, peri-implant soft tissue conditions, marginal bone level, intrasinus apical bone level, and sinus health were studied in patients subjected to autologous bone graft and delayed placement of implants with turned or oxidized surfaces. After a minimum of 5 years of functional loading, all patients were clinically examined regarding gingival pocket depth (PD) and bleeding on probing (BoP). The marginal bone level (MBL) was measured in intraoral radiographs. Cone beam computed tomography was used to evaluate the apical bone level (ABL) of the implants and intrasinus conditions. Results: Twenty-eight patients received sinus elevation and a total of 92 dental implants. Thirteen patients received 47 implants with a turned surface, and 15 patients received 45 implants with an oxidized surface. Mean follow-up was 10 years (range, 5 to 19 years). No significant difference was found between the two implant surfaces in terms of PD, BoP, MBL, or ABL. Four patients (14%) exhibited radiographic signs of sinus pathology, with opacification, polyplike structures, and thickening of the sinus membrane. Radiographic signs of sinus pathology were not correlated to implant survival or to the investigated parameters. Conclusion: Grafting of the maxillary sinus floor with intraorally harvested bone and delayed placement of either turned or oxidized implants results in equally high long-term survival rates, stable marginal and apical bone levels, and good peri-implant soft tissue health.

  • 248.
    Jungner, Måns
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Legrell, Per-Erik
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Apical and marginal bone levels in patients rehabilitated with maxillary sinus floor augmentation using particulated mandibular bone graft and delayed placement of implants with two different surfaces. A minimum 5-year clinical and radiologic follow up in 28 patients.Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: To compare healing of endosseous implants with different surface characteristics in patients with sinus elevation procedures, autologous bone graft and delayed implant installation. Implant survival, peri-implant soft tissue conditions, marginal bone level, intra-sinus apical bone level and sinus health were studied.

    Material and Methods: Twenty-eight patients were subjected to autologous bone graft and delayed implant placement, with a total of 92 dental implants. Thirteen patients received 47 implants with a turned surface and 15 patients received 45 implants with an oxidized surface. After a minimum of 5 years of functional loading (mean 10 years, range 5 - 19 years), all patients were clinically examined regarding gingival pocket depth (PD) and bleeding on probing (BoP). The marginal bone level (MBL) was measured in intraoral radiographs. A cone beam computed tomography (CBCT) was used for evaluating the apical bone level (ABL) of the implants and intrasinus conditions.

    Results: No significant difference was found between the two implants surfaces used in terms of PD, BoP, MBL or ABL. Pathological reactions to the sinus membrane was seen in four of the patients (14%). Radiographic signs of sinus pathology were not correlated to either survival rate of the implants nor the investigated parameters. Conclusion: Grafting of the maxillary sinus floor with intra-orally harvested bone and delayed placement of either turned or oxidized implants results in equally high long-term survival rates, stable marginal and apical bone levels and good peri-implant soft tissue health.

  • 249.
    Jungner, Måns
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Karolinska Univ Hosp, Dept Oral & Maxillofacial Surg, SE-17176 Stockholm, Sweden.
    Lundqvist, Peter
    Umeå Implant Center, Umeå, Sweden.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology.
    A retrospective comparison of oxidized and turned implants with respect to implant survival, marginal bone level and peri-implant soft tissue conditions after at least 5 years in function2014In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 16, no 2, p. 230-237Article in journal (Refereed)
    Abstract [en]

    Background: Long-term clinical follow-up studies comparing different implant surfaces with regard to survival and marginal conditions are rare. Objectives: The objective of this study was to compare the clinical performance of turned and oxidized implants after more than 5 years of loading Material and Methods: One hundred three patients (43 men, 60 women; mean age 67.4 years, range 32–90) previously treated with 287 implants (Nobel Biocare AB, Gothenburg, Sweden), 133 with turned surface (MKIII, Nobel Biocare AB) and 154 with an oxidized surface (MKIII, TiUnite, Nobel Biocare AB) were examined after at least 5 years of loading (mean 82 months, range 60–93 months). The implants had been used for support of single crowns (33 patients/36 implants), partial bridges (39 patients/103 implants), or full bridges (31 patients/148 implants) following an early loading protocol (14 patients /54 implants), a one-stage protocol (32 patients/59 implants) or a two-stage protocol (57 patients/174 implants). Clinical examinations of bleeding on probing (BoP) and pocket depth (PD) were performed. Intraoral radiographs were used for assessments of marginal bone levels (MBLs). Results: Seven turned implants and one oxidized implant failed, giving overall cumulative survival rates of 94.7 and 99.4%, respectively. There were no differences for BoP scores (0.5 1 0.7 vs 0.4 1 0.6) and PD measurements (1.7 1 0.8 mm vs 1.8 1 1.0 mm) parameters when comparing turned and oxidized implants, respectively. The mean MBL was 1.8 1 0.8 mm and 2.0 1 0.9 mm for turned and oxidized implants, respectively, after more than 5 years in function (NS). Frequency distribution of MBL loss showed no statistically significant differences between the two surfaces. A total of four implants (1.4%) (three oxidized and one turned) showed a PD > 3 mm, MBL > 4 mm, and BoP. However, none of these were associated with suppuration on examination. Conclusion: The present study does not state any differences in implant failure, MBL, presence of bleeding or PD around implants when comparing turned and oxidized titanium implants after at least 5 years of function. 

  • 250.
    Jungner, Måns
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundqvist, Peter
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lundgren, Stefan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Oxidized titanium implants (Nobel Biocares TiUnite) compared with turned titanium implants (Nobel Biocares mark III) with respect to implant failure in a group of consecutive patients treated with early functional loading and two-stage protocol2005In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 16, no 3, p. 308-312Article in journal (Refereed)
2345678 201 - 250 of 599
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