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  • 1. Bou Serhal, C
    et al.
    Jacobs, R
    Flygare, Lennart
    Quirynen, M
    van Steenberghe, D
    Perioperative validation of localisation of the mental foramen2002Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 31, nr 1, s. 39-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To assess the accuracy of panoramic radiography and spiral or computed tomography for the localisation of the mental foramen.

    MATERIALS AND METHODS: The distance from the alveolar crest to the mental foramen was measured from panoramic radiographs, spiral tomograms and CT scans. The same distance was measured during implant surgery using a specially designed caliper.

    RESULTS: Panoramic radiography showed more deviation (+0.6 mm) from the perioperative measurements than either spiral or computed tomography (+0.4 and -0.3 mm respectively). The difference was significant (P<0.05). In general, distances were overestimated on the panoramic radiographs.

    CONCLUSIONS: Cross-sectional imaging techniques are recommended for the pre-operative planning of implants in the posterior mandible.

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  • 2. de Almeida, F. J. Mota
    et al.
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Knutsson, K.
    Wolf, E.
    'Seeing is believing': a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden2019Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, nr 10, s. 1519-1528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To gain insight into the decision processes of dentists when requesting a cone beam computed tomography (CBCT) examination in endodontic settings.

    Methodology: Fourteen dentists (eight female) 33-58 years of age (mean = 44) practising in Sweden were interviewed. Ten of the dentists were specialists in Endodontics. The absolute inclusion criterion was experience of referring patients for CBCT for endodontic reasons. The included dentists comprised a strategically selected diverse sample in terms of gender, age, work experience, educational background, location of practice, service affiliation and accessibility to CBCT. Data were obtained through semistructured interviews exposing the context of their last three self-reported referrals. Dentists were encouraged to describe their experiences of the circumstances in their own words, aided by the interviewer's open-ended questions. The interviews were audio-recorded and transcribed verbatim. The text was analysed by qualitative content analysis.

    Results: The manifest content was organized into three categories that were defined as visualization as a desire, facilitating tough decisions and allocating responsibility.

    Conclusion: An overall theme (covering the latent content) was identified: A balance between clinical common sense and a 'better safe than sorry' attitude guides the use of CBCT in endodontic settings. Informants had high clinical standards, knowledge concerning radiation risks and good sense, which could compensate for their lack of knowledge of guidelines. The national radiation regulatory system was perceived to work as a slightly porous gatekeeper for over-usage.

  • 3.
    de Almeida, F. J. Mota
    et al.
    Department of Endodontics, Tandvårdens Kompetenscentrum, Norrbottens County Counci, Luleå; Department of Oral-and-Maxillofacial Radiology, Odontologiska fakulteten, Malmö University, Malmö, Sweden.
    Knutsson, K.
    Department of Oral-and-Maxillofacial Radiology, Odontologiska fakulteten, Malmö University, Malmö, Sweden.
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    The impact of cone beam computed tomography on the choice of endodontic diagnosis2015Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, nr 6, s. 564-572Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim To determine whether the outcome of cone beam computed tomography (CBCT) examinations performed in accordance with the European Commission guidelines in a clinical setting has an impact on choosing diagnoses in endodontics. Methodology A prospective observational study was conducted. Fifty-three consecutive patients (81 teeth) from two different endodontic specialist clinics in Sweden were followed. After performing a thorough clinical examination (based on the history, clinical findings, and diagnostic tests such as intra-oral radiography), the examiner wrote down a preliminary diagnosis before CBCT examination. After the CBCT examination, a new diagnosis was made by the same examiner. Both the pre- and the post-CBCT examination diagnoses were plotted according to patients and teeth. The CBCT examinations were performed using similar equipment and protocols that were standardized amongst the clinics. Results The diagnoses were changed for at least one tooth in 22 patients (41%); overall, the diagnoses were changed for 28 teeth (35%). Conclusion CBCT has a substantial impact on diagnostic thinking in endodontics when used in accordance with the European Commission guidelines.

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  • 4. De Bruyn, H
    et al.
    Collaert, B
    Lindén, U
    Flygare, L
    A comparative study of the clinical efficacy of Screw Vent implants versus Brånemark fixtures, installed in a periodontal clinic.1992Ingår i: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 3, nr 1, s. 32-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The clinical success of 85 Screw Vent and 107 Brånemark implants, consecutively installed in a private periodontal clinic under the same conditions and by the same operator, is compared. Mobile implants were removed and considered as failures. Intra-oral radiographs were assessed for the presence of peri-implant radiolucencies and for analysis of bone loss after functional loading. 85 Screw Vent implants were installed in 31 patients. Of 23 implants installed in 9 mandibles, none failed after 16.8 (range 12-25) months of function. Of 62 Screw Vent implants installed in 23 maxillae, 6 failed at abutment connection, 1 failed after 2 months and 2 after 13 months of function. The absolute failure rate after 13.2 (range 6-24) months was 9/62. Mean loss of bone was 1.47 mm (-1.0- +4) after 12 months of functional loading. 107 Brånemark fixtures were installed in 25 patients. Of 51 fixtures inserted in 12 mandibles, none failed; of 56 fixtures installed in 13 maxillae 1 failed before and 2 failed during abutment connection. The absolute failure is 3/56. All remaining fixtures were immobile after loading. 13 fixtures were more than 6 months in function. Only short-term comparison between both systems is possible because the observation time is longer for the Screw Vent implants. In the 1st year, only 1 implant system was available to the periodontist. Short-term comparison reveals 11.3% versus 5.3% of cumulative failure after 6 months for the Screw Vent and Brånemark implants, respectively. The results indicate that clinical efficacy is as effectively obtained with Screw Vent as with Brånemark implants in the mandible. The outcome of treatment with Screw Vent implants in the maxilla seems less predictable.

  • 5. Eckerbom, M
    et al.
    Flygare, Lennart
    Department of Maxillofacial Radiology, Sunderby Sjukhus, Luleå, Sweden.
    Magnusson, T
    A 20-year follow-up study of endodontic variables and apical status in a Swedish population2007Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 40, nr 12, s. 940-948Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings.

    METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered.

    RESULTS: The frequency of root canal treated teeth increased significantly (P < 0.05) from 13.9% at the first investigation to 17.7% after 20 years. There was also a statistically significant increase (P < 0.05) in teeth with apical periodontitis from 3.3% to 6.8%. Apical periodontitis both in connection with root canal treated teeth and teeth without endodontic treatment, had increased during the follow-up period. Even though the quality of the root fillings had improved, there was no corresponding improvement of the apical status in teeth with root fillings.

    CONCLUSIONS: There is still a great need for endodontic treatment in the Swedish population, and no improvement in apical health was found during this 20-year follow up.

  • 6.
    Flygare, Lennart
    Department of Oral Radiology, Faculty of Odontology, Lund University, Malmö.
    Degenerative changes of the human temporomandibular joint: A radiological, microscopical, histomorphometrical and biochemical study1997Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    I fem autopsistudier undersöktes humana käkledspreparat med tomografi (skiktröntgen), makroskopiskt (inspektion) och mikroskopiskt för förekomst av degenerativa (nedbrytande) förändringar. Speciellt undersöktes förekomst av erosiva förändringar i benet samt förändringar i den förkalkade broskzonen (skiktet mellan mjukbrosk och ben). Det förkalkade brosket var i normala fall avgränsat mot överliggande mjukbrosk av en jämn basofil vågig linje, den s.k. tidemark. Avgränsningen mot benet var oregelbunden. Ett samband fanns mellan tjockleken på det "mjuka" brosket och det förkalkade brosklagret. Detta tyder på att den förkalkade broskzonen är en biologiskt aktiv zon även hos vuxna individer. Två typer av erosiva benförändringar kunde urskiljas. En typ där det överliggande brosket var intakt och en typ där det överliggande brosket var s.g.s. helt bortskalat. Den senare typen av förändring fanns i större antal i condylen (käkledshuvudet), medan förändringarna i den temporala ledkomponenten (ledhålan i skallbasen) oftare var av den första typen och mindre utbredda. Detta kan tyda på en skillnad i biologisk reaktion mellan de båda ledkomponenterna. Skiktröntgen undervärderade både antalet och utbredningen av de erosiva förändringarna. Positiva prediktiva värden (d.v.s. sannolikheten att ett röntgenfynd av en erosion verkligen motsvaras av en erosion) var 70% i kondylen och 91% i den temporala komponenten. Negativa prediktiva värden (d.v.s. sannolikheten att ytor som ser friska ut på röntgen verkligen är det) var 83% i condylen och 68% i den temporala komponenten. Tre olika tekniker för benvolymsbestämning med hjälp av databaserad bildanalys utvärderades, en automatisk, en manuell och en semi-automatisk. Den semi-automatiska tekniken gav en god reproducerbarhet och liten variation när man använde sig av endast en operatör. Den semi-automatisk tekniken användes för att mäta benvolymen i käkledspreparaten. Käkledskondyler med erosiva förändringar visade sig generellt vara tätare i benet än käkleder utan förändringar. Detta talar för att bentätheten spelar en roll i uppkomsten av erosiva förändringar i käkleden. I en klinisk studie undersöktes ledvätskan från patienter som fick käkledsdisken bortopererad. Prover på käkledsvätskan togs dels vid operationen och 6 månader efter operationen. Proverna analyserades avseende förekomst av fragment av två olika broskmolekyler Aggrecan och COMP. Dessa molekylerna finns normalt i ledbrosket och "läcker ut" i ledvätskan när brosket skadas. Det visade sig att ration (förhållandet) mellan Aggrecan/COMP var högre i alla ledvätskorna vid 6-månaderskontrollen. Vid denna kontroll uppvisade dessutom samtliga leder benförändringar av degenerativ karaktär (på röntgen). Detta talar för att man eventuellt kommer att kunna spåra tidiga broskskador i käkleden genom att analysera ledvätskan. Tekniken måste dock först förfinas både vad avser provtagning och den biokemiska analysen.

  • 7.
    Flygare, Lennart
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Al-Ubaedi, Amal
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Öhman, Wilhelm
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Department of Surgery, Skellefteå Hospital, Skellefteå, Sweden.
    Jakobson Mo, Susanna
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Distant metastases and synchronous malignancies on FDG-PET/CT in patients with head and neck cancer: a retrospective study2020Ingår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 61, nr 9, s. 1196-1204Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been proven to be a good method to detect distant spread of head and neck cancer (HNC). However, most prior studies are based on Asian populations and may not be directly transferable to western populations.

    Purpose: To investigate the frequency and distribution of distant metastases and synchronous malignancies detected by PET/CT in HNC in a northern Swedish population.

    Material and Methods: All primary whole-body FDG-PET/CT examinations performed on the suspicion of HNC (n = 524 patients) between 1 January 2013 and 31 December 2016 at Umeå University Hospital in Sweden were retrospectively reviewed . After the exclusion of 189 examinations without evidence of primary HNC, 335 examinations were analyzed.

    Results: Distant metastases were detected in 10 (3%) patients, all with advanced primary tumors corresponding to TNM stage 3–4, most frequently in salivary gland adenocarcinoma, where 50% of patients had distant spread. Four patients had metastases below the diaphragm, representing 20% of the salivary gland malignancies. In the remaining six patients, metastases were supraphrenic, of which all but one were identified by CT alone. Synchronous malignancies were discovered in 14 (4.2%) patients, of which five were below the diaphragm.

    Conclusion: The overall frequency of distant spread and synchronous malignancy in primary HNC was generally low. However, the risk for distant metastases below the diaphragm was relatively higher in salivary gland adenocarcinoma, supporting whole-body FDG-PET/CT in the primary diagnostic work-up in these patients.

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  • 8.
    Flygare, Lennart
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Erdogan, Secil Telli
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Söderkvist, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer2023Ingår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 64, nr 5, s. 1865-1872Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for TN staging in head and neck cancer (HNC) has been proven in numerous studies. A few studies have investigated the value of FDG-PET/magnetic resonance imaging (MRI) in the staging of HNC; the combined results indicate potential for FDG-PET/MRI, but the scientific evidence remains weak.

    Purpose: To compare performance of FDG-PET/CT and FDG-PET/MRI for locoregional staging in patients with oropharyngeal carcinomas.

    Material and Methods: Two radiologists independently of each other retrospectively reviewed primary pre-therapeutic FDG-PET/CT and FDG-PET/MRI examinations from 40 individuals with oropharyngeal carcinomas. TN stage and primary tumor size were noted. The results were compared between observers and modalities and against TN stage set at a multidisciplinary conference.

    Results: For nodal staging, PET/MRI had slightly higher specificity and accuracy than PET/CT for the most experienced observer. Both methods demonstrated excellent sensitivity (≥ 0.97 and 1.00, respectively), as well as high negative predictive values (≥ 0.95 and 1.00, respectively). No significant differences were found for tumor staging or measurement of maximum tumor diameter. There was a weak agreement (κ = 0.35–0.49) between PET/CT and PET/MRI for T and N stages for both observers. Inter-observer agreement was higher for PET/MRI than for PET/CT, both for tumor staging (κ = 0.57 vs. 0.35) and nodal staging (κ = 0.69 vs. 0.55). The agreement between observers was comparable to the agreement between methods.

    Conclusion: PET/MRI may be a viable alternative to PET/CT for locoregional staging (TN staging) and assessment of maximal tumor diameter in oropharyngeal squamous cell cancer.

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  • 9. Flygare, Lennart
    et al.
    Hosoki, Hidehiko
    Petersson, Arne
    Rohlin, Madeleine
    Åkerman, Sigvard
    Bone volume in human temporomandibular autopsy joints with and without erosive changes1997Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 55, nr 3, s. 167-172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to compare the trabecular bone volume (TBV) and the total bone volume (TOBV) of human temporomandibular joints (TMJ) with erosive changes with those of joints without erosive changes. We examined 35 TMJ autopsy specimens from 19 individuals aged 66 88 years. Sagittal sections of the joints were analyzed microscopically for erosive hard-tissue changes. The TBV and the TOBV of the sections were assessed with the aid of computerized image analysis. A significant increase in trabecular and total bone volume was found in condyles with erosive changes (TBV = 21%, TOBV = 54%) as compared with condyles without erosive changes (TBV = 15%, TOBV = 40%). The trabecular bone volume of the temporal component was also increased (TBV = 24%) in joints with erosive changes in the condyle as compared with joints with unaffected condyles (TBV = 16%). The findings indicate that the relative bone mass may play a role in the development of erosive changes in the TMJ.

  • 10. Flygare, Lennart
    et al.
    Hosoki, Hidehiko
    Rohlin, Madeleine
    Petersson, Arne
    Bone histomorphometry using interactive image analysis. A methodological study with application on the human temporomandibular joint.1997Ingår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 105, nr 1, s. 67-73Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to develop a reproducible method for bone histomorphometry with the aid of a computerized image analysis program, and to examine the variation when assessing the total and the trabecular bone volume. Histologic sections of 18 temporomandibular joint autopsy specimens were read interactively using a cursor. The two parameters total bone volume and trabecular bone volume, of the condyle and the temporal component respectively, were estimated 2 x by 1 observer using 3 different threshold settings: an automatic, a semi-automatic and a manual technique. The threshold was based on the gray-scale distribution of the image. 2 observers read the same sections with the aid of the semi-automatic technique. The intra-observer variation expressed as coefficient of variation ranged between 1.9% and 7.1% for the different parameters, when the automatic threshold setting technique was employed, and between 2.8% and 8.7% with the semi-automatic technique. The manual technique resulted in a high intra-observer variation with a coefficient of variation between 5.2% and 19.9%. There was a systematic difference between the estimates of the 2 observers. In general, intra- and inter-observer variation was higher in the temporal component than in the condyle. The inter-section variation was moderate, the coefficient of variation ranging from 3.8% to 11.1%. The automatic and semi-automatic techniques resulted in comparable intra-observer variation, with a lower bias in the estimates of the semi-automatic technique. By letting one observer apply the semi-automatic technique, it was possible to achieve fast and reproducible analysis of the total and trabecular bone volume.

  • 11. Flygare, Lennart
    et al.
    Klinge, Björn
    Rohlin, Madeleine
    Åkerman, Sigvard
    Lanke, Jan
    Calcified cartilage zone and its dimensional relationship to the articular cartilage in the human temporomandibular joint of elderly individuals1993Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 51, nr 3, s. 183-191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to describe the appearance of the calcified cartilage zone (CCZ) and to determine its dimensional relationship to the articular cartilage thickness in the normal human temporomandibular joint. An autopsy material comprising 21 joints from 12 elderly individuals was examined microscopically. The appearance of the CCZ was examined, and the thickness of the CCZ and of the total articular cartilage was measured in 18 different positions in each joint. The CCZ was outlined by a flat or gently undulating tidemark and an irregular osteochondral junction. The cellularity of the CCZ varied extensively. The cells were numerous in the CCZ when the overlying articular cartilage displayed high cellularity. Statistical analysis of the measurements demonstrated a relationship (p < 0.001) between the thickness of the CCZ and of the articular cartilage. Our findings, both qualitative and quantitative, indicate a close relationship between the physiology of the CCZ and of the overlying articular cartilage.

  • 12.
    Flygare, Lennart
    et al.
    Sundebyns sjukhus, Luleå.
    Legrell, Per Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Oral diagnostisk radiologi.
    Kontrastmedel inom odontologisk radiologi2009Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 101, nr 2, s. 68-73Artikel i tidskrift (Övrigt vetenskapligt)
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  • 13.
    Flygare, Lennart
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Miles, D. A.
    Imaging paranasal sinus disease2001Ingår i: Oral and Maxillofacial Surgery Clinics of North America, Vol. 13, nr 4, s. 639-655Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In short, a proper diagnostic strategy for radiologic investigation of the nose and sinuses is suggested as follows: 1. CR remain useful for the detection of disease. 2. CT is appropriate for trauma, anomalies, recurrent inflammatory conditions, preoperative, and postoperative evaluation. 3. CT MR imaging should be used for mapping of tumors.

  • 14.
    Flygare, Lennart
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Möystad, Anne
    Oslo Universitet.
    Apajalahti, Satu
    Helsingfors Universitetssjukhus.
    Ultraljudsundersökningar i huvud- och halsregionen2009Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 101, nr 2, s. 78-86Artikel i tidskrift (Refereegranskat)
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  • 15. Flygare, Lennart
    et al.
    Norderyd, Johanna
    Kubista, Josef
    Ohlsson, Jan
    Vallö-Christiansen, Jörgen
    Magnusson, Bengt
    Chronic recurrent multifocal osteomyelitis involving both jaws: report of a case including magnetic resonance correlation1997Ingår i: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, ISSN 1079-2104, E-ISSN 1528-395X, Vol. 83, nr 2, s. 300-305Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

  • 16. Flygare, Lennart
    et al.
    Rohlin, Madeleine
    Åkerman, Sigvard
    Macroscopic and microscopic findings of areas with radiologic erosions in human temporomandibular joints1992Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 50, nr 2, s. 91-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to describe the macroscopic and microscopic findings of areas with radiologic erosions in the human temporomandibular joint. An autopsy material of 40 human joints, removed as blocks, was examined with tomography, and an erosion was found in 37 areas. A macroscopic and a microscopic examination focused on the presence of the calcified cartilage zone (CCZ) was performed in these areas. In the condyle 13 of 14 areas with a radiologic erosion showed denudation of bone macroscopically. Microscopically, these areas were covered by a thin fibrocellular tissue, and the CCZ was absent. In the temporal component, only 1 of the 23 areas showed bone exposure macroscopically. Microscopically, the soft tissue in these areas varied in thickness. The CCZ was missing in 13 of the 23 areas, even in some areas that appeared normal macroscopically and were microscopically covered by intact soft tissue. Thus, in areas with a radiologic erosion the macroscopic and microscopic appearance differed between the condyle and the temporal component. The nature of the findings is discussed.

  • 17. Flygare, Lennart
    et al.
    Rohlin, Madeleine
    Åkerman, Sigvard
    Microscopy and tomography of erosive changes in the temporomandibular joint. An autopsy study.1995Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 53, nr 5, s. 297-303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Thirty-nine temporomandibular joint autopsy specimens were examined by microscopy and tomography for erosive changes. We found two types of erosive changes, an extensive type with complete loss of cartilage and a local type with retained articular cartilage. On microscopic examination nearly twice as many temporal components as condyles were eroded. The erosions were generally more extensive in the condyle. Erosions in the condyle were evenly distributed. In the temporal component there was a slight predominance of erosions located to the lateral part of the tubercle. The radiologic investigation underestimated both the presence and the extent of the erosions. Positive predictive values and negative predictive values were 0.70 and 0.83, respectively, for erosions in the condyle and 0.91 and 0.68 for erosions in the temporal component. It is suggested that the initial event in osteoarthrosis of the TMJ can occur as a subarticular hard-tissue change. The need for more accurate diagnostic tools than radiography should be stressed.

  • 18. Flygare, Lennart
    et al.
    Wendel, Mikael
    Saxne, Tore
    Ericson, Sune
    Eriksson, Lars
    Petersson, Arne
    Rohlin, Madeleine
    Cartilage matrix macromolecules in lavage fluid of temporomandibular joints before and 6 months after diskectomy1997Ingår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 105, nr 4, s. 369-372Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose was to investigate if antigenic fragments of aggrecan and cartilage oligomeric matrix protein (COMP) are detectable by enzyme-linked immunosorbent assay in lavage fluids from the temporomandibular joint (TMJ) and to examine if the relative content of these cartilage markers changes during development of osteoarthrosis (OA) after diskectomy. Lavage fluid was obtained at surgery and 6 months postoperatively in 13 patients. Computed tomography or magnetic resonance imaging was without evidence of hard-tissue changes prior to surgery in all patients. In 9 of the patients, sufficient material for analysis was obtained at both examinations. Aggrecan and COMP were detectable in all but 2 fluids, in which the COMP levels were below detection limit. The aggrecan/COMP ratio increased in all 9 patients during the 6-month period, indicating increased release of aggrecan relative to COMP fragments. The changed aggrecan/COMP ratio possibly reflects increased cartilage turnover during development of OA. Changes compatible with OA were present on computed tomography in all cases at the 6-month follow-up. This study shows that the lavage procedure is feasible for obtaining synovial fluid from the TMJ for immunochemical analyses of tissue-derived macromolecules.

  • 19. Flygare, Lennart
    et al.
    Öhman, A
    Kull, L
    Letter to the editor concerning Parrott LA, Ng SY. A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study published in Dentomaxillofacial Radiology (2001;40:102–109).2011Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 40, nr 4, s. 262-263Artikel i tidskrift (Refereegranskat)
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  • 20.
    Flygare, Lennart
    et al.
    Department of Radiology, Sunderby Hospital, 971 80, Lulea, Sweden.
    Öhman, Anders
    Preoperative imaging procedures for lower wisdom teeth removal2008Ingår i: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 12, nr 4, s. 291-302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of this paper were to critically review the role of radiographic imaging before lower third molar removal and to suggest a strategy for preoperative imaging based on available scientific evidence and clinical experience. Original articles and reviews including the MESH terms "third molar" and "radiography" were selected from the Medline database. Other sources were taken from references of selected papers. It was found that the scientific evidence on the usefulness of different preoperative imaging techniques of wisdom teeth is low. Therefore, information gathered from the literature was combined with the authors' clinical experience to suggest a strategy for preoperative imaging of lower third molars. Currently available radiological techniques used for preoperative imaging of lower third molars are also presented. It is suggested that panoramic and/or intraoral radiographs are sufficient as preoperative imaging in the vast majority of cases where there is no overlap between the mandibular canal and the wisdom tooth. Supplement with a posteroanterior open mouth projection will solve most of the remaining cases. In a restricted number of cases where there is an intimate relationship between the mandibular canal and the wisdom tooth, volume tomography such as cone beam computed tomography or low-dose computed tomography is indicated.

  • 21. Horner, K
    et al.
    Islam, M
    Flygare, Lennart
    Tsiklakis, K
    Whaites, E
    Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology2009Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 38, nr 4, s. 187-195Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To develop "basic principles" on the use of dental cone beam CT by consensus of the membership of the European Academy of Dental and Maxillofacial Radiology.

    METHODS: A guideline development panel was formed to develop a set of draft statements using existing European directives and guidelines on radiation protection. These statements were revised after an open debate of attendees at a European Academy of Dental and Maxillofacial Radiology (EADMFR) Congress in June 2008. A modified Delphi procedure was used to present the revised statements to the EADMFR membership, utilising an online survey in October/November 2008.

    RESULTS: Of the 339 EADMFR members, 282 had valid e-mail addresses and could be alerted to the online survey. A response rate of 71.3% of those contacted by e-mail was achieved. Consensus of EADMFR members, indicated by high level of agreement for all statements, was achieved without a need for further rounds of the Delphi process.

    CONCLUSIONS: A set of 20 basic principles on the use of dental cone beam CT has been devised. They will act as core standards for EADMFR and, it is hoped, will be of value in national standard-setting within Europe.

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  • 22. Mota de Almeida, F. J.
    et al.
    Knutsson, K.
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics2014Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 43, nr 4, artikel-id 20130137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems.

    Methods: The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis.

    Results: 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%).

    Conclusions: CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

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  • 23. Ohman, A
    et al.
    Kivijärvi, K
    Blombäck, U
    Flygare, Lennart
    Department of Radiology, Sunderby Hospital, SE-971 80, Luleå, Sweden.
    Pre-operative radiographic evaluation of lower third molars with computed tomography2006Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 35, nr 1, s. 30-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To report radiographic findings of examinations with computed tomography (CT) of impacted lower third molars with an intimate relation to the mandibular canal and to investigate how findings of a dark band across the roots of the lower third molar on panoramic views correspond to the CT findings.

    METHODS: CT images of 90 lower third molars (64 patients, mean age 34.6 years) in which plain radiography was insufficient to allow determination of the precise anatomical relations were reviewed retrospectively. Panoramic views of 88 teeth existed; these images were interpreted independent of the CT examinations with respect to presence of a dark band across the roots.

    RESULTS: In 31% of the CT images, the course of the mandibular canal was buccal, in 33% lingual, in 26% inferior, and in 10% inter-radicular. The tooth was in contact with the mandibular canal in 94% and with the lingual cortex in 86%. In 23%, grooving of the root by the canal was judged to be present. In 63% of the cases where a dark band across the roots was observed on panoramic radiographs, CT revealed grooving of the root.

    CONCLUSIONS: Pre-operative CT of lower third molars is motivated in selected cases when plain radiography is inconclusive. The finding of a dark band across the roots on panoramic radiographs is an indicator of grooving of the tooth by the canal and justifies a pre-operative CT examination. The absence of dark bands on panoramic views does not exclude grooving of the roots.

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  • 24.
    Vestin Fredriksson, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Kuoljok, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Berggren, Diana
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Tano, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Clinical Manifestations and Symptoms of Maxillary Sinusitis of Odontogenic Origin Demonstrated by Cone Beam Computed Tomography2019Ingår i: Journal of General Practice, E-ISSN 2329-9126, Vol. 7, nr 1, artikel-id 371Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To compare the symptomatology of patients with maxillary sinusitis of dental origin (MSDO) with sinusitis due to upper respiratory tract infection (URTI) with a special focus on time to correct diagnosis. To define the accuracy of cone beam computed tomography (CBCT) in detecting the dental origin of the sinusitis.

    Methods: Retrospective review of the otolaryngology specialist care, primary health care and dental health care medical records of patients with maxillary sinusitis who has been referred for radiology. All patients were examined by CBCT, which has a better resolution regarding bony structures than low-dose computed tomography. To the best of our knowledge there is no previous study on this topic based on CBCT as diagnostic method.

    Results: Sixty-one patients were included in the study; of these, 25 had MSDO and 36 had URTI sinusitis. The MSDO patients more frequently reported foul odour and foul taste than patients with URTI sinusitis. The URTI sinusitis patients more frequently reported symptoms such as facial pain, facial congestion and cold-related symptoms. Both the time from the onset of symptoms to the first medical visit and the subsequent time to a correct diagnosis were significantly longer in the MSDO group. The accuracy of CBCT for detecting dental pathology as the underlying cause of sinusitis was 97%.

    Conclusion: The present study verifies that maxillary sinusitis of dental origin differs from viral-induced rhinosinusitis concerning symptomatology and clinical findings. Certain findings and symptoms could serve as valuable indicators of an underlying dental pathology, because although MSDO is well known, the present study shows that these patients are often misdiagnosed and the correct diagnose and treatment is often delayed several months. Consequently, better assessment is important. The suspicion of MSDO should be raised for patients with unilateral sinusitis presenting little pain, foul odour or foul taste and a long time course. These patients should be referred for radiology, preferably CBCT, to rule out odontogenic cause. CBCT is easy to perform for sinusitis examinations and has advances to common CT, especially regarding detection of pathology in bony structures as the periapical area. Because of this CBCT is a reliable tool in order to detect maxillary sinusitis of dental origin.

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  • 25.
    Vestin Fredriksson, Malin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Öhman, Anders
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Tano, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis2017Ingår i: Laryngoscope Investigative Otolaryngology (LIO), E-ISSN 2378-8038, Vol. 2, nr 6, s. 442-446Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: This study sought to investigate the proportion of patients with suspected sinusitis referred for radiological examination who have radiologically verified sinusitis of odontogenic origin and to describe this type of sinusitis. Study Design: This investigation is a retrospective study. Methods: A total of 303 sinus examinations involving cone beam computed tomography (CBCT) performed at Sunderby Hospital, Lulea, Sweden in 2012 were independently reviewed by two radiologists. The number of cases of maxillary sinusitis and the correlation between maxillary sinusitis and odontogenic infections were determined. Results: Overall, 24% of the verified cases of sinusitis were odontogenic. An odontogenic origin was identified in 40% of unilateral maxillary sinusitis cases but only 6% of bilateral maxillary sinusitis cases (p=0.0015). Forty-nine out of 54 patients with periapical destruction had adjacent mucosal swelling in the maxillary sinus, but only 15 of these patients satisfied the criteria for sinusitis. Conclusion: The present study confirms the close relationship between odontogenic infections and unilateral maxillary sinusitis.

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  • 26.
    Zborayova, Katarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Blomqvist, L.
    Flygare, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Gebre-Medhin, M.
    Jonsson, Joakim
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Söderkvist, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Zackrisson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Early changes in multiparametric imaging parameters during radiotherapy of squamous carcinoma2019Ingår i: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 132, s. 63-63Artikel i tidskrift (Övrigt vetenskapligt)
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