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Warfvinge, Gunnar
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Olsson, P., Ekblad, F., Hassler, A., Bengtsson, M., Warfvinge, G., Mandl, T. & Kvarnström, M. (2023). Complications after minor salivary gland biopsy: a retrospective study of 630 patients from two Swedish centres. Scandinavian Journal of Rheumatology, 52(2), 208-216
Open this publication in new window or tab >>Complications after minor salivary gland biopsy: a retrospective study of 630 patients from two Swedish centres
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2023 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 52, no 2, p. 208-216Article in journal (Refereed) Published
Abstract [en]

Objectives The aims of the study were to investigate the prevalence of impaired sensation after minor salivary gland biopsy (MSGB) in two Swedish centres [Karolinska University Hospital (KUH) and Skane University Hospital (SUH)] and to assess its impact on quality of life (QoL) and associated risk factors. Method A questionnaire including questions regarding the presence of impaired sensation, impact on QoL, and impact on everyday life was sent to patients who had undergone MSGB between 2007 and 2016, and their medical notes were scrutinized. Results The study included 630 patients (505 from KUH and 125 from SUH). In KUH the biopsies were performed by rheumatologists and in SUH by dentists or oral and maxillofacial surgeons (OMSs). Long-standing, probably permanent, impaired sensation after MSGB was reported by 21% of patients, and was associated with lower age and absence of anti-SSA antibodies. Patients with long-standing impaired sensation reported the inconvenience (1-10) of impaired sensation as 4.0 (2.0-7.0) [median (interquartile range)], and 32% reported an influence on their QoL, the reported influence (1-10) on everyday life being 3.0 (1.0-5.0). When comparing the outcomes from KUH and SUH, patients from SUH reported a significantly lower frequency of long-standing impaired sensation (14% vs 23%; p = 0.02). Conclusion A high frequency of long-standing impaired sensation after MSGB was found among patients who had undergone MSGB, although it had a low impact on everyday life. The complication frequency was less pronounced when a dentist or an OMS had performed the biopsy.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
National Category
Surgery
Identifiers
urn:nbn:se:mau:diva-49976 (URN)10.1080/03009742.2021.1999671 (DOI)000744777100001 ()35049421 (PubMedID)2-s2.0-85123413640 (Scopus ID)
Available from: 2022-02-07 Created: 2022-02-07 Last updated: 2024-02-05Bibliographically approved
Tollemar, V., Arvidsson, H., Häbel, H., Tudzarovski, N., Legert, K. G., Le Blanc, K., . . . Sugars, R. V. (2023). Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation. Heliyon, 9(4), Article ID e15517.
Open this publication in new window or tab >>Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation
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2023 (English)In: Heliyon, E-ISSN 2405-8440, Vol. 9, no 4, article id e15517Article in journal (Refereed) Published
Abstract [en]

Objectives: The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) patho-physiology's. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. Design: Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0-16 points, Grade (G) 0 to IV). Second, a modified Sjo center dot gren's Syndrome focus-score with parenchymal damage was also adapted, (0-10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the his-topathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. Results: The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of "likely" sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Conclu-sions: Both schemes were verified as being suitable for histological grading to improve assess-ment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of "no/inactive", "possible" or "likely" cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD.

Place, publisher, year, edition, pages
Cell Press, 2023
Keywords
Oral cGVHD, Histopathology, Grading, Large cohort, Hematopoietic cell transplantation
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-61857 (URN)10.1016/j.heliyon.2023.e15517 (DOI)000999086300001 ()37128306 (PubMedID)2-s2.0-85152651367 (Scopus ID)
Available from: 2023-08-15 Created: 2023-08-15 Last updated: 2024-06-18Bibliographically approved
Tollemar, V., Ström, J., Tudzarovski, N., Häbel, H., Legert, K. G., Heymann, R., . . . Sugars, R. V. (2023). Immunohistopathology of oral mucosal chronic graft-versus-host disease severity and duration. Oral Diseases, 29(8), 3346-3359
Open this publication in new window or tab >>Immunohistopathology of oral mucosal chronic graft-versus-host disease severity and duration
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2023 (English)In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 29, no 8, p. 3346-3359Article in journal (Refereed) Published
Abstract [en]

Objective Chronic graft-versus-host disease (cGVHD) is the main cause of late non-relapse mortality following hematopoietic cell transplantation. Oral mucosal (om-) cGVHD is common, but diagnosis and assessment rely on clinical interpretation and patient-reported symptoms. We investigated immunohistopathological profiles with respect to om-cGVHD severity disease duration. Material and methods Ninety-four transplant patients and 15 healthy controls (n = 212 biopsies) were investigated by quantitative immunohistochemistry for T cells (CD4, CD8, and CD5), B cells (CD19 and CD20), macrophages (CD68), and Langerhans cells (CD1a). Results We found significant increases in T (CD4, CD8) and monocytic (CD68) cells in om-cGVHD, and a notable absence of B (CD19 and CD20) cells. Histopathological activity correlated with increased CD4, CD8 and CD68. However, CD4 was associated with mild om-cGVHD, whereas CD8 and CD68 were found to be elevated in severe om-cGVHD. CD8 and CD68 levels were raised at disease onset, but during late phase, the predominant CD68 population was accompanied by CD4. Conclusion Oral cGVHD is a heterogenous clinical disorder, but our knowledge of the underlying biology remains limited. We highlight the importance of CD4, CD8 and CD68 immune profiling, together with histological grading for the staging of oral cGVHD, to broaden our understanding of the biology and individual disease course.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
hematopoietic cell transplantation, histopathology, immunopathology, large cohort, oral mucosal cGVHD
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-54059 (URN)10.1111/odi.14303 (DOI)000828162300001 ()35796584 (PubMedID)2-s2.0-85134517544 (Scopus ID)
Available from: 2022-08-02 Created: 2022-08-02 Last updated: 2024-06-18Bibliographically approved
Olsson, J., Mattsson, U., Bultzingslowen, I. v., Pettersson, B., Warfvinge, G. & Ljunggren, A. (2022). Pre-medical dental evaluation and treatment of oral infection: a survey study among hospital-affiliated dentists in Sweden. Acta Odontologica Scandinavica, 80(1), 29-37
Open this publication in new window or tab >>Pre-medical dental evaluation and treatment of oral infection: a survey study among hospital-affiliated dentists in Sweden
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2022 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, no 1, p. 29-37Article in journal (Refereed) Published
Abstract [en]

Objective To examine how hospital-affiliated dentists assess risk and evaluate oral foci of infection in patients facing certain medical treatments, and whether the nature of upcoming medical treatment affects the choice of dental intervention. Materials and methods A survey comprising six clinical cases (50 teeth) was sent to hospital-affiliated dentists in Sweden. A treatment option for the affected tooth/teeth in each case was selected whether the patient was facing heart valve surgery, chemotherapy, radiation therapy, intravenous bisphosphonate treatment, solid organ transplantation or was diagnosed with endocarditis. Results Consensus in choice of dental treatment was high in 62%, moderate in 32% and low in 6% of the assessments. High variability of choice of treatment was seen for eight teeth whereas the remaining 42 teeth often received the same therapy regardless of medical issue. Chemotherapy and radiotherapy were thought to entail the highest risk for oral infectious sequelae with a risk ranging from 1% to 100%. Conclusion Pre-medical dental evaluations and recommended treatments are often uniform with the exception of the management of asymptomatic root canal treated teeth with persisting apical radiolucency and heavily decayed molars. In many instances, dental diagnosis has a greater impact on choice of treatment than the underlying medical issue and associated implications thereof.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Pre-medical dental evaluation, oral infectious sequelae, assessment of risk
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-43930 (URN)10.1080/00016357.2021.1934535 (DOI)000659333100001 ()34107238 (PubMedID)2-s2.0-85107617693 (Scopus ID)
Available from: 2021-06-22 Created: 2021-06-22 Last updated: 2024-02-05Bibliographically approved
Guellil, M., Kersten, O., Namouchi, A., Luciani, S., Marota, I., Arcini, C. A., . . . Bramanti, B. (2020). A genomic and historical synthesis of plague in 18th century Eurasia.. Proceedings of the National Academy of Sciences of the United States of America, 117(45), 28328-28335, Article ID 202009677.
Open this publication in new window or tab >>A genomic and historical synthesis of plague in 18th century Eurasia.
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2020 (English)In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 117, no 45, p. 28328-28335, article id 202009677Article in journal (Refereed) Published
Abstract [en]

genomes from nine individuals covering four Eurasian sites and placed them into an historical context within the established phylogeny. CHE1 (Chechnya, Russia, 18th century) is now the latest Second Plague Pandemic genome and the first non-European sample in the post-Black Death lineage. Its placement in the phylogeny and our synthesis point toward the existence of an extra-European reservoir feeding plague into Western Europe in multiple waves. By considering socioeconomic, ecological, and climatic factors we highlight the importance of a noneurocentric approach for the discussion on Second Plague Pandemic dynamics in Europe.

Place, publisher, year, edition, pages
National Academy of Sciences, 2020
Keywords
Yersinia pestis, aDNA, ancient DNA, pathogen, plague
National Category
History and Archaeology
Identifiers
urn:nbn:se:mau:diva-36777 (URN)10.1073/pnas.2009677117 (DOI)000590745300015 ()33106412 (PubMedID)2-s2.0-85096079818 (Scopus ID)
Available from: 2020-11-11 Created: 2020-11-11 Last updated: 2024-06-17Bibliographically approved
Tollemar, V., Tudzarovski, N., Warfvinge, G., Yarom, N., Remberger, M., Heymann, R., . . . Sugars, R. V. (2020). Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease: Large Cohort Analysis. Biology of blood and marrow transplantation, 26(10), 1971-1979, Article ID S1083-8791(20)30401-8.
Open this publication in new window or tab >>Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease: Large Cohort Analysis
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2020 (English)In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 26, no 10, p. 1971-1979, article id S1083-8791(20)30401-8Article in journal (Refereed) Published
Abstract [en]

Graft-versus-host disease (GVHD) can manifest as acute or chronic complications in patients after hematopoietic cell transplantation (HCT). Oral chronic GVHD (cGVHD) occurs in approximately 70% of HCT recipients and includes lichenoid-like mucosal reactions, restricted mouth opening, and salivary gland dysfunction. However, the underlying histopathological presentation remains to be validated in large cohorts. We characterized the histopathological features of oral mucosal cGVHD and devised a scoring model in a large patient cohort (n = 112). Oral mucosal biopsy sections (n = 303) with and without oral cGVHD were identified from archived and current HCT recipients with additional healthy controls. Histological screening was performed on hematoxylin and eosin-stained and periodic acid-Schiff-stained sections. A points-based grading tool (0 to 19, grade 0 to IV) was established based on intraepithelial lymphocytes and band-like inflammatory infiltrate, atrophic epithelium with basal cell liquefaction degeneration, including apoptosis, as well as separation of epithelium and pseudo-rete ridges. Validation involved 62 biopsy specimens, including post-HCT (n = 47) and healthy (n = 15) specimens. Remaining biopsy specimens (n = 199) were blindly graded by 3 observers. Histological severity was correlated with clinical diagnostic and distinctive features, demonstrating a spectrum of individual patient severity, including frequent signs of subclinical GVHD in healthy mucosa. However, oral cGVHD presented with significantly higher (P < .001) scores compared with HCT controls, with moderate to high positive likelihood ratios for inflammatory infiltrate, exocytosis, and basal membrane alterations. The grade II-IV biopsy specimens demonstrated a histopathological diagnosis of active mucosal lichenoid-like cGVHD, highlighting the importance of correlating clinical presentation with the dynamic histopathological processes for improved patient stratification. In addition, this tool could be used for assessing treatments, pathological processes, and immune cellular content to provide further insight into this debilitating disease.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Grading, Hematopoietic cell transplantation, Histopathology, Large cohort, Oral cGVHD
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-18018 (URN)10.1016/j.bbmt.2020.06.031 (DOI)000580076900030 ()32659433 (PubMedID)2-s2.0-85089299066 (Scopus ID)
Available from: 2020-08-18 Created: 2020-08-18 Last updated: 2024-05-17Bibliographically approved
Robledo-Sierra, J., Landin-Wilhelmsen, K., Nyström, H. F., Eggertsen, R., Larsson, L., Dafar, A., . . . Jontell, M. (2018). A mechanistic linkage between oral lichen planus and autoimmune thyroid disease (ed.). Oral Diseases, 24(6), 1001-1011
Open this publication in new window or tab >>A mechanistic linkage between oral lichen planus and autoimmune thyroid disease
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2018 (English)In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 24, no 6, p. 1001-1011Article in journal (Refereed)
Abstract [en]

ObjectiveTo determine the levels of antithyroid antibodies and thyroid hormones in the sera of patients with oral lichen planus (OLP), and to quantify the expression of thyroid proteins in OLP lesions. Subjects and MethodsVenous blood samples were drawn from 110 patients with OLP who had no history of thyroid disease or levothyroxine supplementation (OLP+/LT4-). A random population sample of 657 healthy subjects was used as the control group. Two additional groups were used as comparators. Immunohistochemical and qPCR analyses were performed on tissue specimens collected from the patients with OLP and thyroid disease and healthy subjects. ResultsNo association was found between the presence of antithyroid antibodies and OLP. More patients in the OLP+/LT4- group showed high levels of thyroid-stimulating hormone and low levels of free thyroxine than were seen in the control group. Thyroid-stimulating hormone receptor was more highly expressed in the OLP lesions of patients with thyroid disease than in the healthy oral mucosa. ConclusionsA significant number of patients with OLP who are not previously diagnosed with thyroid disease have thyroid parameters that are compatible with hypothyroidism. The expression of thyroid-stimulating hormone receptor in OLP lesions suggests that mechanisms related to autoimmune thyroid disease are involved in the aetiology of OLP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
antithyroid antibodies, autoimmune thyroid disease, comorbidity, oral lichen planus, thyroid hormones, thyroid-stimulating hormone receptor
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6055 (URN)10.1111/odi.12850 (DOI)000442499600016 ()29500871 (PubMedID)2-s2.0-85047751262 (Scopus ID)26607 (Local ID)26607 (Archive number)26607 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-18Bibliographically approved
Abreu Velez, A. M., Yi, H., Warfvinge, G. & Howard, M. S. (2018). Autoantibodies to full body vascular cell junctions colocalize with MYZAP, ARVCF, desmoplakins I and II and p0071 in endemic pemphigus in Colombia, South America (ed.). International Journal of Dermatology, 57(3), 291-298
Open this publication in new window or tab >>Autoantibodies to full body vascular cell junctions colocalize with MYZAP, ARVCF, desmoplakins I and II and p0071 in endemic pemphigus in Colombia, South America
2018 (English)In: International Journal of Dermatology, ISSN 0011-9059, E-ISSN 1365-4632, Vol. 57, no 3, p. 291-298Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We previously described a new variant of endemic pemphigus foliaceus in El Bagre, Colombia (El Bagre-EPF). METHODS: Here we aimed to investigate disease autoreactivity to vessels in all body organs/systems. We compared 57 patients and 57 controls from the endemic area, matched by demographics, age, sex, and work activity. We performed immunofluorescence, immunohistochemistry, confocal microscopy, immunoblotting, indirect immune electron microscopy studies, and autometallographic studies. We performed ultrasonography on large patient arteries, investigating for vascular anomalies. In addition, we reviewed autopsies on seven patients who died affected by El Bagre-EPF. We immunoadsorbed any positive vessel immunofluorescence with desmoglein (Dsg1), investigating for new autoantigens. RESULTS: Overall, 57/57 patients affected by El Bagre-EPF displayed autoantibodies to vessels in all the organs/systems of the body via all methods (P < 0.01). The autoreactivity was polyclonal, and the patient's antibodies colocalized with commercial antibodies to desmoplakins I and II, p0071, ARVCF, and MYZAP (all from Progen Biotechnik, Germany; P < 0.01; all present at cell junctions). Immunoadsorption with Dsg1 on positive vessel immunofluorescence showed that the immune response against the vessels was directed against non-Dsg1 antigen(s). Autometallographic studies showed deposits of metals and metalloids in vessel cell junctions and in erythrocytes of 85% of patients (P < 0.01). CONCLUSIONS: Immune response to these vascular antigens is likely altering endothelial cells and vessel shapes, thus disturbing hemodynamic flow. The flow alterations likely lead to inflammation and may play a role in the atherogenesis often seen in these patients.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-6046 (URN)10.1111/ijd.13827 (DOI)000424877900014 ()29152726 (PubMedID)2-s2.0-85034236783 (Scopus ID)25805 (Local ID)25805 (Archive number)25805 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-06-17Bibliographically approved
Kroona, L., Isaksson, M., Ahlgren, C., Dahlin, J., Bruze, M. & Warfvinge, G. (2018). Carvone Contact Allergy in Southern Sweden: A 21-year Retrospective Study. (ed.). Acta Dermato-Venereologica, 98(10), 938-942
Open this publication in new window or tab >>Carvone Contact Allergy in Southern Sweden: A 21-year Retrospective Study.
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2018 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 98, no 10, p. 938-942Article in journal (Refereed)
Abstract [en]

Carvone (l-carvone), a mint flavour in spearmint oil, is considered a mild skin sensitizer. Carvone-sensitization may be linked to oral/perioral signs and oral lichen planus, but studies are sparse. The prevalence of patch test reactions to carvone and relevant findings from the positive group were investigated. Records for patch-tested patients at the Malmö clinic, for the period 1996 to 2016, were studied. Carvone-positive and carvone-negative patients were compared regarding patch test data from baseline series and dental series. Dental series-tested carvone-positive patients were also compared with a matched group. A total of 147 out of 4,221 referred patients had a positive patch test to carvone. Sensitized patients had higher mean age and were primarily women; 73% had oral signs and 57% had oral lichen. Concomitant patch test reactions to gold, nickel and mercury were common. In the matched group-comparison carvone-positive patients had a higher frequency of oral lichen, but no difference was found in sensitization to gold and mercury.

Place, publisher, year, edition, pages
European Society of Dermatology and Psychiatry (ESDaP), 2018
Keywords
l-carvone, spearmint, patch test, allergens, contact allergy, oral lichen planus, oral lichenoid lesions
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-15301 (URN)10.2340/00015555-3009 (DOI)000447740400004 ()30085320 (PubMedID)2-s2.0-85056285172 (Scopus ID)26732 (Local ID)26732 (Archive number)26732 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
Hallmer, F., Andersson, G., Götrick, B., Warfvinge, G., Anderud, J. & Bjørnland, T. (2018). Prevalence, initiating factor, and treatment outcome of medication-related osteonecrosis of the jaw-a 4-year prospective study (ed.). Oral surgery, oral medicine, oral pathology and oral radiology, 126(6), 477-485
Open this publication in new window or tab >>Prevalence, initiating factor, and treatment outcome of medication-related osteonecrosis of the jaw-a 4-year prospective study
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2018 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 126, no 6, p. 477-485Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) has a wide range of prevalence, and a standard therapy has not yet been established. The aim of this study was to analyze the prevalence and initiating factors of MRONJ and the outcomes of surgical therapy. STUDY DESIGN: In a prospective cohort study, all patients diagnosed with MRONJ in the Region of Skane, in Sweden, were included. Predictor variables (comorbidity, site, stage, gender) and initiating factors (tooth extraction, periodontitis) were recorded. Surgical treatment was sequestrectomy or block resection, and the outcome variable was healing after 2 months. To estimate the prevalence, data on the use of bisphosphonate and denosumab were used. RESULTS: Fifty-five patients with MRONJ were identified. The prevalence of MRONJ was 0.043% among patients treated with oral bisphosphonates, 1.03% among those on intravenous bisphosphonates and 3.64% in those on high-dose denosumab. Periodontal disease preceded development of MRONJ in 41 patients. Fifty patients were treated surgically and followed up for at least 2 months. Remission or healing occurred in 80% of patients treated with sequestrectomy and in 92.5% of patients treated with block resection. CONCLUSIONS: The prevalence of MRONJ in Sweden is low. Periodontitis is the most common initiating factor. The outcome of treatment of MRONJ is healing in most patients treated surgically.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15628 (URN)10.1016/j.oooo.2018.08.015 (DOI)000453266800007 ()30249535 (PubMedID)2-s2.0-85053692310 (Scopus ID)26668 (Local ID)26668 (Archive number)26668 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
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