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  • 1.
    Abdelbari Fashil, Jehin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Calderon Aguilar, Johana Claribel
    Malmö University, Faculty of Odontology (OD).
    Mechanical properties of multi-layered translucent zirconia materials produced with different strategies for gaining translucency; differences in yttria content or color saturation.2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Purpose 

    This study aimed to evaluate the mechanical properties of the different layers of multi-layered zirconia materials produced with different strategies for gaining translucency.

     

    Materials and methods 

    Sixty zirconia specimens were prepared in a bar shape from two different partially sintered multi-layered zirconia blanks (KATANA™ Multi-layered Zirconia HTML, Kuraray Noritake Dental, EU) and (IPS e.max® ZirCAD Prime, Ivoclar, USA). The specimens were distributed into two groups based on the material used (n=30) and further subdivided into three subgroups according to the different layers of zirconia blanks: translucent, transition, and dentin (n=10). All specimens were subjected to a static three-point flexural strength test. A one-way ANOVA and a T-test were performed to determine the significant differences among the groups. 

     

    Results 

    The different layers of ZirCAD Prime showed significant differences in flexural strength (p=0.001). In contrast, the different layers of KATANA™ HTML showed no significant differences (p=0.437). A T-test was conducted to compare the results from different layers within the same material. The results of the One-Way ANOVA test for the different groups of KATANA™ HTML demonstrated no difference between the groups (p=0.437). 

     

    Conclusion 

    Different compositions of different multi-layered zirconia materials result in various mechanical properties. Brand-specific differences are an essential consideration for dentists and dental technicians when using multi-layered zirconia. It is crucial to consider various factors such as type of restoration, positioning of the restoration in the disc (nesting), and restoration to be used anteriorly or posteriorly, and the desired esthetical requirements as the translucency are gained in different ways.   

  • 2.
    Abdelghani, Omar
    et al.
    Malmö University, Faculty of Odontology (OD).
    Salih, Hevy
    Malmö University, Faculty of Odontology (OD).
    Hur tandvården framställs i pressen och dess påverkan på allmänhetens förtroende - Media innehållsanalys2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study is to investigate how Swedish dental care is represented in the media, since it is an important factor that can affect the public's trust in dental care. Material & method: To investigate what was written and how much was written in both general and negative sense about dental care in the Swedish press between 2007 - 2018, two source selections were used. One selection was called the broad source selection and included all Swedish editorial press in retriever's media archive. The second source selection was called the limited source selection and included only six powerful sources. The material was analyzed both quantitatively and qualitatively using Media content analysis. Result: The overall publicity on dental care in general sense was at its most 2008, thereafter it decreased at a steady pace. The negative reporting has been uneven with clear increases in some years that can be attributed to specific events relating to dental care. In the negative reporting it was written about dentists who got rid of their license and that in dental care there is carelessness, malpractice, over-treatment and cheating. But mostly, it was written negatively about the functioning of the dental care system and that dental care is expensive. Conclusion: By comparing available customer satisfaction and trust measurements with the negative and general media reporting, we were unable to conclude that media reporting has affected public trust between 2007-2018. We found, among other things, that when it was written negatively about dental care, criticism was mainly directed at private dental care, despite this trust and customer satisfaction levels were higher for private dental care compared to public dental care during the same period. Further studies are needed to investigate how media reports affects peoples trust in dental care.

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  • 3.
    Abdel-Halim, Maha
    et al.
    Malmö University, Faculty of Odontology (OD).
    Issa, Dalia
    Malmö University, Faculty of Odontology (OD).
    The impact of dental implant length on failure rates: a systematic review and meta-analysis2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Purpose

     To evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants.

     

    Materials and methods

    A search was undertaken in three electronic databases, complemented by manual search of some journals. Implant failure was the outcome evaluated, with the estimate of relative effect expressed in risk ratio (RR). Heterogeneity among studies was evaluated by I2statistic. Inverse variance method was used for random- or fixed-effects models. Quality assessment of the studies was performed, and a funnel plot was drawn. A meta-regression was performed in order to verify how the RR was associated with the follow-up time.

     

    Results

    The reviews included 353 publications. Altogether, there were 25,490 short implants and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher risk of failure than long implants (RR 2.437, p<0.001). The meta-regression observed that the follow-up time did not have any effect of the RR of failure between short and long implants. A sensitivity analysis plotting together only the studies with follow-up up until 7 years, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up.

     

    Conclusion

    Short implants showed (< 10 mm) a 2.5 times higher risk of failure than long implants (≥ 10 mm). Implant failure is multifactorial and the implant length is only one of the many factors contributing to the loss of implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

     

     

     

    Keywords: dental implant, failure, implant length, systematic review, meta-analysis

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  • 4.
    Abdel-Halim, Maha
    et al.
    Malmö University, Faculty of Odontology (OD).
    Issa, Dalia
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD).
    The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis2021In: Materials, ISSN 1996-1944, E-ISSN 1996-1944, Vol. 14, no 14, article id 3972Article, review/survey (Refereed)
    Abstract [en]

    The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (>= 10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient's general health should be taken into account when planning for an implant treatment.

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  • 5.
    Abdul Rahim, Maha
    et al.
    Malmö University, Faculty of Odontology (OD).
    Khan, Kashmala
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Influence of Crown-Implant Ratio and Implant Inclination on Marginal Bone Loss around Dental Implants Supporting Single Crowns in the Posterior Region: A Retrospective Clinical Study.2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 9, article id 3219Article in journal (Refereed)
    Abstract [en]

    The aim of this present record-based retrospective study was to investigate the influence of the crown-implant ratio (CIR) and implant inclination in relation to the occlusal plane on the marginal bone loss (MBL) around dental implants supporting single crowns in the posterior region of the jaws. All the cases of implant-supported single crowns in the premolar and molar regions were initially considered for inclusion. Only implants not lost, with baseline radiographs taken within 12 months after implant placement and with a minimum of 36 months of radiological follow-up, were considered for the analysis of MBL. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built. After the exclusion of 49 cases, a total of 316 implant-supported single crowns in 234 patients were included. The results from the statistical models suggested that implant inclination and anatomical- and clinical CIR (the main related factors investigated in the study) were not statistically significantly related to MBL over time. Age (older people), tooth region (premolar), and bruxism (bruxers) had a statistically significant influence on MBL over time.

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  • 6.
    Abdulraheem, Salem
    Malmö University, Faculty of Odontology (OD).
    Efficacy of fluoride varnish in preventing white spot lesions during treatment with fixed orthodontic appliances A triple blinded randomized controlled trial2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study was to evaluate the efficacy of a novel fluoride varnish (NFPV, Fluor Protector S) in preventing development of white spot lesions in adolescents undergoing treatment with fixed orthodontic appliances. Material and methods: 185 patients aged between 12 and 18 years planned for orthodontic treatment with fixed appliance were randomized into varnish or placebo group. The varnish group received a varnish with the active ingredient ammonium fluoride and the placebo group received a similar varnish but without ammonium fluoride. All patients received treatment with fixed orthodontic appliance in the upper arch for a period of more than one year, and before bonding all patients had three intra-oral photos. Varnish in both groups was applied on the maxillary anterior teeth and premolars during every check-up at the orthodontic clinic (every 6 weeks). After debond, the composite on the teeth was carefully removed using carbide bur and three new intra-oral photos were taken. Finally, white spot lesions (WSL) were evaluated and scored on a monitor in a dark room using Gorelick scoring index. Results: 66 patients of the 185 patients were debonded and represent the final number of patients included in present master thesis. The incidence of WSL after debond was 19.9% in the test group and 18.1% in the placebo group, respectively. No statistically significant difference between the groups was recorded. Conclusion: Based on the limited amount of the patients in present master thesis, the null hypothesis was confirmed, there is no additional benefit to apply ammonium fluoride varnish during treatment with fixed orthodontic appliance to reduce the incidence of WSL.

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  • 7.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    Hawthorne effect reporting in orthodontic randomized controlled trials: truth or myth? Blessing or curse?2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 5, p. 475-479Article, review/survey (Refereed)
    Abstract [en]

    Objective To investigate in 10 orthodontic journals how many randomized controlled trials (RCTs) considered the Hawthorne effect, and if considered, to determine whether it was related to the patients or the therapists involved in the trial and, finally, to discuss the Hawthorne effect in an educational way. Materials and methods A search was performed on the Medline database, via PubMed, for publication type ‘randomized controlled trial’ published for each journal between 1 August 2007 and 31 July 2017. The American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, Australian Orthodontic Journal, Dental Press Journal of Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, Journal of Orofacial Orthopedics, Korean Journal of Orthodontics, Orthodontics and Craniofacial Research and Progress in Orthodontics were assessed. Two independent reviewers extracted the data and identified whether the Hawthorne effect was considered or discussed in the articles and whether the Hawthorne effect was related to the behaviour of the patients, the therapists, or both. Results The initial search generated 502 possible trials. After applying the inclusion and exclusion criteria, 290 RCTs were included and assessed. The Hawthorne effect was considered or discussed in 10 of 290 RCTs (3.4%), and all were related to the patients’ and none to the therapists’ behaviour. Conclusions The Hawthorne effect reported in orthodontic RCTs was suboptimal. The researchers’ lack of knowledge about this phenomenon is evident, despite evidence that the Hawthorne effect may cause over-optimistic results or false-positive bias.

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  • 8.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    The reporting of blinding in orthodontic randomized controlled trials: where do we stand?2019In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 1, p. 54-58Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse in 10 orthodontic journals how many randomized controlled trials (RCTs) performed 'single-', 'double-', 'triple-', or 'outcome assessors blinding' and to evaluate, from the number of RCTs that did not conduct blinding, how many could actually have achieved it. Material and methods: Randomized controlled trials published in 10 orthodontic journals between 1 September 2012 and 28 February 2018 were included. A search was performed in PubMed and conducted for publication type 'randomized controlled trial' for each journal. Two reviewers independently analysed each RCT and registered that blinding was performed and included which specific type. It was also evaluated whether misclassifications of blinding items occurred and whether it was possible to achieve blinding among the RCTs that did not perform blinding. Results: After applying the inclusion criteria, 203 RCTs were assessed, and 61.6 per cent of them had used blinding, with the main type being 'outcome assessors blinding' (40.4%) followed by 'single-blinding' (15.3%), 'double-blinding' (2.5%), and 'triple-blinding' (3.4%). In 38.4 per cent of the trials, no blinding was performed; however, 79.4 per cent of them could have achieved blinding. Fifteen RCTs (7.3%) misclassified the blinding in relation to single-, double-, or triple-blinding. Journals followed the CONSORT (AJODO, EJO, JO, OCR) published together significantly more RCTs that performed blinding than journals not following the CONSORT. Conclusions: Blinding of outcome assessors was the most frequent type, as orthodontic trials are often of intervention design and thereby difficult to mask for patients and trial staff. The misclassifications of blinding items may indicate suboptimal knowledge among researchers and peer-reviewers regarding the definitions for diverse blinding types.

  • 9.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD).
    Paulsson, Liselotte
    Malmö University, Faculty of Odontology (OD).
    Petrén, Sofia
    Malmö University, Faculty of Odontology (OD).
    Sonesson, Mikael
    Malmö University, Faculty of Odontology (OD).
    Do fixed orthodontic appliances cause halitosis? A systematic review2019In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 19, no 1, article id 72Article, review/survey (Refereed)
    Abstract [en]

    Objective: To examine: (I) the current evidence of the impact of fixed orthodontic appliances on the development of halitosis in patients undergoing orthodontic treatment, and (II) the influence of different orthodontic bracket systems on halitosis. Material and methods: Three electronic databases (PubMed, Scopus, and Cochrane Library) were searched prior to March 15, 2018. The review was systematically conducted and reported according to the Cochrane Handbook and the PRISMA statement. Only Randomised Clinical Trials (RCTs) were considered. Selected full-text papers were independently assessed by four investigators and any disagreements were resolved by consensus. The Cochrane Handbook was used to grade the risk of bias and the quality of evidence was rated according to GRADE. Results: Out of 363 identified studies, three RCTs on halitosis and fixed orthodontic appliances met the inclusion criteria. The risk of bias in the three studies was rated as high and the quality of evidence was rated as very low. Conclusions/clinical implications: There is a lack of scientific evidence that subjects with fixed orthodontic appliances develop halitosis during treatment. Additional well-conducted RCTs with extended periods of assessment are needed as well as consensus concerning cut-off values for the diagnosis of halitosis.

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  • 10.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD).
    Schütz-Fransson, Ulrike
    Bjerklin, Krister
    Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes?2020In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 42, no 1, p. 52-59, article id cjz020Article in journal (Refereed)
    Abstract [en]

    AIMS: To identify if lower incisor movements after orthodontic treatment are due to the relapse of the orthodontic treatment or due to natural growth. SUBJECTS AND METHODS: The subjects consisted of 92 patients who have had orthodontic treatment, divided into three groups, group 1: 38 individuals had no retainer in the lower jaw. Group 2: 24 individuals had a retainer 0.028 inch, a spring hard wire bonded to the mandibular canines only. Group 3: 30 individuals had a 0.0195-inch Twist-Flex wire, bonded to all mandibular incisors and canines. Study models before orthodontic treatment (T0), immediately after orthodontic treatment (T1), 6 years after orthodontic treatment (T2), and 12 years after orthodontic treatment (T3) were used for the measurements. The wires in groups 2 and 3 were removed after mean 2.6 years (SD 1.49). Little Irregularity Index (LII), inter-canine distance, available mandibular anterior space, and number of crowded incisors were registered. A Tooth Displacement Index (TDI) was developed to measure the tooth displacement directions at T0 and T3. RESULTS: The LII showed equal values before treatment (T0) and at the follow-up registrations (T2 and T3). But about 25 per cent of the tooth displacements at T2 and T3 did not exist before treatment, at T0. This indicates usual growth changes and not relapse of the orthodontic treatment. CONCLUSION: As about 25 per cent of the displaced incisors can be considered as an effect of natural growth, not a relapse of the orthodontic treatment, it is valuable to use a displacement index in combination with other variables for investigations of stability after orthodontic treatment. Importance of the present study is that it is possible to differ between relapse and usual growth changes.

  • 11.
    Abdulrasak, Houda
    Malmö University, Faculty of Odontology (OD).
    Determining the link between Chronic Periodontitis and Abdominal Aortic Aneurysm: A questionnaire-based study2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study was to find if there is a correlation between AAA and chronic periodontitis in regards to their relation with the help of a questionnaire. Material and methods: Men that have undergone screening in the Vascular Centre at Skånes University Hospital in Malmö, Sweden were invited to participate in this study via telephone. The questionnaire was formulated mainly with questions from the study conducted in Self-reported measures for Surveillance of Periodontitis (Eke et al. 2013). Questions asking the respondents about tobacco habits, if they suffered other diseases, medication, and more were added as part of this study. Captured data was analysed using IBM SPSS Statistics 25 (SPSS Inc., Chicago, IL, USA). Normal distribution was not assumed for the analyses. Values were processed with Mann-Whitney U test and χ2-test. P-value < 0.05 was accepted as statistically significant Results: A total of 300 individuals were contacted, of which 65 (21.7%) were included in the study. Of these, 42 (64.6 %) were controls and 23 (35.4 %) had AAA. Bone loss was more commonly present in AAA group (37.9%) versus control (11.9%) (p= 0.010) Conclusion: A weak link between chronic periodontitis and AAA may be suggested, however more studies with larger cohorts and potentially clinically verified periodontitis diagnosis, are necessary to establish this potential link more firmly.

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  • 12.
    Abou Zarad, Malek
    et al.
    Malmö University, Faculty of Odontology (OD).
    Rennstam, André
    Malmö University, Faculty of Odontology (OD).
    Vetenskapliga artiklar i Tandläkartidningen -Trender över tid2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract: One of the dentists' assignments is to work according to scientific evidence and proven clinical expertise. To achieve this goal, one must stay updated . The purpose of this study was to examine the scientific articles in the Swedish dental journal Tandläkartidningen. The empirical material consisted of articles in the scientific section of Tandläkartidningen between 2008 to 2017. The data gathering and categorization was done by two reviewers according to a prepared template. These articles formed the basis for analysis in order to examine trends and subject-specific spreading, but also a categorization of the authors´ gender and nationality. The method used and the type of every article was also categorized. These data were compiled in the statistical program IBM SPSS Statistics 25. The results showed that oral medicine (12.6%), material science and technology (9.1%), cariology (8.2%) periodontology (7.7%), prosthetics (6.9%) were the five most published subjects in the journal .Article type distribution was 61% review articles, 14% doctoral thesis summary, 10% debate articles, 9% scientific original articles and 6% case descriptions. If the 10-years period was divided into two, ie 2008-2012 and 2013-2017, an increase was seen regarding female authors from 40.5% between 2008-2012 and 43.5% during the period 2013-2017. The majority of authors were female authors in the period 2015-2017 in Sweden. In summary, it can be concluded that there is a certain spread in dental subjects published in the journal where some subjects dominate over this period. Most often, the authors were men, although the proportion of female writers has increased over time. To create an overview of subjects that dominate and to see clearer trends about authors, a longer time range needs to be analyzed.

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  • 13.
    Abrahamsson, Helene
    et al.
    Malmö University, Faculty of Odontology (OD).
    Eriksson, Lars
    Malmö University, Faculty of Odontology (OD).
    Abrahamsson, Peter
    Häggman-Henrikson, Birgitta
    Malmö University, Faculty of Odontology (OD).
    Treatment of temporomandibular joint luxation: a systematic literature review2020In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 24, p. 61-70Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation. MATERIALS AND METHODS: This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018. RESULTS: Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients. CONCLUSIONS: In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods. CLINICAL RELEVANCE: Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.

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  • 14. Abreu Velez, Ana M
    et al.
    Yi, Hong
    Warfvinge, Gunnar
    Malmö University, Faculty of Odontology (OD).
    Howard, Michael S
    Autoantibodies to full body vascular cell junctions colocalize with MYZAP, ARVCF, desmoplakins I and II and p0071 in endemic pemphigus in Colombia, South America2018In: International Journal of Dermatology, ISSN 0011-9059, E-ISSN 1365-4632, Vol. 57, no 3, p. 291-298Article in journal (Refereed)
    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.

  • 15. Adern, Bengt
    et al.
    Minston, Ava
    Nohlert, Eva
    Tegelberg, Åke
    Malmö University, Faculty of Odontology (OD).
    Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 20132018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 7, p. 530-534Article in journal (Refereed)
    Abstract [en]

    Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of Sormland, Sweden, during a 3-year period, 2011-2013. Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition. Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (<= 35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively. Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.

  • 16.
    Agerström, Josefin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Engholm, Clara
    Malmö University, Faculty of Odontology (OD).
    Varför byter tandläkare arbetsplats? - en intervjustudie2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Objective: The aim of this study was to ascertain the reasons why dentists change their place of work and what factors that might affect if they remain. Methods: The study is based on nine interviews with dentists graduated between 2014 and 2018. The interviews were recorded and transcribed. The empirical material was analyzed and constructed into categories and overall themes. Results: The dentists in the study expressed the importance of appreciation for their work. The appreciation could be in form of rewards such as salary and/or opportunities of development. They also mentioned credit and encouragement from their colleagues and influence in the business. The dentists described a situation at work where high work liability limited their development and made the work less stimulating. A good working climate was given high priority. When the dentists did not experience appreciation or felt satisfaction as a health care provider and besides felt discomfort at their workplace, they tended to move. Conclusion: This study showed that lack of appreciation and unsound work climate may result in changing workplace. If the dentists like their place of work, the lack of appreciation could be ignored. Rather, the working climate is seen as a catalyst and not a primary cause of workplace change. This study has investigated reasons for newly graduated dentists to change their workplace. It is of interest to study the management and the managers views on the mobility of dentists, how they manage and how they work to retain their employees.

  • 17.
    Aghazadeh, Ahmad
    Malmö University, Faculty of Odontology (OD).
    Peri-implantitis: risk factors and outcome of reconstructive therapy2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis is focused on (I) the outcome of reconstructive treatment of peri-implant defects and (II) risk factors for the development of peri-implantitis.

    Background

    An increasing number of individuals have dental implant-supported reconstructions. The long-time survival rate of dental implants is good, but complications do occur. Accumulation of bacteria on oral implants and the development of a pathogenic biofilm at the mucosal margin will result in inflammatory responses diagnosed as peri-implant mucositis(PiM). Furthermore, PiM may progress to peri-implantitis (Pi) involving the implant-supporting bone and potentially result in a severe inflammatory process resulting in alveolar bone destruction and consequently implantloss. Currently, Pi is a common clinical complication following implant therapy.The prevalence of peri-implantitis has been reported to be around 20 %. Susceptibility to infections and a history of periodontitis are considered as important risk indicators for peri-implantitis. It seems logical that a past history of periodontitis is linked to an increased risk of peri-implantitis. It is possible that other patient-associated factors such as a smoking habit, and presence of general diseases may also be linked to a higher risk for developing peri-implantitis.Treatment of peri-implantitis is difficult. Non-surgical treatment modalities may not be sufficient to resolve the inflammatory process to obtain healthy conditions.Surgical treatment of peri-implantitis has commonly been employed in clinical practice to obtain access to the implant surface thereby increasing the possibility to effectively decontaminate the implant surfaces.The effectiveness and long-term outcomes of reconstructive surgical treatments of peri-implantitis has been debated. The scientific evidence suggests that regular supportive care is an essential component in order to maintain and secure long-term results following treatment of peri-implantitis.

    Aims

    1. To assess the short-term efficacy of reconstructive surgical treatmentof peri-implantitis  (Study I).

    2. To analyse risk factors related to the occurrence of peri-implantitis(Study II).

    3. To assess the importance of defect configuration on the healing response after reconstructive surgical therapy of peri-implantitis (Study III).

    4. To assess the long-term efficacy of reconstructive surgical treatmentof peri-implantitis (Study IV).

    MethodsFour studies were designed to fulfil the aims:

    - A single-blinded prospective randomised controlled longitudinal human clinical trial evaluating the clinical and radiographic results of reconstructive surgical treatment of peri-implantitis defects usingeither AB or BDX.

    - A retrospective analysis of individuals with either peri-implantitis, or presenting with either peri-implant health, or peri-implant mucositis assessing the likelihood that peri-implantitis was associated with a history of systemic disease, a history of periodontitis, and smoking.

    - A prospective study evaluating if the alveolar bone defect configuration at dental implants diagnosed with peri-implantitisis related to clinical parameters at the time of surgical intervention and if the short- and long-term outcome of surgical intervention of peri-implantitis is dependent on defect configuration at the time of treatment.

    - A prospective 5-year follow-up of patients treated either with AB or BDX.

    Results

    - The success for both surgical reconstructive procedures was limited. Nevertheless, bovine xenograft provided evidence of more radiographic bone fill than AB. Improvements in PD, BOP, and SUP were observed for both treatment modalities

    -In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was expressed in the presence of a history of periodontitis and a medical history of cardiovascular disease

    - The buccal-lingual width of the alveolar bone crest was explanatory to defect configuration

    - 4-wall defects and deeper defects demonstrated more radiographic evidence of defect fill

    - Reconstructive surgical treatment of peri-implant defects may result in successful clinical outcomes, that can be maintained over at least five years

    - The use of BDX is more predictable than use of harvested bone from the patient (AB)

    Conclusions

    The study results suggest that a bovine xenograft provides better radiographic evidence of defect fill than the use of autogenous bone harvested from cortical autologous bone grafts.Treatment with bone grafts to obtain radiographic evidence of defect fill is more predictable at 3- and 4-wall defects than at peri-implantitis bone defects with fewer bone walls.In relation to a diagnosis of peri-implantitis, a high likelihood of comorbidity was found for a history of periodontitis and a history of cardiovascular disease.

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  • 18.
    Aghazadeh, Ahmad
    et al.
    Tand & Implantat Specialistkliniken, Solna, Sweden.
    Persson, G Rutger
    Department of Periodontics and Oral Medicine, University of Washington USA; .
    Stavropoulos, Andreas
    Malmö University, Faculty of Odontology (OD). Division of Regenerative Dental Medicine and Periodontology, CUMD, University of Geneva, Geneva, Switzerland.
    Renvert, Stefan
    Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.
    Reconstructive treatment of peri-implant defects- Results after three and five years.2022In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 33, no 11, p. 1114-1124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to assess the long-term efficacy of reconstructive treatment of peri-implantitis intraosseous defects.

    MATERIAL AND METHODS: Peri-implant intraosseous defects were augmented using either an autogenous bone graft (AB) or a bovine-derived xenograft (BDX) in combination with a collagen membrane. Maintenance was provided every third month.

    RESULTS: In the AB group, 16 patients with 25 implants remained at year five. In the BDX group, 23 patients with 38 implants remained. Between baseline and year 5, bleeding on probing (BOP) and probing pocket depth (PPD) scores were reduced in both groups (p < .001). In the AB and BDX groups, mean PPD between baseline and year five was reduced by 1.7 and 2.8 mm, respectively. The difference between groups was significant (p < .001). In the AB group, the mean bone level change at implant level between baseline and years three and five was-0,2 and -0.7 mm, respectively. In the BDX group, the mean bone level change at implant level between baseline and years three and five was 1.6 and 1.6 mm, respectively. The difference between the groups was significant (p < .001). Successful treatment (no bone loss, no probing pocket depth (PPD) > 5 mm, no suppuration, maximum one implant surface with bleeding on probing (BOP) at year five) was obtained in 9/25 implants (36%) in the AB group and in 29/37 implants (78.3%) in the BDX group.

    CONCLUSIONS: Reconstructive surgical treatment of peri-implant defects using BDX resulted in more predictable outcomes than using autogenous bone over 5 years.

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  • 19.
    Aherne, Olivia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Biomedical Science (BMV). Malmö University, Biofilms Research Center for Biointerfaces. CR Competence, Naturvetarvägen 14, 223 62, Lund, Sweden.
    Ortiz, Roberto
    CR Competence, Naturvetarvägen 14, 223 62, Lund, Sweden.
    Fazli, Magnus M
    Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; SoftOx Solutions AS, Copenhagen, Denmark.
    Davies, Julia R
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Effects of stabilized hypochlorous acid on oral biofilm bacteria2022In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 22, no 1, article id 415Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Caries and periodontitis are amongst the most prevalent diseases worldwide, leading to pain and loss of oral function for those affected. Prevention relies heavily on mechanical removal of dental plaque biofilms but for populations where this is not achievable, alternative plaque control methods are required. With concerns over undesirable side-effects and potential bacterial resistance due to the use of chlorhexidine gluconate (CHX), new antimicrobial substances for oral use are greatly needed. Here we have investigated the antimicrobial effect of hypochlorous acid (HOCl), stabilized with acetic acid (HAc), on oral biofilms and compared it to that of CHX. Possible adverse effects of stabilized HOCl on hydroxyapatite surfaces were also examined.

    METHODS: Single- and mixed-species biofilms of six common oral bacteria (Streptococcus mutans, Streptococcus gordonii, Actinomyces odontolyticus, Veillonella parvula, Parvimonas micra and Porphyromonas gingivalis) within a flow-cell model were exposed to HOCl stabilized with 0.14% or 2% HAc, pH 4.6, as well as HOCl or HAc alone. Biofilm viability was assessed in situ using confocal laser scanning microscopy following LIVE/DEAD® BacLight™ staining. In-situ quartz crystal microbalance with dissipation (QCM-D) was used to study erosion of hydroxyapatite (HA) surfaces by stabilized HOCl.

    RESULTS: Low concentrations of HOCl (5 ppm), stabilized with 0.14% or 2% HAc, significantly reduced viability in multi-species biofilms representing supra- and sub-gingival oral communities, after 5 min, without causing erosion of HA surfaces. No equivalent antimicrobial effect was seen for CHX. Gram-positive and Gram-negative bacteria showed no significant differential suceptibility to stabilized HOCl.

    CONCLUSIONS: At low concentrations and with exposure times which could be achieved through oral rinsing, HOCl stabilized with HAc had a robust antimicrobial activity on oral biofilms, without causing erosion of HA surfaces or affecting viability of oral keratinocytes. This substance thus appears to offer potential for prevention and/or treatment of oral biofilm-mediated diseases.

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  • 20. Ahl, Magnus
    et al.
    Marcusson, Agneta
    Ulander, Martin
    Magnusson, Anders
    Cardemil, Carina
    Larsson, Pernilla
    Malmö University, Faculty of Odontology (OD).
    Translation and validation of the English-language instrument Orthognathic Quality of Life Questionair into Swedish2021In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    Introduction: In orthognathic surgery, understanding the patient’s motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument ‘Orthognathic Quality of Life Questionnaire’ (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test–retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

  • 21.
    Ahmad, Rashed
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nazir, Rahmani
    Malmö University, Faculty of Odontology (OD).
    Rotfyllningskvalitet vid endodontiska behandlingar på studentklinik med utgångspunkt från kliniska och röntgenologiska parametrar.2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: To evaluate how well the working length radiograph and obturation radiograph corresponded with the working length (WL) measured initially by electronic apex locator (EAL). Furthermore, the aim of this study was to evaluate if the quality of root canal fillings was dependent on tooth type, number of dental visits and if there was any different in treatment procedure before and during the Covid-19 pandemic. Additionally, signs of healing were evaluated if radiographs were available.

     Material and method: Patient journal and intraoral radiographs of 635 patients who had undergone endodontic treatment by students at the Faculty of Odontology at University of Malmö during 2016–2021 were evaluated. A total number of 350 patients fulfilled the inclusion’s criteria. Patient’s journal and radiographs were reviewed by two independent observers. 

    Results: Of 350 teeth, in 262 teeth working length radiograph and obturation radiograph was consistent with the working length determined by EAL. Mandibular morals followed by maxillary molars and premolars were tooth types that failed to keep WL measured by EAL. Approximately 70% teeth were treated between 2-6 visits. In 84 cases radiographs were available and signs of healing were observed in 78 cases (approx. 92%). No significant differences were observed in treatment procedure before and under the Covid-19 pandemic.  

    Conclusion: The root canal fillings were of good quality based on clinical and radiographic evidence. Students need more time to carry out endodontic treatment but, in most cases, root canal fillings were of good quality and periapical healing was obtained. Furthermore, the students need clearer recommendations regarding determination of WL. 

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  • 22.
    Ahmad, Salman
    Malmö University, Faculty of Odontology (OD).
    Impact of peri-implant buccal bone thickness, implant fixture diameter, abutment and/or prosthetic reconstruction material on the accuracy of Cone Beam Computed Tomography to assess peri-implant buccal bone level: an in vitro study in pig jaw2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract Aim: To evaluate the impact of peri-implant buccal bone thickness, implant fixture diameter, abutment material (Titanium Ti, Zirconium Zr) and/or prosthetic reconstruction material (metal ceramic vs ceramic) on the accuracy of Cone Beam Computed Tomography (CBCT) to assess peri-implant buccal bone level. Materials and methods: Titanium implants were inserted into 36 blocks of pig mandible in a way to create variable buccal bone thicknesses groups, each group with 12 blocks; group 1 (0.5-1 mm), group 2 (>1-1.5 mm) and group 3 (>1.5-2 mm), half of each group received a dehiscence which was created of variable extent. Two groups regarding abutment-crown material; (Ti abutment with CoCr crown, Zr abutment with Zr crown) and implant diameter; (standard/narrow) were assessed. Dehiscences were measured on CBCT image using 2 programs (i-Dixel and Photoshop) and were compared to the gold standard. Results: Thin buccal bone thickness group (0.5-1 mm) had major impact on the accuracy of CBCT to correctly detect and measure the extent of a bony dehiscence. No differences were detected between standard or narrow diameter implant and between TiTi/CoCr combination and TiZr/Zr combination in regards to possibility of CBCT to detect and evaluate accurately the extent of a bony dehiscence. Conclusion: Thin peri-implant buccal bone (≤ 1 mm) has a negative effect on the accuracy of CBCT to assess peri-implant buccal bone level. The possibility to identify and to assess the extent of peri-implant buccal bone dehiscence in CBCT was hardly affected by using different abutments and crown materials and different implant diameters.

  • 23.
    Ahmed, Ifrah
    Malmö University, Faculty of Odontology (OD).
    The Effects of Periodontal Treatment on Atherosclerosis: A Systematic Review2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study was to systematically review the evidence from clinical intervention trials evaluating the effect of periodontal treatment (PT) on surrogate markers on individuals diagnosed with periodontal disease (PD) and atherosclerotic cardiovascular disease (ACVD). The systematic review was based on quantitative literature. Method: A electronic search for relevant articles published between October 2012- October 2022 was carried out in the following databases: PubMed, Cochrane Library, and Web of Science. Results: The systematic search identified 686 articles, after the title and abstract screening 14 articles were read in full-text, 7 articles underwent risk of bias assessment, 1 was excluded due to high risk of bias and 6 articles were ultimately included. The results found that PT led to decreased levels of inflammatory biomarkers and surrogate markers of ACVD, improved periodontal parameters and endothelial function, and reduced levels of periodontopathogens. Conclusion: The findings indicate that PT can potentially benefit atherosclerosis by managing and improving its risk factors. As demonstrated by the small sample size further research is needed to fully determine the effects of PT on atherosclerosis.

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  • 24. Ahonen, Hanna
    et al.
    Kvarnvik, Christine
    Norderyd, Ola
    Malmö University, Faculty of Odontology (OD).
    Broström, Anders
    Fransson, Eleonor I
    Lindmark, Ulrika
    Clinical and self-reported measurements to be included in the core elements of the World Dental Federation's theoretical framework of oral health2021In: International Dental Journal, ISSN 0020-6539, E-ISSN 1875-595X, Vol. 71, no 1, p. 53-62Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs.

    OBJECTIVES: To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDI's theoretical framework of oral health.

    MATERIALS AND METHODS: A psychometric study was performed, using cross-sectional data from Sweden (N = 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbach's Alpha.

    RESULTS: The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbach's Alpha indicated good to sufficient internal consistency for each component in the constructs (α = 0.88, 0.68, 0.61, respectively).

    CONCLUSION: In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDI's theoretical framework.

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  • 25.
    Aidoukovitch, Alexandra
    et al.
    Lund University; Folktandvården Skåne.
    Bankell, Elisabeth
    Lund University.
    Davies, Julia R
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Nilsson, Bengt-Olof
    Lund University.
    Exogenous LL-37 but not homogenates of desquamated oral epithelial cells shows activity against Streptococcus mutans2021In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 6, p. 466-472Article in journal (Refereed)
    Abstract [en]

    Objective:  The antimicrobial peptide hCAP18/LL-37 is detected in desquamated epithelial cells of human whole saliva, but the functional importance of this pool of hCAP18/LL-37 is not understood. Here, we assess the impact of homogenates of desquamated oral epithelial cells and exogenous, synthetic LL-37 on two oral bacteria: S. mutans and S. gordonii.

    Material and methods:  Desquamated epithelial cells of unstimulated whole saliva were isolated and cellular and extracellular levels of hCAP18/LL-37 analyzed by ELISA. Bacterial viability was determined by BacLight Live/Dead staining and confocal laser scanning microscopy.

    Results:  Desquamated oral epithelial cells harboured hCAP18/LL-37, and they spontaneously released/leaked the peptide to their medium. Exogenous, synthetic LL-37 showed cytotoxic activity against S. mutans but not S gordonii, suggesting that LL-37 acts differentially on these two types of oral bacteria. Homogenates of desquamated oral epithelial cells had no effect on S. mutans viability. Treatment with exogenous, synthetic LL-37 (8 and 10 μM) reduced S. mutans viability, whereas lower concentrations (0.1 and 1 µM) of the peptide lacked effect.

    Conclusions:  Desquamated oral epithelial cells contain hCAP18/LL-37, but their cellular levels of hCAP18/LL-37 are too low to affect S. mutans viability, whereas exogenous, synthetic LL-37 has a strong effect on these bacteria.

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  • 26.
    Aisaiti, Adila
    et al.
    Nanjing Medical University, China.
    Zhou, Yanli
    Nanjing Medical University, China.
    Wen, Yue
    Nanjing Medical University, China.
    Zhou, Weina
    Nanjing Medical University, China.
    Wang, Chen
    Nanjing Medical University, China.
    Zhao, Jing
    Nanjing Medical University, China.
    Yu, Linfeng
    Nanjing Medical University, China.
    Zhang, Jinglu
    Nanjing Medical University, China.
    Wang, Kelun
    Nanjing Medical University, China; Aalborg University, Denmark; Aarhus University, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Aarhus University, Denmark; Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
    Effect of photobiomodulation therapy on painful temporomandibular disorders2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 9049Article in journal (Refereed)
    Abstract [en]

    To evaluate the effect of photobiomodulation therapy (PBMT) on painful temporomandibular disorders (TMD) patients in a randomized, double-blinded, placebo-controlled manner. Participants were divided into a masseter myalgia group (n = 88) and a temporomandibular joint (TMJ) arthralgia group (n = 87) according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Both groups randomly received PBMT or placebo treatment once a day for 7 consecutive days, one session. The PBMT was applied with a gallium-aluminum-arsenide (GaAlAs) laser (wavelength = 810 nm) at pre-determined points in the masseter muscle (6 J/cm2, 3 regions, 60 s) or TMJ region (6 J/cm2, 5 points, 30 s) according to their most painful site. Pain intensity was rated on a 0–10 numerical rating scale (NRS) and pressure pain thresholds (PPT) and mechanical sensitivity mapping were recorded before and after the treatment on day 1 and day 7. Jaw function was assessed by pain free jaw opening, maximum unassisted jaw opening, maximum assisted jaw opening, maximum protrusion and right and left excursion. Data were analyzed with a mixed model analysis of variance (ANOVA). Pain intensity in arthralgia patients decreased over time (P < 0.001) for both types of interventions, however, PBMT caused greater reduction in pain scores than placebo (P = 0.014). For myalgia patients, pain intensity decreased over time (P < 0.001) but without difference between interventions (P = 0.074). PPTs increased in both myalgia (P < 0.001) and TMJ arthralgia patients over time (P < 0.001) but without difference between interventions (P ≥ 0.614). Overall, PBMT was associated with marginally better improvements in range of motion compared to placebo in both myalgia and arthralgia patients. Pain intensity, sensory function and jaw movements improve after both PBMT and placebo treatments in myalgia and arthralgia patients indicating a substantial non-specific effect of PBMT.

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  • 27.
    Aiyar, Akila
    et al.
    Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Shimada, Akiko
    Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences, Nagasaki University; Department of Geriatric Dentistry, Osaka Dental University, Japan.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Section for Orofacial Pain and Jaw function, Department of Dentistry and Oral Health, Aarhus University, Denmark.
    Assessment of masticatory efficiency based on glucose concentration in orthodontic patients - a methodological study2022In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 49, no 10, p. 954-960Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Treatment for malocclusion can cause discomfort and pain in the teeth and periodontium, which may impair masticatory efficiency. The glucose concentration method is widely used to assess masticatory efficiency for its convenience in the clinical situation, although its validity has not been shown.

    OBJECTIVE: The aims were to determine the validity of the glucose concentration method and investigate if this method can be applicable to orthodontic patients with braces.

    DESIGN: Sixteen healthy individuals (7 men, 9 women, and 26±5 years old) and 16 patients with malocclusions needing orthodontic treatment (5 men, 11 women, and 26±4 years old) participated. Glucose concentration was measured after 5-, 10-, and 15-s mastication of gummy jelly and compared to Hue values obtained from the color-changing gum method (reference method). In addition, all participants were asked to fill out the Oral Health Impact Profile questionnaire (OHIP) to assess differences in perception related to the mouth before and after the placement of braces.

    RESULTS: = 0.711, P < 0.001) Masticatory efficiency assessed by both methods was significantly lower in orthodontic patients compared to controls (P<0.05), even though it was not affected by bonding (P>0.09). In addition, OHIP scores in physical pain dimension and psychological disability were higher in orthodontic patients than in the control group (P<0.005).

    CONCLUSION: Measurement of glucose concentration was confirmed as a reliable and convenient method for assessing masticatory efficiency. Furthermore, it appears that this method is applicable to patients with braces whose perception in the oral cavity could change.

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  • 28.
    Al Ansari, Yasmin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Shahwan, Halime
    Malmö University, Faculty of Odontology (OD).
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Diabetes Mellitus and Dental Implants: A Systematic Review and Meta-Analysis2022In: Materials, ISSN 1996-1944, E-ISSN 1996-1944, Vol. 15, no 9, article id 3227Article, review/survey (Refereed)
    Abstract [en]

    The present review aimed to evaluate the impact of diabetes mellitus on dental implant failure rates and marginal bone loss (MBL). An electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed as well as meta-regressions in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. The review included 89 publications. Altogether, there were 5510 and 62,780 implants placed in diabetic and non-diabetic patients, respectively. Pairwise meta-analysis showed that implants in diabetic patients had a higher failure risk in comparison to non-diabetic patients (OR 1.777, p < 0.001). Implant failures were more likely to occur in type 1 diabetes patients than in type 2 (OR 4.477, p = 0.032). The difference in implant failure between the groups was statistically significant in the maxilla but not in the mandible. The MBL mean difference (MD) between the groups was 0.776 mm (p = 0.027), with an estimated increase of 0.032 mm in the MBL MD between groups for every additional month of follow-up (p < 0.001). There was an estimated decrease of 0.007 in OR for every additional month of follow-up (p = 0.048). In conclusion, implants in diabetic patients showed a 77.7% higher risk of failure than in non-diabetic patients.

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  • 29.
    Al Atabi, Willy
    et al.
    Malmö University, Faculty of Odontology (OD).
    Mahmoud, Mahmoud
    Malmö University, Faculty of Odontology (OD).
    Sura dryckers inverkan på biaxiala böjhållfastheten hos en litiumdisilikatbaserad glaskeram2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Aim: The aim of the study is to investigate whether the strength of lithiumdisilicate-based glass ceramics that have been produced by pressing technologyare affected by an energy drink (NOCCO) and orange juice after treatmentcorresponding to 13 years of consumption.

    Material and method: A total of 30 specimens by IPS e.max Press® weremanufactured, then divided into two groups exposed to acidic beverages (EMA &EMN) and one group was assigned as a control group (EMK) with 10 specimensin each group, measuring 12 mm in diameter and 1.7 mm in thickness. EMA waspreserved with 8 °C orange juice, EMN was preserved with 8 °C NOCCO focus 4legend soda and EMK was preserved in 37 °C distilled water. After 14 days, thespecimens were subjected to biaxial flexural strength and subsequently analyzedwith One-way ANOVA, Tukey's test with a significance level of α = 0.05.

    Result: The results showed that EMK had the lowest mean (215 MPa) and EMAhad the highest mean (432 MPa). It turned out that EMK had a significance incomparison with all groups, while EMN and EMA have no significant differencefrom each other.

    Conclusion: The following conclusions are drawn from this in vitro study; acidicbeverages have no effect on the flexural strength of lithium disilicate-based glassceramics produced by pressing technology.

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  • 30.
    Al Ateyah, Amjad
    Malmö University, Faculty of Odontology (OD).
    Three-Dimensional Prediction in Orthognathic Surgery. Treatment Outcome Evaluated in Clinical Photographs2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Planning for orthognathic surgery was enhanced through the past years and is performed nowadays using two-dimensional (2D) and three-dimensional (3D) planning methods. Aim: This project aimed to compare outcome of these two treatment planning methods according to improvements in clinical photographs of the subjects. Also, to compare the results from photographic evaluation with results on cephalometric accuracy measurements and Health Related Quality of Life (HRQoL) measurements in the same study cohort. Material & Methods: In a randomized controlled trial (RCT) design, a professional evaluation panel judged pre and post-operative photographs of 57 patients underwent orthognathic surgery in either 2D or 3D planning. Results were correlated to findings of cephalometric accuracy and HRQoL for the same cohort. Results: No significant difference between subjects underwent Orthognathic surgery in 2D or 3D planning (p>0.30). No significant correlation with HRQoL was found (p>0.30). A significant correlation between A point and overall facial esthetic was found (p=0.024). Conclusion : There is no esthetical advantage of using 3D planing over 2D planing for orthognathic surgery as judged by a professional evaluation panel.

  • 31.
    Al Said, Ahmad
    et al.
    Malmö University, Faculty of Odontology (OD).
    Mustafa, Ola
    Malmö University, Faculty of Odontology (OD).
    Efficacy of Air Polishing in Disinfecting Implant Surfaces. A Laboratory Study Simulating a Surgical Approach2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: To examine whether the type of implant surface (turned and moderately rough), type of handpiece (supra- and submucosal), and treatment settings (power and treatment time) influence the effectiveness of decontamination of the implant surface when using an air polishing device, simulated surgical treatment with horizontal and intraosseous (vertical) bone defect models in an in vitro study.

    Materials and Methods: A biofilm simulation was applied to 108 turned and 108 moderately rough implant surfaces. The study included two different models of peri-implant bone defects, horizontal and vertical, each with a corresponding 5 mm peri-implant bone loss. Debridement of the biofilm simulation was performed with an air polishing device using either the supra- or submucosal handpiece with three different treatment settings. The amount of remaining biofilm simulation on the implant surface was automatically quantified on standardised photographs and analysed with 4- and 5-way ANOVA.

    Results: In horizontal bone defect models, the supramucosal handpiece was more effective compared to the submucosal handpiece, yielding low values of residual biofilm simulation mass regardless of treatment settings and implant surface type (i.e., all implants showed <15% residual biofilm simulation), while this was vice versa for vertical bone defect models. A 4-way ANOVA showed a significant difference regarding the effect on the amount of biofilm simulation for the following: bone defect model type (p < 0.001), type of handpiece (p = 0.003), and treatment settings (p < 0.001), but the type of implant surface was not significant. Moreover, a 5-way ANOVA indicated the area on the implant surface (coronal, central, and apical) as a significant factor. However, the area with the most remaining biofilm simulation varied depending on the defect model type and the type of handpiece used.

    Conclusion: During in vitro intraoperative debridement of implants with various peri-implant bone defect models using an air polishing device, the handpiece should be selected based on the type of bone defect model. The supramucosal handpiece appears superior in models with horizontal bone defect, and the submucosal handpiece appears superior in models with vertical bone defect. Furthermore, in the case of a model with a vertical bone defect, a longer treatment time - but not necessarily a higher power - may result in less residual biofilm simulation. Removal of the biofilm simulation is more predictable in the models with horizontal bone defect compared to the models with vertical bone defect.

  • 32.
    Al-Ateia, Imad
    et al.
    Malmö University, Faculty of Odontology (OD).
    Taleb, Josef
    Malmö University, Faculty of Odontology (OD).
    Retrospective clinical evaluation of implant-supported zirconia fixed dental prostheses2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT 

    Purpose

    The aim of the present study was to evaluate the clinical outcomes of implant-supported restorations of zirconia.

     

    Materials and methods

    This retrospective study included all patients rehabilitated with implant-supported fixed prostheses made of zirconia in a dental clinical private practice, based on data from patients’ dental records. Implant/prosthesis failure, marginal bone loss, and technical complications were the outcomes analyzed. Survival analyses were used to evaluate the associations between clinical covariates and the outcomes. Univariate and multiple linear model analyses analyzed the association of the marginal bone level (MBL) between the independent variables.

     

    Results

    Ninety-four patients that received 244 implants supporting 143 fixed prostheses made of zirconia. The implants and the prostheses were followed up for a mean 26 and 20 months, respectively. Only one implant failed, placed in a fresh extraction socket, 27 days after installation. None of the prostheses failed. The most prevalent technical complication was loss/fracture of implant access hole sealing. Restoration chipping occurred in five veneered zirconia restorations, and none in monolithic zirconia prostheses. The cumulative survival rate with regards to restoration chipping was of 92.2% after 4 years. None of the nine independent variables presented a statistically significant hazard ratio (HR) in relation to restoration chipping in the univariate Cox proportional hazard models. Despite the univariate linear models suggesting that some of the independent variables might have an influence on the MBL over time, the results of the multiple linear regression model suggested that none of these predictor variables had a statistically significant influence on MBL.

     

    Conclusions

    Implant-supported zirconia fixed dental prostheses showed a 100% survival rate in this short-term retrospective study. The cumulative survival rate (CSR) for restoration chipping was 92.2% after 4 years, with all the cases occurring in veneered zirconia restorations, although no variable presented a statistically significant HR on this outcome. None of the predictor variables had a statistically significant influence on MBL.

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  • 33.
    Al-Attar, Haidar
    et al.
    Malmö University, Faculty of Odontology (OD).
    Nawlo, Sanaa
    Malmö University, Faculty of Odontology (OD).
    A Literature Review of buccally impacted permanent maxillary canines- Etiology, Characteristics, and Prevalence2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Objective: To conduct a literature review of published studies of buccally impacted maxillary canines, which presents the etiology, characteristics, and prevalence of these teeth. 

     

    Material and method: The search covered three different electronic databases (PubMed, Scopus, and Cochrane Library). The inclusion criteria were studies on maxillary canines ectopia, specifically patients with either a unilateral or bilateral diagnosis of buccally displaced maxillary canines; studies on children and adolescents under 18 years; however, most focus on children aged 9-11 years, and only fulltext articles published in English or Swedish were accepted. In addition, different study designs were included, for example, reviews, retrospective, and biometric studies. Two reviewers independently evaluated selected full-text articles, and any disagreements were resolved by consensus.

    Results: The applied search terms identified 319 articles in the different databases, out of the 319 yielded articles, 163 were excluded as duplicates. The remaining 183 studies were screened in abstract form by all three reviewers. Out of them, only 11 studies on buccally displaced/impacted canines met the inclusion criteria and were prescribed as eligible studies for full-text analysis. There was a wide variation in the objectives of these 11 studies, though all of them included at least one of the studies' investigations requirements: etiology, characteristics, or prevalence. The results from the final analysis were presented in a preset protocol. 

    Conclusion: This literature review disclosed that few studies have investigated and presented buccally impaction of the canines. Additional investigations are warranted. 

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  • 34.
    Al-Azzawi, Tara Ali Ziad
    et al.
    Malmö University, Faculty of Odontology (OD).
    Kurtanovic, Amina
    Malmö University, Faculty of Odontology (OD).
    Bone antiresorptive or antiangiogenic medication and dental implant treatment in osteoporotic patients: A systematic review2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The overall aim is to (i) analyze the prognosis of dental implant treatment concerning marginal bone loss (MBL) in patients undergoing or have undergone treatment with bone antiresorptive or antiangiogenic medication for osteoporosis (ii) and additional purpose to assess the available scientific literature in the first aim concerning the risk of getting medication-related osteonecrosis of the jaw (MRONJ) associated with dental implant installation. 

    Material and methods: A systematic literature search was conducted in October 2021 in the following three databases; MEDLINE/PubMed, Cochrane Library and Web of Science. PRISMA 2009 Flow Diagram were used for the selection process, whereas the included studies were evaluated for quality assessment using Newcastle Ottawa Scale (NOS). 

    Results: The search resulted in four included studies considering the eligibility criteria. The studies evaluated MBL in osteoporotic patients undergoing or have undergone oral bisphosphonate (BP) treatment before and/or during implant placement. MRONJ was also assessed in all four articles. 

    Conclusions: The results of this present study do not indicate that patients undergoing or have undergone antiresorptive or antiangiogenic medication for osteoporosis are at an increased risk of MBL in dental implants during follow-up periods. The present data assessing the risk for developing MRONJ remains low for osteoporotic patients. Therefore, dental implant surgery is considered possible with success in osteoporotic patients receiving earlier mentioned medications. However additional studies are required to evaluate the effects on this patient group concerning osseointegration of dental implant regarding MBL.

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  • 35.
    Albahoth, Ahmad
    Malmö University, Faculty of Odontology (OD).
    Effectiveness of Casein Phosphopeptide- Amorphous Calcium Phosphate (CPP-ACP) in Remineralization of Early Carious Lesions. A systematic review2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract Aim To assess the effectiveness of CPP-ACP in combination with daily fluoride use versus daily fluoride use alone on remineralization of early carious lesions in randomized controlled trials (RCTs). Material and methods A systematic literature search was conducted following the PRISMA 2009 statement. The literature obtained from the searches in electronic databases were reviewed individually by two reviewers and the relevant titles and abstracts were selected with specific inclusion and exclusion criteria. The search was limited to articles published in English. Only randomized controlled clinical trials (RCTs) in which CPP-ACP was delivered by cream form were selected. The included studies were assessed for risk of bias and quality. Results The initial search carried out on PubMed and the Cochrane Library for publications up to January 2018 resulted in 267 scientific articles. Six randomized controlled trials (RCTs) were met the inclusion and exclusion criteria and were selected as eligible studies. Out of six studies in this review, three studies were judged to have a low risk of bias, one study was classified as moderate risk of bias and two studies were high risk of bias. No specific adverse effect related to CPP-ACP usage was observed.  Conclusions Based on the literature, there is a tendency towards the benefits of CPP-ACP usage in addition to fluoride toothpaste and/or mouth rinse compared to fluoride toothpaste and/or mouth rinse alone on regression of early carious lesions. However, further well-designed long term clinical trials are required to establish this therapeutic strategy in the main stream clinical practice.

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  • 36.
    Albertsson, Josefin
    Malmö University, Faculty of Odontology (OD).
    The risk of ankylosis of 89 avulsed human teeth stored in saliva prior to replantation - A retrospective clinical follow up study2020Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Purpose: The aim of the study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage condition prior to replantation. Material and methods: Data from patients with replanted permanent teeth stored in saliva prior to replantation were selected from a database at Copenhagen University Hospital. Periodontal healing related to ankylosis was analyzed. Results: Seventy-four patients (54 male and 20 female) with 89 avulsed and replanted teeth, which all had been placed in saliva prior to replantation, were retrieved. The time the avulsed teeth were placed in saliva ranged from 1 to 150 minutes (mean time 35 minutes). Around 40 % of the saliva stored teeth showed healing without ankylosis. Dry storage for 5 minutes or less before saliva storage resulted in ankylosis in 40% of the teeth but when dry storage exceeded 5 minutes prior to storage in saliva, ankylosis was seen in 80%. Teeth with mature root development were significantly more often affected by ankylosis than teeth with immature root development. Ankylosis increased with increased storage time in saliva. Conclusion: Storing a tooth in saliva prior to replantation decreases the risk of ankylosis compared with dry storage. Immature teeth have a better prognosis than mature teeth. Temporary storage in saliva should be encouraged if an avulsed permanent tooth cannot be immediately replanted or a suitable storage medium such as milk or saline are not immediately available at the place of accident. Keywords: ankylosis, replantation, saliva, storage medium, tooth avulsion.

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  • 37.
    Albertsson, Josefin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Lauridsen, Eva
    University Hospital, Copenhagen, Denmark.
    Andreasen, Jens O.
    University Hospital, Copenhagen, Denmark.
    Gerds, Thomas A.
    University of Copenhagen, Denmark.
    Andersson, Lars
    Malmö University, Faculty of Odontology (OD).
    The risks of ankylosis of 89 avulsed human teeth stored in saliva prior to replantation-A re-evaluation of a long-term clinical study2021In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 37, no 4, p. 537-545Article in journal (Refereed)
    Abstract [en]

    Background/Aim: The survival of an avulsed tooth highly depends on the emergency management. The aim of this study was to evaluate the risk of ankylosis for avulsed human teeth stored in saliva preceded by various dry storage conditions prior to replantation. Material and methods: Data include 74 patients (54 male and 20 female) with 89 avulsed and replanted teeth (16 immature teeth, 73 mature teeth). Patient ages ranged from 6 to 36 years (median: 13.0 years). All teeth were stored in saliva before replantation. Treatment and follow-up were performed according to a standardized procedure. Follow-up periods ranged from 7 months to 20 years (mean 5.3 years). The risk of ankylosis over time was estimated by the Aalen-Johansen method in relation to the length of dry storage and the stage of root development. The effect of risk factors (root development and length of dry time) on the risk of ankylosis was analysed by Cox regression analysis. Results: For mature teeth, dry storage for 5 min or less before saliva storage resulted in a 47.4% (95% confidence interval (CI): 32.8-60.7) ankylosis rate. When dry storage was >5 min and <20 min, the risk of ankylosis was 76.8% (95% CI: 45.7-91.5). When dry storage exceeded 20 min prior to saliva storage, ankylosis increased to 89.3% (95% CI: 68.0-96.7). Ankylosis also increased with increasing saliva storage time. Specifically, one additional minute of wet time increased the ankylosis hazard rate (HR) by approximately 1% (CI = [0%, 2%], p = .052). Teeth with mature root development were significantly more frequently affected by ankylosis than teeth with immature root development (HR: 2.4 (95% CI: 1.0-5.5), p = .04). Conclusion: Temporary storage in saliva should be encouraged if an avulsed permanent tooth cannot be immediately replanted or a suitable storage medium such as milk or saline is not immediately available at the place of the accident.

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  • 38.
    Albrektsson, Tomas
    Malmö University, Faculty of Odontology (OD).
    On Implant Prosthodontics: One Narrative, Twelve Voices - 1.2018In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 31, no Suppl 2018, p. s11-s14Article in journal (Refereed)
  • 39.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD).
    Becker, William
    Coli, Pierluigi
    Jemt, Torsten
    Mölne, Johan
    Sennerby, Lars
    Bone loss around oral and orthopedic implants: An immunologically based condition2019In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, no 4, p. 786-795Article, review/survey (Refereed)
    Abstract [en]

    Background Marginal bone resorption has by some been identified as a "disease" whereas in reality it generally represents a condition. Purpose The present article is a comparison between oral and orthopedic implants, as previously preferred comparisons between oral implants and teeth seem meaningless. Materials and Methods The article is a narrative review on reasons for marginal bone loss. Results and Conclusions The pathology of an oral implant is as little related to a tooth as is pathology of a hip arthroplasty to a normally functioning, pristine hip joint. Oral as well as orthopedic implants are recognized as foreign bodies by the immune system and bone is formed, either in contact or distance osteogenesis, to shield off the foreign materials from remaining tissues. A mild immune reaction coupled to a chronic state of inflammation around the implant serve to protect implants from bacterial attacks. Having said this, an overreaction of the immune system may lead to clinical problems. Marginal bone loss around oral and orthopedic implants is generally not dependent on disease, but represents an immunologically driven rejection mechanism that, if continuous, will threaten implant survival. The immune system may be activated by various combined patient and clinical factors or, if rarely, by microbes. However, the great majority of cases with marginal bone loss represents a temporary immune overreaction only and will not lead to implant failure due to various defense mechanisms.

  • 40.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Chrcanovic, Bruno
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Mölne, Johan
    Wennerberg, Ann
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Foreign body reactions, marginal bone loss and allergies in relation to titanium implants2018In: European Journal of Oral Implantology, ISSN 1756-2406, E-ISSN 1756-2414, Vol. 11, no Suppl 1, p. S37-S46Article, review/survey (Refereed)
    Abstract [en]

    Aim: To describe general observations of immunological reactions to foreign materials and to realize that CP titanium gives rise to a foreign body reaction with subsequent bone embedment when placed as oral implants. To analyse the possibility of titanium allergy. Materials and methods: The present paper is of a narrative review type. Hand and Medline searches were performed to evaluate marginal bone loss of oral implants and the potential of titanium allergy. Results: Immunological reactions to foreign substances include Type I hypersensitivity reactions such as allergy, Type II hypersensitivity reactions characterised by IgM or IgG antibodies that may react with blood group antigens at transfusion, and Type III hypersensitivity caused by antigen-antibody immune complexes exemplified by acute serum sickness. There is also Type IV hypersensitivity, or delayed hypersensitivity, which is typically found in drug and foreign body reactions. It proved very difficult to find a universally acceptable definition of reasons for marginal bone loss around oral implants, which lead to most varying figures of so-called peri-implantitis being 1% to 2% in some 10-year follow-up papers to between 28% and 56% of all placed implants in other papers. It was recognised that bone resorption to oral as well as orthopaedic implants may be due to immunological reactions. Today, osseointegration is seen as an immune-modulated inflammatory process where the immune system is locally either up- or downregulated. Titanium implant allergy is a rare condition, if it exists. The authors found only two papers presenting strong evidence of allergy to CP titanium, but with the lack of universally accepted and tested patch tests, the precise diagnosis is difficult. Conclusions: CP titanium acts as a foreign body when placed in live tissues. There may be immunological reasons behind marginal bone loss. Titanium allergy may exist in rare cases, but there is a lack of properly designed and analysed patch tests at present.

  • 41.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Dahlin, Christer
    Reinedahl, David
    Tengvall, Pentti
    Trindade, Ricardo
    Wennerberg, Ann
    An Imbalance of the Immune System Instead of a Disease Behind Marginal Bone Loss Around Oral Implants: Position Paper2020In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 35, no 3, p. 495-502Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to present evidence that supports the notion that the primary reason behind marginal bone loss and implant failure is immune-based and that bacterial actions in the great majority of problematic cases are of a secondary nature. Materials and Methods: The paper is written as a narrative review. Results: Evidence is presented that commercially pure titanium is not biologically inert, but instead activates the innate immune system of the body. For its function, the clinical implant is dependent on an immune/inflammatory defense against bacteria. Biologic models such as ligature studies have incorrectly assumed that the primary response causing marginal bone loss is due to bacterial action. In reality, bacterial actions are secondary to an imbalance of the innate immune system caused by the combination of titanium implants and ligatures, ie, nonself. This immunologic imbalance may lead to marginal bone resorption even in the absence of bacteria. Conclusion: Marginal bone loss and imminent oral implant failure cannot be properly analyzed without a clear understanding of immunologically caused tissue responses.

  • 42.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD).
    Jemt, Torsten
    Molne, Johan
    Tengvall, Pentti
    Wennerberg, Ann
    Department of Prosthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    On inflammation-immunological balance theory-A critical apprehension of disease concepts around implants: Mucositis and marginal bone loss may represent normal conditions and not necessarily a state of disease2019In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, no 1, p. 183-189Article, review/survey (Refereed)
    Abstract [en]

    Background Oral implants have displayed clinical survival results at the 95%-99% level for over 10 years of follow up. Nevertheless, some clinical researchers see implant disease as a most common phenomenon. Oral implants are regarded to display disease in the form of mucositis or peri-implantitis. One purpose of the present article is to investigate whether a state of disease is necessarily occurring when implants display soft tissue inflammation or partially lose their bony attachment. Another purpose of this article is to analyze the mode of defense for implants that are placed in a bacteria rich environment and to analyze when an obtained steady state between tissue and the foreign materials is disturbed. Materials and Methods The present article is authored as a narrative review contribution. Results Evidence is presented that further documents the fact that implants are but foreign bodies that elicit a foreign body response when placed in bone tissue. The foreign body response is characterized by a bony demarcation of implants in combination with a chronic inflammation in soft tissues. Oral implants survive in the bacteria-rich environments where they are placed due to a dual defense system in form of chronic inflammation coupled to immunological cellular actions. Clear evidence is presented that questions the automatic diagnostics of an oral implant disease based on the finding of so called mucositis that in many instances represents but a normal tissue response to foreign body implants instead of disease. Furthermore, neither is marginal bone loss around implants necessarily indicative of a disease; the challenge to the implant represented by bone resorption may be successfully counteracted by local defense mechanisms and a new tissue-implant steady state may evolve. Similar reactions including chronic inflammation occur in the interface of orthopedic implants that display similarly good long-term results as do oral implants, if mainly evaluated based on revision surgery in orthopedic cases. The most common mode of failure of orthopedic implants is aseptic loosening which has been found coupled to a reactivation of the inflammatory- immune system. Conclusions Implants survive in the body due to balanced defense reactions in form of chronic inflammation and activation of the innate immune system. Ten year results of oral and hip /knee implants are hence in the 90+ percentage region. Clinical problems may occur with bone resorption that in most cases is successfully counterbalanced by the defense/healing systems. However, in certain instances implant failure will ensue characterized by bacterial attacks and/or by reactivation of the immune system that now will act to remove the foreign bodies from the tissues.

  • 43.
    Albrektsson, Tomas
    et al.
    Malmö University, Faculty of Odontology (OD).
    Wennerberg, Ann
    On osseointegration in relation to implant surfaces2019In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 21, no S1, p. 4-7Article, review/survey (Refereed)
    Abstract [en]

    Background The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results. Purpose The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research. Materials and Methods The present article is a narrative review of some osseointegration and implant surface-related details. Results and Conclusions Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect.

  • 44.
    Aldahool, Yasser
    et al.
    Folktandvården Stockholm, Spånga, Sårgårdsvägen 24, 163 51 Spånga, Stockholm, Sweden.
    Sonesson, Mikael
    Malmö University, Faculty of Odontology (OD).
    Dimberg, Lillemor
    Malmö University, Faculty of Odontology (OD). Department of Orthodontics, Folktandvården Eastmaninstitutet, Folktandvården Stockholm, Stockholm.
    Spontaneous space closure in patients treated with early extraction of the first permanent molar: a retrospective cohort study using radiographs2024In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 94, no 2, p. 180-186Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the success rate of spontaneous space closure after extraction of the first permanent molar (FPM) in the maxilla and the mandible, and to identify the factors that make spontaneous space closure most favorable in each.

    MATERIALS AND METHODS: A retrospective records-based cohort study was conducted through a search of the database of the Public Dental Service, Stockholm County Council, Stockholm, for young adults born between 2000 and 2001, who underwent extraction of one or more FPM between 2006 and 2016. A total of 995 extracted teeth were identified, of which 203 teeth in 155 patients met the inclusion criteria.

    RESULTS: Of the 203 extracted teeth, 166 (81.8%) did not receive any orthodontic treatment. The success rate for space closure in orthodontically treated patients was 91.9%. The success rate for spontaneous space closure was 84.3%. All unsuccessful spontaneous space closure in the maxilla occurred in patients older than 12 years. The dental developmental stage of the second permanent molar (SPM) had a statistically significant association with spontaneous space closure in the mandible (P < .001).

    CONCLUSIONS: The success rate of spontaneous space closure was high (84.3%) and was higher in the maxilla (94.1%) than the mandible (74.1%). Age at time of extraction and dental developmental stage of the SPM were significant factors for successful spontaneous space closure in the maxilla and mandible, respectively.

  • 45.
    Aldaoudi, Marwah
    Malmö University, Faculty of Odontology (OD).
    Metabolites linking periodontal disease and cardiometabolic syndrome2022Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: Periodontal disease is associated with metabolic syndrome (MS). We investigate if the metabolite profile of MS is associated with periodontal disease. Dimethylguanidino Valeric Acid (DMGV) is a validated biomarker of nonalcoholic fatty liver disease and predicts future development of diabetes type 2 up to 12 years before onset. Beta-carotene is obtained from fruits, vegetables and is cardioprotective. We aim to investigate the association between plasma levels of DMGV and beta-carotene in relation to gingival inflammation, periodontal pockets and other additional markers.

    Method: Malmö Offspring Dental Study is the dental arm of The Malmö Offspring Study, which include periodontal registering. Liquid chromatography-mass spectrometry was used to measure plasma levels of DMGV and beta-carotene. Multivariable linear regression was utilized to study the plasma levels in relation to periodontal parameters.

    Results: Elevated DMGV levels were associated with increased gingival inflammation measured as %BoP (beta 1.36, p=0.039) adjusting for age, sex, education level, fasting plasma glucose levels, BMI and smoking status. DMGV levels were not associated with periodontal pockets >4mm. Higher beta-carotene levels were associated with less %BoP (beta -3.25, p = <0.001) and fewer periodontal pockets >4 mm (beta -1.15, p = 0.005) in fully adjusted models.

    Conclusion: DMGV is associated with increased gingival inflammation. Beta-carotene is associated with less gingival inflammation and fewer periodontal pockets > 4 mm, concluding that MS and periodontal disease share metabolite biomarker profile in respect to DMGV and beta-carotene. However, findings need to be confirmed in longitudinal cohort studies to allow for general conclusions to be drawn.

  • 46.
    Aldescu, Kevin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Shareef, Lewis
    Malmö University, Faculty of Odontology (OD).
    Utvärdering av ytkontamination i behandlingsrum före och efter behandling2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study was to evaluate surface contamination in treatment rooms before and after treatment at the student and specialist clinic in the Dental University, department of Endodontics at Malmö University.

    Materials and methods: Sampling was performed at Malmö University, Dental University, Endodontics, before and after treatment at the specialist clinic and student clinic. The following surfaces were evaluated: keyboard, mouse, lamphandle, the operator's unit and the assistant's unit. A total of 200 surfaces were sampled. ATP-bioluminescence was applied to evaluate potential contamination by microorganisms at a threshold value of 250 RLU/100cm². Fluid thioglycollatemedium (FTM) was used for bacterial cultivation.

    Results: The microbial growth rate in the treatment rooms was higher before treatment compared to after. The specialist clinic had a higher growth before treatment compared to the student clinic. After treatment, growth was higher at the student clinic. Highest frequency of growth was detected on keyboards and mouses in both clinics. ATP-bioluminescence showed a sensitivity of 80 % and specificity of 31 %.

    Conclusion: Despite hygiene routines and preventive measures that are applied, there is a failure in the disinfection of surfaces such as the keyboard and mouse as these had the highest frequency of contamination. From the study, it can be concluded that ATP-bioluminescence and FTM can be used as an evaluation tool in control of hygiene routines. More studies are required in dental care that evaluate surface contamination and the occurrence of healthcare-associated infections to achieve a safer healthcare environment.

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  • 47.
    Aldouri, Nabaa
    et al.
    Malmö University, Faculty of Odontology (OD).
    Al-Hadi, Ahmed
    Malmö University, Faculty of Odontology (OD).
    Konsekvenser av COVID-19 på besöksfrekvensen på Odontologiska fakulteten: En registerstudie2023Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study is to investigate how the frequency of visits at the Faculty of Odontology, Malmö University has been affected during the COVID-19 pandemic.

    Material and method: The study analyzed register data from the faculty’s journal system T4. All patients that had visited the faculty’s clinic and hence were found in the check-out list during the period January 2019 to December 2021 were included. In-depth analyses of the dental care visits at the Oral Diagnosis department were performed, where the variables gender and age were investigated. Data were compiled and analyzed in tables and charts.

    Results: The number of patient visits was higher in 2019 compared to 2020 and 2021 at the Faculty of Odontology. The largest decrease during the three examined years occurred in 2020. The largest decrease in frequency of visits was found in the oldest age group (65+ years old) between 2019 and 2020. However, the frequency increased again between 2020 and 2021. There have been more female visitors at Oral Diagnosis through all the investigated years. 

    Conclusion: The COVID-19 pandemic has affected the frequency of visits in the Faculty of Odontology. How big an impact the pandemic has had on oral health is still unclear and further studies are needed.

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  • 48.
    Alenezi, Ali
    Malmö University, Faculty of Odontology (OD).
    On enhancement of bone formation using local drug delivery systems2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Despite that many reports have confirmed the long-term clinical success rates associated with implant treatment, implant failure to achieve and maintain osseointegration still occurs in many cases. Local and sustained drug release at the bone-implant interface is one of the strategies that have been suggested to improve the osseointegration. The local drug release could help avoiding the risks usually associated with systemic administration, such as high drug dose or the loss of drug bioavailability. Aims: To map out the most commonly used chemical compounds and drug delivery systems used in animal experiments for implant research (Study I). Furthermore, to develop a new surface coating designed for medical devices and implants, and to examine the drug release mechanism from the coating using near infrared light (NIR) as an external stimulus (Study II). In addition, we examined the release of clarithromycin from PLGA microspheres within beta-tricalcium phosphate (β-TCP), and evaluated their osteogenic effect in a calvaria defect model in vivo (Study III). In Study IV, we evaluated the local release of strontium ranelate (Sr-ranelate) from implant surface coated with mesoporous titania films, and investigated if the local release of Sr-ranelate could improve bone formation around implants in an animal model. Materials and Methods: The articles included in the present thesis consist of four different studies. For Study I, an electronic search was done in three databases (PubMed, Scopus, Embase) to map out the most commonly used methods for local drug and chemical compound delivery to implant sites, and to assess their influence on bone response. Meta-analyses were performed for the outcome of bone-to-implant contact (BIC). In Study II, PNIPAAm-AAm polymers were synthesized at different compositions. The polymers were then incorporated with gold nanorods (GNRs) since these rods at predetermined aspect ratio can absorb NIR light to generate heat within the polymeric layer to initiate a drug release. The volume-phase transition behavior for the polymers was analyzed using differential scanning calorimetry (DSC). The GNRs-incorporated PNIPAAm was characterized using scanning electron microscopy (SEM) and quartz crystal microbalance with dissipation monitoring (QCM-D). The release behavior using phenol as drug model was investigated upon NIR irradiation using UV/VIS spectroscopy. In addition, the antibacterial behavior of polymer layers loaded with vancomycin was examined against Staphylococcus epidermidis. In Study III, four bone defects (5 mm of diameter) were created in the calvaria of New Zealand White rabbits (n = 21, n= 7/time point). The defects were randomly designated to four groups. Group 1: no augmentation (sham), Group 2: β-TCP, Group 3: β-TCP with 0.12 mg clarithromycin, and Group 4: β-TCP with 6.12 mg PLGA microspheres loaded with 0.12 mg clarithromycin. After 2, 4, and 12 weeks of healing, bone regeneration was evaluated using micro-computed tomography (µCT) and histology. In Study IV, mini-screw titanium implants were coated with mesoporous TiO2 films using Pluronic (P123) with or without poly propylene glycol (PPG) to create films with two different pore sizes. The implants were then incorporated with Sr-ranelate. SEM evaluation was performed to visualize the mesoporous TiO2 films and determine the pore size. The absorption and release kinetics of Sr-ranelate from mesoporous TiO2 films were evaluated by QCM-D. For the in vivo experiment, mini-screw titanium implants with or without Sr-ranelate were inserted in rats’ tibia bone to evaluate bone formation after 2 and 6 weeks. Results: In the systematic review (Study I), sixty-one studies met the inclusion criteria. Calcium phosphate (CaP), bisphosphonates (BPs), and bone morphogenetic proteins (BMPs) were the most commonly used chemical compounds. There were two main methods for local drug delivery at the bone-implant interface: (1) directly from an implant surface by coating or immobilizing techniques, and (2) the local application of drugs to the implant site, using carriers. There was a statistically significant increase in BIC for both local drug delivery methods (p= .02 and p < .0001, respectively) when compared to controls. There was a statistically significant increase in BIC when CaP (p= .0001) and BMPs (p= .02) were either coated into implants or delivered to the implant site, in comparison to when drugs were not used. The difference was not significant for the use of BPs (p= .15). In Study II, the DSC analyses showed that PNIPAAm-AAm containing 10% acrylamide had an appropriate phase transition temperature of 42◦C. SEM images showed that the surface coating consisted of a 200 nm thick uniform polymer layer. The QCM-D analysis coupled with in situ NIR irradiation demonstrated a dramatic shift in frequency that was attributed to mass being released from the surface upon irradiation. This mass release correlated well with the drug release profile as determined using UV/VIS spectroscopy with phenol as a model drug. For Study III, clarithromycin release from PLGA microspheres revealed sustained release for around 4 weeks with 50% release during the first week. Histologically, new bone formation was evident at 2 and 4 weeks of healing in all groups and bone formation increased as a function of healing time. At 12 weeks, Group 4 (β-TCP with PLGA microspheres loaded with clarithromycin) showed significantly higher amount of newly formed bone compared to Group 1 (sham). The µCT showed that Group 4 expressed significantly higher bone formation compared to Group 1 at all time points. In Study IV, the SEM images showed TiO2 films with porous structures covering the entire surface with pore sizes determined to be 6 nm for P123 and 7.2 nm for P123-PPG. The QCM-D analysis revealed an absorption of 3300 ng/cm2 of Sr-ranelate on the 7.2 nm TiO2 films, which was about 3 times more than the observed amount on the 6 nm TiO2 films (1200 ng/cm2). The histomorphometric analyses revealed higher percentages of bone implant contact (BIC) and bone area (BA) for implants with Sr-ranelate compared to implants in the control group after 2 and 6 weeks of healing. However, these differences were found not to be significant (BIC with a p-value of 0.43 after 2 weeks and 0.172 after 6 weeks), (BA with a p-value of 0.503 after 2 weeks, and 0.088 after 6 weeks). The mean BIC and BA values within the same group showed significant increase among all groups after comparing 2 and 6 weeks. Conclusions: Most studies assessing local drug/chemical compound release systems in implants evaluated the influence of the use of BPs, CaP, and BMPs on bone healing. The use of local chemical compound delivery systems around implants could significantly improve implant osseointegration in animal models (Study I). In addition, on demand-release of the antibiotic agent vancomycin from the coating induced by NIR light resulted in a clear inhibition zone around a coated substrate in a bacteria culture test, thereby providing proof of concept of the developed drug delivery system (Study II). The in vivo findings showed that β-TCP with clarithromycin-loaded microspheres can enhance bone formation in bone defects (Study III). Meanwhile, the in vivo findings on Sr-ranelate study (Study IV) could not confirm the positive effects of Sr-ranelate on implant incorporation in bone made by other authors.

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  • 49.
    Alenezi, Ali
    et al.
    Department of Prosthodontics, College of Dentistry, Qassim University, Buraydah 52571, Saudi Arabia.
    Alsweed, Mohammad
    Private Practice, Qassim Region, Buraydah 52571, Saudi Arabia.
    Alsidrani, Saleh
    Private Practice, Qassim Region, Buraydah 52571, Saudi Arabia.
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces.
    Long-Term Survival and Complication Rates of Porcelain Laminate Veneers in Clinical Studies: A Systematic Review2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 5, article id 1074Article in journal (Refereed)
    Abstract [en]

    The presented study aimed to assess the survival rate of porcelain laminate veneers (PLV) based on a systematic review of the literature. An electronic search was last updated in February 2021. Eligibility criteria included clinical series of patients rehabilitated with PLVs published in the last 25 years, with a minimum follow-up of 3 years. Survival analysis methods were applied. Twenty-five studies were included, with 6500 PLVs. The 10-year estimated cumulative survival rate (CSR) of PLVs was 95.5%. The 10-year CSR of PLVs when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as isolated reasons for failure were 96.3%, 99.2%, 99.3%, and 99.0%, respectively. PLVs without incisal coverage had a higher failure rate than PLVs with incisal coverage. Non-feldspathic PLVs performed better than feldspathic PLVs. As a conclusion, the 10-year CSR of PLVs was 95.5%, when fracture, debonding, occurrence of secondary caries, and need of endodontic treatment were considered as reasons for restoration failure. Fracture seems to be most common complication of PLVs, followed by debonding, with both more commonly happening within the first years after PLV cementation. PLVs with incisal coverage and non-feldspathic PLVs presented lower failure rates than PLVs without incisal coverage and feldspathic PLVs.

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  • 50.
    Alenezi, Ali
    et al.
    Department of Prosthodontics, College of Dentistry, Qassim University, Saudi Arabia.
    Chrcanovic, Bruno Ramos
    Malmö University, Faculty of Odontology (OD).
    Effects of the local administration of antibiotics on bone formation on implant surface in animal models: A systematic review and meta-analysis2020In: Japanese Dental Science Review, ISSN 1882-7616, Vol. 56, no 1, p. 177-183Article, review/survey (Refereed)
    Abstract [en]

    Purpose: This review aimed to evaluate the effects of the local delivery of antibiotics incorporated in implant surfaces on some quantitative parameters of bone formation. Materials and methods: An electronic search was undertaken in three databases (PubMed, Scopus, Embase) in addition to hand searching. The search was limited to animal experiments using endosseous implants combined with localized antibiotics release. Meta-analyses were performed for the percentages of bone volume (BV) and bone-to-implant contact (BIC). Results: Nine studies met the inclusion criteria. Several methods were identified for local delivery of antibiotics at the bone-implant interface, but the most commonly used method was by coating (incorporating the implant surface with the antibiotic agents). Different antibiotic agents were used, namely bacitracin, doxycycline, enoxacin, gentamicin, minocycline, tobramycin, and vancomycin. There was no statistically significant difference in the percentage of BIC between implants with or without localized antibiotic release (P = 0.59). The meta-analysis revealed higher BV around implants coated with antibiotics compared to control groups (without antibiotics) (P < 0.01). Conclusion: It is suggested that the local administration of antibiotics around implants did not adversely affect the percentage of direct bone contact around implants, with a tendency for a slightly better bone formation around implants when combined with local administration of antibiotics. It is a matter of debate whether these in vivo results will have the same effect in the clinical setting. However, the risk of bias of these studies may, to some extent, question the validity of these results. (C) 2020 The Author. Published by Elsevier Ltd on behalf of The Japanese Association for Dental Science.

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