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  • 1.
    Klinge, Anna
    Malmö universitet, Odontologiska fakulteten (OD).
    Craniofacial Height in Relation to Alveolar Bone Morphology2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    There is a constant development towards a more aesthetically oriented dentistry. New techniques and new materials are introduced to improve and optimise treatment results and shorten treatment time. This development can be favourable for both the dentist and the patient. If missing one or more teeth due to congenital reason or an incident (dental trauma), it is often challenging to already at an early stage choose the best and most optimal treatment for the particular clinical situation and individual. This thesis presents an overview of the basic biological factor of importance for a succesful treatment outcome: the relation between craniofacial height and alveolar bone height and width (morphology). The idea is to not just focus on the area of the missing tooth, but to incorporate other important factors, such as craniofacial height, sex, and age, in a broader context.

    The overall aim of this thesis is to investigate the relation between craniofacial height and alveolar bone morphology (height and width of the maxilla and mandible) as a support and tool in therapy planning of individuals in need of tooth replacement through orthodontic treatment and/or dental implant treatment.

    Paper I reports results of an investigation regarding the relation between the craniofacial height and height and width of the maxilla and mandible. The craniofacial height of the patients is divided into three groups: low, normal, and high angle. A radiographic profile image was used to establish the craniofacial height. Two separate lines are traced between anatomical structures on the radiographic 11image. The angle formed between these two lines is used for the classification of craniofacial height (low < 27°, normal 27-37°, high >37°).

    The alveolar bone is measured in millimeter with a digital caliper on radiographs obtained in three planes. The measurements of the jaws are performed both in the maxilla and in the mandible, between the teeth in the front (midline), between the premolars, and between the molars, on the right and left side respectively. An association between the craniofacial height and the height and width of the alveolar bone (morphology) was found. The greatest differences between the three craniofacial groups were seen in the anterior region, both in the maxilla and in the mandible. This means that an individual from the high-angle group displays a higher alveolar bone which also is more narrow in the anterior region, especially in the mandible. The opposite pattern is displayed in the low-angle group where the subjects present a low and wide alveolar bone.

    In paper II, the measurement technique for the maxilla and mandible was evaluated. Five raters with different experiences within the field of dentistry repeats the same measurements, independent of each other. The results show strong reliability of the measurement technique.

    In paper III, new measurements of the alveolar bone were presented, however this time focus was on the anterior part of the maxilla, which is a more aesthetically challenging area. The results from this study strengthen the association previously reported between the craniofacial height and height and width of the maxilla measured on cross-sectional images.

    Paper IV is a systematic review of the scientific literature, evaluating risk factors for a maxillary anterior tooth to end up in infraposition over time and to not follow the growth pattern of the adjacent teeth. Infraposition occurs when a tooth or dental implant does not continue to erupt and follow the anticipated growth pattern of the individual. This results in a growth cessation of the topical area and a dental implant still remain in the same place as immediately following treatment, whereas the surrounding teeth continue to erupt as the jaw grows. Dental infraposition can be a disadvantage from both an aesthetic and a functional perspective. An individual with a high angle (high craniofacial height), who presents with a thinner and longer alveolar bone, especially in the anterior part of the jaw, seems to be at a greater risk of developing infraposition of a traumatised tooth or a dental implant since growth seems to continue for longer (both as measured in mm and in years) compared to individuals with a low craniofacial height. The different risk factors investigated were age, sex, and craniofacial height. According to the findings in our systematic review, there is a lack of new scientific papers of high quality and the topic needs to be explored further in order for any conclusions to be drawn.

    In conclusion, the results of the present thesis show that craniofacial height should be considered in therapy planning in order to achieve the best long-term treatment results for the patients. This seems to be especially relevant in young individuals where continued growth is expected.

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  • 2.
    Klinge, Anna
    Malmö högskola, Odontologiska fakulteten (OD).
    Kartläggning av käkbenet och dess relation till ansiktshöjden2014Ingår i: Tandläkartidningen, ISSN 0039-6982, Vol. 106, nr 8, s. 60-61Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 3.
    Klinge, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Ahmad, Marianne
    Malmö universitet, Odontologiska fakulteten (OD).
    Eldh, Peter
    Malmö universitet, Odontologiska fakulteten (OD).
    Ulvan, Rasmus
    Malmö universitet, Odontologiska fakulteten (OD).
    Andersson, Lars
    Malmö universitet, Odontologiska fakulteten (OD).
    Becktor, Jonas P
    Malmö universitet, Odontologiska fakulteten (OD).
    Craniofacial Height in Relation to Cross-Sectional Morphology of the Anterior Maxilla: An Anatomica Considers ion in Implant Therapy2020Ingår i: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 35, nr 2, s. 386-394Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Patients who have a vertical growth pattern are more prone to complete alveolar bone growth later and run a higher risk for inhibition of growth and infraposition after implants have been placed. Moreover, it has been suggested for the same category of patients that craniofacial height may influence the alveolar bone morphology of the anterior maxilla during growth. Hence, it is important to identify such patients early when considering implant treatment in young patients. The purpose of this study was to investigate the height and width of the alveolar bone in the anterior maxilla in subjects with different craniofacial heights to assess if there is a relation between craniofacial height and the dimensions of the alveolar bone in the anterior part of the maxilla. Materials and Methods: Measurements on cephalograms and cone beam computed tomography (CBCT) images of the maxilla from 180 fully dentate subjects were analyzed and categorized into three angle groups based on the craniofacial height: low-, normal-, and high-angle groups. Measurements of the alveolar bone were taken interradicular, at six reference points distributed between the first premolar regions in the maxilla. The height and width of the alveolar bone were measured with a standardized technique at 3, 6, 9, and 12 mm from the top of the alveolar process. Results: Significant differences were found regarding the height of the alveolar bone in all the subgroups and regarding the width in the 9- and 12-mm subgroups, and between low-/normal- and low-/high-angle groups, where the high-angle group represented the thinnest alveolar bone. A significant difference was found between male and female patients concerning all dimensions of the alveolar bone. Conclusion: There is a relation between craniofacial height and the dimensions of the alveolar bone in the anterior part of the maxilla. Craniofacial height is an important factor to analyze when implant treatment is considered in the maxillary anterior region. This identification can preferably be carried out early in young patients who are still growing when various treatment options can still be considered.

  • 4.
    Klinge, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Al-Okshi, Ayman
    Malmö universitet, Odontologiska fakulteten (OD). Department of Oral Medicine and Radiology, Sebha University, Sebha, Libyan Arab Jamahiriya.
    Becktor, Jonas P
    Malmö universitet, Odontologiska fakulteten (OD).
    Lindh, Christina
    Malmö universitet, Odontologiska fakulteten (OD).
    A rater agreement study on measurements in cross-sectional CBCT images exploring the association between alveolar bone morphology and craniofacial height2021Ingår i: Oral Radiology/Springer, ISSN 0911-6028, E-ISSN 1613-9674, Vol. 37, s. 573-584Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate rater agreement regarding measurements of height and width of the maxilla and mandible using cross-sectional images from CBCT examinations. Furthermore, to explore the association between vertical craniofacial height and alveolar bone morphology.

    METHODS: Pre-treatment CBCT scans from 450 patients referred for treatment to a private clinic for orthodontics and oral surgery in Scandinavia were available and of these, 180 were selected. Lateral head images were generated from the CBCT volumes to categorise subjects into three groups based on their craniofacial height. Cross-sectional images of the maxillary and mandibular bodies at three locations in the maxilla and mandible, respectively, were obtained and measured at one height and two width recordings by five raters. One-way analysis of variance with a Tukey post hoc test was performed. A significance level of 5% was used.

    RESULTS: Rater agreement was mostly excellent or good when measuring height and width of the maxilla and mandible in cross-sectional CBCT images. For height (of the alveolar bone/bodies), there were statistically significant differences between the low- and the high-angle groups for all the observers when measuring in the premolar and midline regions, both in the maxilla and in the mandible.

    CONCLUSION: The high agreement found ensures a reliable measurement technique and confirms the relation between craniofacial height and alveolar bone height and width.

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  • 5.
    Klinge, Anna
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Becktor, Karin
    Clinic for Orthodontics and Oral Surgery, Strandvejen 116A, 2900, Hellerup, Copenhagen, Denmark.
    Lindh, Christina
    Malmö högskola, Odontologiska fakulteten (OD).
    Becktor, Jonas P
    Malmö högskola, Odontologiska fakulteten (OD).
    Craniofacial height in relation to cross-sectional maxillary and mandibular morphology2017Ingår i: Progress in Orthodontics, ISSN 1723-7785, Vol. 18, nr 32, artikel-id 32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background In order to gain a better understanding of how growth of the alveolar bone is linked to the vertical development of the face, the purpose of this study was to investigate if there is an association between the cross-sectional morphology of the maxillary and mandibular bodies with the craniofacial height, using images from cone beam computed tomography (CBCT). Methods From 450 pre-treatment CBCT scans, 180 were selected to be included in the study. Lateral head images were generated from the CBCT scans and were used to categorise subjects into three groups based on their vertical craniofacial height. Cross-sectional images from CBCT volumes were reformatted of the maxillary and mandibular bodies at five locations in the maxilla and five in the mandible. Each image was measured at one height and two width measurements. Statistical analysis performed was the one-way analysis of variance with a Tukey post hoc test. A significance level of 5% was used in all comparisons. Results Patients with large vertical craniofacial height had a significantly higher cross-sectional area both in the maxilla and in the mandible. In the same group, the cross-sectional area was significantly thinner in the mandible compared with the other two groups, especially in the anterior region. Conclusions This study further highlights the close relationship between craniofacial height and alveolar bone dimensions and contributes with important knowledge for planning and follow-up of comprehensive dental- and orthodontic treatments.

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  • 6.
    Klinge, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Khalil, Dalia
    Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden.
    Klinge, Björn
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden.
    Lund, Bodil
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway.
    Naimi-Akbar, Aron
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Tranæus, Sofia
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Division of Cariology, Karolinska Institutet, Stockholm, Sweden.
    Hultin, Margareta
    Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden.
    Prophylactic antibiotics for staged bone augmentation in implant dentistry2020Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 78, nr 1, s. 64-73Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The objective of the study was to assess the effect of prophylactic antibiotics on the outcome of bone augmentation and subsequent dental implant placement by combining the recommended quality assessment methods for systematic reviews and primary studies.

    Materials and methods: This is a complex systematic review in which systematic reviews as well as primary studies are scrutinised. A search of Medline (OVID), The Cochrane Library (Wiley) and EMBASE, PubMed and Health technology assessment (HTA) organisations as-well as a complementary hand-search was carried out. Selected primary studies were assessed using GRADE. Each study was reviewed by three authors independently.

    Results: Abstract screening yielded six potential systematic reviews allocated for full-text inspection. A total of ten primary studies were read in full-text. No relevant systematic reviews regarding the topic of this article were found. The quality assessment resulted in two primary studies with a moderate risk of bias. Of the two studies with a moderate risk of bias, one compared a single dose of clindamycin 600 mg preoperatively with the same preoperative dose followed by four doses of 300 mg every 6 h. The second study compared a single dose prophylaxis of two different types of antibiotic compounds.

    Conclusion: In conclusion, the scientific evidence regarding the use of antibiotic prophylaxis for reducing the risk of infection in conjunction with bone augmentation procedures during dental implant placement is very limited. The infection rate as compared to nonusage of prophylactic antibiotics, selection of the most suitable compound, and the optimal duration of prophylactic treatment is still unknown.

  • 7.
    Klinge, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Tranaeus, Sofia
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden.
    Becktor, Jonas P
    Malmö universitet, Odontologiska fakulteten (OD).
    Winitsky, Nicole
    Folktandvården Eastmaninstitutet. Public Dental Health, Stockholm, Sweden.
    Naimi-Akbar, Aron
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden; Folktandvården Eastmaninstitutet. Public Dental Health, Stockholm, Sweden.
    The risk for infraposition of dental implants and ankylosed teeth in the anterior maxilla related to craniofacial growth, a systematic review2021Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, nr 1, s. 59-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The aim of the study was to evaluate a potential association between individuals with different craniofacial types or other exposures, and the risk of infraposition due to continued growth/eruption of adjacent teeth in the anterior maxilla. Materials and methods This is a systematic review in which primary studies as well as other systematic reviews are scrutinised. A search of PubMed (Medline), Scopus, Web of science and Health technology assessment (HTA) organisations and a complementary handsearch was carried out. Selected studies were read in full-text by several reviewers. The quality of the included primary studies was assessed using a protocol for assessment of risk of bias in exposure studies. Results The literature search resulted in 3,296 publications. Title and abstract screening yielded 25, whereof one systematic review, potential publications allocated for full-text inspection. The quality assessment resulted in a total of seven studies with a low/moderate risk of bias and four studies with a high risk of bias. Conclusion In conclusion, a long-term risk for infraposition of dental implants, or ankylosed teeth, among natural teeth can be observed in some cases. The predisposing factors are still not fully understood since the current scientific evidence is very limited.

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  • 8.
    Klinge, Björn
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Stockholm, Sweden.
    Klinge, Anna
    Malmö universitet, Odontologiska fakulteten (OD).
    Bertl, Kristina
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.
    Stavropoulos, Andreas
    Malmö universitet, Odontologiska fakulteten (OD).
    Peri-implant diseases2018Ingår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 126, nr Suppl 1: S1, s. 88-94Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    When celebrating 100 yr of dental research in the Nordic dental research commu- nity (i.e. Nordisk Odontologisk Fo€rening (NOF)), it is relevant to include dental implant treatment. In essence, the successful progress of implant treatment has added both to the quality of life for patients and also to many aspects of profes- sional development and job satisfaction for dentists. When appreciating the success story it also seems relevant to highlight some of the problems related to this treat- ment. Both technical and biological complications have often been ignored when reporting long-term results following implant treatment. Different opinions have been expressed in relation to the etiology of peri-implant diseases. Some even choose to ignore this condition as a clinical problem. This article presents a short overview of peri-implant diseases (i.e. peri-implant mucositis and peri-implantitis). The lack of internationally agreed disease definitions for peri-implant diseases, as with periodontitis, results in wide variation of estimates for the occurrence of peri- implant diseases when epidemiological data are reported. The profession still strives to find and define the best way to deal with peri-implant diseases once they are accurately diagnosed. Awareness of the tissue conditions in the peri-implant area, and relevant action when indicated, seems to be critical for the continued long-term successful outcome of dental implant treatment.

  • 9.
    Klinge, Björn
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Mats
    Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden.
    Rosén, Måns
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Bertl, Kristina
    Malmö universitet, Odontologiska fakulteten (OD). Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.
    Klinge, Anna
    Malmö universitet, Odontologiska fakulteten (OD).
    Stavropoulos, Andreas
    Malmö universitet, Odontologiska fakulteten (OD).
    Dental Implant Quality Register: A possible tool to further improve implant treatment and outcome2018Ingår i: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 29, nr Suppl 18, s. 145-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Board of EAO (European Association for Osseointegration) has discussed an initiative to explore the conditions to establish a Dental Implant Register. It was suggested to bring this issue to the EAO Consensus Conference 2018 for a discussion and to possibly propose relevant and manageable parameters. This article presents some select examples from quality registers in the medical field. Based on the experience of established registers, essentially in the medical field, factors considered to be of importance, if and when establishing a Dental Implant Register are introduced and discussed.

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  • 10.
    Naimi-Akbar, Aron
    et al.
    Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden; Department of Dental Medicine, Division of Cariology, Karolinska Institutet, Stockholm, Sweden.
    Hultin, Margareta
    Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden.
    Klinge, Anna
    Malmö universitet, Odontologiska fakulteten (OD).
    Klinge, Björn
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Stockholm, Sweden.
    Tranæus, Sofia
    Malmö universitet, Odontologiska fakulteten (OD). Department of Dental Medicine, Division of Cariology, Karolinska Institutet, Stockholm, Sweden.
    Lund, Bodil
    Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Huddinge, Sweden; Department of Dental Medicine, Division of Oral Maxillofacial Diagnostics and Surgery, Section of Oral Maxillofacial Surgery, Karolinska Institutet, Stockholm, Sweden.
    Antibiotic prophylaxis in orthognathic surgery: A complex systematic review2018Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 13, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery. Methods Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR. Results Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total, 14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information. Conclusion With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration.

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  • 11.
    Åkerman, Sigvard
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Isaksson, Sten
    Klinge, Anna
    Malmö högskola, Odontologiska fakulteten (OD).
    Klinge, Björn
    Malmö högskola, Odontologiska fakulteten (OD).
    Munhålan2012Ingår i: Kliniska färdigheter: informationsutbyte mellan patient och läkare / [ed] Stefan Lindgren, Knut Aspegren, Studentlitteratur AB, 2012, s. 131-145Kapitel i bok, del av antologi (Övrigt vetenskapligt)
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