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  • 1. Bakhshandeh, Azam
    et al.
    Borum, Mette
    Høvenhoff, Lars
    Gaard, Hanne
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Stangvaltaite, Lina
    Bjørndal, Lars
    Calibration in radiographical diagnostics and removal of carious tissue in deep lesions2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Variations in inter- and intra-examiner agreement were found. Repeated monitoring centre visits are necessary for improved calibration in radiographical diagnostics and performance of carious removal.

    Fulltekst (pdf)
    FULLTEXT01
  • 2. Bjørndal, Lars
    et al.
    Bruun, Gitte
    Markvart, Merete
    Kjaeldgaard, Marianne
    Näsman, Peggy
    Thordrup, Marianne
    Dige, Irene
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Lager, Anders
    Malmö högskola, Odontologiska fakulteten (OD).
    Olsson, Jadranka
    Magnusson Santimano, Eva
    Wennström, Annette
    Randomised clinical trial on deep caries excavation 3-5 yr follow-up2012Inngår i: Journal of dental research, Vol. 91, nr Spec Iss b, artikkel-id 3032Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objectives: Long term follow-up data based on randomised clinical trials are needed in relation to deep caries treatment. The aim of the present trial is to investigate the beneficial and harmful long term effects of stepwise excavation during two visits versus one completed excavation of deep caries in permanent teeth in adults. Methods: Consecutive patients contacting clinical units in Sweden and Denmark were included. The trial is a centrally randomised patient- and observer-blinded multicenter trial, with two parallel intervention groups. A sample size calculation showed that 134 patients were needed in each group. Taking dropouts into account, a total of 314 patients fulfilled well-defined inclusion and exclusion criteria and were centrally block-randomised stratified by age and pain. Inclusion criteria: (i) Person ≥ 18 yrs having deep caries with or without pain (ii) x-ray showing primary caries into the inner 1/4 of the dentin, with the presence of a radiopaque zone at the pulpal wall. Success was defined as unexposed pulp with sustained pulp vitality without apical radiolucency after follow-up. Blinded evaluation of 1½ follow-up has previously been carried out in 106 patients (stepwise excavation group) and 93 patients (direct complete excavation) (Bjørndal et al. 2010, EJOS). Results: At 3-5 yr follow up there was a statistically significantly higher success with stepwise excavation [difference: 11.5%, 95% confidence interval (0.5; 22.2)] versus a direct complete excavation procedure, being similarly with the short term follow-up data. 53.3% (n = 102) of the material has been controlled and no significant differences were noted between the two intervention groups in terms of patients not yet controlled, lost patients and failures (Table). Conclusion: A stepwise excavation procedure still seems preferable after a long term follow up and presumably related to the reduced risk of exposing the inflamed pulp associated with deep caries.

  • 3. Bjørndal, Lars
    et al.
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Bruun, Gitte
    Markvart, Merete
    Kjældgaard, Marianne
    Näsman, Peggy
    Hedenbjörk-Lager, Anders
    Malmö högskola, Odontologiska fakulteten (OD).
    Dige, Irene
    Thordrup, Marianne
    Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up2017Inngår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 96, nr 7, s. 747-753Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Deep caries presents a dilemma in terms of which treatment that will render an optimal prognosis by maintaining pulp vitality with absence of apical pathology. Previously, 2 randomized clinical trials were performed testing the short-term effects of stepwise carious tissue removal versus nonselective carious removal to hard dentin with or without pulp exposure. The aim of this article was to report the 5-y outcome on these previously treated patients having radiographically well-defined carious lesions extending into the pulpal quarter of the dentin but with a well-defined radiodense zone between the carious lesion and the pulp. In this long-term study, 239 of 314 (76.2%) patients were analyzed. The stepwise removal group had a significantly higher proportion of success (60.2%) at 5-y follow-up compared with the nonselective carious removal to hard dentin group (46.3%) ( P = 0.031) when pulp exposures per se were included as failures. Pulp exposure rate was significantly lower in the stepwise carious removal group (21.2% vs. 35.5%; P = 0.014). Irrespective of pulp exposure status, the difference (13.3%) was still significant when sustained pulp vitality without apical radiolucency and unbearable pain was considered (95% confidence interval, 3.1-26.3, P = 0.045). After pulp exposure, only 9% ( n = 4) of the analyzed patients were assessed as successful, indicating that the prognosis is highly dubious following conventional pulp-capping procedures (direct pulp capping or partial pulpotomy) in deep carious lesions in adults. In conclusion, the stepwise carious removal group had a significantly higher proportion of pulps with sustained vitality without apical radiolucency versus nonselective carious removal of deep carious lesions in adult teeth at 5-y follow-up (ClinicalTrials.gov NCT00187837 and NCT00187850).

  • 4. Bjørndal, Lars
    et al.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Simon, Stéphane
    Treatment of vital pulp conditions2018Inngår i: Textbook of Endodontology / [ed] Lars Bjørndal, Lise-Lotte Kirkevang, John Whitworth, Wiley-Blackwell, 2018, s. 79-100Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 5. Bjørndal, Lars
    et al.
    Reit, Claes
    Bruun, Gitte
    Markvart, Merete
    Kjældgaard, Marianne
    Näsman, Peggy
    Thordrup, Marianne
    Dige, Irene
    Nyvad, Bente
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Lager, Anders
    Malmö högskola, Odontologiska fakulteten (OD).
    Ericson, Dan
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Olsson, Jadranka
    Santimano, Eva M
    Wennström, Anette
    Winkel, Per
    Gluud, Christian
    Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy2010Inngår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 118, nr 3, s. 290-297Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI ()22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

  • 6.
    Brodén, Joséphine
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Davidson, Thomas
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth2019Inngår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 2751-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. MATERIAL AND METHODS: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. RESULTS: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. CONCLUSIONS: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.

  • 7.
    Brodén, Joséphine
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Davidson, Thomas
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Health economic evaluation of pulp capping versus root canal treatment in young permanent teeth2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objective. There is a lack of knowledge regarding the health economic consequences of pulp capping and root canal treatment in order to treat children’s and adolescents’ permanent teeth with pulp exposures due to caries. Therefore, the aim of this study was to study the cost effectiveness of performing a pulp capping compared to a root canal treatment in children and adolescents with pulp exposures due to caries. Methods. The cost effectiveness was studied by the use of a Markov simulation model where a simulated 12-year-old patient with a pulp exposure in a permanent tooth was followed for 9 years. The probability of making a transition from one health state to another was calculated from data retrieved after literature searches of published clinical studies. The outcome was measured as avoided extractions until the subject was 21 years old. The time spent on the two treatments was studied by sending a survey to general dentists. Costs were discounted with 3% annually. Results. Based on the answers from the general dentists, the cost for a pulp capping as the initial treatment was 138 EUR and the cost for a root canal treatment as the initial treatment was 608 EUR during the 9 years. We found that less teeth were extracted after a pulp capping than after a root canal treatment in this age group. Pulp capping was found to be cost effective (dominant) compared to root canal treatment as the initial treatment.

  • 8.
    Brodén, Joséphine
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    Fransson, Helena
    Malmö universitet, Foresight.
    Vareman, Niklas
    Lunds universitet.
    Pigg, Maria
    Malmö universitet, Foresight.
    Reflection to enhance students' awareness of and comfort with uncertainty.Manuskript (preprint) (Annet vitenskapelig)
  • 9.
    Brodén, Joséphine
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Heimdal, Håvard
    Malmö högskola, Odontologiska fakulteten (OD).
    Josefsson, Oliver
    Malmö högskola, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Direct pulp capping procedures versus root canal treatment in young permanent vital teeth with pulp exposures due to caries: A systematic review2016Inngår i: American Journal of Dentistry, ISSN 0894-8275, Vol. 29, nr 4, s. 201-206Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose: To evaluate the available evidence on pulp capping procedures and root canal treatment in young permanent teeth with vital pulps exposed by caries. Methods: The study was conducted as a systematic review of the literature. Three databases, PubMed, Web of Knowledge, and The Cochrane Library were searched. Reference lists of relevant articles were hand searched. The quality of all relevant publications was rated. Results: Ten original scientific studies were included in the review. The quality was rated as low in all studies. The search failed to disclose any article directly comparing pulp capping and root canal treatment. The level of evidence was insufficient to draw any conclusions regarding the effectiveness of the two treatment concepts. High success rates are reported for pulp capping procedures in exposure due to caries, though it is not possible to compare them to success rates of root canal treatment. The review confirms the lack of high quality studies on the treatment of young permanent teeth with cariously exposed pulps.

  • 10.
    Brodén, Joséphine
    et al.
    Department of Dental Medicine, Karolinska Institutet, Stockholm.
    Pigg, Maria
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    Vareman, Niklas
    Department of Medical Ethics, Lund University.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    “Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth2023Inngår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, artikkel-id EP02Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aims: Reflection on a deeper level is recognized as an important skill to learn for undergraduate students since mastering reflection can be helpful throughout their future careers. The aim with this study was to (i) examine if short structured written reflections could stimulate deep reflection among a group of dental students and (ii) explore specifically how the students reflected on clinical experience in relation to uncertainty when assessing the risk for exacerbation of apical periodontitis in root filled teeth.Methods: Short reflections were written by 52 dental students at Malmö University in 2021. All students first answered some questions associated with the risk for exacerbation of apical periodontitis in a case with a root filled tooth with a diffuse widening of the periodontal ligament space. After this, they were asked to write short reflections following prompts developed specifically to stimulate reflection. For each student, the reflections were analyzed and the level of reflection according to the 4Rs framework (Reporting/responding, Relating, Reasoning, Reconstructing) was assessed. The written content in the reflections were analyzed by a qualitative method, Systematic Text Condensation (STC). Results: Thirteen of the students (25%) reached the deepest level of reflection, Reconstructing. Sixteen students (31%), reached only the most superficial level, Report/respond. Two themes about experience and lack of experience were identified in the reflections: Theme 1 “The meaning of clinical experience” and Theme 2 “Differences and similarities”. The themes were subdivided into nine subgroups and described in more detail the relationship between experience and certainty as perceived by the students.Conclusions: A short reflection exercise stimulated deep reflection in a proportion of, but not all, dental students. The students believed that certainty comes with experience even when there is a lack of scientific evidence.

  • 11.
    Brodén, Joséphine
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    Pigg, Maria
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    Vareman, Niklas
    Lunds universitet.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    What is the relationship between certainty and experience?: A qualitative study on dental students’ reflections on risk assessment of root filled teeth.Manuskript (preprint) (Annet vitenskapelig)
  • 12.
    Danesh, Noushin
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Ljunggren, Anna Camilla
    Malmö universitet, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö universitet, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Development of criteria for investigation of periapical tissue from root-filled teeth.2019Inngår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 269-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To develop and assess a set of criteria to grade inflammation including relative area of inflammation in periapical lesions in endodontically treated teeth. Material and methods: A set of criteria was developed, encompassing data on: Lymphocytes, denoting chronic inflammation, were graded 0 (occasional) to 4 (heavy/dense inflammation). Polymorphonuclear cells, denoting acute inflammation, were graded 0 (none) to 2 (many). The third parameter, area of inflammation, that is, the relative area of the specimen that was inflamed, was graded 0 (none) to 4 (76–100%). The criteria were tested on 199 consecutive biopsies from 180 patients (aged 31–75 years). Information about symptoms was retrieved from the referrals. Mann–Whitney’s U-test was used to calculate possible differences in average values for the histopathological variables in the two groups of patients: symptomatic or asymptomatic. Results: Using the criteria, varying grades of inflammation were seen in the biopsies. The majority showed few or no PMN cells. There was a correlation between symptoms and the extent of infiltration of lymphocytes and plasma cells (p = .001), PMN cells (p < .001) and the area of inflammation (p = .002): biopsies from the asymptomatic patients exhibited less pronounced and relatively smaller areas of inflammation. Conclusions: Using the criteria on a specific selection of root-filled teeth with persisting apical periodontitis, periapical inflammation was common, but varied in extent and severity. The inflammation was less pronounced and affected a relatively smaller area in asymptomatic teeth, although outliers in both directions were identified.

  • 13.
    Dawson, Victoria
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Amjad, Shwan
    Malmö högskola, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review2015Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, nr 7, s. 627-638Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants.

  • 14.
    Dawson, Victoria
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lunds University.
    EndoReCo,
    EndoReCo (Endodontic Research Collaboration in Scandinavia) .
    Wigsten, Emma
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg.
    Further interventions after root canal treatment in relation to type of coronal restoration and tooth group: a 10-year follow-up of a Swedish dental register2023Inngår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, artikkel-id R043Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aim: To investigate the frequency of further interventions after root filling during a follow-up of 10 to 11 years, and to compare the outcomes with respect to type of coronal restoration and tooth group.Methods: Data from the Swedish Social Insurance Agency´s register of dental treatments were obtained to identify the teeth registered as root filled in Sweden 2009. Type of coronal restoration within 6 months after root filling, as well as the frequency of further interventions (nonsurgical retreatment, periradicular surgery, extraction, further direct and indirect restoration) were tracked in the data register until December 31, 2019. Descriptive statistics and Chi-square tests were used for statistical analysis.Results: Of the 215 611 teeth root filled in 2009, nonsurgical retreatment, periradicular surgery, and extraction were registered for 3.5%, 1.4% and 20%, respectively. The highest frequency of nonsurgical retreatment was registered for molars (4.2%), and periradicular surgery was most frequent in maxillary canines and incisors (2.3%). The highest frequency of extractions was registered for mandibular molars (25.1%). Directly restored teeth had higher frequency of nonsurgical retreatment (3.9%) and extraction (20.8%), compared to indirectly restored teeth (1.7% and 13.6%, respectively; P < 0.001). Of teeth restored with direct restoration within 6 months after root filling, 41.5% were registered with at least one further direct restoration and 14.7% with an indirect restoration. In the group of indirectly restored teeth, 9.3% and 7.1% underwent further restorative treatment with direct and indirect restoration, respectively. The differences registered between directly and indirectly restored root filled teeth were statistically significant (P < 0.001).Conclusions: The frequencies of nonsurgical retreatment and periradicular surgery were low 10 to 11 years after root filling, despite one in five root filled teeth being registered as extracted. Further interventions were significantly more common for directly restored teeth than for those indirectly restored.

  • 15.
    Dawson, Victoria
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Leonard, Kerstin
    Vidigsson, My
    Wolf, Eva
    Malmö universitet, Odontologiska fakulteten (OD).
    Coronal Restoration of Root-filled Teeth: General Dental Practitioners' Decision-Making Process2019Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: A better outcome has been shown for teeth restored with laboratory-fabricated crowns. This may not necessarily imply that full crowns are better than direct restorations, as it may be a result of selection bias. The aim was to describe the decision process regarding the choice of coronal restoration on a root-filled tooth from the perspective of the dentist. Methods: A strategic selection of 15 general dental practitioners (GDPs) in Sweden was performed. An absolute inclusion criterion was that the dentist had a recent experience of root canal treatments followed by a decision concerning permanent coronal restoration. The included dentists provided a variation concerning gender, age, work experience, location of undergraduate education and dental service provider. Semi-structured in-depth interviews were conducted with focus on the personal experience of the informant when choosing how to permanently restore the root-filled tooth. The informants were invited to, in their own words, narrate on the two latest occasions when this situation occurred for direct and full crown restorations respectively. The interviews were verbatim transcribed and then analyzed according to Qualitative Content Analysis, to be classified into an overall theme covering the latent content together with categories and subcategories illustrating the manifest content. Results: Preliminary results indicate a pattern, not yet definitely classified, but revealing the GDPs' efforts to take their current theoretical knowledge and clinical experience into consideration in the decision-making process together with an assessment of the residual tooth substance and the patients' oral health conditions. This is done parallel to an evaluation of and with certain emphasis to the patients' economic situation and preferences. Conclusions: The general dental practitioners' decision-making process regarding the choice of coronal restoration on a root-filled tooth was based not only on clinical factors: decisive for the decision was contextual factors comprising a patient centered approach.

  • 16.
    Dawson, Victoria
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö universitet, Odontologiska fakulteten (OD).
    Coronal restoration of the root filled tooth: a qualitative analysis of the dentists' decision-making process2021Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, nr 4, s. 490-500Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth.

    METHODOLOGY: GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semi-structured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27 - 64 (mean age 46 years), were included and analyzed according to Qualitative Content Analysis.

    RESULTS: A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven sub-categories (manifest content), were identified. The categories were clinical factors, contextual factors and patient´s views. Clinical factors underlying the GDPs´ decision included the current dental status and the estimated longevity of the intended restoration. In certain cases contextual factors were also of importance, either supporting the GDPs´ decision or modifying it. However, the patient´s views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient´s economic status and opinions.

    CONCLUSIONS: With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.

    Fulltekst (pdf)
    fulltext
  • 17.
    Dawson, Victoria
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Isberg, Per-Erik
    Kvist, Thomas
    EndoReCo,
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations2017Inngår i: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, nr 9, s. 1428-1432Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The aim of this study was to evaluate the frequencies of nonsurgical retreatment, root-end surgery, extraction, and further restoration of root-filled teeth in Sweden in 2009 during a follow-up period of 5 years and to compare the outcomes in teeth restored with direct or indirect restorations. METHODS: Data from the Swedish Social Insurance Agency were analyzed, and the frequencies of nonsurgical retreatment, root-end surgery, extractions, and further restoration were calculated for all teeth registered as root filled during 2009. Chi-square tests were applied to detect any significant differences in the frequency of further treatment in teeth registered as restored with either a direct or an indirect restoration within 6 months of root filling. RESULTS: Of the 248,299 teeth reported root filled in Sweden in 2009, nonsurgical retreatment was registered in 2.2%, root-end surgery in 1.0%, and extractions in 9.2% during the follow-up period. Of the teeth restored with a direct restoration within 6 months after the root filling, 30.3% were registered as having undergone at least 1 further direct restoration; the corresponding percentage of teeth with indirect restorations was 6.4%. A statistically significant difference in the frequency of nonsurgical retreatment, extraction, and further restoration was found; teeth restored with an indirect restoration within 6 months of root filling had fewer of these treatments than those restored by direct restoration. CONCLUSIONS: Low frequencies of nonsurgical retreatment and root-end surgery were reported 5 years after root filling, whereas extraction was more common. Fewer additional treatment procedures were registered for teeth with indirect restorations than for those with direct restorations.

  • 18.
    Dawson, Victoria
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Kvist, Thomas
    Frisk, Fredrik
    Bjørndal, Lars
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Survival of Root-filled Teeth in Relation to Restoration and Tooth-group2016Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: To compare the survival of teeth root-filled in Sweden in 2009 in relation to type of restoration and tooth-group.Methods: The database at the Swedish Social Insurance Agency containing information on treatments was used to identify all teeth in Sweden that were root-filled during 2009, by searching for the treatment codes corresponding to root-filling. The completed root-fillings could be linked to a specific tooth in a specific individual. Teeth registered as restored with a direct or indirect restoration within 6 months after completion of the root-filling were tagged and tracked until December 31st 2014. During this period, the treatment codes for extraction were registered for the identified root-filled teeth in order to construct Kaplan-Meier tooth survival analyses.Results: 248,299 teeth were registered as root-filled in Sweden in the year 2009. Of these 142,264 (57.3%) were restored with a direct restoration and 64,092 (25.8%) with an indirect restoration. Survival analysis disclosed that 5-6 years after root canal treatment 93.1% of the teeth with an indirect restoration had survived and 89.6% of the teeth with a direct restoration had survived. In the total material, irrespectively to any coronal restoration, premolars and upper anterior teeth had the highest survival (93.0% respectively 91.4%) and molars the lowest survival (87.6%). The same pattern was observed in sub-group analysis in the group of root-filled teeth with direct restorations. In the group with root-filled teeth with indirect restorations another pattern was observed; upper anterior teeth (92.6%) had a relatively lower survival, equivalent to those of molar teeth (92.6%).Conclusions: 5-6 year survival of root-filled teeth in Sweden were higher in the group with indirect restorations compared to the group with direct restoration. Root-filled upper incisors had an overall high survival, though for root-filled upper anterior teeth with indirect restorations the survival was relatively low.

  • 19.
    Dawson, Victoria S.
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    Wigsten, Emma
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Further Interventions After Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10–11-Year Follow-Up of the Adult Swedish Population2024Inngår i: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10 to 11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration, and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.

    Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and Chi-square tests were used for statistical analysis.

    Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < 0.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years.

    Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite one in five root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

  • 20. Duncan, H F
    et al.
    Galler, K M
    Tomson, P L
    Simon, S
    El-Karim, I
    Kundzina, R
    Krastl, G
    Dammaschke, T
    Fransson, H
    Malmö universitet, Odontologiska fakulteten (OD).
    Markvart, M
    Zehnder, M
    Bjørndal, L
    European Society of Endodontology position statement: Management of deep caries and the exposed pulp2019Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, nr 7, s. 923-934Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement is to summarise current best evidence on the diagnosis and classification of deep caries and caries-induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low-quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information, and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges. This article is protected by copyright. All rights reserved.

    Fulltekst (pdf)
    FULLTEXT01
  • 21.
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    On the repair of the dentine barrier2012Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Det övergripande målet för avhandlingen har varit att studera några aspekter av läkningen av tandens huvudsakliga hårdvävnad, dentinet. Vid mycket djupa kariesangrepp där dentinet förstörts och pulpan därmed blottats, rotbehandlas ofta tanden vilket innebär att pulpan tas bort och att rotkanalen fylls med ett rotfyllningsmaterial. Djupare kunskaper om dentinets läkningsförmåga kan leda till att andra mindre invasiva och kostsamma behandlingsmetoder än rotbehandlingar skulle kunna användas vid mycket djupa kariesangrepp. Kroppens ytor har barriärfunktioner för att skydda kroppen mot skadliga ämnen. I tanden svarar pulpans yttersta cell-lager för en viktig del i barriärfunktionen. Dessa celler, odontoblasterna, bildar dentinet och verkar spela en central roll i de skyddsmekanismer som tanden har. När ett kariesangrepp bryter ned tandens hårdvävnader kan bakterier eller deras produkter få möjlighet att tränga in till pulpan vilket leder till ett inflammatoriskt och immunologiskt svar som kan leda till vävnadsdöd av pulpan. Under vissa omständigheter verkar dock pulpan ha förmåga att reparera hårdvävnadsbarriären på ett sådant sätt att den fysiologiska funktionen kvarstår så att vävnadsdöd och därmed invasion av mikroorganismer undviks. Det finns emellertid studier som antyder att den reparerade hårdvävnadens barriärfunktion ger vika och att den inte kan stå emot ny mikrobiell belastning.Pulpaöverkappning är en behandling som används när pulpan blivit blottad i ett försök att bibehålla pulpans vitalitet och funktion. Faktorer som påverkar hårdvävnadsbildningen vid pulpaöverkappningar har studerats i en systematisk litteraturöversikt. Baserat på det begränsade vetenskapliga stödet visade resultaten att kalciumhydroxidbaserade material men inte bondingmaterial ger en hårdvävnadsbildning som täcker pulpasåret då de används som överkappningsmaterial. Det finns inget vetenskapligt stöd för att kunna fastslå att mineraltrioxidaggregat (MTA) skulle ge mer hårdvävnadsbildning jämfört med kalciumhydroxidbaserade material när dessa används som överkappningsmaterial. En gel (Emdogain®Gel) som innehåller amelogenin som man vet är inblandat i processen då dentinet börjar bildas, utvärderades i en klinisk studie med syfte att studera hårdvävnadsbildningen. En större mängd hårdvävnad bildades efter appliceringen av gelen jämfört med kontrollmaterialet. Hårdvävnaden kunde karaktäriseras som att vara likt det ursprungliga dentinet, men den bildades inte i en struktur som skulle kunna utgöra en fysiologisk barriär. Under ett kariesangrepp bör odontoblasterna svara på närvaro av bakterier med försvarsreaktioner såsom bildande av nytt dentin, men kvalitén på det dentinet verkar ibland bli sämre än det ursprungliga dentinet. Produkter från bakterier tagna från ett djupt kariesangrepp användes för att studera dess effekter på odontoblastliknande cellers aktivitet och förmåga att bilda en typ av kollagen som är den huvudsakliga beståndsdelen i nybildat dentin. Vissa bakterier hade en negativ påverkan på odontoblasternas aktivitet och bakteriernas effekt på kollagenproduktionen varierade, vilket skulle kunna tyda på att bakterier kan ha en direkt effekt på odontoblasternas förmåga att upprätthålla dentinets barriärfunktion.Sammanfattningsvis kan man säga att Emdogain®Gel initierade dentinbildning, men inte i en struktur som skulle kunna utgöra en barriär och det förefaller som om bakterier i olika grad kan påverka odontoblasternas förmåga att bilda en dentinbarriär.

    Fulltekst (pdf)
    Comprehensive Summary
  • 22.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Department of Endodontology, University of Gothenburg, Gothenburg, Sweden.
    Bjørndal, L
    Section of Clinical Oral Microbiology, Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
    Frisk, F
    Department of Endodontology, University of Gothenburg, Gothenburg, Sweden; Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Landt, Kristoffer
    Malmö universitet, Odontologiska fakulteten (OD).
    Isberg, P-E
    Department of Statistics, Lund University School of Economics and Management, Lund University, Lund, Sweden.
    EndoReCo,
    Endodontic Research Collaboration in Scandinavia.
    Kvist, T
    Department of Endodontology, University of Gothenburg, Gothenburg, Sweden.
    Factors Associated with Extraction following Root Canal Filling in Adults2021Inngår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 100, nr 6, s. 608-614, artikkel-id 22034520982962Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Essentially, root fillings are performed to preserve natural teeth. Over time, however, some root-filled teeth will inevitably be extracted. The aim of this historical prospective cohort study in the adult Swedish population was to identify factors associated with extractions within 5 y of registration of a root filling. The cohort consisted of all those whose root fillings had been reported to the tax-funded Swedish Social Insurance Agency (SSIA) in 2009. Demographic data on the individuals registered with a root filling (sex, age, country of birth, disposable income, educational level, and marital status) were received from Statistics Sweden or the SSIA. Dental care setting, tooth type, and any registration of subsequent restorations within 6 mo were received from the SSIA. Multivariable regression analysis was used, and P < 0.05 was considered statistically significant. In total, 216,764 individuals had been registered with at least 1 root filling. Individuals (n = 824) without complete data were excluded from the analyses. After 5 y, 9.3% of the root-filled teeth had been registered as extracted. Logistic regression analysis found significant associations for all variables except country of birth, disposable income, and educational level. The highest odds ratios for extractions were associated with the type of restoration: teeth with no registration of any restoration and teeth with a direct restoration combined with a post were 3 times more likely to undergo extraction than teeth restored with an indirect restoration combined with a post and core. Overall, high odds ratios for extractions were associated with any type of composite restoration, including composite fillings and crowns combined with or without any post. In summary, after root filling in the Swedish adult population, several individual- and tooth-specific variables were associated with extraction. The reasons for the extractions remain to be studied further.

  • 23.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Bjørndal, Lars
    Sektion for Klinisk Oral Mikrobiologi, Odontologisk Institut, Det Sundhedsvidenskabelige Fakultet, Københavns Universitet.
    The Management of Deep Caries Using Selective and Non-Selective Removal of Carious Tissue, Stepwise Excavation and Indirect Pulp Capping2024Inngår i: Vital Pulp Treatment / [ed] Henry F. Duncan, Ikhlas A. El-Karim, Hoboken, USA: John Wiley & Sons, 2024, 1, s. 59-83Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [en]

    For deep carious lesions, there are different treatment modalities that aim to avoid exposing the pulp and, thus, in the long-term root canal treatment. Understanding the biological events in caries pathology will facilitate the choice of treatment and why selective caries removal treatments, in many cases, can be recommended. Before selecting any modality, it is advantageous to know the expected prognosis based on clinical studies. After treatment, the patient should be monitored for signs of pulp disease. Current practice differs between dentists, and this chapter aims to provide evidence-based and consensus recommendations for the treatment of deep carious lesions.

  • 24.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Bjørndal, Lars
    Odont inst, Köpenhamns universitet.
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Frisk, Fredrik
    Odont inst, Folktandvården, Region Jönköpings län..
    Kvist, Thomas
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    Markvart, Merete
    Odont inst, Köpen-hamns universitet.
    Pigg, Maria
    Malmö universitet, Odontologiska fakulteten (OD).
    Wigsten, Emma
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    EndoReCo banar väg för ökad kunskap och akademisk meritering2022Inngår i: Tandläkartidningen, ISSN 0039-6982, Vol. 114, nr 12, s. 46-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    För att minska kunskapsluckorna inom odontologin krävs samarbete mellan lärosätena. Det ger även möjlighet till akademisk meritering, vilket är angeläget då antalet seniora forskare med behörighet för forskningshandledning i Sverige är färre än någonsin. EndoReCo (Endodontic Research Collaboration) är ett skandinaviskt forskningsnätverk i endodonti som kan ta del av just dessa fördelar.

  • 25.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). University of Gothenburg.
    Davidson, Thomas
    Linköping University.
    Rohlin, Madeleine
    Malmö universitet, Odontologiska fakulteten (OD).
    Christell, Helena
    Helsingborg Hospital.
    There is a paucity of economic evaluations of prediction methods of caries and periodontitis: A systematic review2021Inngår i: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 7, nr 3, s. 385-398Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). Material and methods: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. Results: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. Conclusions: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.

    Fulltekst (pdf)
    fulltext
  • 26.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Tooth survival after endodontic treatment2023Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, nr S2, s. 140-153Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. However, we do not know if or how this affects the health of the individual. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ´healthy periapical tissues´ or ´tooth survival´ they are equally important to know. Factors affecting the outcome ´healthy periapical tissues´ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ´tooth survival´ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.

    Fulltekst (pdf)
    fulltext
  • 27.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Dawson, Victoria
    Malmö högskola, Odontologiska fakulteten (OD).
    Frisk, Fredrik
    Bjørndal, Lars
    EndoReCo,
    Kvist, Thomas
    Survival of Root-filled Teeth in the Swedish Adult Population2016Inngår i: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 42, nr 2, s. 216-220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The aim was to assess survival in the Swedish population of teeth treated by nonsurgical root canal treatment during 2009. METHODS: Data from the Swedish Social Insurance Agency were analyzed by Kaplan-Meier analysis to assess cumulative tooth survival during a period of 5-6 years of all teeth that were root-filled during 2009. RESULTS: In 2009, 248,299 teeth were reported as root-filled. The average age of the patients at the time of the root filling was 55 years (range, 20-102 years). The teeth most frequently root-filled were the maxillary and mandibular first molars. During the 5- to 6-year period 25,228 of the root-filled teeth (10.2%) were reported to have been extracted; thus 223,071 teeth (89.8%) survived. Tooth survival was highest in the youngest age group (93.2%). The highest survival (93.0%) was for the mandibular premolars, and the lowest (87.5%) was for the mandibular molars. Teeth restored with indirect restorations within 6 months of the root filling had higher survival rates (93.1%) than those restored with a direct filling (89.6%). CONCLUSIONS: In the adult population of Sweden, teeth that are root-filled by general practitioners under the tax-funded Swedish Social Insurance Agency have a 5- to 6-year survival rate of approximately 90%.

  • 28.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Landt, Kristoffer
    Malmö högskola, Odontologiska fakulteten (OD).
    Hagstam, Linda
    Malmö högskola, Odontologiska fakulteten (OD).
    Frisk, Fredrik
    Bjørndal, Lars
    Kvist, Thomas
    Demographics of Individuals Extracting Root-filled Teeth in Sweden2016Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: To study some demographic variables of individuals registered receiving a root canal filling in a tooth that during the subsequent 5 to 6 years was registered as being extracted in comparison of individuals retaining the equivalent root-filled tooth during the same period.Methods: Data from the Swedish Social Insurance Agency were analyzed regarding all teeth that were reported root-filled in Sweden during 2009. The upper first molars were chosen to be a model for the comparisons. A control group was constructed by randomly selecting individuals with upper first molars not extracted. Demographical data on the individuals were received from Statistics Sweden and the groups were studied in regard to gender, age, ethnicity, mean income, educational level and civil status.Results: During 2009 a total of 36,139 upper first molars was registered as being root-filled and during the subsequent 5 to 6 years 4,362 (12.9%) of these teeth were registered as being extracted. The studied demographic variables were almost equal between the individuals who had their root-filled teeth extracted and the individuals in the control group who retained their root-filled teeth. The individuals extracting was in average older (52.7 years) than those retaining (51.1 years). A larger percentage of women (51.8) than men (48.2) was found in the group whose teeth were extracted.Conclusions: Demographic variables differed somewhat in regard to gender and age in individuals extracting root-filled upper first molars compared to individuals retaining their teeth. In regard to ethnicity, mean income, educational level and civil status only minor differences were detected.

  • 29.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Landt, Kristoffer
    Malmö universitet, Odontologiska fakulteten (OD).
    Kvist, Thomas
    Bjørndal, Lars
    Frisk, Fredrik
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Factors Associated with Extractions Following Root-filling in Swedish Adults2019Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: Root-fillings are essentially performed to preserve natural teeth. However over time some root-filled teeth will be extracted. The aim of this study was to identify factors associated with extractions within a period of 5 years after completion of a root-filling in the adult Swedish population. Methods: In this registry study, the cohort consisted of all root-fillings reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. Tooth type, any registration of subsequent coronal restorations within 6 months and type of caregiver were recorded. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t-test and logistic regression analysis. P<0.05 was considered statistically significant. Results: The total number of individuals registered with at least one root-filling was 216,764. Not all had a registration of a tooth number or had no registrations at Statistics Sweden (n=824) and were excluded from the analyses. After 5 years, 9.4% of the teeth had been registered as extracted. Preliminary data showed risk factors associated with higher odds for extractions to be molar teeth, teeth with no registration of any permanent coronal restoration within 6 months following the registration of the root-filling, root-fillings performed in the private sector, women, older age-group and widow(er)s or divorcees. Conclusions: Several individual and tooth specific factors were associated with extraction following root-filling in the Swedish adult population. The direct reasons for the extractions remain to be studied further.

  • 30.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Larsson, Kerstin
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Efficacy of lasers as an adjunct to chemo-mechanical disinfection of infected root canals: a systematic review2013Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 46, nr 4, s. 296-307Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to evaluate the efficacy of various types of lasers used as an adjunct to chemo-mechanical disinfection of infected root canals with the outcome measures 'normal periapical condition' or 'reduction of microbial load'. PubMed, CENTRAL and ISI Web of Knowledge literature searches with specific indexing terms and a subsequent hand search were made with stated limits and criteria. Relevant publications were retrieved, followed by interpretation. The quality of each included publication was assessed as high, moderate or low. The initial search process yielded 234 publications. All abstracts of these publications were read, and the reference lists of relevant publications were hand-searched. Ten articles were read in full text and interpreted according to a data extraction form. Five were included in the systematic review and were assessed. A meta-analysis was impossible to perform because the included studies were heterogeneous with regard to study design, treatment and outcome measures. Positive effects were reported; however, no concluding evidence grade could be made because each included study was judged to have low quality, primarily due to lack of a power analysis, blinding and reproducibility. The evidence grade for whether lasers can be recommended as an adjunct to chemo-mechanical disinfection of infected root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies.

  • 31.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD).
    Dentine sialoprotein and Collagen I expression after experimental pulp capping in humans using Emdogain(R) Gel2011Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 44, nr 3, s. 259-267Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain®Gel (Biora AB, Malmö, Sweden) – , a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Formation of hard tissue following pulp capping in these teeth has previously been observed and reported. Methodology Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from 9 pairs of contra-lateral premolars, that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. The teeth were extracted 12 weeks after being pulp capped. Results In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. Conclusions The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine.

  • 32.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD).
    DSP and collagen 1 expression in newly formed hard tissue after pulp capping in humans.2008Konferansepaper (Annet vitenskapelig)
  • 33.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD).
    DSP and Collagen I Expression After Pulp Capping in Humans2008Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Formation of hard tissue following treatment of pulp exposures has been observed in both clinical and experimental studies. However it is not known if such tissue has the functions of primary dentin which are likely to be important in protecting the pulp from the oral environment. Objectives: To study the expression of two relatively specific markers for dentin; dentin sialoprotein (DSP) and type 1 collagen (Col I) in human teeth experimentally pulp capped either with Emdogain®Gel (Biora AB, Malmö, Sweden) - a derivative of enamel matrix (EMD) in a propylene glycol alginate vehicle, or with calcium hydroxide. Methods: Nine pairs of contra-lateral premolars scheduled for extraction on orthodontic grounds were experimentally pulp amputated and capped with EMDgel or calcium hydroxide. After 12 weeks the teeth were extracted, prepared for light microscopic examination and stained using affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies. Results: In the EMDgel treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside exposed dentin surfaces and in patches in the adjacent pulp tissue. In the calcium hydroxide treated teeth, the new hard tissue was formed as a bridge. DSP staining was seen in the newly formed hard tissue and in the cells lining it in both groups but was more marked in the EMDgel treated teeth. Col I staining was seen in the newly formed hard tissue in both groups. Conclusion: The expression of DSP and Col I suggests that the new hard tissue formed after pulp capping with EMDgel or calcium hydroxide is dentin. Supported by Biora AB, Malmö, Sweden, the European Society of Endodontology and the Swedish Dental Society.

  • 34.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD).
    Effects of bacterial products on the activity of odontoblast-like cells and their formation of type 1 collagen2014Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 47, nr 4, s. 397-404Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To study how products released from different bacteria in a deep carious lesion affect the metabolic activity of odontoblast-like cells and their ability to produce the major organic component of dentine, collagen 1. METHODOLOGY: MDPC-23 cells were exposed to supernatants from biofilm cultures of strains isolated from the deepest part of a carious lesion as well as from a clinical isolate of Enterococcus faecalis. Lipoteichoic acid (LTA) and lipopolysaccharide (LPS) were used for comparison. Cell activity was assessed using an methyl-thiazolyl-diphenyl tetrazolium bromide (MTT) assay, and collagen 1 levels were determined by ELISA. RESULTS:The lesion microflora was dominated by Lactobacillus spp. Neither extracellular products from the isolates nor LPS affected the activity of the MDPC-23 cells, whereas extracellular products from E. faecalis and LTA significantly reduced total cell activity (P < 0.01). Enterococcus faecalis had an inhibitory effect upon collagen 1 production by the cells, whereas no such effect or even a slight stimulatory effect was seen for the isolates from the deep carious lesion. CONCLUSIONS: These studies indicate that culture supernatants from E. faecalis reduced the metabolic activity of odontoblast-like cells as shown using the MTT assay. No effect was seen for supernatants from biofilms of bacteria recovered from a deep carious lesion. Different bacteria varied in their effects upon collagen 1 production suggesting that the nature of the bacterial species in a carious lesion may have a direct influence upon the ability of the odontoblasts to produce tertiary dentine.

  • 35.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Stangvaltaite-Mouhat, Lina
    Oral Healtenter of Expertise in Eastern Norway (OHCE-E), Oslo, Norge.
    Croft, Katri
    Helsingfors universitet, Helsingfors, Finland.
    Bletsa, Athanasia
    Universitetet i Bergen, Bergen, Norge.
    Bjørndal, Lars
    Københavns universitet, Köpenhamn, Danmark.
    Behandlingar av vital pulpa i tänder med djupa karieslesioner2023Inngår i: Tandläkartidningen, ISSN 0039-6982, Vol. 115, nr 2, s. 56-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Vital pulpabehandling utförs för att bevara pulpans försvarsfunktioner och därmed undvika pulpektomi och rotfyllning som kan vara tekniskt krävande och inte alltid ger önskat resultat. European Society of Endodontology (ESE) har publicerat ett positionsdokument avseende vitalbehandling av tänder med djupa karieslesioner vilket delvis överensstämmer med de nationella riktlinjerna i de nordiska länderna. Det finns svårigheter när det gäller att bedöma pulpans status i tänder med djupa karieslesioner. Så länge karieslesionen inte har nått pulpan rekommenderas behandlingar som utförs för att undvika exponering av pulpan, såsom stegvis exkavering.

    Å andra sidan, när pulpan exponerats på grund av karies, skiljer sig rekommendationerna något åt mellan ESE och de nationella riktlinjerna i de nordiska länderna. Detta beror troligen på avsaknad av evidens som talar för fördelar av den ena behandlingen framför den andra och på grund av svårigheterna att bedöma vilka exponerade pulpor som är irreversibelt skadade. Minimalinvasiva behandlingsstrategier som använder sig av nyligen utvecklade hydrauliska kalciumsilikatcement visar lovande resultat vid vitalbehandling av pulpa. Vital pulpabehandling vidareutvecklas och förändringar i de kliniska rekommendationerna är att förvänta.

    Fulltekst (pdf)
    fulltext
  • 36.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Stangvaltaite-Mouhat, Lina
    Oral Health Center of Expertise in Eastern Norway (OHCE-E), Oslo, Norway.
    Croft, Katri
    Oral Health Care in City of Espoo and Institute of Dentistry, Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
    Bletsa, Athanasia
    Oral Health Centre of Expertise in Western Norway, Vestland Bergen and Institute of Clinical Dentistry, University of Bergen, Bergen, Norway.
    Bjørndal, Lars
    Sektion for Klinisk Oral Mikrobiologi, Odontologisk Institut, Det Sundhedsvidenskabelige Fakultet, Københavns Universitet.
    Vitaalin pulpan hoito hampaissa, joissa on syviä kariesvaurioita2023Inngår i: Suomen hammaslaakarilehti, ISSN 0355-4090, Vol. 30, nr 3, s. 34-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [fi]

    Vitaalin pulpan hoidon tarkoituksena on säilyttää pulpan puolustustoiminnot sekä välttää juurihoito, joka voi olla teknisesti haastava eikä aina onnistu toivotusti. ESE (European Society of Endodontology) on julkaissut suosituksen liittyen vitaalin pulpan hoitoon hampaissa, joissa on syviä kariesvaurioita. Suositus on osittain yhteneväinen Pohjoismaissa käytössä olevien kansallisten suositusten kanssa.

    Hampaissa, joissa on syviä kariesvaurioita, pulpan tilan arviointiin liittyy ratkaisemattomia kysymyksiä. Mikäli vaurio ei vielä ulotu pulpaan asti, suositellaan hoitomuotoja, joissa pulpan paljastuminen voidaan välttää, kuten vaiheittaista kariesvaurion poistoa. Tilanteessa, jossa pulpa on jo paljastunut, ESE:n ja pohjoismaisten kansallisten suositusten välillä ilmenee joitakin eroja. Syynä on todennäköisesti näytön puute sen suhteen, että jokin hoito tehoaisi muita paremmin. Lisäksi on vaikea arvioida, milloin paljastunut pulpa on vaurioitunut palautumattomasti.

    Mini-invasiivisilla menetelmillä, joissa hyödynnetään hiljattain kehitettyjä kalsiumsilikaattisementtejä, on saatu lupaavia tuloksia juurihoidon välttämiseen tähtäävissä vitaalin pulpan hoidoissa. Vitaalin pulpan hoitomenetelmiä kehitetään edelleen, ja kliinisiin suosituksiin on odotettavissa muutoksia.

  • 37.
    Fransson, Helena
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Stangvaltaite-Mouhat, Lina
    Oral Health Center of Expertise in Eastern Norway (OHCE-E), Oslo, Norway.
    Croft, Katri
    Oral Health Care in City of Espoo and Institute of Dentistry, Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
    Bletsa, Athanasia
    Oral Health Centre of Expertise in Western Norway, Vestland Bergen and Institute of Clinical Dentistry, University of Bergen, Bergen, Norway.
    Bjørndal, Lars
    Sektion for Klinisk Oral Mikrobiologi, Odontologisk Institut, Det Sundhedsvidenskabelige Fakultet, Københavns Universitet.
    Vitale pulpabehandlinger i tænder med profund caries2023Inngår i: Tandlægebladet, ISSN 0039-9353, Vol. 127, s. 36-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [da]

    Vitale pulpabehandlinger udføres med henblik på at bevare pulpas forsvarsfunktioner og undgå pulpektomi og rodfyldning, som kan være teknisk udfordrende og ikke altid fører til det ønskede resultat. The European Society of Endodontology (ESE) har publiceret en statusrapport om vital pulpabehandling i tænder med profunde carieslæsioner, som i et vist omfang stemmer overens med de nationale retningslinjer i de nordiske lande. Der er stadig problemer med at vurdere pulpas tilstand i tænder med profunde carieslæsioner. Så længe carieslæsionen ikke har nået pulpa, anbefales behandlinger, der sigter på at undgå pulpaeksponering, fx gradvis ekskavering. Men når pulpa er eksponeret på grund af caries, er der ikke overensstemmelse mellem anbefalingerne fra ESE og de nordiske landes nationale retningslinjer. Dette skyldes sandsynligvis manglende evidens for bedre effekt af én behandling frem for andre samt vanskeligheder med at afgøre, hvornår pulpa er irreversibelt beskadiget. Minimalt invasive behandlingsstrategier med nyudviklede hydrauliske calciumsilikatcementer har vist lovende resultater af vital pulpabehandling med henblik på at undgå rodkanalbehandling. Konceptet er under stadig udvikling, og man må forvente, at de kliniske anbefalinger på sigt bliver ændret. 

  • 38.
    Fransson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans: an updated systematic review2016Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 49, s. 533-542Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue barrier after pulp capping and partial pulpotomy of experimental exposures in humans. PubMed (01-01-2005 to 01-03-2014) and CENTRAL were searched using specific keywords. Hand searches were made and the level of evidence for each included article was evaluated by the authors. The evidence of the conclusions was graded as strong, moderately strong, limited or insufficient. The initial search in PubMed yielded 215 abstracts. Hand searches of reference lists yielded no additional original scientific articles. After a selection process and interpretation, 22 articles were included and rated for level of evidence: no article was rated as high and seven as moderate. Overall the methodological quality of studies has improved since the previous systematic review was published in 2006. The conclusions are that there is limited scientific evidence that application of calcium hydroxide or mineral trioxide aggregate to an exposed pulp frequently results in formation of a hard tissue barrier, whereas adhesives or enamel matrix derivatives do not. There is insufficient scientific evidence that mineral trioxide aggregate promotes hard tissue formation more frequently than calcium hydroxide.

  • 39. Granevik Lindström, Maria
    et al.
    Wolf, Eva
    Malmö högskola, Odontologiska fakulteten (OD).
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    The Antibacterial Effect of Nd:YAG Laser Treatment of Teeth with Apical Periodontitis: A Randomized Controlled Trial2017Inngår i: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, nr 6, s. 857-863Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: The aim of this blind, in vivo, randomized controlled trial was to evaluate the antibacterial effect of Nd:YAG laser irradiation in endodontic treatment of single-rooted teeth with apical periodontitis. The hypothesis was that mechanical enlargement of the root canal and Nd:YAG laser irradiation would yield more negative bacterial samples than conventional treatment. METHODS: Forty-one patients (45 teeth) were allocated to the laser (n = 22) or control (n = 23) group. The teeth in the laser group were instrumented, irrigated with saline, and irradiated with Nd:YAG laser according to a standard protocol. The teeth in the control group were similarly instrumented but irrigated with 1% unbuffered sodium hypochlorite and 15% EDTA solution. Bacterial samples were taken before and after treatment, blinded, and immediately sent for culturing and analysis. RESULTS: The initial bacterial samples were positive in 20 of 22 teeth in the laser group and 18 of 23 (P = .414) in the control group. After the initial treatment, negative bacterial samples were found in 11 teeth in the laser group and 13 (P = .768) in the control group. After 2 to 4 days with no antibacterial dressing in the root canals, 5 teeth in the laser group and 9 (P = .337) in the control group yielded negative bacterial samples. CONCLUSIONS: After intervention, neither the test group nor the control group yielded predictable negative bacterial samples. Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly more negative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

  • 40.
    Jakovljevic, Aleksandar
    et al.
    Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
    Jaćimović, Jelena
    Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
    Aminoshariae, Anita
    Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review2023Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, nr S3, s. 340-354Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited.

    OBJECTIVES: This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome?

    METHODS: A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials.

    RESULTS: Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed.

    DISCUSSION: Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials.

    CONCLUSIONS: Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal.

    REGISTRATION: PROSPERO database (CRD42021259742).

  • 41. Kebke, S
    et al.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Brundin, M
    Mota de Almeida, Fernando José
    Tooth survival following root canal treatment by general dental practitioners in a Swedish county - a 10-year follow-up study of a historical cohort.2021Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, nr 1, s. 5-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To evaluate the 10-year survival rate of root filled teeth treated by general dental practitioners (GDPs), and to identify possible prognostic factors.

    METHODOLOGY: In 2006, 3 676 individuals had at least one tooth root filled by a GDP within the Norrbotten Public Dental Service, Sweden. Over the next 10 years, 331 individuals died and were excluded. A random sample of 302 of the remaining individuals were included in the study, of whom 280 (n=280 teeth) were included in the analysis. Dental records were reviewed retrospectively by a calibrated researcher to collect predetermined data regarding individual, preoperative, intra-operative, and postoperative factors. The outcome measure was tooth extraction over time, and cases with no events were censored, regardless of apical status or symptoms, until last known date of tooth survival. In case of missing data, individuals were recalled for a control visit. Kaplan-Meier survival tables, and Cox regression models were used for analysis. P<0.05 was considered statistically significant.

    RESULTS: The cumulative 10-year survival was 81.7% (standard error: 2.6%), and the mean incidence of tooth extraction during the 10 years was 1.8% per year. The univariate analysis identified three possible prognostic factors (p<0.05) that were associated with extraction: molars, two or more emergency inter-appointment visits during the treatment, and root canal treatments consisting of five or more separate sessions. A multivariate regression analysis revealed no significant relationships for the variables gender, tooth type, number of contacts, any emergency visits during endodontic treatment, number of sessions to complete endodontic treatment, pulp diagnosis, or type of permanent restoration and extraction.

    CONCLUSIONS: The mean incidence of tooth loss over the first 10 years after completion of root canal treatment performed by a GDP was approximately 2% per year. No prognostic factors could be identified.

    Fulltekst (pdf)
    fulltext
  • 42.
    Landt, Kristoffer
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Hagstam-Harrison, Linda
    Malmö universitet, Odontologiska fakulteten (OD).
    Kvist, Thomas
    Frisk, Fredrik
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Bjørndal, Lars
    EndoReCo,
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study2018Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 51, nr 9, s. 975-980Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6 years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. METHODOLOGY: The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. RESULTS: In the year 2009, 36 139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6 year period. Only minor intergroup differences were noted: 86.5% of the study group were Swedish-born, compared with 84.4% of the comparison group (P = 0.007). Women comprised 53.2% of the study group and 50.5% (P = 0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. CONCLUSIONS: There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6 years, and the comparison group, with uneventful outcomes after a corresponding root filling.

  • 43.
    Markvart, M
    et al.
    University of Copenhagen, Denmark.
    Tibbelin, N
    Specialist Clinic for Endodontics, Public Dental Service, Lund,.
    Pigg, Maria
    Malmö universitet, Odontologiska fakulteten (OD).
    EndoReCo,
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD). University of Gothenburg.
    Frequency of additional treatments in relation to the number of root filled canals in molar teeth in the Swedish adult population2021Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, nr 6, s. 826-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To investigate the 5-year frequency of additional treatments in relation to the number of reported root filled canals in molar teeth in Sweden.

    METHODOLOGY: The cohort included first and second molars in adult individuals who were registered with a root filling performed in 2009. Treatment codes corresponding to root fillings of teeth with from one up to four root filled canals were identified in the Swedish Social Insurance Agency database. The studied additional treatments were extraction, non-surgical root canal retreatment and endodontic surgery during the subsequent 5 years, identified by corresponding codes for these treatments registered on these specific teeth. Differences in the frequency of additional treatments based on the number of root filled canals were analysed using Chi-square test, and considered statistically significant at p<0.05.

    RESULTS: In 2009, root fillings on a first or second molar tooth were registered in 100 720 individuals. The study included 32 901 maxillary first molars (6.4% with four root filled canals), 12 763 maxillary second molars (3.3% with four root filled canals), 37 703 mandibular first molars (19.2% with four root filled canals) and 17 353 mandibular second molars (3.7% with four root filled canals). The total frequency additional treatments was 14.3% (n=14 425) during the 5-year observational period. Additional treatments were more frequent in teeth with 1-3 root filled canals compared to teeth with four root filled canals for maxillary first molars (15.2% vs. 12.7%, p=0.002), maxillary second molars (13.8% vs. 9.1%, p=0.007) and mandibular first molars (14.0% vs. 10.7%, p<0.001) but not mandibular second molars (15.6% vs. 13.7%, p=0.200).

    CONCLUSIONS: Over 5 years, 85.7% of the included teeth were not registered with any additional treatments. Maxillary first and second molars and mandibular first molar teeth had a greater frequency of additional treatments when ≤3 root canals were root filled compared to 4 canals.

  • 44. Markvart, Merete
    et al.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    EndoReCo,
    Bjørndal, Lars
    Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners2018Inngår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, nr 7, s. 515-519Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to re-assess the adoption of certain endodontic technology and central treatment principles of root canal treatments as advocated by guidelines presented by the European Society of Endodontology. Material and methods: The questionnaire included the same questions in 2003 and 2013. The general dental practitioners (GDPs) anonymously reported how frequent ('often', 'occasionally', and 'never') they used certain endodontic technology and adhered to central treatment principles. The statistical analyses were performed using Chi-squared test and Goodman-Kruskal's gamma-coefficient as an association measure. Results: The overall response rate of the 2013 group was 46.5% (n = 531). The frequencies of GDPs reporting often use of rubber dam, apex locator and rotary NiTi instruments were significantly higher (p < .0001) than in 2003, as well as reporting the use of composite resin for coronal sealing (p < .019). Adoption was significantly influenced by the factors gender (p = .601) and time since graduation (p = .361), and the cluster analyses revealed the neglected use of rubber dam to be associated with no established postoperative recall system. Conclusions: After 10 years, there was a higher frequency of GDPs who had adopted certain endodontic technologies. However, progress towards high-quality root canal treatment might be obstructed as the majority of GDPs avoids consistent use of rubber dam, and routinely neglects recalls for postoperative controls of their endodontic treatments.

  • 45.
    Mota de Almeida, Fernando José
    et al.
    Tandvårdens Kompetenscentrum, Norrbotten Public Dental Service Luleå Sweden;Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Dawson, Victoria
    Malmö universitet, Odontologiska fakulteten (OD).
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg, Sweden.
    Frisk, Fredrik
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden;Department of Endodontology Institute for Postgraduate Dental Education Jönköping Sweden;School of Health and Welfare Jönköping University Jönköping Sweden.
    Bjørndal, Lars
    Department of Cariology and Endodontics, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.
    Isberg, Per‐Erik
    Department of Statistics, Lund University School of Economics and Management Lund University Lund Sweden.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Periradicular surgery: A longitudinal registry study of 10‐year outcomes and factors predictive of post‐surgical extraction2023Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, nr 10, s. 1212-1221Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery.

    Methodology: The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) during 2009. The cohort was followed until December 31, 2020. Subsequent registrations of extractions were collected for Kaplan-Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and P < 0.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed.

    Results: After data cleaning, and exclusion of 157 teeth, 5 622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20-97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5 548 teeth, of which 1 461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both P < 0.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975-2.987, P < 0.001).

    Conclusions: After periradicular surgery in predominantly elderly people in Sweden, approximately three quarters of the teeth are retained over a 10-year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines.

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  • 46.
    Mota de Almeida, Fernando José
    et al.
    Tandvårdens Kompetenscentrum, Norrbotten Public Dental Service, Luleå, Sweden.
    Lundqvist, Robert
    Norrbotten County Council, Luleå, Sweden; Department of Clinical Medicine and Public Health, Umeå University, Umeå, Sweden.
    Kebke, Stephen
    Piteå Hospital, Norrbotten Public Dental Service, Piteå, Sweden.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Brundin, Malin
    Department of Odontology, Umeå University, Umeå, Sweden.
    Additional treatment indicative of an unfavorable endodontic outcome in a Swedish county: a 10-year observational study2023Inngår i: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 49, nr 3, s. 267-275, artikkel-id S0099-2399(22)00849-4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: This study's aim was to calculate the incidence of first additional endodontic treatment or extraction as the result of an unfavourable endodontic outcome following orthograde root canal treatment (RCT) performed by general dental practitioners (GDPs) during a 10-year period and to identify possible predictors for outcomes.

    METHODS: A randomised cohort of 280 individuals (and as many teeth) with an orthograde RCT was followed for over 10 years. Dental records were reviewed, and individuals were recalled when data were missing. The following terminal events indicative of unfavourable endodontic treatment outcome were orthograde retreatment, surgical endodontics, and tooth extractions exclusively due to endodontic reasons. Selected variables related to individuals and treatment (pre-, intra-, and post-operative) were harvested to analyze possible associations with the terminal events. Unadjusted survival analysis and Cox regression analysis were performed and P < 0.05 was considered statistically significant.

    RESULTS: Terminal events were registered for 22 teeth/individuals and 17 of these were orthograde retreatments. The cumulative 10-year survival of RCTs was 92.7% (standard error 1.7%), with a higher yearly incidence during the first two years. The univariate analysis identified five factors associated with the outcome. There were too few events to perform a multivariate analysis.

    CONCLUSIONS: The mean incidence of additional treatment indicative of unfavourable endodontic outcome was 0.7% per year during the first 10 years, but the mean incidence was greater during the first two years. Five factors were associated with an unfavourable outcome; however, confounders cannot be excluded from the associations.

  • 47.
    Olsson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD).
    Holst, KE
    Schröder, Ulla
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Dental pulp capping: effect of Emdogain Gel on experimentally exposed human pulps2005Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 38, nr 3, s. 186-194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.

  • 48.
    Olsson, Helena
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Petersson, Kerstin
    Malmö högskola, Odontologiska fakulteten (OD).
    Rohlin, Madeleine
    Malmö högskola, Odontologiska fakulteten (OD).
    Formation of a hard tissue barrier after pulp cappings in gumans. A systematic review2006Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 39, nr 6, s. 429-442Artikkel, forskningsoversikt (Annet vitenskapelig)
    Abstract [en]

    Aim To evaluate the evidence on the formation of a hard tissue barrier after pulp capping in humans. Methodology A PubMed and CENTRAL literature search with specific indexing terms and a hand search were made. The authors assessed the level of evidence of each publication as high, moderate or low. Based on this, the evidence grade of the conclusions was rated as strong, moderately strong, limited or insufficient. Results The initial search process resulted in a total of 171 publications. After reading the abstracts and hand searching the reference lists of the retrieved publications, 107 studies were retrieved in full-text and interpreted. After the interpretation, 21 studies remained and were included in the systematic review and given a level of evidence. No study had a high level of evidence, one study had moderate and 20 studies had a low level of evidence. There was heterogeneity between the studies; therefore, no meta-analysis was performed. The majority of studies on pulp capping using calcium hydroxide based materials reported formation of hard tissue bridging, studies on other pulp capping materials such as bonding agents presented inferior results. The evidence grade was insufficient. Conclusions Insufficient evidence grade does not necessarily imply that there is no effect of a pulp capping procedure or that it should not be used. Rather, the insufficient evidence underpins the need for high-quality studies.

  • 49.
    Olsson, Sara R
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Dental Research Department, Public Dental Health Service, Örebro, Sweden.
    Jonsson Sjögren, Jakob
    Malmö universitet, Odontologiska fakulteten (OD). Dental Research Department, Public Dental Health Service Örebro Sweden.
    Pigg, Maria
    Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Foresight.
    Fransson, Helena
    Malmö universitet, Odontologiska fakulteten (OD).
    Eliasson, Alf
    Dental Research Department, Public Dental Health Service Örebro Sweden;Department of Dentistry, Faculty of Medicine and Health Örebro University Örebro Sweden.
    EndoReCo, .
    Endodontic Research Collaboration in Scandinavia .
    Kvist, Thomas
    Department of Endodontology, Institute of Odontology at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study2024Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To  investigate  what  happens  to  cross-  sectionally  identified  root-  filled  teeth  over  a  6-  year  period,  regardless  of  the  time  that  elapsed  since  primary  root  canal  treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root- filled teeth  over  the  same  time  were  associated  with  variables  obtained  from  a  baseline  examination.Methodology: Adult patients with ≥1 previously root- filled tooth and regularly at-tending the Public Dental Service in Örebro County were enrolled for study partici-pation in 2015. General dental practitioners examined all identified root- filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision- making and treatments. After six years, information on events of the root- filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5- point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient-  and tooth- related factors and events.Results: A total of 445 patients with 1007 root- filled teeth were followed the entire observation time. Twenty (2.0%) of the root- filled teeth had endodontic retreatment and  150  (14.9%)  were  extracted  over  six  years.  Among  teeth  with  periapical  radio-lucency  or  pain,  the  majority  did  not  undergo  retreatment  or  extraction;  however,  the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p< .0001),  tenderness to percussion (p<   .0001), and poor coronal restoration (p< .0001).Conclusions: This  study  corroborates  the  notion  that  in  general  dentistry,  root-  filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore,  it  also  reveals  that  root-  filled  teeth  presenting  with  mild  pain  do  not  necessarily  receive  any  intervention.  However,  teeth  with  baseline  signs  of  apical  periodontitis,  pain,  or  inadequate  coronal  restoration  were  more  likely  to  have  re-ceived intervention during the six- year period.

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    fulltext
  • 50.
    Olsson, Sara R
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Pigg, Maria
    Malmö högskola, Odontologiska fakulteten (OD).
    Isberg, Per-Erik
    Fransson, Helena
    Malmö högskola, Odontologiska fakulteten (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population2017Inngår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 50, nr S1, s. 33-33, artikkel-id R096Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Aim: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals receiving other restorations after completion of a root filling. The hypothesis was that there are demographic differences for individuals who chose an indirect and those who chose another coronal restoration after root canal treatment. Methodology: This was a registry study of a cohort consisting of all root filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. The root filled teeth were identified by tooth position 16 and 26, and by specific registry codes applied to root fillings. After registration of the root filling, any subsequent coronal restorations within two years was identified. The study group consisted of individuals registered with a root filling followed by an indirect coronal restoration and the control group was the remaining individuals with a root-filled tooth and a direct coronal restoration or no registration of any coronal restoration. Data on nationality, disposable income, educational level, civil status, age and gender were received from Statistics Sweden or SSIA. Chi-square test, t-test and logistic regression compared groups. P<0.05 was considered statistically significant. Results: 7 806 individuals (21.9%) received an indirect coronal restoration and 27 886 individuals (78.1%) comprised the control group. All demographic variables but gender and nationality differed significantly between groups A significantly larger proportion of individuals in the study group had higher education, higher disposable income, were older and were less likely to be living on their own. Conclusions: The identified demographic differences between individuals having their newly root filled teeth restored with an indirect restoration compared to those receiving other restorations indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.

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