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  • 1.
    Wrangstål, Linnéa
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Almutairi, Nawaf
    Conservative Dental Science Department, College of Dentistry, Qassim University, Qassim, Saudi Arabia.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model2024In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 57, no 2, p. 119-132Article in journal (Refereed)
    Abstract [en]

    Aim: To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields.

    Methodology: The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant.

    Results: Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001).

    Conclusions: According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

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  • 2.
    Dawson, Victoria S.
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (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 Population2024In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554Article in journal (Refereed)
    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.

  • 3.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per‐Erik
    Department of Statistics, Lund University School of Economics and Management Lund University Lund Sweden.
    Dawson, Victoria S.
    Malmö University, Faculty of Odontology (OD).
    General dental practitioners' fees for root canal treatment, coronal restoration and follow‐on treatment in the adult population in Sweden: A 10‐year follow‐up of data from the Swedish Dental Register2024In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 10, no 1, article id e826Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyze the accumulated fees connected with root filling, permanent coronal restoration and follow-on treatment charged by Swedish dentists over a 10-11-year follow-up period. Furthermore, analyzing these fees with reference to the type of restoration, tooth group, and the root-filled teeth which survived compared to those requiring extraction.

    Material and methods: In 2009, the data register of the Swedish Social Insurance Agency recorded a total of 215,611 teeth as root-filled. The accumulated fees for each tooth encompassed the following interventions: initial root filling, coronal restorations, and follow-up treatments during the designated period. The outcomes were analyzed using descriptive and analytic statistics, including t tests and one-way analysis of variance. The fees are presented in Euros (€1 = SEK 8.94).

    Results: The total accumulated fees for root fillings amounted to 72 million Euros: the mean fee per root filled tooth was €333.6. The total mean fee over a 10-11-year period, comprising root canal treatment, coronal restorations, and any follow-up treatments, was €923.4. Root-filled teeth with indirect restorations presented a higher mean fee (€1 279.3) compared to those with direct restorations (€829.4) or those without specified restorations (€832.7; p < .001). Moreover, molars presented a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; p < .001). Lastly, the mean fee for extracted teeth was €1225.3, which was higher compared to those who survived the follow-up period (€848.0; p < .001).

    Conclusions: Fees charged by general dental practitioners for root-filled teeth accumulate over time, probably due to the need for further treatment of the tooth. The total mean fee was significantly higher for molars and root-filled teeth with indirect restorations. However, an analysis of the total costs would require prospective clinical cost-effectiveness studies.

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  • 4.
    Olsson, Sara R
    et al.
    Malmö University, Faculty of Odontology (OD). Dental Research Department, Public Dental Health Service, Örebro, Sweden.
    Jonsson Sjögren, Jakob
    Malmö University, Faculty of Odontology (OD). Dental Research Department, Public Dental Health Service Örebro Sweden.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Fransson, Helena
    Malmö University, Faculty of Odontology (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 study2024In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591Article in journal (Refereed)
    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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  • 5.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (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 Capping2024In: Vital Pulp Treatment / [ed] Henry F. Duncan, Ikhlas A. El-Karim, Hoboken, USA: John Wiley & Sons, 2024, 1, p. 59-83Chapter in book (Other academic)
    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.

  • 6.
    Senneby, Anna
    et al.
    Malmö University, Foresight. Malmö University, Faculty of Odontology (OD). Malmö University, Biofilms Research Center for Biointerfaces. Department of Oral Radiology, Skåne University Hospital, Malmö, Sweden.
    Fransson, Helena
    Malmö University, Foresight. Malmö University, Faculty of Odontology (OD). Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Vareman, Niklas
    Department of Medical Ethics, Lund University, Lund, Sweden.
    What is risk? The challenge of defining ‘risk’ in caries risk assessment2024In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 42-46Article in journal (Other academic)
  • 7.
    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 University, Faculty of Odontology (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 study2023In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 49, no 3, p. 267-275, article id S0099-2399(22)00849-4Article in journal (Refereed)
    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.

  • 8.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (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 karieslesioner2023In: Tandläkartidningen, ISSN 0039-6982, Vol. 115, no 2, p. 56-62Article in journal (Refereed)
    Abstract [en]

    Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp, and thus to avoid pulpectomy and root filling, which can be technically demanding and do not always result in the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions, which partly s to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. If the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations vary between the ESE and the national Nordic countries guidelines. This is most probably due to the lack of evidence favoring one treatment over the other, and due to difficulties in assessing, which exposed pulps are irreversibly damaged. Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results for VPTs aimed at avoiding root canal treatment. VPTs will be further developed and changes to clinical recommendations are anticipated.

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  • 9.
    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 University, Faculty of Odontology (OD).
    Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no S3, p. 340-354Article in journal (Refereed)
    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).

  • 10.
    Brodén, Joséphine
    et al.
    Department of Dental Medicine, Karolinska Institutet, Stockholm.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Vareman, Niklas
    Department of Medical Ethics, Lund University.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    “Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id EP02Conference paper (Other academic)
    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.
    Wigsten, Emma
    et al.
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg,.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University School of Economics and Management, Lunds University.
    EndoReCo,
    EndoReCo (Endodontic Research Collaboration in Scandinavia) .
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Fees for root canal treatment and further dental care in the adult population in sweden: a 10-year follow-up of data from the Swedish dental register2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id R107Conference paper (Other academic)
    Abstract [en]

    Aim: To investigate the fees for root filling and further dental care charged by Swedish dentists during a follow-up period of 10 to 11 years. Comparisons are made between type of restoration registered within 6 months of the root filling, the tooth group, and the root filled teeth that survived versus those that were extracted.Methods: A total of 215 611 teeth were registered as root filled in the Swedish Social Insurance Agency’s data register in 2009. For each identified tooth, the fees for the following interventions were tracked: initial root filling, coronal restorations, and further dental interventions registered during the follow-up period. The outcomes were analysed with descriptive and analytic statistics, using one-way ANOVA and t-tests. The fees are presented in Euro (€1 = SEK 8.94; 01/01/2012).Results: The total fee for the root fillings was 72 million euros, and the mean fee was €333.6 per root filling. The total mean fee for the preservation of a root filled tooth over 10 to 11 years was €923.4, which included root canal treatment, coronal restorations, and further interventions. The mean fee for indirectly restored root filled teeth was higher (€1 279.3) than for those directly restored (€829.4) and for teeth without specified restorations (€832.7; P < 0.001). Molars had a significantly higher mean fee (€966.4) compared to premolars (€882.8) and anterior teeth (€891.3; P < 0.001). The mean fee for teeth that were extracted was higher (€1 225.3) than for those that survived the follow-up (€848.0; P < 0.001). Conclusions: Fees for root filled teeth have accumulated over time probably due to further dental care needed. The total mean fee was significantly higher for indirectly restored root filled teeth than for directly restored. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs.

  • 12.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (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 register2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id R043Conference paper (Other academic)
    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.

  • 13.
    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 University, Faculty of Odontology (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 University, Faculty of Odontology (OD).
    Periradicular surgery: A longitudinal registry study of 10‐year outcomes and factors predictive of post‐surgical extraction2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no 10, p. 1212-1221Article in journal (Refereed)
    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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  • 14.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Tooth survival after endodontic treatment2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no S2, p. 140-153Article, review/survey (Refereed)
    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.

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  • 15.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (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 kariesvaurioita2023In: Suomen hammaslaakarilehti, ISSN 0355-4090, Vol. 30, no 3, p. 34-41Article in journal (Refereed)
    Abstract [en]

    Vital pulp treatments in teeth with deep carious lesions

    Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp and, thus, to avoid pulpectomy and root filling which can be technically demanding and not always result in the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions which partly adhere to national guidelines in Nordic countries.

    There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. As long as the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations are somewhat different between the ESE and national guidelines in Nordic countries. This is most probably due to a lack of evidence favoring one treatment over the other and due to difficulties in assessing which exposed pulps are irreversibly damaged.

    Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results of VPTs aiming at avoiding root canal treatment. The VPTs will be further developed and changes to clinical recommendations are anticipated.

  • 16.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (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 caries2023In: Tandlægebladet, ISSN 0039-9353, Vol. 127, p. 36-44Article in journal (Refereed)
    Abstract [en]

    VITAL PULP TREATMENTS IN TEETH WITH DEEP CARIOUS LESIONS 

    Vital pulp treatments (VPT) are performed to preserve the defense functions of the pulp and thus to avoid pulpectomy and root filling which can be technically demanding and not always ends up with the desired outcome. The European Society of Endodontology (ESE) has published a position paper on VPT in teeth with deep carious lesions which partly matches to national guidelines in Nordic countries. There are unsolved difficulties in assessing the pulpal status in teeth with deep carious lesions. As long as the carious lesion has not reached the pulp, treatments performed to avoid pulp exposure, such as stepwise excavation, are recommended. On the other hand, when the pulp is exposed due to caries, the recommendations are somewhat different between the ESE and national guidelines in Nordic countries. This is most probably due to lack of evidence favoring one treatment over the other and due to difficulties in assessing which exposed pulps are irreversibly damaged. Minimally invasive management strategies with recently developed hydraulic calcium silicate cements show promising results of VPTs aiming at avoiding root canal treatment. The VPTs will be further developed and changes to clinical recommendations are anticipated.

  • 17.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    Odont inst, Köpenhamns universitet.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (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 University, Faculty of Odontology (OD).
    Wigsten, Emma
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    EndoReCo banar väg för ökad kunskap och akademisk meritering2022In: Tandläkartidningen, ISSN 0039-6982, Vol. 114, no 12, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Collaboration is essential to focus on the urgent research questions and to fill knowledge gaps in Odontology. Larger research consortiums have a better potential to utilize different competencies and other resources, and consequently increase research output. Bigger, more complex projects can be undertaken, which in turn improves the potential to attract external funding. Collaboration with other institutions also facilitates academic meriting, which is highly desirable from a Swedish perspective, especially since the number of senior researchers with formal competence to supervise doctoral research projects is lower than ever before. Here, we present EndoReCo, a Scandinavian research network in Endodontics initiated a decade ago with these very opportunities in mind. The article describes the results of this collaboration to date, highlights the success factors and difficulties, and aims to inspire others to similar collaborations in other disciplines.

  • 18.
    Pigg, Maria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Brodén, Joséphine
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Vareman, Niklas
    Department of Medical Ethics, Lund University, Sweden.
    How do we and how should we deal with uncertainty in Endodontics?2022In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 55, no 4, p. 282-289Article, review/survey (Refereed)
    Abstract [en]

    In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis - in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition "persistent apical periodontitis associated with a previously root filled tooth" as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard it as a weakness. While some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper.

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  • 19.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Coronal restoration of the root filled tooth: a qualitative analysis of the dentists' decision-making process2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 4, p. 490-500Article in journal (Refereed)
    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.

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  • 20.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (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 University, Faculty of Odontology (OD).
    Landt, Kristoffer
    Malmö University, Faculty of Odontology (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 Adults2021In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 100, no 6, p. 608-614, article id 22034520982962Article in journal (Refereed)
    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.

  • 21.
    Markvart, M
    et al.
    University of Copenhagen, Denmark.
    Tibbelin, N
    Specialist Clinic for Endodontics, Public Dental Service, Lund,.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    EndoReCo,
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). University of Gothenburg.
    Frequency of additional treatments in relation to the number of root filled canals in molar teeth in the Swedish adult population2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 6, p. 826-833Article in journal (Refereed)
    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.

  • 22.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD). University of Gothenburg.
    Davidson, Thomas
    Linköping University.
    Rohlin, Madeleine
    Malmö University, Faculty of Odontology (OD).
    Christell, Helena
    Helsingborg Hospital.
    There is a paucity of economic evaluations of prediction methods of caries and periodontitis: A systematic review2021In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 7, no 3, p. 385-398Article in journal (Refereed)
    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.

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  • 23. Kebke, S
    et al.
    Fransson, Helena
    Malmö University, Faculty of Odontology (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.2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 1, p. 5-14Article in journal (Refereed)
    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.

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  • 24.
    Dawson, Victoria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Leonard, Kerstin
    Vidigsson, My
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Coronal Restoration of Root-filled Teeth: General Dental Practitioners' Decision-Making Process2019Conference paper (Other academic)
    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.

  • 25.
    Brodén, Joséphine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Davidson, Thomas
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 4, p. 2751-7Article in journal (Refereed)
    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.

  • 26.
    Olsson, Sara R
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population.2019In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, no 1, p. 58-64Article in journal (Refereed)
  • 27.
    Danesh, Noushin
    et al.
    Malmö University, Faculty of Odontology (OD).
    Ljunggren, Anna Camilla
    Malmö University, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Development of criteria for investigation of periapical tissue from root-filled teeth.2019In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, no 4, p. 269-274Article in journal (Refereed)
    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.

  • 28. 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 University, Faculty of Odontology (OD).
    Markvart, M
    Zehnder, M
    Bjørndal, L
    European Society of Endodontology position statement: Management of deep caries and the exposed pulp2019In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 7, p. 923-934Article in journal (Refereed)
    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.

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  • 29.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Landt, Kristoffer
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Bjørndal, Lars
    Frisk, Fredrik
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Factors Associated with Extractions Following Root-filling in Swedish Adults2019Conference paper (Other academic)
    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.
    Pigg, Maria
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Klinisk riskbedömning av apikal parodontit vid rotfyllda tänder2019In: Vetenskap och beprövad erfarenhet Tandvård, VBE programmet och författarna , 2019, p. 57-70Chapter in book (Other academic)
  • 31. Bakhshandeh, Azam
    et al.
    Borum, Mette
    Høvenhoff, Lars
    Gaard, Hanne
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Stangvaltaite, Lina
    Bjørndal, Lars
    Calibration in radiographical diagnostics and removal of carious tissue in deep lesions2018Conference paper (Other academic)
    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.

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  • 32. Wigsten, Emma
    et al.
    Kvist, Thomas
    Dawson, Victoria S
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    EndoReCo,
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Comparative analysis of general dental practitioners' fees and scheduled fees for root canal treatment and coronal restorations in the adult population of Sweden: a five-year follow-up of data from the Swedish Dental Register.2018In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 51, no 2, p. 141-147Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the fees charged by Swedish dentists for root fillings, coronal restorations and further dental interventions during a follow-up period of 5-6 years. METHODOLOGY: A total of 248,299 root fillings were linked with the tooth, the patient and the provider and entered into the Swedish Social Insurance Agency register in 2009. The data register also recorded the subsidy-based (scheduled) fee and the fee actually charged for the root fillings. Fees charged for direct or indirect coronal restorations and additional interventions during the follow-up period were also recorded. One-way ANOVA and T-test were used for statistical analysis. RESULTS: The mean overall fee charged for a root filling was approximately 332 Euro and differed only marginally (13 Euro) from the scheduled fee. The total mean fee for preservation of a root filled tooth was 717 Euro, which included the root canal treatment, the coronal restoration and any additional interventions during the follow-up period. The fees for indirectly restored root filled teeth were significantly higher (1,105 Euro) than for directly restored teeth (610 Euro), despite further additional treatment (P< 0.001). The mean fee for teeth which were subsequently extracted was higher (769 Euro) than for the retained teeth (711 Euro) (P< 0.001). CONCLUSIONS: Fees charged by Swedish dentists for root canal treatment were in accordance with the scheduled fees. The overall mean fee was significantly higher for root filled teeth with indirect restorations than for teeth with direct coronal restorations. However, prospective clinical cost-effectiveness studies are needed to analyse the total costs. This article is protected by copyright. All rights reserved.

  • 33.
    Landt, Kristoffer
    et al.
    Malmö University, Faculty of Odontology (OD).
    Hagstam-Harrison, Linda
    Malmö University, Faculty of Odontology (OD).
    Kvist, Thomas
    Frisk, Fredrik
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    EndoReCo,
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Demographic factors in Swedish adults undergoing root filling and subsequent extraction of a maxillary first molar: a comparative study2018In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 51, no 9, p. 975-980Article in journal (Refereed)
    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.

  • 34.
    Brodén, Joséphine
    et al.
    Malmö University, Faculty of Odontology (OD).
    Davidson, Thomas
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Health economic evaluation of pulp capping versus root canal treatment in young permanent teeth2018Conference paper (Other academic)
    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.

  • 35. Markvart, Merete
    et al.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    EndoReCo,
    Bjørndal, Lars
    Ten-year follow-up on adoption of endodontic technology and clinical guidelines amongst Danish general dental practitioners2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 7, p. 515-519Article in journal (Refereed)
    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.

  • 36. Bjørndal, Lars
    et al.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Simon, Stéphane
    Treatment of vital pulp conditions2018In: Textbook of Endodontology / [ed] Lars Bjørndal, Lise-Lotte Kirkevang, John Whitworth, Wiley-Blackwell, 2018, p. 79-100Chapter in book (Other academic)
  • 37.
    Olsson, Sara R
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population2017In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 50, no S1, p. 33-33, article id R096Article in journal (Other academic)
    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.

  • 38.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Kvist, Thomas
    EndoReCo,
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations2017In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, no 9, p. 1428-1432Article in journal (Refereed)
    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.

  • 39. Bjørndal, Lars
    et al.
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Bruun, Gitte
    Markvart, Merete
    Kjældgaard, Marianne
    Näsman, Peggy
    Hedenbjörk-Lager, Anders
    Malmö högskola, Faculty of Odontology (OD).
    Dige, Irene
    Thordrup, Marianne
    Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up2017In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 96, no 7, p. 747-753Article in journal (Refereed)
    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).

  • 40. Granevik Lindström, Maria
    et al.
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    The Antibacterial Effect of Nd:YAG Laser Treatment of Teeth with Apical Periodontitis: A Randomized Controlled Trial2017In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 43, no 6, p. 857-863Article in journal (Refereed)
    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.

  • 41.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Landt, Kristoffer
    Malmö högskola, Faculty of Odontology (OD).
    Hagstam, Linda
    Malmö högskola, Faculty of Odontology (OD).
    Frisk, Fredrik
    Bjørndal, Lars
    Kvist, Thomas
    Demographics of Individuals Extracting Root-filled Teeth in Sweden2016Conference paper (Other academic)
    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.

  • 42.
    Brodén, Joséphine
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Heimdal, Håvard
    Malmö högskola, Faculty of Odontology (OD).
    Josefsson, Oliver
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Direct pulp capping procedures versus root canal treatment in young permanent vital teeth with pulp exposures due to caries: A systematic review2016In: American Journal of Dentistry, ISSN 0894-8275, Vol. 29, no 4, p. 201-206Article, review/survey (Refereed)
    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.

  • 43.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans: an updated systematic review2016In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 49, p. 533-542Article, review/survey (Refereed)
    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.

  • 44.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Kvist, Thomas
    Frisk, Fredrik
    Bjørndal, Lars
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Survival of Root-filled Teeth in Relation to Restoration and Tooth-group2016Conference paper (Other academic)
    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.

  • 45.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Dawson, Victoria
    Malmö högskola, Faculty of Odontology (OD).
    Frisk, Fredrik
    Bjørndal, Lars
    EndoReCo,
    Kvist, Thomas
    Survival of Root-filled Teeth in the Swedish Adult Population2016In: Journal of Endodontics, ISSN 0099-2399, E-ISSN 1878-3554, Vol. 42, no 2, p. 216-220Article in journal (Refereed)
    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%.

  • 46.
    Petersson, Kerstin
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Håkansson, Jan
    Twenty-year follow-up of root filled teeth in a Swedish population receiving high-cost dental care2016In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 49, no 7, p. 636-645Article in journal (Refereed)
    Abstract [en]

    AIM: To study the 20-year survival rate and periapical status of root filled teeth in a Swedish population requiring high-cost dental care and to identify factors related to survival and normal periapical status at follow-up. METHODOLOGY: The study population comprised 104 patients selected from four local health insurance districts with treatment plans including radiographs submitted for approval for reimbursement from the Swedish National Dental Insurance in 1977. In 1998, a clinical and radiographic follow-up examination was conducted, to register the status of 449 teeth identified as root filled at baseline. Differences in tooth survival and periapical status at follow-up, with reference to periapical status and quality of root filling at baseline, were analysed by chi-square tests. Multiple regression analysis was used to describe tooth survival and normal periapical status at follow-up, with the explanatory baseline variables: tooth type, type of restoration, type of post, quality of root filling, periapical status, marginal bone loss and caries. Differences were considered significant at a 5% level. RESULTS: Two hundred and ninety (65%) of the root filled teeth survived at follow-up. Baseline variables associated with low odds for tooth survival were mandibular molar, maxillary premolar, prefabricated posts other than screw posts, severe marginal bone loss, caries and apical periodontitis (AP). Normal periapical status at follow-up was registered in 49% of the root filled teeth. Baseline variables associated with low odds for normal periapical status (high risk for AP) at follow-up were mandibular molar, maxillary premolar, AP, severe marginal bone loss and inadequate root filling quality. Of the root filled teeth with AP at baseline, 42% had been left untreated during the observation period, and at follow-up, the AP persisted in 57% of these teeth. CONCLUSIONS: After 20 years, 65% of the root filled teeth had survived and one-third remained with a sound periapical condition, without any further treatment. Almost half of the APs registered at baseline were left without treatment, and more than half of them persisted after 20 years.

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  • 47.
    Dawson, Victoria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Amjad, Shwan
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review2015In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, no 7, p. 627-638Article, review/survey (Refereed)
    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.

  • 48.
    Wolf, Eva
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Jonasson, Peter
    Antibiotikabehandling vid endodontiska infektioner2014In: Tandläkartidningen, ISSN 0039-6982, Vol. 106, no 4, p. 76-78Article in journal (Refereed)
    Abstract [sv]

    Enligt aktuella nationella riktlinjer (Socialstyrelsen 2012) bör tandvården i första hand erbjuda antibiotikabehandling endast till personer med symtom på grund av apikal parodontit, där infeltionen kring rotspetsen visar på spridning och där personens allmäntillstånd är påverkat. Vid symtomatisk tand då infektionen inte tillfredsställande kan avlägsnas, till exempel då patienten inte kan gapa eller då rotkanalen inte är tillgänglig för infektionsbehandling kan sys- temisk antibiotika ordineras i avvaktan på att endodontisk behandling eller extraktion är möj- lig. Syftet med förskrivningen är då att begränsa spridning av befintlig infektion eller hindra progression av sjukdomen. När allmäntillståndet är påverkat är antibiotikabehandling indicerad eftersom detta är ett tecken på infektionsspridning. För exartikulerade och replanterade permanenta tänder har systemisk antibiotikabehandling tidigare rekommenderats, för att eventuellt underlätta den parodontala läkningen och minska risken för rotresorption. I en senare systematisk översikt har man inte kunnat påvisa några entydiga positiva effekter av detta. Utöver detta rekommenderas lokal antibiotikabehandling av roten före replantering av tand med oavslutad rotutveckling för att öka chanserna för revaskularisering.

  • 49.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Petersson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    Davies, Julia
    Malmö högskola, Faculty of Odontology (OD).
    Effects of bacterial products on the activity of odontoblast-like cells and their formation of type 1 collagen2014In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 47, no 4, p. 397-404Article in journal (Refereed)
    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.

  • 50.
    Fransson, Helena
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Larsson, Kerstin
    Wolf, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Efficacy of lasers as an adjunct to chemo-mechanical disinfection of infected root canals: a systematic review2013In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 46, no 4, p. 296-307Article in journal (Refereed)
    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.

12 1 - 50 of 63
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