Aim: To investigate dental biofilm bacteria for growth and acid production in different environments. The occurrence of inherent buffering capacity by alkali production in an artificial consortium and oral consortium was also examined. Materials and method: Fresh isolates of Actinomyces, Lactobacillus paracasei, Streptococcus mutans, Streptococcus intermedius and Streptococcus oralis were incubated in growth media with neutral or acidic initial pH and with and without glucose and/ or urea. Growth was monitored by measuring optical density at 600nm. Acid and alkali production was monitored using a pH meter. Results: L. paracasei and S. intermedius showed growth independent of pH and a more acidic final pH at acidic than neutral initial pH. S. oralis and Actinomyces showed a greater growth at neutral pH and had an acid production insensitive to an acidic environment. All species reached a final pH below the critical pH for enamel (5.5) independent of initial pH. Growth was unaffected by glucose. In oral consortium, the final pH was less acidic in the medium with glucose and urea compared to in the medium with only glucose. Conclusion: All species showed acidic and aciduric properties and may contribute to tooth demineralization. Further studies with a larger number of measurements are needed to assess the cariogenicity of these species with a higher reliability. Alkali production in saccharolytic species may affect the plaque pH. Further studies are needed to assess the occurrence of alkali production in saccharolytic species related to caries and its effects on the pH in the biofilm.

Abstract Objectives: To evaluate the space-maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self-inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh.

About 30 % of individuals in the Swedish population will at some stage during life have treatment with orthodontic appliances. In more severe cases, when orthodontic treatment is not considered sufficient enough to correct the malocclusion, the orthodontic treatment is combined with orthognathic surgery. For these cases, a satisfying jaw relation is achieved by surgically moving the maxilla and/or the mandible into a pre-planned position.Patients due to be treated with orthognathic surgery often suffer from an impaired masticatory function, symptoms from the masti- catory muscles or temporomandibular joints (temporomandibular disorders), headaches as well as dissatisfaction with their facial aesthetics.Since orthognathic treatment is expensive, in many cases arduous to the patient and not without complications, it is important to assess the treatment outcome and if this is satisfying for the patients. Previous studies that have examined the outcome after ortho- gnathic treatment have had diverging study designs and have come to different conclusions with regard to both temporomandibular disorders and masticatory function.The overall aim of this thesis was to assess and compare the frequencies of temporomandibular disorders and the masticatory function in patients with dentofacial deformities before and after orthognathic treatment.The thesis is based on the following studies:paper i is a systematic literature review aiming to, in an evidence- based approach, answer the question whether orthognathic treatment affects the prevalence of signs and symptoms of temporomandibular disorders. The review encompasses the period from January 1966 to April 2006 and was further extended to May 2013 in the frame story of this thesis.Conclusions in Paper I and the complementary survey• There is insufficient scientific evidence for a decrease of sub diagnoses of temporomandibular disorders after orthognathic treatment.• There is limited scientific evidence for a reduction of masticatory muscle pain on palpation after orthognathic treatment.• There is insufficient scientific evidence for an effect on temporomandibular joint pain on palpation and temporomandibularjoint sounds from orthognathic surgery.• Further controlled, well-designed studies assessing temporomandibular disorders before and after orthognathic treatment are needed to consolidate strong evidence considering treatment outcomes.papers II and III are studies comparing frequencies of temporomandibular disorders in patients with dentofacial deformities with a control group. The patients were referred for a combined orthodontic and orthognathic treatment to correct their malocclusion. The control group comprised individuals with normal occlusion or minor malocclusion traits not in need of orthodontic treatment. In Paper III, temporomandibular disorders were longitudinally analysed by assessing and comparing frequencies before and after orthognathic treatment. All individuals in the studies were diagnosed according to the research diagnostic criteria for temporomandibular disorders.Conclusions in Papers II and III• Patients due to be treated with orthognathic surgery had more signs and symptoms of temporomandibular disorders and a higher frequency of diagnosed temporomandibular disorders compared with the age- and gender matched control group.• Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, had a positive treatment outcome in respect of myofascial pain and arthralgia.• After treatment the frequency of temporomandibular disorders in the treatment group was low and at an equivalent level of that in the control group.paper iV evaluates the self-estimated masticatory ability and the masticatory performance before and after orthognathic treatment in the same individuals as in Paper II and III.Conclusions in Paper IV• Masticatory ability and performance increased after orthognathic treatment.• The number of occlusal contacts and severity of overall symptoms of TMD influenced both the masticatory ability and performance.• Open bite had a negative effect on masticatory performance.Key conclusions and clinical implications:Patients with dentofacial deformities diagnosed with temporomandibular disorders do in most cases benefit from orthognathic treatment. In addition, masticatory ability and performance, which is impaired in patients with dentofacial deformities, improve after treatment. Thus, patients with dentofacial deformities that are to be treated with orthodontics in combination with orthognathic surgery can be recommended the treatment in order to relieve symptoms of TMD and impaired mastication.

Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVE: To answer the question whether orthognathic surgery does affect the prevalence of signs and symptoms of temporomandibular disorders (TMDs). MATERIALS AND METHODS: A literature survey in the PubMed and Cochrane Library electronic databases was performed and covered the period from January 1966 to April 2006. The inclusion criteria were controlled, prospective or retrospective studies comparing TMDs before and after orthognathic surgery in patients with malocclusion. There were no language restrictions, and three reviewers selected and extracted the data independently. The quality of the retrieved articles was evaluated by four reviewers. RESULTS: The search strategy resulted in 467 articles, of which 3 met the inclusion criteria. Because of few studies with unambiguous results and heterogeneity in study design, the scientific evidence was insufficient to evaluate the effects that orthognathic surgery had on TMD. Moreover, the studies had problems with inadequate selection description, confounding factors, and lack of method error analysis. CONCLUSION: To obtain reliable scientific evidence, additional well-controlled and well-designed studies are needed to determine how and if orthognathic surgery alters signs and symptoms of TMD.

Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVE: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. MATERIALS AND METHODS: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. CONCLUSIONS: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVES: The aim of this study was to investigate the self-estimated masticatory ability and masticatory performance in patients with dentofacial deformities before and after orthognathic treatment; in comparison to an age- and gender-matched control group. SUBJECTS AND METHODS: The masticatory ability and masticatory performance were evaluated in 121 consecutive patients (treatment group), referred for orthognathic treatment. Eighteen months after treatment, 98 patients (81%) completed a follow-up examination. Masticatory ability was assessed on a visual analog scale, while the masticatory performance was evaluated by a masticatory test using round silicon tablets. Signs and symptoms of temporomandibular disorders (TMD) were registered by a clinical examination and a questionnaire. The control group comprised 56 age- and gender-matched subjects who were examined at baseline. RESULTS: At the baseline examination, the treatment group had a significantly lower masticatory ability and performance compared with the control group. After treatment, the masticatory ability significantly improved in the treatment group and reached the same level as in the control group. The masticatory performance index increased significantly but was still lower than in the control group. Both the masticatory ability and masticatory performance were affected by the number of occlusal contacts during maximal biting pressure and by the self-estimated overall symptoms of TMD. CONCLUSIONS: Patients with dentofacial deformities, corrected by orthognathic treatment, have a significant positive treatment outcome in respect of masticatory ability and masticatory performance. Furthermore, the occlusion and symptoms of TMD have an impact on both masticatory ability and masticatory performance.

Abstract The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P=.035) and arthralgia (P=.040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P=.050, P=.004, P=.041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain

Insufficient regeneration of missing bone and soft-tissue may presentaesthetic or functional problems in patients indicated for dentalimplant surgery. Several techniques such as bone grafts, bone substitutesand guided tissue regeneration (GTR) have been described torebuild a compromised alveolar ridge. Adequate soft-tissue coverageof grafted bone and titanium-mesh is important to avoid exposurewhich may result in loss of the bone graft.The general aim of this thesis was to evaluate use of an osmotictissue expander for expanding intra-oral soft tissue – creating a surplusof soft tissue – in preparation for onlay bone grafting.An experimental rabbit model was used in studies (I), (II) and (III).In (I) an osmotic soft-tissue expander was placed bilaterally on thelateral wall of the mandible via an extra-oral approach. After twoweeks of expansion the rabbits were killed and specimens were collectedfor histology. No inflammatory reaction and no resorbtion ofthe cortical bone occured. The periosteum was expanded and newbone formation was seen in the edges of the expander.In (II) and (III) the expander was placed under the periosteum in thesame way as in (I): bilaterally in 13 rabbits in (II) and unilaterally in11 rabbits in (III).After two weeks of expansion the expander was identified andremoved. In (II) particulated bone was placed at the recipient siteprotected by a titanium mesh in one site and a bio-resorbable meshon the other site. In (III), DBBM particles and bone particles collected from the lateralborder of the mandible separated by a collagen membrane wasplaced at the recipient site. The graft was protected by a pre-benttitanium mesh covered by a collagen membrane.After a healing period of 3 months specimens were collected forhistological and SEM examination. New bone was growing in directcontact with the titanium mesh and bio resorbable mesh. The newlyformed bone had the same calcium content as the mature bone in thebase of the mandible.In the clinical study (IV) 20 patients were consecutively recruitedand randomised into two groups.The experimental group (ten patients) had an osmotic soft tissueexpander implanted. After two weeks of expansion the expanderwas removed and a particulated bone graft protected by a titaniummesh and a collagen membrane was fixed to the recipient site. Titaniumimplants were installed after a healing period of 6 months.The patients in the reference group had a bone block grafted fromthe anterior ramus fixated to the recipient site with one or two titaniummini screws. Implants were installed after a healing period of6 months.A three dimensional optical measuring device was used to measurealterations in the soft tissue profile before each surgical procedure.The three-dimensional changes were then analysed on a PC.The results from the clinical study in patients confirmed the resultsfrom the experimental rabbit studies. The osmotic tissue expanderexpanded the soft tissue. Expander perforations of the soft tissueoccurred in two patients. The optical measurements demonstrated apositive volume gain after soft tissue expansion and bone grafting.The expanded tissue could be used to cover a bone graft. There stillwas a risk of mesh exposure, even after soft tissue expansion, whichoccurred in two patients. In both groups, implants could be installedin the grafted bone in positions that would allow the crowns to fitaesthetically into the dental arch.

OBJECTIVES: To evaluate the space-maintaining capacity of titanium mesh covered by a collagen membrane after soft tissue expansion on the lateral border of the mandible in rabbits, and to assess bone quantity and quality using autogenous particulate bone or bone-substitute (Bio-Oss(®) ), and if soft tissue ingrowth can be avoided by covering the mesh with a collagen membrane.

MATERIAL AND METHODS: In 11 rabbits, a self-inflatable soft tissue expander was placed under the lateral mandibular periosteum via an extra-oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft and deproteinized bovine bone mineral (DBBM) (Bio-Oss(®) ) were placed in the expanded area and covered by a titanium mesh. The bone and DBBM were separated in two compartments under the mesh with a collagen membrane in between. The mesh was then covered with a collagen membrane. After 3 months, the animals were sacrificed and specimens were collected for histology.

RESULTS: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, no soft tissue dehiscence was recorded. The mean bone fill was 58.1±18% in the bone grafted area and 56.9±13.7% in the DBBM area. There was no significant difference between the autologous bone graft and the DDBM under the titanium mesh with regard to the total bone area or the mineralized bone area. Scanning electron microscopy showed that new bone was growing in direct contact with the DBBM particles and the titanium mesh. There is a soft tissue ingrowth even after soft tissue expansion and protection of the titanium mesh with a collagen membrane.

CONCLUSION: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue, and that new bone can subsequently be generated under a titanium mesh with the use of an autologous bone graft or DBBM.

We aimed to evaluate a new technique for intraoral expansion of soft tissue with a self-inflatable expander in rabbits. We placed a self-inflatable soft tissue expander bilaterally in eight rabbits under the periosteum of the mandible through an extraoral approach. The expander was left to self-inflate for two weeks, after which the animals were killed and specimens collected for histological examination. The self-inflatable soft tissue expanders expanded the periosteum. There were no dehiscences or infections. Histological observations showed no signs of any inflammatory reaction and there was no evidence of bony resorption. New bone had formed at the edges of the expanded periosteum. In the control area no new bone had formed. The osmotic soft tissue expander model for intraoral soft tissue and periosteal expansion suggests a promising way of creating a surplus of soft tissue that can be used to cover bone grafts.

To determine whether it is possible to vertically augment bone utilizing a block graft from compressed titanium granules mainly used previously for contained bone defects and to determine whether there exists a difference in osteoconductive properties between the white and the grey granules. In 11 rabbits, 4 titanium blocks were inserted on each rabbit's skull bone according to a randomized scheme. These blocks were made from standardized compressed titanium granules. Type A: PTG grey, small granules (Pourus Titanium Granules, Tigran, Malmo, Sweden); Type B: PTG grey, large granules; Type C: PTG white, small granules; Type D: PTG white large granules. After 12 weeks, the animals were sacrificed and specimens were collected for histology and mu CT scanning. From both the mu CT and histology, it can be said that bone formation was successfully achieved for all groups, and the granules maintained their volume. The histomorphometric BA (bone area) evaluation in the entire grafted area presented that there were no statistical differences between all groups tested. The lowest 1/4 BA in contact with the rabbit skull presented that groups A and C presented the highest mean BA, and group A presented significantly higher BA than that of group D (p = 0,049). No significant differences were noted between groups A, B and C. Within the limitation of this study, no differences were noted between small white or grey PTG blocks. The large granules presented less bone ingrowth area compared to the small granules and this trend was regardless of the different PTG types. The entire grafted area was not filled with new bone suggesting that bone migration occurred mostly from the existing cortical bone side suggesting contact osteogenesis.

To evaluate the outcome of intraoral soft tissue expansion by measuring the profile change using objective 3D metering equipment and to evaluate localized bone grafting after soft tissue expansion with regard to gain of bone and complications.

A novel variant of endemic pemphigus foliaceus (EPF) was described among individuals in an area surrounding El Bagre, Colombia, South America. The population in this rural mining community is exposed to high environmental levels of mercury, used for gold extraction, as well as other minerals, metalloids, and trace elements (e.g., quartz, rutile, granite, magnetite, and almenite) and ultraviolet radiation. Fifty con-trol subjects and fifty EPF patients in the endemic area were examined for the presence of mercury in skin biopsies and hair, using autometal-lographic and mass spectroscopic analyses, respectively. Simultane-ously, serum levels of IgE were measured, and cutaneous tests for hy-persensitivity reactions were performed. Using autometallography, mercuric sulfides/selenides were detected in 14 of 51 skin biopsies dis-tributed similarly in the control and patient groups. However, signifi-cantly higher serum IgE levels and mercury concentrations in hair, urine, and nails were found in patients compared with controls. Mi-croscopic analysis revealed mercuric sulfides/selenides concentrated within and around the sweat gland epithelium, as well as in dendritic cells. Five skin biopsies from EPF patients and five from controls that tested positive for the presence of mercuric sulfides/selenides by autometallography were randomly selected for electron microscopic analysis. This analysis revealed a mixed electron-dense and electron-light material closely associated with desmosomes in patients. How-ever, there were intracellular vesicles containing an amalgam of elec-tron-dense and electron-light materials only in the EPF patients. Thus, EPF-affected individuals are exposed to high levels of environmental mercuric sulfides/selenides and other elements. This is the first study reporting mercuric sulfides/selenides in skin biopsies from people liv-ing in a focus of EPF, and these compounds may play a role in the pathogenesis of autoimmunity.

Objective. To analyse the prevalence of temporomandibular disorders and related pain (TMD-pain) among adult recall patients in general dental practice. Materials and methods. From November 2006 to September 2008, all adults attending a Swedish Public Dental Service (PDS) clinic for recall examination were asked two standardized questions about temporomandibular pain and dysfunction. Mouth-opening capacity was measured. The responses to the questions and mouth-opening capacity were combined to give a TMD-pain score, on a scale of 0-3. The patients' acceptance of their TMD condition was also noted. Results. The subjects comprised 2837 adults (53% females, 47% men). Of the total sample, 4.9% reported a TMD-pain score of 1-3. The gender difference was significant: women predominated (p < 0.003). Forty-three per cent of those with TMD-pain scores of 1-3 (36% men, 47% women) considered that the condition warranted treatment, especially those registering a pain score (significant difference between pain and dysfunction groups, p < 0.000). Conclusions. The TMD-pain score shows promise as a useful instrument for detecting and recording TMD-pain. The prevalence of TMD disclosed in the study is high enough to be considered a public health concern. Most of the subjects with lower scores on the TMD-pain scale accepted their condition as not severe enough to require treatment.

Purpose – Ti-6Al-4V is one of the most attractive materials being used in aerospace, automotive and medical implant industries. Electron beam melting (EBM) is one of the direct digital manufacturing methods to produce complex geometries of fully dense and near net shape parts. The EBM system provides an opportunity to built metallic objects with different processing parameter settings like beam current, scan speed, probe size on powder, etc. The purpose of this paper is to determine and understand the effect of part's thickness and variation in process parameter settings of the EBM system on surface roughness/topography of EBM fabricated Ti-6Al-4V metallic parts. Design/methodology/approach – A mathematical model based upon response surface methodology (RSM) is developed to study the variation of surface roughness with changing process parameter settings. Surface roughness of the test slabs produced with different parameter settings and thickness has been studied under confocal microscope. Response surface methodology was used to develop a multiple regression model to correlate the effect of variation in EBM process parameters settings and thickness of parts on surface roughness of EBM produced Ti-6Al-4V. Findings – It has been observed that every part produced by EBM system has detectable surface roughness. The surface roughness parameter Ra varies between 1-20 µm for different samples depending upon the process parameter setting and thickness. The Ra value increases with increasing sample thickness and beam current, and decreases with increase in offset focus and scan speed. Originality/value – Surface roughness is related to wear and friction property of the material and hence is related to the life time and performance of the part. Surface roughness is an important property of any material to be considered as biomaterial. The surface roughness of the material depends upon the manufacturing method and environment and hence it is controllable either during fabrication or by post processing. From the 1st order regression model developed in this study, it is also evident that sample thickness, scan speed and beam current have relatively more effect on roughness value then the offset focus. With the model obtained equation, a designer can subsequently select the best combination of sample thickness and process parameter values to achieve desired surface roughness.

Specialistinstanser i bettfysiologi möter i huvudsak patienter som har en långvarig och svårt smärtproblematik. Under 1900-talet har dock även behandling av obstruktiv sömnapné tillkommit. Ofta är det en läkare som remitterat patienten till den bettfysiologiska kliniken. Denna studie visar att bettfysiologen är en viktig länk mellan tandvården och sjukvården vid utredning och behandling av orofacial smärta. Syf-tet med studien var att jämföra orsakerna till remisser till bettfysiologi. En jämförelse gjordes mellan fyra specialistkliniker i bettfysiologi un-der en 4-månadersperiod år 2001. De flesta remitterade patienter var kvinnor i åldern 20 år och uppåt. Bland de remitterade kvinnorna var smärta den dominerande orsaken medan männen lika ofta remittera-des för sömnstörning som för smärta. 86 procent av patienterna som remitterats för smärta värderade smärtans intensitet som måttlig till väldigt svår. Hos 80 procent av dessa patienter var smärtan långvarig.

Tea Tree Oil eller TTO som det förkortas, är en olja som utvinns ur en australiensisk buske vid det latinska namnet Melaleuca alternifolia. Oljan har sedan många år använts som antiinflammatoriskt och bakteriedödande ämne. Denna litteraturstudie gjordes på 13 artiklar som svarade på tre sökningar i databasen PubMed. Artiklarna påvisar att TTO har en viss antibakteriell förmåga och kan fungera som antimykotiskt medel, men fler in vivo studer behövs för att säkerställa TTO:s effekt på olika parodontala åkommor.

Guld har i många år använts som rekonstruktionsmaterial vid bettrehabilitering. Mer än 50% av Sveriges vuxna befolkning har kronor och/eller broar framställda i guldlegering och guld används också till stift i rotfyllda tänder, på vilka sedan kronor kan fästas. Guld har länge betraktats vara inert, dvs. ej kunna ge några reaktioner vid användning i kroppen, men på senare år har en ökad frekvens av kontaktallergi mot guld kunnat konstateras. Kontaktallergi är en typ av allergi, som vid upprepad kontakt med ämnet kan ge patienten en reaktion i hud och slemhinna. När det gäller guld kan kontaktallergi uppstå t.ex. under guldringar, av örhänge eller av halsband. När man utreder patienter för kontaktallergi mot guld – s.k. lapptestning, fäster man en häfta med guldsaltet guldnatriumtiosulfat (GSTS) på ryggen i 48 timmar. Patienten tar efter dessa två dygn bort testlappen och 3–4 samt 7 dagar efter exponeringen värderas den eventuellt uppkomna reaktionen av en hudläkare. Reaktionerna kan klassas som ospecifika irritationsreaktioner, negativa reaktioner, tveksamma reak-tioner och allergiska (positiva) reaktioner av eksemtyp. 1991 började man i Malmö rutinmässigt använda GSTS vid lapptestning av kontaktallergi mot guld, och då kunde konstateras att 10 % av de testade uppvisade kontaktallergi mot guld. Man har också visat att ett positivt lapptest är en manifestation av kontaktallergi. GSTS är, efter nickelsulfat, det näst vanligaste allergenet, som ger positiv hudreaktion vid rutintestning av eksempatienter. Detta tillsammans med en enkätstudie, som indikerade att kontaktallergi för guld var överrepresenterat hos patienter som hade guld i munnen, utgör bakgrunden till detta avhandlingsprojekt. I det första delarbetet studerades om dentalt guld (kronor, broar, inlägg) kunde sättas i samband med kontaktallergi för guld. Patienterna som ingick i studien var patienter som skulle testas eftersom de hade eksem. Resultaten visade att de patienter som vid tandläkarundersökning visat sig ha guld i munnen också i större utsträckning hade kontaktallergi för guld vid lapptestning. Symtom i munnen eller tecken på munslemhinnereaktioner kunde dock inte sättas i samband med dentalt guld eller positivt lapptest för guld. Däremot kunde det konstateras att de som hade mycket guld i munnen i större utsträckning hade kontaktallergi mot guld. I delarbete två studerades guldhalten i blodet hos samma patientpopulation. Det kunde konstateras att de patienter som hade dentalt guld hade förhöjda värden av guld i blod. I tredje delarbetet undersöktes mängden guld i blod efter att patienterna fått guldinlägg, vilket motsvarar en krona men med en fyllnings utsträckning. Patienterna hade mer guld i blodet efter att inläggen satts in jämfört med mängden guld i blod innan inläggen sattes fast. Fortfarande 15 år efter att inläggen sattes in hade patienterna förhöjda värden av guld i blod, vilket måste tolkas som en kontinuerlig frisättning av guld från dentalt guld till blod. Förhöjda värden av guld i blod har visat sig ha betydelse för hudens reaktion i kontakt med guld. Huruvida det föreligger ett samband mellan dentalt guld, kontaktallergi mot guld och munslemhinnelesioner, är inte väl utrett. Dock har studier på patienter med oral lichen indikerat att dessa patienter skulle kunna vara allergiska mot guld, men även mot andra tandvårdsmaterial. I fjärde delarbetet undersöktes därför patienter med oral lichen, med avseende på kontaktallergi mot guld i jämförelse med kontrollpatienter, vilka var remitterade till Yrkes- och miljödermatologiska avdelningen, Hudkliniken i Malmö, för misstanke om allergiskt kontakteksem. I denna studie kunde man finna en numerär skillnad avseende kontaktallergi för guld men inte någon statistisk skillnad mellan grupperna. Det är därför av vikt att i fortsatta studier, med större undersökningsmaterial, försöka utröna om det finns ett statistiskt säkert samband mellan oral lichen och kontaktallergi mot guld eller andra tandvårdsmaterial eftersom dessa patienter kan uppleva perioder med stora besvär, vilka kan försvåra både födointag och upprätthållande av en adekvat munhygien.

Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

The aim of the present controlled study was to investigate a possible relationship between contact allergies to potential allergens and oral lichen lesions. Eighty-three patients with oral lichen lesions (OLL) and control groups of age- and gender-matched dermatitis patients (DP, n = 83) and patch-tested dermatitis patients randomly selected from files (PSFF, n = 319) were included in the study. OLL and DP groups were patch-tested epicutaneously and examined intraorally. The frequencies of contact allergy to mercury and carvone were statistically higher in the OLL group than in the DP group. Surfaces of amalgam and composite restorations were statistically more frequent in the OLL group compared to the DP group. Contact allergy to nickel and colophony, the latter with a statistically significant difference, was more common in the DP group. The numerical difference found for nickel allergy was, however, not significant comparing the OLL and PSFF groups. Contact allergy to mercury was overrepresented in patients with OLL and has been reported in previous studies, but the present finding of an overrepresentation of contact allergy to carvone in patients with oral lichen lesions has not been reported previously. Carvone, in addition to mercury and gold, as previously suggested, can be one of the causative or maintenant factors for oral lichen lesions. Carvone-hypersensitive patients with oral lichen lesions should therefore avoid carvone-containing products for oral use.

The aetiology of oral lichen lesions is obscure. In this study the frequency of contact allergy to gold in 83 patients with oral lichen lesions was compared with that in two control groups, comprising 319 age- and gender-matched patients with dermatitis selected from files and 83 clinically examined dermatitis patients. All patients were tested epicutaneously with gold sodium thiosulphate. The two control groups tested were under examination for a tentative diagnosis of allergic dermatitis not related to oral problems. The frequency of contact allergy to gold was 28.9% in the patients with oral lichen lesions, 18.2% in patients selected from files, and 22.9% in the clinically examined control patients. The difference in frequency between patients with oral lichen lesions and those taken from files was statistically significant.

Establishing the clinical relevance of contact allergy to dental materials in patients with oral lichen lesions (OLL) may be difficult, and tests are often read only on day 3 or day 4; also, concentration of the tested allergens may vary. Several studies on dermatitis patients have shown that additional positive patch test reactions can be found after day 4. Therefore, the aim of the present study was to analyse the frequency of late positive reactions to potential allergens in patients with OLL. Eighty-three of 96 consecutive patients with biopsy-verified OLL were patch-tested with a recently developed lichen series. The patches were removed after 48 h and reactions read 3 and 7 days after application. A total of 129 contact allergies were found, and 26 (20.2 %) of the allergic reactions in 23 patients were seen on day 7 only. The 25.2 % increase in positive test reactions with an additional reading on day 7 in addition to day 3 was statistically significant. Metals were the substances with the highest frequency of late positive reactions. Patients with OLL cannot be considered properly investigated with regard to contact allergy, unless the testing has been performed with mandatory readings on day 3 (or day 4) and day 7. Late patch test readings are crucial in order to elucidate the role of contact allergy to dental materials in the aetiology of OLL.

OBJECTIVE: Several studies have reported increased levels of gold (Au) in the blood of patients with dental gold restorations. This study analyzed gold levels in blood plasma before dental gold inlay insertion, 0-12 months after, and 15 years after. MATERIAL AND METHODS: Plasma samples from 9 patients were taken before and 0-10 months after gold inlay insertion. Fifteen years after gold inlay insertion, further blood samples taken from 8 of these patients were analyzed for gold using inductively coupled plasma mass spectrometry. An oral examination was also carried out before and 15 years after gold inlay insertion. RESULTS: Gold levels in plasma were significantly higher 0-12 months after gold inlay insertion than before treatment (p=0.008). No significant difference in gold plasma levels was found between 0-12 months after and 15 years after insertion (p=0.109), although there was a significant correlation between the number of gold alloy surfaces and the amount of gold in plasma 15 years after insertion (p=0.028). CONCLUSIONS: This study supports a dose-related release of gold into plasma from dental gold restorations, a release that appears to be stable over time.

SAMMANFATTNING Syftet med arbetet var att belysa sambandet mellan tobaksanvändning, oral och allmän hälsa. Dessutom skulle ungdomars kunskap om tobakens skadliga effekter på oral och allmän hälsa undersökas. Våra specifika frågeställningar var följande: Vad vet ungdomar om tobakens skadliga effekter på oral och allmän hälsa? Varifrån har de fått sin kunskap? Kan kunskapsnivån påverka tobaksanvändningen? Finns det någon skillnad mellan pojkars och flickors kunskap? För att komma fram till resultatet har valts att göra en litteraturstudie. Informationen har hämtats från böcker, vetenskapliga artiklar och från internet. Studien slår fast att rökning orsakar skador på kroppens alla organ, speciellt på munhåla, svalg och lungor. Dessutom ger den upphov till hjärt- kärlsjukdomar. De studier som tagits med i arbetet visar att majoriteten av svenska ungdomar hade relativt bra kunskap om tobakens skadliga effekter på allmän hälsa. Men kunskapsnivån var inte avgörande om ungdomar skulle avstå från tobaksanvändning.

The aim was to investigate how endogenous cytokine control of tumor necrosis factor (TNF) influences temporomandibular joint (TMJ) pain in relation to the role of anti-citrullinated peptide antibodies (ACPA) in patients with rheumatoid arthritis (RA). Twenty-six consecutive patients with TMJ RA were included. Temporomandibular joint pain intensity was assessed at rest, on maximum mouth opening, on chewing, and on palpation. Mandibular movement capacity and degree of anterior open bite (a clinical sign of structural destruction of TMJ tissues) were also assessed. Systemic inflammatory activity was assessed using the Disease Activity Score in 28 joints (DAS28) for rheumatoid arthritis. Samples of TMJ synovial fluid and blood were obtained and analyzed for TNF, its soluble receptor, soluble TNF receptor II (TNFsRII), and ACPA. A high concentration of TNF in relation to the concentration of TNFsRII in TMJ synovial fluid was associated with TMJ pain on posterior palpation on maximum mouth opening. The ACPA concentration correlated significantly to the TNF concentration, but not to the TNFsRII concentration, indicating that increased inflammatory activity is mainly caused by an insufficient increase in anti-inflammatory mediators. This study indicates that TMJ pain on palpation in patients with RA is related to a deficiency in local cytokine control that contributes to increased inflammatory activity, including sensitization to mechanical stimuli over the TMJ.

OBJECTIVE: To investigate if TNF, IL-1 or their endogenous controls, in relation to ACPA, are associated with radiological signs of ongoing temporomandibular joint (TMJ) bone tissue resorption and disc displacement in RA patients. METHODS: Twenty-two consecutive outpatients with TMJ of RA were included. Systemic inflammatory activity was assessed by DAS28. The number of painful regions in the body and ESR, CRP, RF and ACPA were analyzed. TMJ synovial fluid and blood samples were obtained and analyzed for TNF, TNFsRII, IL-1ra, IL-1sRII and ACPA. The ratios between the mediators and their endogenous control receptors were used in the statistical analysis. Magnetic resonance imaging was performed in closed- and open-mouth positions and evaluated regarding disc position and presence of condylar and temporal erosions of the TMJ. RESULTS: A high TNF level in relation to TNFsRII in TMJ synovial fluid correlated to the degree of TMJ condylar erosion. A high IL-1ra level in relation to TNF in TMJ synovial fluid was also correlated to the degree of TMJ condylar erosion. The total degree of TMJ condylar erosion was correlated with the number of painful regions. CONCLUSION: This study indicates that TNF in TMJ synovial fluid mediates TMJ cartilage and bone tissue resorption in RA. The study also suggests that the degree of endogenous cytokine control is of importance for development of bone tissue destruction.

Previous studies have demonstrated an association between gold allergy and the presence of dental gold restorations. The aim of the present study was to investigate the relationship between the concentration of gold in blood (B-Au) and the number of tooth surfaces with gold alloys in subjects with and without contact allergy to gold. In 80 patients referred for patch testing because of eczematous disease, blood samples were taken and analyzed for B-Au using inductively coupled plasma mass spectrometry. The detection limit for the Au determination was 0.04 microg/L. In addition, a dentist made a clinical and radiological examination of the patients and registered the number of dental gold surfaces. Patients with dental gold restorations had a statistically significantly higher B-Au in Mann-Whitney U test (P = 0.025), (range < 0.04-1.07 microg/L) than patients without (range < 0.04-0.15 microg/L). Furthermore, a positive correlation was found between B-Au and the number of dental gold surfaces (P < 0.01). There was no statistically significant difference in B-Au between persons with and without contact allergy to gold. The study thus indicates that gold is released from dental restorations and taken tip into the circulation.

Strontium (Sr2+) is the active substance of pharmaceuticals used for reducing fracture risk in osteoporotic patients. Lately, Sr2+ is combined with biomaterials to enhance osteogenesis, which has been vaguely studied considering periodontal tissue regeneration. Despite extensive use, the mechanisms of action of Sr2+ are not fully understood. The present study assesses the impact of Sr2+ on primary human periodontal ligament cells (PDL cells) and human osteoblasts in regard to proliferation and pro-osteogenic activity. Cultured human PDL cells and osteoblast cell lines MG63 and hFOB 1.19 were treated with SrCl2 (0.1-10 mM) or vehicle for 72 h. Cells were counted manually using a Bürker chamber. Total protein content was determined by colorimetric analysis using Bio-Rad protein assay. Alkaline phosphatase activity was determined enzymatically and normalized to total protein content. SrCl2 had no significant effect on PDL cells (p>0.05), but a tendency towards induced osteogenic characteristics was observed. In contrast, 5 mM SrCl2 enhanced total MG63 cell protein content by 37% (p<0.01), compared to vehicle, whereas a lower concentration (0.1 mM) did not. 5 mM SrCl2 increased MG63 cell number by 38% (p<0.001), while a higher concentration (10 mM) did not have a significant additional effect over the 5 mM (+54%, compared to vehicle, p<0.05). The results demonstrate that 72 h administration of ≥ 5 mM SrCl2 exerts a pro-proliferative effect on human osteoblast-like MG63 cells and display a tendency to induce osteogenic characteristics in primary human PDL cells.

Strontium ranelate (SrRan) is the active component of drugs currently used for reducing the risk of fractures in patients suffering from osteoporosis. Despite extensive use, the underlying mechanisms of action of Sr2+ are not fully understood. In the present study, we assess the impact of SrCl2 on human osteoblast activity and proliferation. Cultures of the human osteoblast-like cell line MG63 were treated for 72 h in presence of 0.1 mM, 1 mM, 5 mM and 10 mM SrCl2 or vehicle, used in control groups. Cells were counted manually using a Bürker chamber. Total protein content was determined by colorimetric analysis performed by a microplate reader using Bio-Rad protein assay. Alkaline phosphatase (ALP) activity was determined enzymatically and normalized to total protein content in each sample. Cell viability was assessed using the MTT assay. Treatment with 5 mM SrCl2 for 72 h enhanced total MG63 cell protein content by 37% compared to controls (p<0.01). A lower concentration (0.1 mM) of SrCl2 had no effect on total protein. Incubation with 5 mM SrCl2 for 72 h increased MG63 cell number by 38% compared to controls (p<0.001). The SrCl2-induced increase in cell number was associated with enhanced (+14% compared to controls, p<0.05) cell viability. Treatment with a higher concentration (10 mM) of SrCl2 enhanced cell number similar to 5 mM SrCl2 (+54% compared to controls, p<0.05). Treatment with 0.1 or 5 mM SrCl2 for 72 h had no effect (p>0.05) on MG63 cell ALP activity, while 1 mM SrCl2 reduced ALP activity as well as total protein content by about 25% compared to controls (p<0.05). The current results demonstrate that treatment with SrCl2 for 72 h, at concentrations higher than 1 mM promotes cell proliferation in human osteoblast-like cells, suggesting that Sr2+ may enhance bone formation through this mechanism.

Sammanfattning Implantatinstallation utan lambåuppfällning borde kunna leda till minskade postoperativa besvär. För att utvärdera kortsiktiga subjektiva och objektiva tecken på postoperativa besvär hos patienter som genomgått implantatkirurgi utan lambå jämfört med konventionell teknik, genomfördes en pilotstudie i form av en prospektiv enkätstudie på två kliniker. Mellan december 2010 och januari 2012 inkluderades 20 patienter konsekutivt. Elva patienter opererades med konventionell, öppen kirurgi och nio utan lambåuppfällning. Svullnad, konsumtion av analgetika samt sömnsvårigheter utvärderades upp till sju dagar efter operation. En klinisk undersökning gjordes en vecka postoperativt. Signifikant skillnad i postoperativ upplevd svullnad uppgavs efter 24 timmar av patienter som fått fyra implantat eller fler samt efter 3 dagar postoperativt hos patienter som fått singelimplantat. Ingen skillnad fanns avseende sömnsvårigheter, smärta eller analgetikakonsumtion. Den kliniska undersökningen en vecka postoperativt visade inga skillnader mellan grupperna rörande sårläkning, rodnad i mucosan eller förekomst av pus. Från denna studie drogs slutsatsen att implantatkirurgi utan lambåuppfällning förefaller ha en begränsad effekt på ökad postoperativ komfort jämfört med öppen kirurgi. Det föreligger ett behov av randomiserade studier för att ytterligare klarlägga eventuella skillnader mellan de båda operationsteknikerna.

OBJECTIVE: A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period. STUDY DESIGN: The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons. RESULTS: Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected. CONCLUSIONS: The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Aim Investigate the influence of chronic orofacial pain and psychological factors on sleep quality in patients with myalgia of the masticatory muscles. Material and methods This retrospective study included 37 patients (6 men, 31 women, mean age: 49 years) with masticatory muscle myalgia. Sleep quality (Pittsburgh Sleep Quality Index), pain intensity and pain-related disability (Graded Chronic Pain Scale), depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), stress (Perceived Stress Scale-10) and catastrophizing (Patient Catastrophizing Scale) were assessed by questionnaires. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were used to identify patients with myalgia. Results 75% of the patients reported poor sleep quality, 73% reported at least mild depression degree, 54% reported at least mild degree of anxiety, 59% reported at least a moderate stress level and 38% reported a clinically relevant degree of catastrophizing. Impaired sleep quality was related to degree of depression (rs = 0.45, n = 37, p = 0.008), anxiety (rs = 0.46, n = 37, p = 0.007), stress (rs = 0.43, n = 37, p = 0.014) and catastrophizing (rs = 0.37, n = 37, p = 0.034). Multivariate logistic regression showed that characteristic pain intensity, degree of pain-related disability, depression, anxiety, stress, catastrophizing and number of masticatory muscle sites with referred pain significantly explained poor sleep quality (p = 0.031). Conclusion Sleep quality in patients with masticatory myalgia is influenced by chronic pain intensity and related disability, number of masticatory muscle sites with referred pain as well as depression, anxiety, stress and catastrophizing.

Inledning: Att skönhet och attraktivitet ger fördelar i livet har bekräftats i många studier. Tänderna är en bidragande faktor till hur människor bedömer varandra. Vita tänder föredras i många fall och missfärgade tänder är minst önskvärt. En studie visar att endast skillnader i tändernas utseende kan påverka hur vi uppfattar en annan människa och vackrare tänder kan få en person att uppfattas som mer intelligent och mer framgångsrik. Syfte: Syftet med studien var att undersöka om det finns någon skillnad i bedömningen av personlighetsdrag utifrån ett blekt, ett missfärgat och ett omanipulerat bett, samt jämföra resultatet mellan hur tandläkarstudenter i Sverige och Sri Lanka bedömer detta. Material och metod: Ett fotografi på en man och en kvinna manipulerades till tre olika utseenden: Blekt, omanipulerat och missfärgat. En enkät för att mäta karaktärsdrag utformades. Enkäten, ett fotografi av sex möjliga och ett informationsblad delades ut till totalt 126 tandläkarstudenter på respektive universitet. Resultat: Signifikanta skillnader fanns i Sverige mellan kvinnan med det blekta bettet och kvinnan med det missfärgade bettet. I Sri Lanka fanns en signifikant skillnad mellan det omanipulerade bettet på kvinnan och det missfärgade bettet på kvinnan. Slutsats: Det fanns ingen signifikant skillnad mellan Sverige och Sri Lanka på hur bilderna bedömdes. Inom länderna fanns dock signifikanta skillnader på hur studenterna tolkade karaktärsdragen på de olika bilderna. I Sverige bedömdes det blekta bettet som mest positivt och det missfärgade som mest negativt. I Sri Lanka bedömdes det omanipulerade bettet som mest positivt och det missfärgade som mest negativt.

Neurosensory disturbance (NSD) is a common complication to surgical corrections of mandibular deformities particularly when the sagittal split technique is used. With this technique the inferior alveolar nerve can be directly injured during surgery or damaged when trapped between the two bone segments. The incidence of sensory disturbance after sagittal split osteotomy varies considerably between centres. As an alternative to sagittal split osteotomy (SSO) the intra-oral vertical ramus osteotomy (IVRO) can be used to correct mandibular prognathism. The main advantage with this technique is the low incidence of nerve damage, which outweighs a period of postoperative intermaxillary fixation. The clinical studies were carried out to evaluate neurosensory disturbance with regard to kind of surgical procedure, direction of mandibular movement during surgery, the additional procedure of genioplasty, age, gender and the perioperative use of steroids. Whereas mandibular movement, additional genioplasty or gender did not affect the incidence, age and the perioperative use of steroids seemed to be factors to consider. As expected the incidence of NSD was lower with the use of IVRO than SSO. Also with the latter NSD was comparatively low, when steroids were given perioperatively. The observation that the introduction of the use of perioperatively administered steroids coincided with the decrease in the incidence of impaired sensibility prompted experimental studies to elucidate the role of the steroids. These showed that steroids facilitated nerve healing as reflected in functional tests and in the nerve morphology [recruited macrophages and nerve growth factors (NGF-R p75)].

This retrospective study aimed at evaluating the long-term incidence of neurosensory disturbance (NSD) after sagittal split osteotomy (SSO) and intraoral vertical ramus osteotomy (IVRO). Furthermore, a comparison was made between the results obtained by questionnaires and information in the patient records in the evaluation of nerve function. Finally, the degree of discomfort caused by the NSD was evaluated. One hundred and twentynine patients, who underwent IVRO (79 patients) and SSO (50 patients), were included. Questionnaires were mailed to the patients at least one year after the operation. The records of all patients, who returned the questionnaires, were reviewed. The results of NSD obtained by questionnaires and records differed indicating a disagreement between the judgement of the surgeon and the patient's opinion. Long lasting NSD was underestimated by the surgeon as compared to the patient's subjective symptom. Long lasting NSD was reported in 7.5% (questionnaire), 3.8% (record) after IVRO and in 11.6% (questionnaire) and 8.1% (record) after SSO.

We mailed questionnaires to all patients who had had sagittal split osteotomies alone (n= 84) or in combination with genioplasty (n = 37) between 1995 and 2000, to find out the incidence of postoperative sensory disturbances. The patients with sagittal split osteotomies alone reported sensory disturbance in 48/131 (37%) operated sides. When combined with genioplasty patients experienced them in 20/54 (37%) operated sides. The incidences were 36/101 (36%) for mandibular advancement and 12/30 (40%) for mandibular setback. Out of the patients with sagittal split osteotomies alone, 59/66 (89%) were satisfied with the result of the operation, and when combined with the genioplasty the corresponding figure was 23/27 (85%). We conclude that differences in the incidence of sensory disturbance after sagittal split osteotomy for mandibular advancement and setback were not significant. The combination with genioplasty did not increase the incidence of sensory disturbance. Sensory changes after the osteotomies do not serve to be the main determinant of the patients' satisfaction.

PURPOSE: The aim of the study was to evaluate the effect of perioperatively systemically administered betamethasone on nerve recovery (within or outside a confined space) after induced nerve crush injury. MATERIALS AND METHODS: The sciatic nerve of 40 adult Wistar rats was crushed. In half of the animals, the injured nerve was entrapped in a silicone tube to simulate the environment of a closed space, and in the other half the nerve was left to heal. Half of the rats in each group were treated with subcutaneous betamethasone (2 mg/kg body weight/day) during the first 24 hours, starting preoperatively, whereas the other half, the control animals, were given the same amount of physiological saline. All animals underwent preoperative and postoperative walking track analysis (toe spread [TS] and intermediate toe spread [ITS]) twice weekly for 6 weeks. RESULTS: For nonconfined space groups, there was no significant difference between the 2 groups (P = .052 for ITS and P = .315 for TS) during the first 2 weeks. Starting from the end of the second week, animals treated with betamethasone recovered more rapidly than did the controls (P < .001) and continued to do so until the end of the observation period. In the confined space groups, there was a significant difference between the 2 groups for ITS (P < .001) and for TS (P < .05) during the first 2 weeks. The difference continued at almost the same level of significance (P = .001) for ITS, whereas for TS, the difference disappeared after the second week. CONCLUSIONS: We conclude that short-term perioperative administration of betamethasone has a beneficial effect on the recovery of the injured rat sciatic nerve.

PURPOSE: The purpose of this retrospective study was to assess the incidence of the neurosensory disturbance (NSD) after sagittal split osteotomy and evaluate NSD in relation to patient age, gender, satisfaction, and effect of steroids. PATIENTS AND METHODS: Questionnaires were mailed to all patients (31 women, 19 men) who underwent bilateral sagittal split osteotomy between 1995 and 1999, at least 1 year after the operation. Patients were queried about perceived NSD in the distribution of both inferior alveolar and lingual nerves, duration of these changes, and any influence of these changes on their quality of life. RESULTS: Eightysix percent of the mailed questionnaires were returned and analyzed (27 women, 16 men). Eight patients with 10 affected sides (11.6% of sides) reported long lasting NSD correspond-ing to the distribution of the inferior alveolar nerve. NSD was re-ported in 16.7% of the operated sides in women, while 3% of the operated sides in the men had such changes. Fifty percent of the operated sides in patients over 40 years of age were affected. Steroid treatment seemed to decrease NSD. Four patients (9%) were not satisfied, but only 1 attributed the dissatisfaction to sensory impairment. CONCLUSION: The incidence of NSD after sagittal split osteotomy in-creases in patients over the age of 40. Steroid regimen might be beneficial in reducing NSD after sagittal split osteotomy, although further investigation is required. The discomfort of the nerve damage seems outweighed by the result of function and esthetics.

Background A consensus meeting was arranged to critically analyze whether the high figures of peri-implantitis at machined implants that recently have been reported in the literature are valid also for modern implants. Purpose The aims of this paper were to present the outcomes from the consensus meeting and to evaluate recent long-term clinical studies on modern implants with regard to frequency of peri-implant infection. Materials and Methods Ten different studies of three modern implant brands of moderately rough surfaces with 10-year or longer follow-up times were found through a PubMed and manual search. Results It was concluded that bleeding on probing or probing depths are weak indicators of crestal bone loss (CBL); that CBL occurs for many other reasons than infection; that implant-, clinician-, and patient-related factors contribute to CBL; and that modern oral implants outperform older devices. Based on a literature search, the frequency of implants with reported peri-implant infection and significant bone loss leading to implant removal or other surgical intervention was on average 2.7% during 7 to 16 years of function. Conclusion The summed frequency of peri-implantitis and implant failure is commonly less than 5% over 10 years of follow-up for modern implants when using established protocols.

Background: The discrepancy between some scientific views and the daily clinical experience with dental implants has made the topic of "periimplantitis" highly controversial, especially the discussion whether "periimplantitis" should even be considered a "disease" or whether marginal bone loss instead would represent a complication of having a foreign body placed in the oral cavity. Purpose: The aim of the present paper was to present the outcomes from a consensus meeting on "peri-implantitis" in Rome, Italy (January 8-10, 2016). Materials and Methods: Seventeen clinical scientists were invited to, based on prepared reviews of the literature, discuss topics related to "periimplantitis." Results and conclusions: Oral implants may lose bone or even display clinical failure. However, progressive bone loss threatening implant survival is rare and limited to a percent or two of all implants followed up over 10 years or more, provided that controlled implant systems are being used by properly trained clinicians. There is very little evidence pointing to implants suffering from a defined disease entity entitled "peri-implantitis." Marginal bone loss around implants is in the great majority of cases associated with immune-osteolytic reactions. Complicating factors include patient genetic disorders, patient smoking, cement or impression material remnants in the peri-implant sulcus, bacterial contamination of the implant components and technical issues such as loose screws, mobile components or fractured materials. These reactions combine to result in cellular responses with the end result being a shift in the delicate balance between the osteoblast and the osteoclast resulting in bone resorption. However, the great majority of controlled implants display a foreign body equilibrium resulting in very high survival rates of the implants over long term of follow-up.

Osseointegration was discovered in 1962 and coined as a term in 1977. Original definitions implied direct contact between foreign materials and bone without any interposed soft tissue layers. Today, osseointegration is regarded to be a foreign body response to separate foreign elements from bone. A new definition of the term is suggested in this paper; “Osseointegration is a foreign body reaction where interfacial bone is formed as a defense reaction to shield off the implant from the tissues”. Excellent clinical results of osseointegrated implants have been reported from dentistry and Ear Nose Throat surgery, the latter with the indications of a stable anchorage of hearing aids or facial epistheses in cases of facial trauma. In Orthopaedic surgery a randomized controlled clinical trial has been undertaken demonstrating very good clinical results supported by positive radiostereo-photogrammetical data.