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Guillet, C., Birgersson, U., Engstrand, T., Åberg, J., Lopes, V., Thor, A., . . . Forterre, F. (2023). Bone formation beyond the skeletal envelope using calcium phosphate granules packed into a collagen pouch-a pilot study. Biomedical Materials, 18(3), Article ID 035007.
Open this publication in new window or tab >>Bone formation beyond the skeletal envelope using calcium phosphate granules packed into a collagen pouch-a pilot study
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2023 (English)In: Biomedical Materials, ISSN 1748-6041, E-ISSN 1748-605X, Vol. 18, no 3, article id 035007Article in journal (Refereed) Published
Abstract [en]

In this proof-of-concept, bone neoformation beyond the skeletal envelope is explored by using a collagen pouch (n = 6) packed with calcium phosphate (CaP) granules placed over the frontal bone in sheep (n = 3). At 13 weeks, macroscopic examination showed specimens covered by an adherent fibrinous envelope with slight vascularization. Histology revealed colonization of the implant by newly formed woven bone and fibrous connective tissue. Surface osteoblasts as well as material-filled macrophages, lymphocytes, polymorphonuclear cells and giant cells were also found in large quantities surrounding the newly formed bone tissue inside the collagen pouch. On the side facing the recipient bone, the collagen membrane had to a large extent been resorbed and bridging bone formation was clearly visible between the test article and recipient bone. On the other side facing soft tissue, the collagen pouch remained intact with a visible fibrous capsule. This study demonstrated that the use of a collagen sleeve as a container for CaP granules allows for good neoformation beyond the skeletal envelope with bridging bone formation clearly visible between the test article and recipient bone. Additionally, in this model, macrophages rather than osteoclasts appear to modulate CaP granule resorption and remodeling into new bone. This construct opens new perspectives for treatment methods that could be used for bone augmentation and restoration of cranio-maxillofacial defects and malformations.

Place, publisher, year, edition, pages
Institute of Physics Publishing (IOPP), 2023
Keywords
calcium phosphate, bioceramics, bone formation, animal test, materials, barrier membranes
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-500310 (URN)10.1088/1748-605X/acc55e (DOI)000955491100001 ()36930978 (PubMedID)
Available from: 2023-04-14 Created: 2023-04-14 Last updated: 2023-04-14Bibliographically approved
Danielsson, D., Hagel, E., Dybeck-Udd, S., Sjostrom, M., Kjeller, G., Bengtsson, M., . . . Munck-Wikland, E. (2023). Brachytherapy and osteoradionecrosis in patients with base of tongue cancer. Acta Oto-Laryngologica, 143(1), 77-84
Open this publication in new window or tab >>Brachytherapy and osteoradionecrosis in patients with base of tongue cancer
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2023 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 143, no 1, p. 77-84Article in journal (Refereed) Published
Abstract [en]

BackgroundBase of tongue cancer incidence and patient survival is increasing why treatment sequelae becomes exceedingly important. Osteoradionecrosis (ORN) is a late adverse effect of radiotherapy and brachytherapy (BT) could be a risk factor. Brachytherapy is used in three out of six health care regions in Sweden.AimsInvestigate if patients treated in regions using BT show an increased risk for ORN and whether brachytherapy has any impact on overall survival.Material and MethodsWe used data from the Swedish Head and Neck Cancer Register between 2008-2014. Due to the nonrandomized nature of the study and possible selection bias we compared the risk for ORN in brachy vs non-brachy regions.ResultsFifty out of 505 patients (9.9%) developed ORN; eight of these were treated in nonbrachy regions (16%), while 42 (84%) were treated in brachy regions. Neither age, sex, TNM-classification/stage, p16, smoking, neck dissection, or chemotherapy differed between ORN and no-ORN patients. The risk for ORN was significantly higher for patients treated in brachy regions compared to non-brachy regions (HR = 2,63, p = .012), whereas overall survival did not differ (HR = 0.95, p = .782).Conclusions and SignificanceBrachytherapy ought to be used cautiously for selected patients or within prospective randomized studies.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Brachytherapy, osteoradionecrosis, base of tongue cancer, head and neck cancer, sequelae
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-497365 (URN)10.1080/00016489.2022.2161627 (DOI)000906655700001 ()36595465 (PubMedID)
Available from: 2023-03-01 Created: 2023-03-01 Last updated: 2023-03-01Bibliographically approved
Tee, R., Schweizer, R., Gomez-Martinez-de-Lecea, C., Vejbrink Kildal, V., Thor, A. & Rodriguez-Lorenzo, A. (2023). Early Second Free Flap is Required in Osteoradionecrosis-related Nonunion after Primary Mandible Reconstruction. Plastic and Reconstructive Surgery - Global Open, 11(6), Article ID e5024.
Open this publication in new window or tab >>Early Second Free Flap is Required in Osteoradionecrosis-related Nonunion after Primary Mandible Reconstruction
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2023 (English)In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 11, no 6, article id e5024Article in journal (Refereed) Published
Abstract [en]

Background: Osteoradionecrosis (ORN) manifested as symptomatic nonunion between primary free flap and native mandible after primary bony reconstruction of the mandible is an entity not included in current conventional ORN staging guidelines. This article reports on and proposes early management of this debilitating condition using a chimeric scapular tip free flap (STFF).

Methods: A retrospective review was performed examining cases with bony nonunion at the junction of primary free fibula flap (FFF) and native mandible at a single center over a 10-year duration, which required a second free bone flap. Details of each case (patient demographics, oncological details, primary surgery, presentation, and secondary surgery) were documented and analyzed. Outcomes of the treatment were assessed.

Results: Four patients (two men and two women; age range, 42–73 years) out of a total of 46 primary FFF were identified. All patients presented with symptoms of low-grade ORN and radiological signs of nonunion. All cases were reconstructed with chimeric STFF. The duration of follow-up ranged from 5 to 20 months. All patients reported resolution of symptoms and radiological evidence of union. Two of four patients subsequently received osseointegrated dental implants.

Conclusions: Institutional rate of nonunion after primary FFF requiring a second free bone flap is 8.7%. All the patients of this cohort presented with a similar clinical entity easily discounted as an infected nonunion postosseous flap reconstruction. There is no ORN grading system that currently guides the management of this cohort. Good outcomes are possible with early surgical intervention with a chimeric STFF.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-506914 (URN)10.1097/GOX.0000000000005024 (DOI)001008168900001 ()37334393 (PubMedID)
Available from: 2023-06-30 Created: 2023-06-30 Last updated: 2024-01-17Bibliographically approved
Oldén, A., Wamalwa, A. O., Lindell Jonsson, E., Thor, A. & Rodriguez-Lorenzo, A. (2023). Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction: A 10-Year Retrospective Study. The Journal of Craniofacial Surgery, 34(6), 1635-1639
Open this publication in new window or tab >>Factors Affecting Complete Oral Rehabilitation in Patients With Vascularized Free Fibula Flap Mandibular Reconstruction: A 10-Year Retrospective Study
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2023 (English)In: The Journal of Craniofacial Surgery, ISSN 1049-2275, E-ISSN 1536-3732, Vol. 34, no 6, p. 1635-1639Article in journal (Refereed) Published
Abstract [en]

The fibula is the preferred bone flap for mandibular reconstructions due to its many advantages, including the possibility to insert dental implants. All patients who received a mandibular reconstruction with a vascularized free fibula flap at the Uppsala University Hospital between 2009 and 2019 were retrospectively examined regarding the proportion of implant insertion and factors that affected implant outcome. Forty-one patients had 42 fibula flap reconstructions. Eleven patients (27%) received dental implants and 8 (20%) completed dental rehabilitation. Patient death and cancer recurrence were the main reasons for not receiving implants. The survival rates of implants placed in irradiated and nonirradiated fibulas were 15% and 76%, respectively. Less than 20% of reconstructed patients received an implant-supported prosthesis. Implants placed in an irradiated fibula should be considered at high risk for implant loss.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-509649 (URN)10.1097/SCS.0000000000009543 (DOI)001059187900040 ()37485965 (PubMedID)
Available from: 2023-08-22 Created: 2023-08-22 Last updated: 2023-12-19Bibliographically approved
Nedelcu, R., Olsson, P., Thulin, M., Nyström, I. & Thor, A. (2023). In vivo trueness and precision of full-arch implant scans using intraoral scanners with three different acquisition protocols. Journal of Dentistry, 128, 104308-104308, Article ID 104308.
Open this publication in new window or tab >>In vivo trueness and precision of full-arch implant scans using intraoral scanners with three different acquisition protocols
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2023 (English)In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 128, p. 104308-104308, article id 104308Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate an in situ reference acquisition method for implant positions in complete edentulous maxillae using an industrial scanner and allowing for in vivo trueness analysis of the restorative workflow. To assess in vivo trueness and precision of intraoral scanners (IOS) using different acquisition protocols. Furthermore, to compare IOS trueness with impression-based models and implant-supported fixed dentures (IFD) in a parallel study on the same cohort using the same in situ reference scan.

Methods: Six scan-bodies mounted to maxillary implants in five subjects were reference scanned (REF) using an industrial scanner. Subjects were scanned with IOS three times using three different protocols: control (CT), dental floss assisted (DF), and acrylic splint (SP). CAD-files of scan-bodies with inter-aligned analogues were geometry-aligned to REF, and SP. Scan-bodies were aligned to CT and DF in proprietary dental laboratory software and exported with analogue positions. Resulting six CAD-analogues per scan were Globally Aligned using a consistent geometry-based alignment. Deviations were computed after a Reference Point System Alignment at the implant/prosthetic platform for Cartesian axes with a linear Resultant.

Results: Resultant trueness was CT: 41±11 μm, DF: 49±22 μm, SP: 55±8 μm. Resultant precision was CT: 48±7μm, DF: 50±7 μm, SP: 45±6 μm

Conclusions: This method is applicable for assessing trueness of maxillary full-arch implant scans in vivo. The CTprotocol was most accurate. CT trueness showed no difference to digitised impression-based models in parallelstudy. CT was more accurate than IFD in a parallel study. CT displayed similar numerical trueness as existing invitro studies.

Critical significance: Using IOS to acquire full-arch implant scans is controversial. The modified protocol in thispilot shows promising results in the maxilla where great care was taken to manage non-attached tissues when amodified scanning pattern was used. However, other IOS may show varying results in vivo. A completed scan doesnot necessarily equate to an accurate scan.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-490180 (URN)10.1016/j.jdent.2022.104308 (DOI)000992408700001 ()
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2024-01-15Bibliographically approved
Nedelcu, R., Olsson, P., Thulin, M., Nyström, I. & Thor, A. (2023). In vivo trueness of full-arch implant-supported CAD/CAM restorations and models based on conventional impressions. Journal of Dentistry, 128, 104381-104381, Article ID 104381.
Open this publication in new window or tab >>In vivo trueness of full-arch implant-supported CAD/CAM restorations and models based on conventional impressions
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2023 (English)In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 128, p. 104381-104381, article id 104381Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate a method for in situ reference acquisition of implant positions in complete edentulous maxillae using an industrial scanner. To assess in vivo trueness of full-arch implant-supported fixed dentures (IFD) and dental models based on conventional impressions.

Methods: In five subjects, scan-bodies were mounted to six maxillary implants and scanned three times using an industrial scanner (REF). Original impression-based models used to manufacture existing IFDs, (MOD1), and models fabricated from new polyether impressions, (MOD2), were scanned three times with a laboratory scanner. Scan-bodies were aligned and exported with analogue positions corresponding to implant positions. Implant analogues were mounted onto existing IFDs and scanned three times (BRIDGE). CAD files of scan-bodies with inter-aligned CAD-analogues were geometry-aligned to REF. CAD-analogues were aligned to exported files of MOD1 and MOD2, and to BRIDGE. Resulting six CAD-analogues were Globally Aligned using a consistent geometry-based alignment. Deviations were computed after a Reference Point System Alignment at the implant/prosthetic platform for Cartesian axes and a linear Resultant.

Results:REF precision was 9.3 ± 1 µm. In vivo trueness for Resultant was MOD1: 36±16 µm, MOD2: 28±7 µm and BRIDGE: 70±23 µm, where MOD1 and MOD2 were statistically significantly different from BRIDGE. In vitro manufacturing trueness of Resultant when MOD1 acted reference for BRIDGE was: 69 ± 22.

Conclusions: This method can be applied for assessing in vivo trueness. CAD/CAM processed IFD showed deviations twice that of impression-based models, however, errors from impressions and subsequent model scans were not additive to the entire workflow.

Place, publisher, year, edition, pages
ElsevierElsevier BV, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-490355 (URN)10.1016/j.jdent.2022.104381 (DOI)000992534000001 ()
Available from: 2022-12-09 Created: 2022-12-09 Last updated: 2024-01-15Bibliographically approved
Eriksson, L. B., Gordh, T., Karlsten, R., LoMartire, R., Thor, A. & Tegelberg, Å. (2023). Intravenous S-ketamine's analgesic efficacy in third molar surgery: A randomized placebo-controlled double-blind clinical trial. British Journal of Pain
Open this publication in new window or tab >>Intravenous S-ketamine's analgesic efficacy in third molar surgery: A randomized placebo-controlled double-blind clinical trial
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2023 (English)In: British Journal of Pain, ISSN 2049-4637Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background

In most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred.

Methods

The study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline).

Results

A primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group.

Conclusions

Pre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
S-Ketamine pain, pain, postoperative pain, pain management, intravenous, sedation, oral surgery
National Category
Dentistry Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-518450 (URN)10.1177/20494637231222327 (DOI)001125533900001 ()
Available from: 2023-12-19 Created: 2023-12-19 Last updated: 2024-02-01Bibliographically approved
Niklasson, J., Rönnblom, A., Lidian, A. & Thor, A. (2023). Oral manifestations and dental considerations of patients with hereditary hemorrhagic telangiectasia: a scoping review. Oral surgery, oral medicine, oral pathology and oral radiology, 136(6), 691-702
Open this publication in new window or tab >>Oral manifestations and dental considerations of patients with hereditary hemorrhagic telangiectasia: a scoping review
2023 (English)In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 136, no 6, p. 691-702Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVE: We examined the range, nature, and extent of research conducted regarding the oral and dental implications of hereditary hemorrhagic telangiectasia (HHT) to identify gaps in the research and knowledge of the field.

STUDY DESIGN: We performed a scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and 2017 Guidance for the Conduct of Joanna Briggs Institute Scoping Reviews. We searched the MEDLINE and Web of Science databases for all full-text articles published in English from December 1946 to October 2022.

RESULTS: We identified 103 articles describing oral and dental considerations of patients with HHT, primarily case reports. Most reported oral telangiectasias of the tongue, lips, and palate. Many reported management of bleeding and the use or recommendation of prophylactic antibiotics before dental procedures.

CONCLUSIONS: Oral telangiectasias are commonly found in patients with hereditary hemorrhagic telangiectasia, and dental professionals may be the first to diagnose it in their patients. Early detection and diagnosis are important to prevent potentially fatal outcomes, and prophylactic antibiotics before procedures may be warranted.

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-515130 (URN)10.1016/j.oooo.2023.08.001 (DOI)001131879200001 ()37752017 (PubMedID)
Funder
Region Uppsala
Available from: 2023-10-27 Created: 2023-10-27 Last updated: 2024-02-21Bibliographically approved
Riben, C., Lewin, S., Kämpe, J., Öhman, C. & Thor, A. (2023). Quantification of Bone Height and Bone Volume Around Dental Implants After Open Maxillary Sinus Elevation Surgery Using CBCT.. International Journal of Oral & Maxillofacial Implants, 38(4), 789-800
Open this publication in new window or tab >>Quantification of Bone Height and Bone Volume Around Dental Implants After Open Maxillary Sinus Elevation Surgery Using CBCT.
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2023 (English)In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 38, no 4, p. 789-800Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess, using CBCT, the volume and height of bone formation after open maxillary sinus elevation without the use of grafts.

Materials and Methods: The study was retrospective and included 24 patients with a total of 67 implants. CBCT examinations were conducted at baseline (0 to 43 days postsurgery) and after an average healing period of 6.2 months (range: 5.1 to 7.8 months). The image analysis included metal artifact reduction, registration, and a standardized protocol for segmenting the anatomical structures of the maxillary sinus, including calculating the 3D volumetric changes after bone formation. Conventional manual 2D measurement of vertical bone formation was executed for comparison. Clinical factors assumed to be relevant for bone formation were obtained from patient medical records.

Results: One implant was lost before prosthetic loading, representing an early implant loss rate of 1.5%. Differences in intra- and interexaminer reproducibility were registered for the conventional 2D method (P < .05). The average vertical bone formation measured with the 2D method was 4.8 mm (4.6 to 5.0 mm), covering 60.2% of the implant height within the sinus. The average volumetric bone formation measured with the developed 3D image-analysis method was 801 mm3 in total and 195 mm3 in a restricted region around each implant. Bone formation was registered in 62% of the volume of the restricted region. A correlation regarding bone formation was found between the two methods (R2 = 0.705). Clinical factors such as age, smoking, general health, and postoperative complications did not correlate with the amount of bone formed.

Conclusion: CBCT image analysis is a promising method for objective 3D evaluation of bone formation after sinus elevation. A correlation was seen between the manually measured bone height (2D) and the bone volume in a restricted region around each implant using the developed method (3D). Reducing visual interpretation minimizes errors related to examiner reliability. Clinical factors did not significantly affect the volumetric bone formation.

Place, publisher, year, edition, pages
Quintessence Publishing, 2023
Keywords
3D, bone volume, CBCT, graftless, sinus elevation
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-515131 (URN)10.11607/jomi.10183 (DOI)001142545300018 ()37669523 (PubMedID)
Available from: 2023-10-27 Created: 2023-10-27 Last updated: 2024-03-21Bibliographically approved
de Lecea, C.-M. G., Schweizer, R., Thor, A. & Rodriguez-Lorenzo, A. (2022). Five-Step Scapula Tip Flap Harvesting for Oromaxillofacial Defects Reconstruction. Plastic and reconstructive surgery (1963), 150(2), 416e-418e
Open this publication in new window or tab >>Five-Step Scapula Tip Flap Harvesting for Oromaxillofacial Defects Reconstruction
2022 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 150, no 2, p. 416e-418eArticle in journal (Refereed) Published
Abstract [en]

In the last 10 years, there has been an increased focus on the scapula tip free flap for head and neck reconstructions. Its several advantages make it a versatile and reliable reconstructive option for patients with orofacial compound defects. The aim of this article is to present a systematic surgical approach for the harvesting of the scapula tip free flap. Herein, a step-by-step surgical approach and some technical tips are described to make the scapula tip flap dissection simpler, safer, and more straightforward.

Place, publisher, year, edition, pages
Ovid Technologies (Wolters Kluwer Health), 2022
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-482028 (URN)10.1097/PRS.0000000000009354 (DOI)000830747300038 ()35674506 (PubMedID)
Available from: 2022-08-19 Created: 2022-08-19 Last updated: 2023-12-19Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-9590-2039

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