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  • 1.
    Esberg, Anders
    et al.
    Umea Univ, Dept Odontol, Umea, Sweden.
    Isehed, Catrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Lundberg, Pernilla
    Umea Univ, Dept Mol Periodontol, Umea, Sweden.
    Peri-implant crevicular fluid proteome before and after adjunctive enamel matrix derivative treatment of peri-implantitis2019In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 46, no 6, p. 669-677Article in journal (Refereed)
    Abstract [en]

    Aim The aim of this study was to explore which peri-implant crevicular fluid (PICF) protein pattern is associated with the active peri-implantitis process. Materials and methods Peri-implant crevicular fluid from 25 peri-implantitis sites were subjected to proteomic analysis using liquid chromatography-tandem mass spectrometry before and at 3, 6 and 12 months after treatment, to identify associations between PICF protein pattern and implant loss, bleeding on probing, pocket depth and enamel matrix derivative (EMD) treatment. Results Clustering of subjects based on their 3-12 months PICF proteomic profiles by principal component analysis defined two major clusters. Cluster 2 differentiated from cluster 3 by 52 proteins (R-2 = 90%, Q(2) = 80%) and belonging to cluster 2 was associated with implant loss (p = 0.009) and bleeding on probing (p = 0.001). Cluster 3 was associated with implant survival and EMD treatment (p = 0.044). Conclusion Here, we demonstrate that a specific PICF proteomic profile associates with active peri-implantitis process and implant loss.

  • 2.
    Holmlund, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hänström, Lennart
    Lerner, Ulf H.
    Bone resorbing activity and cytokine levels in gingival crevicular fluid before and after treatment of periodontal disease2004In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 31, no 6, p. 475-482Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of the present study was to investigate bone resorption activity (BRA), interleukin-1 alpha (IL-1 alpha), IL-1 beta and interleukin-1 receptor antagonist (IL-1ra) in gingival crevicular fluid (GCF) in sites with no signs of periodontal disease and in sites with horizontal or angular loss of periodontal bone. These assessments were performed before and after periodontal treatment. METHODS: GCFs were collected from 10 individuals with filter strips from two healthy sites and four sites with deep pathological periodontal pockets, two of which showed horizontal bone loss and two with angular bone loss. All diseased pockets were treated with flap surgery and systemic Doxyferm. Twelve months later GCF was collected again and treatment outcome evaluated. BRA in GCFs was assessed in a bone organ culture system by following the release of (45)Ca from neonatal mouse calvariae. The amounts of IL-1 alpha, IL-1 beta and IL-1ra in GCFs were quantified by enzyme-linked immunosorbent assay (ELISA). RESULTS: Treatment resulted in reduction of pocket depths with 3.5+/-0.5 mm in sites with angular bone loss and 2.8+/-0.3 mm in sites with horizontal bone loss. Initially, BRA, IL-1 alpha, IL-1 beta and IL-1ra were significantly higher in GCFs from diseased sites compared with healthy sites. No differences in BRA and cytokine levels were seen between GCFs from pockets with horizontal and angular bone losses. The levels of IL-1 alpha, IL-1 beta and IL-1ra were significantly reduced after treatment of diseased pockets. Pocket depths were significantly correlated to BRA only in pre-treatment sites with angular bone loss. BRA was correlated to Il-1 alpha, IL-1 beta, but not to IL-1ra, in diseased sites with angular bone loss, before and after treatment. The reductions of BRA in the individual sites, seen after treatment, were not correlated to the reductions of Il-1 alpha, IL-1 beta or IL-1ra. CONCLUSIONS: These data show that BRA and cytokine levels are increased in GCFs from sites with periodontal disease and that periodontal treatment results in reduction of the cytokines. Our findings further indicate that IL-1 alpha and IL-1 beta play important roles for the BRA present in GCFs, but that other factors also contribute to this activity.

  • 3.
    Isehed, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Umea Univ, Dept Odontol Mol Periodontol, Umea, Sweden.; Gavle Cty Hosp, Dept Periodontol, Gavle, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Dept Periodontol, Gavle, Sweden.
    Renvert, Stefan
    Kristianstad Univ, Dept Hlth Sci, Kristianstad, Sweden.;Trinity Coll Dublin, Sch Dent Sci, Dublin, Ireland.;Blekinge Inst Technol, Karlskrona, Sweden..
    Svenson, Björn
    Postgrad Dent Educ Ctr, Dept Oral Radiol, Orebro, Sweden.;Univ Orebro, Sch Hlth & Med Sci, Fac Med & Hlth, Orebro, Sweden..
    Johansson, Ingegerd
    Umea Univ, Dept Odontol Cariol, Umea, Sweden..
    Lundberg, Pernilla
    Umea Univ, Dept Odontol Mol Periodontol, Umea, Sweden..
    Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis. A randomized controlled trial2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 10, p. 863-873Article in journal (Refereed)
    Abstract [en]

    Objective: This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD).

    Methods: Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months.

    Results: In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram-/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q(2)) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis.

    Conclusion: Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.

  • 4.
    Isehed, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Svenson, Bjorn
    Orebro Univ, Postgrad Dent Educ Ctr, Orebro, Sweden;Orebro Univ, Sch Hlth & Med Sci, Orebro, Sweden.
    Lundberg, Pernilla
    Umea Univ, Dept Mol Periodontol, Umea, Sweden;Gavle Cty Hosp, Publ Dent Hlth Cty Council Gavleborg, Dept Periodontol, Gavle, Sweden.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Surgical treatment of peri-implantitis using enamel matrix derivative, an RCT: 3-and 5-year follow-up2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 6, p. 744-753Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the clinical and radiographic outcomes 3 and 5years after the surgical treatment of peri-implantitis per se or in combination with an enamel matrix derivative (EMD). Materials and Methods: At baseline, 29 patients were randomized to surgical treatment with adjunctive EMD or no EMD. One year after the surgical treatment of peri-implantitis, 25 patients remained eligible for survival analyses at the 3- and 5-year follow-up. The primary outcomes were implant loss and bone level (BL) change measured on radiographs, and the secondary outcomes, bleeding on probing, pus and plaque at each implant were analysed in 18 and 14 patients at the 3- and 5-year follow-up, respectively. Results: After exclusion of four patients who discontinued the study, at the 3-year follow-up, 13 (100%) implants survived in the EMD group, and 10 of 12 (83%) in the non-EMD group. At the 5-year follow-up, 11 of 13 (85%) implants in the EMD group and nine of 12 (75%) in the non-EMD group survived. In multivariate modelling, BL changes and EMD treatment were positively associated with implant survival. Similarly, the same trend was seen in univariate analysis. Conclusions: An exploratory analysis suggests that adjunctive EMD is positively associated with implant survival up to 5 years, but larger studies are needed.

  • 5. Jonsson, Birgitta
    et al.
    Ohrn, Kerstin
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Oscarson, Nils
    Cost-effectiveness of an individually tailored oral health educational programme based on cognitive behavioural strategies in non-surgical periodontal treatment2012In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 39, no 7, p. 659-665Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this cost-effectiveness analysis (CEA), performed from a societal perspective, was to compare costs and consequences of an individually tailored oral health educational programme (ITOHEP) based on cognitive behavioural strategies integrated in non-surgical periodontal treatment compared with a standard treatment programme (ST).

    Material and Methods: A randomized (n = 113), evaluator-blinded, controlled trial, with two different active treatments, was analysed with respect to their costs and consequences 12 months after non-surgical treatment. Costs referred to both treatment costs and costs contributed by the patient. Consequences (outcome) were expressed as the proportion of individuals classified as having reached the pre-set criteria for treatment success after non-surgical treatment (successful-NSPT).

    Results: More individuals in the ITOHEP group reached the pre-set criteria for treatment success than individuals in the ST group did. The CEA revealed an incremental cost-effectiveness of SEK1724 [191.09; pound SEK9.02 = 1 pound (January 2007)] per successful-NSPT case, of which treatment costs represented SEK1189 (131.82) pound, using the unit cost for a dental hygienist.

    Conclusion: The incremental costs per successful-NSPT case can be considered as low and strengthens the suggestion that an ITOHEP integrated into non-surgical periodontal treatment is preferable to a standardized education programme.

  • 6. Jönsson, Birgitta
    et al.
    Baker, Sarah R.
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Oscarson, Nils
    Öhrn, Kerstin
    Factors influencing oral hygiene behaviour and gingival outcomes 3 and 12 months after initial periodontal treatment: an exploratory test of an extended Theory of Reasoned Action2012In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 39, no 2, p. 138-144Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to empirically test the extended Theory of Reasoned Action (TRA) and the prospective direct and indirect role of attitudes, beliefs, subjective norms, self-efficacy, and a cognitive behavioural intervention in adult's oral hygiene behaviour and gingival outcomes at 3-and 12-month follow-up. Materials and Methods: Data were derived from an RCT evaluating the effectiveness of oral hygiene educational programs integrated in non-surgical periodontal treatment (n = 113). Before baseline examination, participants completed a self-report questionnaire. Structural equation modelling using maximum likelihood estimation with bootstrapping was used to test the direct and indirect (mediated) pathways within the extended TRA model. Results: The extended TRA model explained a large amount of variance in gingival outcome scores at 12 months (56%). A higher level of self-efficacy at baseline was associated with higher frequencies of oral hygiene behaviour at 3 months. Being female was linked to more normative beliefs that, in turn, related to greater behavioural beliefs and self-efficacy. Gender was also related to behavioural beliefs, attitudes and subjective norms. Both frequency of oral hygiene behaviour at 3 months and the cognitive behavioural intervention predicted gingival outcome at 12 months. Conclusions: The model demonstrated that self-efficacy, gender and a cognitive behavioural intervention were important predictors of oral hygiene behavioural change.

  • 7.
    Jönsson, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Öhrn, Kerstin
    Högskolan, Dalarna.
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Oscarson, Nils
    Socialstyrelsen, Stockholm.
    Evaluation of an individually tailored oral health educational programme on periodontal health2010In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 37, no 10, p. 912-919Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate an individually tailored oral health educational programme (ITOHEP) on periodontal health compared with a standard oral health educational programme. A further aim was to evaluate whether both interventions had a clinically significant effect on non-surgical periodontal treatment at 12-month follow-up. Material and Method: A randomized, evaluator-blinded, controlled trial with 113 subjects (60 females and 53 males) randomly allocated into two different active treatments was used. ITOHEP was based on cognitive behavioural principles and motivational interviewing. The control condition was standard oral hygiene education (ST). The effect on bleeding on probing (BoP), periodontal pocket depth, "pocket closure" i.e. percentage of periodontal pocket >4 mm before treatment that were <5 mm after treatment, oral hygiene [plaque indices (PlI)], and participants' global rating of oral health was evaluated. Preset criteria for PlI, BoP, and "pocket closure" were used to describe clinically significant non-surgical periodontal treatment success. Results: The ITOHEP group had lower BoP scores 12-month post-treatment (95% confidence interval: 5-15, p<0.001) than the ST group. No difference between the two groups was observed for "pocket closure" and reduction of periodontal pocket depth. More individuals in the ITOHEP group reached a level of treatment success. Lower PlI scores at baseline and ITOHEP intervention gave higher odds of treatment success. Conclusions: ITOHEP intervention in combination with scaling is preferable to the ST programme in non-surgical periodontal treatment.

  • 8.
    Jönsson, Birgitta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Öhrn, Kerstin
    Högskolan Dalarna.
    Oscarson, Nils
    Socialstyrelsen, Stockholm.
    Lindberg, Per
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour in patients with periodontal disease: a blinded randomized-controlled clinical trial (one-year follow-up)2009In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 36, no 12, p. 1025-1034Article in journal (Refereed)
    Abstract [en]

    Aim   To evaluate the effectiveness of an individually tailored oral health   educational programme for oral hygiene self-care in patients with   chronic periodontitis compared with the standard treatment.   Material and Method   A randomized, evaluator-blinded, controlled trial with two different   active treatments were used with 113 subjects (60 females and 53 males)   randomly allocated to an experimental or a control group. The   individually tailored oral health educational programme was based on   cognitive behavioural principles and the individual tailoring for each   participant was based on participants' thoughts, intermediate, and   long-term goals, and oral health status. The effect of the programmes   on gingivitis [gingival index (GI)], oral hygiene [plaque indices (PlI)   and self-report], and participants' global rating of treatment was   evaluated 3 and 12months after oral health education and non-surgical   treatment.   Results   Between baseline and the 12-month follow-up, the experimental group   improved both GI and PlI more than the control group. The mean   gain-score difference was 0.27 for global GI [99.2% confidence interval   (CI): 0.16-0.39, p < 0.001] and 0.40 for proximal GI (99.2% CI:   0.27-0.53, p < 0.001). The mean gain-score difference was 0.16 for   global PlI (99.2% CI: 0.03-0.30, p=0.001), and 0.26 for proximal PlI   (99.2% CI: 0.10-0.43, p < 0.001). The subjects in the experimental   group reported a higher frequency of daily inter-dental cleaning and   were more certain that they could maintain the attained level of   behaviour change.   Conclusion   The individually tailored oral health educational programme was   efficacious in improving long-term adherence to oral hygiene in   periodontal treatment. The largest difference was for interproximal   surfaces.

  • 9.
    Ohshima, Mitsuhiro
    et al.
    Ohu Univ, Sch Pharmaceut Sci, Dept Biochem, Misumido 31-1, Koriyama, Fukushima 9638611, Japan..
    Yamaguchi, Yoko
    Nihon Univ, Sch Dent, Dept Biochem, Tokyo 101, Japan..
    Ambe, Kimiharu
    Ohu Univ, Sch Dent, Dept Morphol Biol, Misumido 31-1, Koriyama, Fukushima 9638611, Japan..
    Horie, Masafumi
    Univ Tokyo, Grad Sch Med, Dept Resp Med, Tokyo, Japan.;Univ Tokyo, Fac Med, Tokyo 113, Japan..
    Saito, Akira
    Univ Tokyo, Grad Sch Med, Dept Resp Med, Tokyo, Japan.;Univ Tokyo, Fac Med, Tokyo 113, Japan..
    Nagase, Takahide
    Univ Tokyo, Grad Sch Med, Dept Resp Med, Tokyo, Japan.;Univ Tokyo, Fac Med, Tokyo 113, Japan..
    Nakashima, Keisuke
    Kyushu Dent Univ, Dept Oral Funct, Div Periodontol, Fukuoka, Japan..
    Ohki, Hidero
    Nihon Univ, Sch Dent, Dept Oral Surg 1, Tokyo, Japan..
    Kawai, Toshihisa
    Forsyth Inst, Dept Immunol, Cambridge, MA USA..
    Abiko, Yoshimitsu
    Nihon Univ, Sch Dent, Dept Mol Biol & Biochem, Matsudo, Chiba 271, Japan..
    Micke, Patrick
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    Kappert, Kai
    Charite, CCR, Inst Lab Med Clin Chem & Pathobiochem, D-13353 Berlin, Germany..
    Fibroblast VEGF-receptor 1 expression as molecular target in periodontitis2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 2, p. 128-137Article in journal (Refereed)
    Abstract [en]

    AimDegradation of extracellular matrices is an integral part in periodontitis. For antagonizing this pathophysiological mechanism, we aimed at identifying gene expression profiles in disease progression contributing periodontitis-associated fibroblasts (PAFs) versus normal gingival fibroblasts to determine their molecular repertoire, and exploit it for therapeutic intervention. Materials and MethodsApplying an exploratory analysis using a small number of microarrays in combination with a three dimensional (3D) invitro culture model that incorporates some aspects of periodontitis, PAFs were initially characterized by gene-expression analyses, followed by targeted gene down-regulation and pharmacological intervention in vitro. Further, immunohistochemistry was applied for phosphorylation analyses in tissue specimens. ResultsPAFs were characterized by 42 genes being commonly up-regulated >1.5-fold, and by five genes that were concordantly down-regulated (<0.7-fold). Expression of vascular endothelial growth factor (VEGF)-receptor 1 (Flt-1) was highly enhanced, and was thus further explored in invitro culture models of periodontal fibroblasts without accounting for the microbiome. Phosphorylation of the VEGF-receptor 1 was enhanced in PAFs. Receptor inhibition by a specific VEGF-receptor inhibitor or intrinsic down-regulation by RNAi of the VEGF-receptor kinase in 3D gel cultures resulted in significant reduction in collagen degradation associated with increased tissue inhibitor of metalloproteinase expression, suggesting that Flt-1 may contribute to periodontitis. ConclusionBased on the finding that VEGF-receptor kinase inhibition impaired collagen degradation pathways, Flt-1 may represent a candidate for therapeutic approaches in periodontitis.

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