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  • 1. Dasmah, Amir
    et al.
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Sennerby, Lars
    Rasmusson, Lars
    A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 2, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Background: Maxillary sinus floor augmentation is a procedure that is indicated in cases when the volume of the posterior maxillary bone is inadequate. The goal of this treatment is to obtain sufficient amount of bone tissue in order to gain osseointegration of endosseous implants. Purpose: The purpose of this study was to conduct a clinical and histological analysis of calcium sulfate (CaS) as bone graft substitute in sinus floor augmentation.

    Material and Methods: Ten patients with edentulous maxillas were included in this study. They had moderate to severe atrophy of the posterior maxilla. Surgiplaster (Classimplant(R), Rome, Italy) was used as graft material in the maxillary sinus and was covered by BioGide(R) (Geistlish Pharmaceutical, Wolhusen, Switzerland). After 4 months of graft healing, 40 dental implants were placed and a biopsy for histomorphometry was taken at these occasions. The specimens were viewed by light microscope, and the extent of bone regeneration and remaining graft material was evaluated. Radiographs were taken at the time of sinus augmentation and after 4 months of graft healing.

    Results: At the time of abutment surgery, one implant was considered as a failure and was consequently removed, giving a survival rate of 97.5% after 1 year of loading. Radiographs showed a mean of 26.5% shrinkage of the augmented area. A significant resorption of CaS was noted with a mean value of 8.8% of remaining graft material after 4 months of healing. The biopsies also revealed new bone formation with a mean value of 21.2% of the total biopsy area. Histology showed signs of an acellular substitution of CaS with bone-like tissue.

    Conclusion: The results of this study show that new bone regeneration occurs in the maxillary sinus after augmentation with CaS. This enabled successful placement, integration, and loading of dental implants in the posterior maxilla, as only 1 of 40 implants was lost during 1 year of follow-up.

  • 2. Dasmah, Amir
    et al.
    Rasmusson, Carl
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Simultaneous or Delayed Placement of Surface Modified and Fluoridated Dental Implants into Autogenous Block Bone Grafts: A Histologic and Biomechanical Study in the Rabbit2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, no 2, p. 395-401Article in journal (Refereed)
    Abstract [en]

    Background: A delayed approach is recommended for reconstruction of the jaws with autogenous bone grafts and dental implants. Experimental studies have shown stronger bone tissue responses to surface modified implants than to nonmodified ones. AimThe aim of the study was to evaluate bone integration and stability of surface modified and fluoridated implants when placed with fresh or healed autogenous bone grafts. Material and Methods: Six rabbits were used in this study. Each right rabbit tibia (control) received an autogenous bone graft, harvested from the calvarium. Eight weeks later, a second graft was harvested from the other side of the calvarium and placed on the left tibia (test) with an implant. Another implant was installed in the healed graft of the right tibia. TiO2-blasted and fluoridated OsseoSpeed(TM) implants (Astra Tech AB, Molndal, Sweden), 3.5mm in diameter and 9mm long, were used. After additional 8 weeks, the rabbits were sacrificed and the implants were removed en bloc for light-microscopic analysis. Bone-to-implant contact (BIC) was registered as well as the amount of bone filling a rectangle indicating a region of interest (ROI). Resonance frequency analysis (RFA) was conducted both at the time of surgery and at the end of the experiment. ResultsThere were no statistically significant differences either in BIC or ROI between the test and control sides. RFA showed higher implant stability for the control side at the time of the surgery, but the difference had leveled out at the time of the sacrifice. Conclusion: The present study showed similar bone tissue responses and stability for surface modified and fluoridated implants after 8 weeks of healing in fresh or healed autogenous bone grafts.

  • 3. Dasmah, Amir
    et al.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ekestubbe, Annika
    Sennerby, Lars
    Rasmusson, Lars
    Marginal Bone-Level Alterations at Implants Installed in Block versus Particulate Onlay Bone Grafts Mixed with Platelet-Rich Plasma in Atrophic Maxilla: A Prospective 5-Year Follow-Up Study of 15 Patients2013In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 15, no 1, p. 7-14Article in journal (Refereed)
    Abstract [en]

    Background:

    Extensive atrophy of the alveolar process may require a bone-grafting procedure prior to implant treatment. Autogenous bone grafts from the iliac crest, used as onlay block and particulate bone, have been used together with sinus-lift procedure in order to rehabilitate patients with extremely resorbed maxillae. However, there are to our knowledge no 5-year follow-up studies evaluating the extent of bone-level change in patients treated with respectively block and particulate autogenous bone grafts.

    Purpose:

    The purpose of this prospective clinical study was to conduct a 5-year follow-up analysis with focus on bone-level alteration in block versus particulate onlay bone grafts.

    Material and Methods:

    Fifteen out of originally 19 patients who were treated with iliac bone grafts and oral implants in the maxilla have been followed through the first 5 postoperative years. In a first study conducted on 19 patients, the role of platelet-rich plasma in conjunction with autogenous bone was evaluated. In this 5-year follow-up study, the marginal bone alterations have been documented at base line, 1 year and 5 years of loading to the nearest 0,1 mm at mesial and distal surfaces of the implants. Two implants were installed on each side of the midline in either block or particulate bone grafts giving test and control sides in each patient. Additionally, two implants on each side were installed in residual bone/grafted sinus floor.

    Result:

    Marginal bone alteration in the anterior maxilla appeared larger at the side augmented by block bone at baseline, and after 1 and 5 years of loading, but the change was not statistically significant. Moreover, there was a significantly higher degree of marginal alteration during the first year of loading, compared with the examinations after 5 years.

    Conclusion:

    The present follow-up study showed that there is no significant difference in the extension of resorption between block- and particulate autogenous bone grafts over a 5-year period. Most of the resorption occurred during the first year in function.

  • 4. Ekstrand, Karl
    et al.
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Malignant tumors of the maxilla: virtual planning and real-time rehabilitation with custom-made R-zygoma fixtures and carbon-graphite fiber-reinforced polymer prosthesis2008In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 10, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Oral cancer is a mutilating disease. Because of the expanding application of computer technology in medicine, new methods are constantly evolving. This project leads into a new technology in maxillofacial reconstructive therapy using a redesigned zygoma fixture. PURPOSE: Previous development experiences showed that the procedure was time-consuming and painful for the patients. Frequent episodes of sedation or general anesthetics were required and the rehabilitation is costly. The aim of our new treatment goal was to allow the patients to wake up after tumor surgery with a functional rehabilitation in place. MATERIALS AND METHODS: Stereolithographic models were introduced to produce a model from the three-dimensional computed tomography (CT). A guide with the proposed resection was fabricated, and the real-time maxillectomy was performed. From the postoperative CT, a second stereolithographic model was manufactured and in addition, a stent for the optimal position of the implants. Customized zygoma implants were installed (R-zygoma, Integration AB, Göteborg, Sweden). A fixed construction was fabricated by using a new material based on poly(methylacrylate) reinforced with carbon/graphite fibers and attached to the implants. On the same master cast, a separate obturator was fabricated in permanent soft silicon. RESULTS: The result of this project showed that it was possible to create a virtual plan preoperatively to apply during surgery in order for the patient to wake up functionally rehabilitated. CONCLUSION: From a quality-of-life perspective, it is an advantage to be rehabilitated fast. By using new computer technology, pain and discomfort are less and the total rehabilitation is faster, which in turn reduces days in hospital and thereby total costs.

  • 5.
    Grandfield, Kathryn
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Palmquist, Anders
    Institute for Clinical Sciences, Dept of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg.
    Ericsson, Fredric
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Microsystems Technology.
    Malmström, Johan
    Institute for Clinical Sciences, Dept of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg.
    Emanuelsson, Lena
    Institute for Clinical Sciences, Dept of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg.
    Slotte, Christer
    Institute for Clinical Sciences, Dept of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg och Dept of Periodontology, The Institute for Postgraduate Dental Education, Jönköping.
    Adolfsson, Erik
    Swedish Ceramic Institute, IVF, Mölndal.
    Botton, Gianluigi A.
    Dept of Materials Science and Engineering, McMasters Unviersity, Hamilton, ON, Kanada.
    Thomsen, Peter
    Institute for Clinical Sciences, Dept of Biomaterials, Sahlgrenska Academy at University of Gothenburg, Göteborg.
    Engqvist, Håkan
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Bone response to free form fabricated hydroxyapatite and zirconia scaffolds: a transmission electron microscopy study in the human maxilla2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 3, p. 461-469Article in journal (Refereed)
    Abstract [en]

    Background: Understanding the interfacial reactions to synthetic bone regenerative scaffolds in vivo is fundamental for improving osseointegration and osteogenesis. Using transmission electron microscopy, it is possible to study the biological response of hydroxyapatite (HA) and zirconia (ZrO2) scaffolds at the nanometer scale.

    Purpose: In this study, the bone-bonding abilities of HA and ZrO2 scaffolds produced by free-form fabrication were evaluated in the human maxilla at 3 months and 7 months.

    Materials and Methods: HA and ZrO2 scaffolds (ø: 3 mm) were implanted in the human maxilla, removed with surrounding bone, embedded in resin, and sectioned. A novel focused ion beam (FIB) sample preparation technique enabled the production of thin lamellae for study by scanning transmission electron microscopy.

    Results: Interface regions were investigated using high-angle annular dark-field imaging and energy-dispersive X-ray spectroscopy analysis. Interfacial apatite layers of 80 nm and 50 nm thickness were noted in the 3- and 7-month HA samples, respectively, and bone growth was discovered in micropores up to 10 µm into the samples.

    Conclusions: The absence of an interfacial layer in the ZrO2 samples suggest the formation of a direct contact with bone, while HA, which bonds through an apatite layer, shows indications of resorption with increasing implantation time. This study demonstrates the potential of HA and ZrO2 scaffolds for use as bone regenerative materials.

  • 6.
    Hjalmarsson, Lars
    et al.
    Public Dental Health Service, The Mälar Hospital, Eskilstuna, Sweden.
    Örtorp, Anders
    Smedberg, Jan-Ivan
    Jemt, Torsten
    Precision of fit to implants: a comparison of Cresco™ and Procera® implant bridge frameworks2010In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 12, no 4, p. 271-280Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The Cresco™ (Astra Tech AB, Mölndal, Sweden) method aims to reduce the inevitable distortions when cast metal frameworks for implant-supported prostheses are fabricated. However, limited data are available for the precision of fit for this method.

    PURPOSE:

    To measure and compare the precision of fit of Cresco- and computer numeric controlled (CNC)-milled metal frameworks for implant-supported fixed complete prostheses.

    MATERIALS AND METHODS:

    Two groups of frameworks were fabricated according to the Cresco method, either in titanium (Cresco-Ti, n = 10) or in a cobalt-chrome alloy (Cresco-CoCr, n = 10). A third group comprised CNC-milled titanium frameworks (Procera® Implant Bridge [PIB], Nobel Biocare AB, Göteborg, Sweden), made from individual model/pattern measurements (PIB, n = 5). Measurements of fit were performed by means of a coordinate measuring machine linked to a computer. The collected data on distortions were analyzed.

    RESULTS:

    Overall, a maximal three-dimensional range of center point distortion of 279 µm was observed for measured frameworks. The framework width (x-axis) decreased for Cresco-CoCr, but increased in Cresco-Ti and PIB; Cresco-CoCr compared to Cresco-Ti (p = .0002) and Cresco-CoCr compared to PIB (p < .0001). In vertical dimension (z-axis), less distortions were present in PIB compared to Cresco-CoCr (p = .0007) and in PIB compared to Cresco-Ti (p < .0001).

    CONCLUSIONS:

    None of the frameworks presented a perfect, completely "passive fit" to the master. Although the direction of distortions varied, the horizontal distortions were of similar magnitudes. However, the PIB frameworks had statistical significant less vertical distortions as compared to the Cresco groups.

  • 7.
    Hong, Jaan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Kurt, Seta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Clinical Immunology.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    A Hydrophilic Dental Implant Surface Exhibit Thrombogenic Properties In Vitro2013In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 15, no 1, p. 105-112Article in journal (Refereed)
    Abstract [en]

    Background:

    Surface modifications of dental implants have gained attention during several years and the thrombotic response from blood components with these materials has become more important during recent years.

    Purpose:

    The aims of this study were to evaluate the thrombogenic response of whole blood, in contact with clinically used dental surfaces, Sandblasted Large grit Acid etched titanium (SLA) and Sandblasted Large grit Acid etched, and chemically modified titanium with hydrophilic properties (SLActive).

    Methods:

    An in vitro slide chamber model, furnished with heparin, was used in which whole blood came in contact with slides of the test surfaces. After incubation (60-minute rotation at 22 rpm in a 37°C water bath), blood was mixed with ethylenediaminetetraacetic acid (EDTA) or citrate, further centrifuged at +4°C. Finally, plasma was collected pending analysis.

    Results:

    Whole blood in contact with surfaces resulted in significantly higher binding of platelets to the hydrophilic surface, accompanied by a significant increase of contact activation of the coagulation cascade. In addition, the platelet activation showed a similar pattern with a significant elevated release of β-TG from platelet granule.

    Conclusions:

    The conclusion that can be drawn from the results in our study is that the hydrophilic modification seems to augment the thrombogenic properties of titanium with implications for healing into bone of, that is titanium dental implants.

  • 8.
    Jarmar, Tobias
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Palmquist, Anders
    Branemark, Rickard
    Hermansson, Leif
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Engqvist, Håkan
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Thomsen, Peter
    Characterization of the surface properties of commercially available dental implants using scanning electron microscopy, focused ion beam, and high-resolution transmission electron microscopy2008In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 10, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    Background: Since osseointegration of the respective implant is claimed by all manufacturing companies, it is obvious that not just one specific surface profile including the chemistry controls bone apposition. Purpose: The purpose was to identify and separate out a particular set of surface features of the implant surfaces that can contribute as factors in the osseointegration process. Material and Methods: The surface properties of several commercially available dental implants were extensively studied using profilometry, scanning electron microscopy, and transmission electron microscopy. Ultrathin sections prepared with focused ion beam microscopy (FIB) provided microstructural and chemical data which have not previously been communicated. The implants were the Nobel Biocare TiUnite (R) (Nobel Biocare AB, Goteborg, Sweden), Nobel Biocare Steri-Oss HA-coated (Nobel Biocare AB, Yorba Linda, CA, USA), Astra-Tech OsseoSpeed (TM) (Astra Tech AB, Molndal, Sweden), Straumann SLA (R) (Straumann AG, Waldenburg, Switzerland), and the Branemark Integration Original Fixture implant (Branemark Integration, Goteborg, Sweden). Results: It was found that their surface properties had differences. The surfaces were covered with crystalline TiO2 (both anatase and rutile), amorphous titanium oxide, phosphorus doped amorphous titanium oxide, fluorine, titanium hydride, and hydroxyapatite, respectively. Conclusion: This indicates that the provision of osseointegration is not exclusively linked to a particular set of surface features if the implant surface character is a major factor in that process. The studied methodology provides an effective tool to also analyze the interface between implant and surrounding bone. This would be a natural next step in understanding the ultrastructure of the interface between bone and implants.

  • 9. Jemt, Torsten
    et al.
    Hjalmarsson, Lars
    The Mälar Hospital, Eskilstuna, Sweden.
    In vitro measurements of precision of fit of implant-supported frameworks: A comparison between "virtual" and "physical" assessments of fit using two different techniques of measurements2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no Suppl 1, p. e175-e182Article in journal (Refereed)
    Abstract [en]

    Background:

    Comparisons between different techniques measuring fit of implant-supported frameworks are few.

    Purpose:

    The purpose of this study was to compare data on precision of fit from two highly accurate measuring techniques and, also, to compare results using software programs for fit assessments considering both a “virtual” as well as a “physical” (i.e., more clinical) situation.

    Materials and Methods:

    Five computer numerical control-milled titanium frameworks (Procera® Implant Bridge, Nobel Biocare AB, Göteborg, Sweden) were fabricated from individual model/pattern measurements, simulating a clinical situation. Measurements of fit between frameworks and models were performed by means of a coordinate measuring machine (CMM; Zeiss Prismo Vast, Carl Zeiss Industrielle Messtechnik GmbH, Oberkochen, Germany) linked to a computer and an optical, high-resolution, three-dimensional scanner (Atos 4M SO, GOM International AG, Widen, Switzerland). Collected data on distortions between frameworks and models were analyzed and compared between the two measurement techniques. A comparison between “virtual” and “physical” fit assessments was also performed, based on data from the three-dimensional scanner.

    Results:

    When using “virtual” fit assessment programs, overall mean three-dimensional distortion between implant and framework center points in absolute figures was 37 (SD 22) and 14 µm (SD 8) for the CMM and three-dimensional scanning measurements, respectively. Corresponding mean three-dimensional distortion when using a “physical” fit assessment program in the scanner was 43 µm (SD 24) (p < 0.001). Mean horizontal (x-axis) measurements of the distance between the two terminal implants of the models and the frameworks were 33.772 and 33.834 mm for the CMM technique. Corresponding measurements for the three-dimensional scanner was 33.798 and 33.806 mm, respectively. Horizontal distances from the three-dimensional scanner were, for most measurements, greater than for the CMM measurements.

    Conclusion:

    Measurements of fit between frameworks and models may vary depending on what technique is used and how fit assessments regarding “virtual” or “physical” fit is approached.

  • 10. Lindgren, Christer
    et al.
    Mordenfeld, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    A Prospective 1-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 1, p. 41-50Article in journal (Refereed)
    Abstract [en]

    Background: The technique of using bone grafts or different biomaterials for augmentation of the maxillary sinus prior to implant placement is well accepted by clinicians. However, clinical documentation of some bone substitutes is still lacking.

    Purpose: This prospective study was designed to evaluate the success rate of implants placed after maxillary sinus augmentation with a novel synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB), the latter acting as control.

    Material and Methods: Nine edentulous patients and two partially edentulous patients with a mean age of 67 years with a bilateral need for sinus augmentation, <5 mm residual bone in the floor of the sinus and a crestal width >/=4 mm, were included in the study. After bilateral elevation of the Schneiderian membrane, all patients were randomized for augmentation with synthetic BCP in one side and DBB in the contralateral side. After 8 months of graft healing, 62 implants with an SLActive surface were placed. Implant survival, graft resorption, plaque index, bleeding on probing, sulcus bleeding index, probing pocket depth, and implant success rate were evaluated after 1 year of functional loading.

    Results: After a mean of 118 days, all patients received their fixed prosthetic constructions. One implant was lost in each biomaterial, giving an overall survival rate of 96.8%. Success rates for implants placed in BCP and DBB were 91.7 and 95.7%, respectively. No significant difference in marginal bone loss was found around implants placed in BCP, DBB, or residual bone, respectively. The mean graft resorption was 0.43 mm (BCP) and 0.29 mm (DBB).

    Conclusion: In this limited study, implant success rate was not dependent on the biomaterial used for maxillary sinus augmentation. Similar results were found after 1 year of functional loading for implants placed after sinus augmentation using BCP or DBB.

  • 11. Merheb, Joe
    et al.
    Temmerman, Andy
    Coucke, Wim
    Rasmusson, Lars
    Kübler, Alexander
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Quirynen, Marc
    Relation between Spongy Bone Density in the Maxilla and Skeletal Bone Density2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, no 6, p. 1180-1187Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Osteoporosis is a disease affecting more than 300 million people worldwide and is responsible for numerous medical complications. This study aimed to investigate the relation between skeletal and maxillary bone density.

    MATERIALS AND METHODS: Seventy-three patients were recruited and divided between group A (osteoporosis), group B (healthy, control), and group C (osteopenia) on the basis of a dual-energy x-ray absorptiomery (DXA) scan. These patients also received a CT scan on which bone density measurements were performed at five sites: maxilla midline, retromolar tuberosities, incisor, premolars, and molar regions.

    RESULTS: The bone density was lower in osteoporotic patients compared with the control patients. The bone mineral density (BMD) of the tuberosities showed the strongest correlations with the BMD of the hip and the spine (respectively, r = 0.50 and r = 0.61). The midline region showed moderate correlations with the hip (r = 0.47) and the spine (r = 0.46). For potential implant sites, the correlations with the BMD of the hip and spine were, however, small to insignificant. Based on measurements of bone density of the maxilla, it was possible to predict if the patient was osteoporotic or not with a sensitivity of 65% and a specificity of 83%.

    CONCLUSIONS: The maxillary bone density of subjects with osteoporosis is significantly lower than that of healthy patients. Moreover, there is a direct correlation between the density of the skeleton and the density of some sites of the maxilla. Using measurements of maxillary bone density in order to predict skeletal bone density might be a useful tool for the screening of osteoporosis.

  • 12.
    Merheb, Joe
    et al.
    Univ Leuven, Dept Oral Hlth Sci, Unit Periodontol, Leuven, Belgium..
    Temmerman, Andy
    Univ Leuven, Dept Oral Hlth Sci, Unit Periodontol, Leuven, Belgium..
    Rasmusson, Lars
    Univ Gothenburg, Sahlgrenska Acad, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden..
    Kubler, Alexander
    Univ Wurzburg, Dept Oral & Maxillofacial Plast Surg, Wurzburg, Germany..
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Quirynen, Marc
    Univ Leuven, Dept Oral Hlth Sci, Unit Periodontol, Leuven, Belgium.;Univ Leuven, Dept Oral Hlth Sci, Res Grp Periodontol & Oral Microbiol, Leuven, Belgium..
    Influence of Skeletal and Local Bone Density on Dental Implant Stability in Patients with Osteoporosis2016In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 18, no 2, p. 253-260Article in journal (Refereed)
    Abstract [en]

    Background and PurposeOsteoporosis is a major skeletal disease affecting millions of people worldwide. Recent studies claim that patients with osteoporosis do not have a higher risk of early implant failure compared to non-osteoporotic patients. The aim of this study was to assess the effect of skeletal osteoporosis and local bone density on initial dental implant stability. Materials and MethodsSeventy-three patients were recruited and were assigned (based on a Dual-energy X-ray Absorptiometry scan) to either the osteoporosis (Opr), osteopenia (Opn), or control (C) group. Forty nine of the 73 patients received dental implants and had implant stability measured by means of resonance frequency analysis (RFA) at implant placement and at prosthetic abutment placement. On the computerized tomography scans, the cortical thickness and the bone density (Hounsfield Units) at the sites of implant placement were measured. ResultsAt implant placement, primary stability was on average lower in group Opr (63.310.3 ISQ) than in group Opn (65.3 +/- 7.5 implant stability qutient (ISQ)), and group C (66.7 +/- 8.7 ISQ). At abutment placement, a similar trend was observed: group Opr (66.4 +/- 9.5 ISQ) scored lower than group Opn (70.7 +/- 7.8 ISQ), while the highest average was for group C (72.2 +/- 7.2 ISQ). The difference between groups Opr and C was significant. Implant length and diameter did not have a significant effect on implant stability as measured with RFA. A significant correlation was found between local bone density and implant stability for all regions of interest. ConclusionsImplant stability seems to be influenced by both local and skeletal bone densities. The lower stability scores in patient with skeletal osteoporosis reinforce the recommendations that safe protocols and longer healing times could be recommended when treating those patients with dental implants.

  • 13.
    Mordenfeld, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Albrektsson, Tomas
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    A 10-Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with an 80: 20 Mixture of Deprotenized Bovine Bone and Autogenous Bone2014In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 16, no 3, p. 435-446Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is a need for prospective, long-term follow-up studies of implants placed after maxillary sinus floor augmentation (MSFA).

    PURPOSE:

    The aim of the present study was to determine whether deprotenized bovine bone (DPBB) used for MSFA may result in long-term stability of placed dental implants.

    MATERIAL AND METHODS:

    Fourteen of the 20 patients included in the study were followed throughout the 10 years study period. These patients had 53 implants placed in 22 (6 unilateral and 8 bilateral) maxillary sinuses augmented with a mixture of 80% DPBB and 20% autogenous bone (80:20), and 15 implants placed in non-grafted sites. Clinical and radiographic examinations of the implants and grafts were performed.

    RESULTS:

    After 10 years of functional loading 15 of the initially placed 108 implants had been lost giving a cumulative survival rate of 86%. The mean marginal bone loss was 1.6 ± 1.0 mm. There were no statistically significant differences in marginal bone level, pocket depth, or ISQ-values between implants placed in residual or grafted bone or between smokers or non-smokers at 10 years follow-up. There was a statistically significant reduction (p < .01) in graft height between 3 months and 2 years but no further significant reduction up to 10 years.

    CONCLUSIONS:

    The first 2 years after placement of implants with turned surfaces placed in sites after sinus floor augmentation with DPBB and autogenous bone seem to be critical for implant survival. At 10 years follow-up, the remaining implants presented excellent clinical and radiological results regardless of smoking habits or implant sites (augmented or residual bone).

  • 14.
    Mordenfeld, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Hlth Serv, Dept Oral & Maxillofacial Surg, Gavle, Sweden.
    Aludden, Hanna
    Aalborg Univ Hosp, Dept Oral & Maxillofacial Surg, Aalborg, Denmark..
    Starch-Jensen, Thomas
    Aalborg Univ Hosp, Dept Oral & Maxillofacial Surg, Aalborg, Denmark..
    Lateral ridge augmentation with two different ratios of deproteinized bovine bone and autogenous bone: A 2-year follow-up of a randomized and controlled trial2017In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 19, no 5, p. 884-894Article in journal (Refereed)
    Abstract [en]

    Background: The optimal ratio of deproteinized bovine bone (DPBB) and autogenous bone (AB) for lateral augmentation is presently unknown.

    Purpose: To evaluate implant treatment outcome and radiological graft changes after lateral ridge augmentation with 2 different mixtures of DPBB and AB, 2 years after functional loading.

    Materials and methods: Thirteen patients were included in a split mouth, randomized, controlled trial. Four partially edentulous and 10 totally edentulous jaws with an alveolar ridge width of <4 mm were augmented with a graft mixture of 90: 10 (DPBB: AB) on one side and 60: 40 (DPBB: AB) on the contra lateral side. Graft width changes were measured on CBCT scans at different time points. Implant survival and success rates were calculated. Resonance frequency analysis and marginal bone measurements were performed after 2 years of loading.

    Results: The survival rate was 94.4% for implants installed in the 90: 10 and 100% for implants installed in the 60: 40. There were no statistically significant differences in survival rate or success rate between the mixtures. The width was 5.7 mm and 6.2 mm, respectively for the 2 groups without any significant difference between the groups after 2 years of loading. There was a significant difference in graft reduction between the groups, 54.4% (90: 10) and 37.5% (60: 40), respectively. There were no statistically significant differences in implant stability or marginal bone levels at any time points.

    Conclusions: The 2 treatment modalities may be successfully used for lateral ridge augmentation and presented good clinical results after 2 years of loading. However, long-term RCTs are required before final conclusions can be provided on this specific topic.

  • 15.
    Mordenfeld, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Dept Oral & Maxillofacial Surg, Gavle, Sweden..
    Lindgren, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Dept Oral & Maxillofacial Surg, Gavle, Sweden..
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Cty Hosp, Dept Oral & Maxillofacial Surg, Gavle, Sweden.;Umea Univ, Dept Oral & Maxillofacial Surg, Umea, Sweden..
    Sinus Floor Augmentation Using Straumann (R) BoneCeramic (TM) and Bio-Oss (R) in a Split Mouth Design and Later Placement of Implants: A 5-Year Report from a Longitudinal Study2016In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 18, no 5, p. 926-936Article in journal (Refereed)
    Abstract [en]

    Background: Straumann (R) BoneCeramic (TM) is a synthetic biphasic calcium phosphate (BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. Purpose: The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio-Oss (R) (DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Materials and Methods: Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. Results: After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 +/- 1.2 mm) and DBB (1.0 +/- 0.7 mm). Graft height reduction (GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. Conclusion: In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal.

  • 16. Rasmusson, Lars
    et al.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Stability Evaluation of Implants Integrated in Grafted and Nongrafted Maxillary Bone: a Clinical Study from Implant Placement to Abutment Connection2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 1, p. 61-66Article in journal (Refereed)
    Abstract [en]

    Background: Clinical studies have shown a higher degree of implant failures in grafted bone compared with normal nongrafted maxillary bone. Additionally, a prolonged time for integration of titanium implants in grafted block bone has been shown by means of resonance frequency analysis (RFA).

    Purpose: The aim of this prospective study was to compare the stability of implants placed in particulate bone, onlay block bone, interpositional bone, and nongrafted maxillary bone during the early phase of osseointegration using RFA and implant failure. Material and

    Methods: Thirty-five patients with edentulism in the maxilla were included in the study. In all, 260 Astra Tech TiOblast™ implants (Astra Tech AB, Mölndal, Sweden) were installed. Twenty-five of these patients had severe maxillary atrophy and were treated with iliac bone grafts 5 to 6 months prior to implant placement, 19 with lateral onlay block grafts on one side (group A, 38 implants) and particulate bone for lateral augmentation on the other (group B, 38 implants). These 19 patients also got bilateral sinus floor augmentation with particulate bone (group C, 76 implants). Six patients had an unfavorable sagittal relation between the jaws and underwent a LeFort I operation with interpositional bone blocks grafted to the nasal and sinus floors (group D, 48 implants). The remaining 10 patients could be treated with implants without bone augmentation and served as control (group E, 60 implants). RFA was performed at implant placement and abutment connection 6 months later and an implant stability quotient (ISQ) value was given for each implant.

    Results: Four implants (1.5%) were found mobile at abutment connection and removed (two in group A and two in group D). RFA showed a slight increase in stability from installation to abutment connection but the differences were not statistically significant in any of the groups (Wilcoxon signed rank test for comparison of paired data). Implants installed in group D had a significantly lower ISQ value at both measurements compared with the other groups (Wilcoxon Rank Sum test for comparisons of independent samples, p = .05).

    Conclusion: It is concluded that TiO(2) -blasted implants placed in nongrafted and grafted maxillary bone using a two-staged protocol show similar stability during the early phase of osseointegration. Patients reconstructed with interpositional bone graft after a LeFort I osteotomy showed lower implant stability values than nongrafted patients and other grafting techniques.

  • 17.
    Riben, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Follow-Up of the Sinus Membrane Elevation Technique for Maxillary Sinus Implants without the Use of Graft Material2016In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 18, no 5, p. 895-905Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a limited amount of studies evaluating long-term results of the sinus membrane elevation technique for bone formation around implants in the maxillary sinus floor without the use of bone graft material.

    PURPOSE: To investigate the long-term results of this technique with regard to implant survival and bone gain in the maxillary sinus floor.

    MATERIALS AND METHODS: A retrospective study was conducted on patients who had undergone the surgical procedure from November 2001 to August 2008. Thirty-six patients with a total of 87 implants (ASTRA TECH Implant System™) in 53 sinuses were examined. After a submerged healing period of 6 months and at least 12 months of loading, the patients were examined clinically and radiologically. Implant stability was measured using resonance frequency analysis (RFA).

    RESULTS: The mean follow-up time was 4.6 years (range 1.5-7 years). Five implants were lost giving a survival rate of 94.3%.Subantral preoperative vertical bone levels were in the range of 1 to 10 mm. The average bone gain at the sinus floor was 6 mm. The 55 fixtures eligible for RFA displayed a mean implant stability quotient of 77 (range 56-85.5).

    CONCLUSION: The present study illustrates the long-term reliability of the technique.

  • 18.
    Sarve, Hamid
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Friberg, Bertil
    Brånemark Clinic.
    Borgefors, Gunilla
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Johansson, Carina B.
    University of Gothenburg, Department of Prosthodontics/Dental Materials Science, Institute of Odontology.
    Introducing a novel analysis technique for osseointegrated dental implants retrieved 29 years postsurgery2013In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 15, no 4, p. 538-549Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate osseointegration of oral implants, which were retrieved from a patient after 29 years in situ, we use novel three-dimensional analysis methods and visualization techniques that supplement conventional two-dimensional analysis. Materials and Methods: The sample processing involved nondecalcification and embedment in resin. Conventional two-dimensional histomorphometrical methods were conducted. Additionally, the quantification was extended to three-dimensional by using synchrotron radiation micro-computed tomography (SRmCT) technique and two relevant visualization methods for the three-dimensional data were introduced. Results: The three-dimensional results involved three-dimensional quantification and visualization of two implant samples with methods beyond state-of-the-art. Traditional two-dimensional histomorphometrical results revealed a mean bone-implant contact (BIC) of about 50%. In most samples, bone area (BA) was lower inside the treads compared with out-folded mirror images, which were confirmed by the three-dimensional quantification. The BIC along four selected regions showed highest percentages in the bottom/valley region and lowest in the thread-peak region. Qualitative observations revealed ongoing bone remodeling areas in all samples. The apical hole demonstrated high osseointegration. Conclusion: The novel techniques including an animation and an out-folding of BIC and BA enabled a simultaneous visualization of the three-dimensional material obtained from SRmCT data. However, the two-dimensional histological sections were needed for qualitative and quantitative evaluation of osseointegration and, thus, both methods are considered equally important.

  • 19.
    Thor, Andreas Li
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hong, Jaan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Kjeller, Göran
    Sennerby, Lars
    Rasmusson, Lars
    Correlation of Platelet Growth Factor Release in Jawbone Defect Repair: A Study in the Dog Mandible2013In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 15, no 5, p. 759-768Article in journal (Refereed)
    Abstract [en]

    Background:

    Platelet concentrate/platelet-rich plasma (PRP) has been studied extensively in various experimental models and there is some agreement among workers to its early effect in bone regeneration and healing. We have earlier showed in vitro that titanium in whole blood activates the thrombogenic response to a higher degree than PRP and that a fluoridated test surface augmented the effect compared with control.

    Purpose:

    We designed this study to evaluate the effect of PRP and whole blood on bone regeneration in a dog implant defect model and, in addition, the effect of a test surface modified in hydrofluoric acid. A correlation attempt between platelet count, release of growth factors, and bone regeneration was made.

    Materials and Methods:

    Six dogs were used and simultaneously with the experimental surgery and implant installation, autologous PRP was prepared. Defects were prepared (6 mm in diameter and 5 mm deep), and implants were installed (TiO2 gritblasted and hydrofluoric acid treated [test] or TiO2 gritblasted [control], 5 mm in diameter and 9 mm long) in defects filled with either PRP or whole blood. Randomization of sides between PRP and whole blood, and sites for test and control implants were made. Blood samples were collected from PRP and whole blood. The dogs were killed after 5 weeks of healing, and samples with implants and surrounding bone were collected and processed for analysis. Enzyme linked immunosorbent assays were used for detection of growth factors in PRP.

    Results:

    The mean increase of platelet count was 424% in PRP. A correlation for platelet counts and transforming growth factor β was found in each dog (r2 = 0.857). Approximately 50% of the region of interest (ROI) in the defects was filled with new bone after 5 weeks. No difference could be observed in ROI by using PRP or whole blood in the defects regarding new bone formation, bone in contact with implant, or distance to first bone contact. However, the fluoridated implants exhibited more new bone formation (p = .03) compared with control, regardless of comparing PRP or whole blood, and also displayed a shorter distance from first bone contact to the margin of the bone envelope (p = .05).

    Conclusions:

    Platelet concentrate/PRP failed to show more new bone regeneration in a peri-implant defect model compared with whole blood. Implants treated with hydrofluoric acid displayed higher percentages of bone fill in the defect.

  • 20.
    Trbakovic, Amela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Bongenhielm, Ulf
    Uppsala & Västerås Käkkirurgiska Ctr, Vaksalagatan 8, S-75320 Uppsala, Sweden.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    A clinical and radiological long-term follow-up study of narrow diameter implants in the aesthetic area2018In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 20, no 4, p. 598-605Article in journal (Refereed)
    Abstract [en]

    Purpose

    To study long-term function of narrow diameter implants (NDI:s) and if reduced implant-tooth distance negatively impacts adjacent teeth.

    Materials and Methods

    A clinical and radiological follow-up of NDI:s replacing maxillary laterals and mandibular incisors was performed. Subjects that received 3.0-3.3 mm-diameter single implants from 3 units in Uppsala and Vasteras, Sweden, between 2002 and 2011 were offered to participate in this retrospective study.

    Results

    Twenty-seven patients (30 implants) underwent clinical and CBCT examination, mean follow-up time was 63.3 months. On average, the implant-tooth distance was 1.6 mm at the cervical region and 17 implants were placed 1 mm or less to the adjacent root. Additionally, 2 patients (3 implants) underwent clinical examination (I). Twenty-seven patients (36 implants) declined the examination but agreed to an interview (II). At the time of the follow-up, all implants had good function, and implant survival of group I and II together was 97.2%. In both groups, the 2 main patient concerns were discoloration and regression of the buccal gingiva.

    Conclusion

    Survival of implants is in accordance to standard diameter studies and although most implants were placed very close to the adjacent teeth, no pathologies could be linked to this except aesthetic concerns.

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