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  • 1.
    Aresdahl, Alexander
    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, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Lindell, Björn
    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, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Dukic, Milena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Congenital granular cell epulis: a case report2015In: Oral and Maxillofacial Surgery Cases, ISSN 2214-5419, Vol. 1, no 1, 8-11 p.Article in journal (Refereed)
    Abstract [en]

    Congenital granular cell epulis (CGCE) is an uncommon benign lesion found in newborns. It has predominance for females with an 8:1 ratio in relation to males and is exclusively encountered in the oral cavity. The most affected oral site is located around the canine/incisor region of the maxillary alveolar ridge, where the lesion arises from the soft tissue as a solitary pedunculated mass. CGCE's histogenesis remains obscure and controversial. We present a rare case of 2 separate CGCE lesions adjacent to each other measuring 23 × 18 × 10 and 15 × 10 mm, positioned facially on the right maxillary alveolar process. The patient, a 2-day-old female newborn, did not experience any serious difficulty regarding breathing or deglutition. Complete surgical excision was the treatment of choice in this case, and the procedure was performed under both general and local anesthesia. Histologic and immunohistochemical analysis confirmed the diagnosis of CGCE. The patient showed satisfactory postoperative healing and excellent health at both the 10-day recall appointment and the 6-month follow-up.

  • 2.
    Blomstrand, Lena
    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.
    Hagberg, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Erdheim-Chester disease presenting as periodontal disease: Experience of treatment with cladribine, interferon-a, local radiotherapy and anakinra2016In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 2, 248-250 p.Article in journal (Refereed)
  • 3.
    Chrcanovic, Bruno Ramos
    et al.
    Malmo Univ, Fac Odontol, Dept Prosthodont, Carl Gustafs Vag 34, SE-20506 Malmo, Sweden.
    Nilsson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Zealand Univ Hosp, Dept Oral & Maxillofacial Surg, Koge, Denmark.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Survival and complications of implants to support craniofacial prosthesis: A systematic review2016In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 44, no 10, 1536-1552 p.Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the survival rate of craniofacial implants (CIs) to support facial prosthesis/epithesis and the prevalence of surgical/biological complications based on previously published studies.

    METHODS: An electronic search was undertaken in March/2016. Only studies with a minimum of 5 patients were included. Untransformed proportions of implant failures for different regions were calculated. A meta-analysis evaluated the influence of radiotherapy on the failure rates. A meta-regression was performed considering the follow-up period as covariate.

    RESULTS: Seventy publications included 2355 patients and 8184 CIs (545 failures). The probability of a failure was 5.5% for all CIs (95%CI 4.5-6.5, P < 0.001), 1.2% for CIs in the auricular region (95%CI 0.8-1.5, P < 0.001), 12.2% for the nasal region (95%CI 9.0-15.5, P = 0.017), and 12.1% for the orbital region (95%CI 9.3-15.0, P < 0.001). Radiotherapy statistically affected the CIs rates (OR 5.80, 95%CI 3.77-8.92, P < 0.00001). There was no statistically significant influence of the follow-up time on the proportion of implant failures (P = 0.814). Soft tissue adverse reactions were the most common complications.

    CONCLUSIONS: Implants placed in the auricular region have a lower probability of failure than those in the nasal and orbital regions. Soft tissue adverse reactions were the most common complications. Radiotherapy significantly affected the CIs failure rates.

  • 4. Dasmah, Amir
    et al.
    Kashani, Hossein
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Integration of fluoridated implants in onlay autogenous bone grafts: An experimental study in the rabbit tibia2014In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 42, no 6, 796-800 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Bone augmentation before treatment with endosseous implants is a common procedure for rehabilitation of the edentulous jaw. Both machined and surface modified implants have been used in one-stage and two-stage surgery protocols with varying results and survival rates. The influence of surface modification on the integration of implants has been documented in both non-grafted and grafted bone. The aim of this study was to compare the integration and stability of surface modified fluoridated vs. machined implants when placed simultaneously with an onlay bone graft. Material and methods: Eight rabbits were used in this study. A disc shaped bone graft was harvested from each side of the sagittal suture of the calvarial bone and fixed bi-cortically to the proximal tibial metaphysis by means of a dental implant, 9 mm long and 3.5 mm in diameter with a smooth machined surface as control and a blasted, fluoridated surface as test. Test and control sides were randomised. After a healing time of 8 weeks, the rabbits were sacrificed and the implants were removed en block 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) in the grafted area. Resonance frequency analysis (RFA) was conducted both at the time of surgery and at the end of the study. Results: Our results showed statistically significant differences in BIC within the grafted area and the total bone to implant contact between the test and control sides in favour of the surface modified implants. The bone area filling the threads within a region of interest showed no statistically significant difference between the test and control sides. RFA showed higher implant stability with significant differences at the time of sacrifice in favour of the fluoridated implants. Conclusion: Surface modified fluoridated implants showed a higher degree of osseointegration and stability in onlay bone grafts compared with control implants with machined surface texture.  

  • 5. 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, 395-401 p.Article 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.

  • 6. 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, 7-14 p.Article 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.

  • 7. 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
    Particulate vs. block bone grafts: Three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up2012In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 40, no 8, 654-659 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Extensive alveolar bone resorption in the maxilla limits the possibility of successful placement and osseointegration of endosseous implants for future prosthetic rehabilitation. Autogenous bone from the iliac crest may be used as lateral onlays in the atrophic maxilla, both as block and particulate bone. To our knowledge, there is no three-dimensional 2-year follow-up study measuring the volumetric reduction of the augmented areas comparing particulate and block bone grafts.

    PURPOSE:

    The aim of this study was to conduct a radiographic 2-year follow-up study, using computed tomographic (CT) images in order to evaluate and compare the extent of bone graft resorption in the frontal maxillae augmented by particulate (test) and block bone (control).

    MATERIAL AND METHODS:

    Eleven patients treated with iliac bone grafts and oral implants in the maxilla were followed with CT examinations directly post grafting and after 2years.

    RESULT:

    The volumetric changes after 6months were extensive. Additionally, the changes in particulate bone tended to be larger after 2years compared to block bone, using this protocol. However, the difference was not statistically significant.

    CONCLUSION:

    The present follow-up study showed that there is radiographically complete integration and embedding of implants installed in grafted bone despite extensive initial graft resorption. There was no significant difference in the amount of volumetric reduction between particulate bone and block bone grafts.

  • 8. Dérand, Per
    et al.
    Warfvinge, Gunnar
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Glomangioma: a case presentation2010In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 68, no 1, 204-207 p.Article in journal (Refereed)
  • 9. Erkapers, Maria
    et al.
    Ekstrand, Karl
    Baer, Russell A.
    Toljanic, Joseph A.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Patient satisfaction following dental implant treatment with immediate loading in the edentulous atrophic maxilla2011In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 26, no 2, 356-364 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: The present study evaluated patient satisfaction using the Oral Health Impact Profile 49 (OHIP-49) questionnaire for patients who received six implants in the severely resorbed maxilla and an implant-supported prosthesis that was delivered within 24 hours after surgery. Materials and Methods: Fifty-one edentulous patients with severe atrophy in the maxilla were included in the study, which was performed at two centers. Six implants were placed in the maxilla and loaded within 24 hours with a provisional restoration. The definitive restorations were delivered 20 to 24 weeks later. Patients were asked to complete the OHIP-49 questionnaire (which includes seven domains representing functional limitation, physical pain, psychologic discomfort, physical disability, psychologic disability, social disability, and handicap) prior to implant placement and on three subsequent occasions. The data were collected and analyzed and OHIP scores were compared over time. Results: Baseline satisfaction scores for the two different centers displayed no statistically significant differences. Treatment resulted in improved total OHIP-49 scores in both centers, with no significant difference between centers. Furthermore, no significant differences were observed in any of the individual pretreatment and posttreatment OHIP-49 domains between centers. All seven domains showed a statistically significant improvement posttreatment. Of the seven domains, social disability and handicap showed the least improvement and had the lowest pretreatment scores, indicating lower significance for these domains compared to the other domains during implant treatment. This study also indicated that domains one to five (functional limitation, physical pain, psychologic discomfort, physical disability, and psychologic disability) are the most important domains in patient satisfaction with implant therapy. Conclusion: Measurement with the OHIP-49 questionnaire displayed that patient satisfaction increases after treatment with a fixed restoration on implants loaded within 24 hours.

  • 10. Hammarfjord, Oscar
    et al.
    Roslund, Johan
    Abrahamsson, Peter
    Nilsson, Peter
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Magnusson, Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Kjeller, Goran
    Englesson-Sahlstrom, Charlotta
    Strandkvist, Tomas
    Warfvinge, Gunnar
    Kruger-Weiner, Carina
    Surgical treatment of recurring ameloblastoma, are there options?2013In: British Journal of Oral & Maxillofacial Surgery, ISSN 0266-4356, E-ISSN 1532-1940, Vol. 51, no 8, 762-766 p.Article in journal (Refereed)
    Abstract [en]

    Our aim was to evaluate the treatment given to patients with intraosseus ameloblastomas with special emphasis on recurrence and the outcomes of primary and secondary resection. Forty-eight patients who were treated for intraosseous ameloblastoma at 8 centres across Sweden met the inclusion criteria. They showed typical distribution of age, sex, site of lesion, and characteristic presenting features. Eleven of the 48 were initially treated with radical resection and none recurred. Twenty-two of the remaining 37 who were initially treated by conservative resection presented with recurrences. Sixteen of the 22 then had conservative secondary resections, which resulted in further recurrence in 6 patients. Initial radical resection is therefore superior to conservative management as far as recurrences are concerned. We argue, however, that a conservative surgical approach is adequate for many intraosseous ameloblastomas with limited extension, because relapse can be followed by radical resection if clinically indicated in selected cases.

  • 11.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reiser, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Skoog, Valdemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth2017In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 139, no 1, 137-148 p.Article in journal (Refereed)
    Abstract [en]

    Background: Clefts involving the alveolus are treated using one of two strategies: primary periosteoplasty at the time of lip repair or secondary alveolar bone grafting at mixed dentition. Most teams favor secondary alveolar bone grafting because of its high success rate, and concerns have been raised that primary periosteoplasty may interfere with maxillary growth. However, primary periosteoplasty may obviate the need for future bone grafting and is still practiced in some centers. Few studies compare the long-term outcomes of these two strategies.

    Methods: Fifty-seven consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. All patients underwent primary lip repair using Skoog's method; 28 patients underwent primary periosteoplasty at the time of lip repair and the remaining 29 underwent secondary alveolar bone grafting at mixed dentition. Occlusal radiographs obtained at ages 10 and 16 years were analyzed for alveolar bone height. Cephalometric analysis assessed growth at ages 5, 10, and 18 years.

    Results: Seventeen of 28 patients treated using primary periosteoplasty required later secondary bone grafting, and the bone height at age 16 years was lower in the primary periosteoplasty group (p < 0.0001). There was a more pronounced decrease in maxillary protrusion from ages 5 to 10 years in the primary periosteoplasty group (p < 0.03). However, at age 18 there was no significant difference in maxillary growth between the two groups.

    Conclusion: Primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.

  • 12.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reiser, Erika
    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.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Correlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 1, 33-37 p.Article in journal (Refereed)
    Abstract [en]

    Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting. Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up. Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up. Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning.

  • 13. Leiggener, C.
    et al.
    Messo, Elias
    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.
    Zeilhofer, H-F.
    Hirsch, J-M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps2009In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 38, no 2, 187-192 p.Article in journal (Refereed)
    Abstract [en]

    The free fibular flap is the standard procedure for reconstructing mandibular defects. The graft has to be contoured to fit the defect so preoperative planning is required. The systems used previously do not allow transfer of the surgical plan to the operation room in an optimal way. The authors present a method to bring the virtual plan to real time surgery using a rapid prototyping guide. Planning was conducted using the Surgicase CMF software simulating surgery on a workstation. The osteotomies were translated into a rapid prototyping guide, sterilised and applied during surgery on the fibula allowing for the osteotomies and osteosynthesis to be performed with intact circulation. During reconstruction the authors were able to choose the best site for the osteotomies regarding circulation and as a result increased the precision and speed of treatment.

  • 14.
    Lindell, Björn
    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.
    A Case of Glenoid Fossa Fracture, Progressive Ankylosis, Total Joint Reconstruction with Alloplastic Prosthesis to Normalized Function Including Evaluation with F18-PET/CT-a Four Year Follow-up2017In: Craniomaxillofacial Trauma & Reconstruction, ISSN 1943-3875, E-ISSN 1943-3883, Vol. 10, no 1, 60-65 p.Article in journal (Refereed)
    Abstract [en]

    Temporomandibular joint replacement (TJR) with alloplastic prosthesis has shown promising long-term results in end stage joint disorders. We present a case of young woman with painful ankylosis that where reconstructed with TJR, due to a complex mandibular fracture with dislocation of the left condyle into the middle cranial fossa two years earlier. At the age of 18 the subject underwent a total joint replacement with custom-made alloplastic TMJ prosthesis. To determine the bone response and remodeling activity around the prosthesis, a F18 PET/CT-scan was used. No sign of increased remodeling or pathology were seen in the imaging after the reconstruction. Four years postoperatively the subject reports no pain and excellent jaw function.

  • 15. 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, 1180-1187 p.Article 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.

  • 16.
    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, 253-260 p.Article 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.

  • 17.
    Nilsson, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. AO Research Institute Davos, Davos, Switzerland.; Zealand University Hospital, Køge, Denmark.
    Richards, Robert Geoff
    AO Research Institute Davos, Davos, Switzerland.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Kamer, Lukas
    AO Research Institute Davos, Davos, Switzerland.
    Virtual bite registration using intraoral digital scanning, CT and CBCT: In vitro evaluation of a new method and its implication for orthognathic surgery2016In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 44, no 9, 1194-1200 p.Article in journal (Refereed)
    Abstract [en]

    Three-dimensional (3D) computer-assisted planning requires detailed visualisation of the craniomaxillofacial region and interocclusal relationship. The aim of this study was to establish and evaluate a method to create a 3D model of the craniomaxillofacial region and to adopt intraoral digital scanning to place the lower jaw into a centric relation (CR) without the need of additional plaster casts and model surgery. A standard plastic skull modified by metallic dental wires and brackets was subjected to computed tomography (CT), cone beam computed tomography (CBCT), and intraoral digital scanning. We evaluated two different virtual bite registrations, a digital scan of the buccal dental surfaces and scanning of the wax bites to position the lower jaw into a CR, and assessed the accuracy of the integration of intraoral scanning to the CT/CBCT scans. The mean registration error of corresponding mesh points for the CT and intraoral scanned images was 0.15 ± 0.12 mm, while this error was 0.18 ± 0.13 mm for the CBCT and intraoral scanned images. The mean accuracy of the two virtual bite registrations ranged from 0.41 to 0.49 mm (buccal scan technique) and from 0.65 to 1.3 mm (virtualised wax bite technique). A method for virtual bite registration was developed. It has the potential to eliminate plaster casts and model surgery and may facilitate 3D computer-assisted planning of orthognathic surgery cases.

  • 18.
    Nilsson, Johanna
    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.
    Kamer, L.
    Development of workflow for recording virtual bite in the planning of orthognathic operations2015In: British Journal of Oral & Maxillofacial Surgery, ISSN 0266-4356, E-ISSN 1532-1940, Vol. 53, no 4, 384-386 p.Article in journal (Refereed)
  • 19.
    Nysjö, Johan
    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.
    Nilsson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Malmberg, Filip
    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.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Nyström, Ingela
    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.
    Rapid and Precise Orbit Segmentation through Interactive 3D PaintingManuscript (preprint) (Other academic)
    Abstract [en]

    In this paper, we present an efficient interactive tool for segmenting and measuring the volume of the bony orbit (eye-socket) in computed tomography (CT) images. The tool implements a 3D painting interface that allows the user to quickly segment or "paint" the fat and soft-tissue content of the orbit by sweeping a volumetric brush over the image. The brush modifies and updates the segmentation result in real-time and takes distance and gradient information into account to fill out and find the exact boundaries of the orbit. A smooth and consistent delineation of the anterior boundary is obtained by fitting a thin-plate spline to user-selected landmarks. We evaluate the tool on 10 CT images of intact and fractured orbits and show that it achieves high intra- and inter-operator precision (mean spatial overlap 95%, less than 1 ml volume variability) and produces segmentation results that are similar to manually corrected reference segmentations, but only requires a few minutes of interaction time.

  • 20.
    Nyström, Ingela
    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.
    Nysjö, Johan
    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.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Malmberg, Filip
    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.
    BoneSplit – A 3D painting tool for interactive bone segmentation in CT images2017In: Pattern Recognition and Information Processing: PRIP 2016, Springer, 2017, 3-13 p.Conference paper (Refereed)
  • 21.
    Olsson, Pontus
    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.
    Nysjö, Fredrik
    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.
    Rodríguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Carlbom, Ingrid B.
    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.
    Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps2015In: Plastic and Reconstructive Surgery - Global Open, ISSN 2169-7574, Vol. 3, no 8, e479Article in journal (Refereed)
    Abstract [en]

    Background: Virtual surgery planning has proven useful for reconstructing head and neck defects by fibula osteocutaneous free flaps (FOFF). Benefits include improved healing, function, and aesthetics, as well as cost savings. But available virtual surgery planning systems incorporating fibula in craniomaxillofacial reconstruction simulate only bone reconstruction without considering vessels and soft tissue.

    Methods: The Haptics-Assisted Surgery Planning (HASP) system incorporates bone, vessels, and soft tissue of the FOFF in craniomaxillofacial defect reconstruction. Two surgeons tested HASP on 4 cases they had previously operated on: 3 with composite mandibular defects and 1 with a composite cervical spine defect. With the HASP stereographics and haptic feedback, using patient-specific computed tomography angiogram data, the surgeons planned the 4 cases, including bone resection, fibula design, recipient vessels selection, pedicle and perforator location selection, and skin paddle configuration.

    Results: Some problems encountered during the actual surgery could have been avoided as they became evident with HASP. In one case, the fibula reconstruction was incomplete because the fibula had to be reversed and thus did not reach the temporal fossa. In another case, the fibula had to be rotated 180 degrees to correct the plate and screw placement in relation to the perforator. In the spinal case, difficulty in finding the optimal fibula shape and position required extra ischemia time.

    Conclusions: The surgeons found HASP to be an efficient planning tool for FOFF reconstructions. The testing of alternative reconstructions to arrive at an optimal FOFF solution preoperatively potentially improves patient function and aesthetics and reduces operating room time.

  • 22.
    Olsson, Pontus
    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.
    Nysjö, Fredrik
    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.
    Singh, Neeru
    Thor, Andreas
    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, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Carlbom, Ingrid
    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.
    Visuohaptic bone saw simulator: Combining vibrotactile and kinesthetic feedback2015In: Proc. 8th ACM SIGGRAPH Asia Technical Briefs, New York: ACM Press, 2015, 10:1-4 p.Conference paper (Refereed)
  • 23. Palma, Guillermo
    et al.
    Vidal, Maria-Esther
    Haag, Eric
    Raschid, Louiqa
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Determining similarity of scientific entities in annotation datasets.2015In: Database: The Journal of Biological Databases and Curation, ISSN 1758-0463, E-ISSN 1758-0463, Vol. 2015Article in journal (Refereed)
    Abstract [en]

    Linked Open Data initiatives have made available a diversity of scientific collections where scientists have annotated entities in the datasets with controlled vocabulary terms from ontologies. Annotations encode scientific knowledge, which is captured in annotation datasets. Determining relatedness between annotated entities becomes a building block for pattern mining, e.g. identifying drug-drug relationships may depend on the similarity of the targets that interact with each drug. A diversity of similarity measures has been proposed in the literature to compute relatedness between a pair of entities. Each measure exploits some knowledge including the name, function, relationships with other entities, taxonomic neighborhood and semantic knowledge. We propose a novel general-purpose annotation similarity measure called 'AnnSim' that measures the relatedness between two entities based on the similarity of their annotations. We model AnnSim as a 1-1 maximum weight bipartite match and exploit properties of existing solvers to provide an efficient solution. We empirically study the performance of AnnSim on real-world datasets of drugs and disease associations from clinical trials and relationships between drugs and (genomic) targets. Using baselines that include a variety of measures, we identify where AnnSim can provide a deeper understanding of the semantics underlying the relatedness of a pair of entities or where it could lead to predicting new links or identifying potential novel patterns. Although AnnSim does not exploit knowledge or properties of a particular domain, its performance compares well with a variety of state-of-the-art domain-specific measures. Database URL: http://www.yeastgenome.org/

  • 24. 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, 61-66 p.Article 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.

  • 25.
    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, 895-905 p.Article 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.

  • 26.
    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.
    The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts - A Review of a Surgical Technique2012In: International journal of dentistry, ISSN 1687-8736, Vol. 2012, 105483- p.Article in journal (Refereed)
    Abstract [en]

    Background

    Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation.

    Aim

    To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique.

    Methods

    The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles.

    Results

    A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies.

    Conclusion

    All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed.

  • 27.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rydevik Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Gudjonsson, Olafur
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Marklund, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Ekberg, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect2014In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 34, no 4, 314-318 p.Article in journal (Refereed)
    Abstract [en]

    When reconstructing combined defects of the cervical spine and the posterior pharyngeal wall the goals are bone stability along with continuity of the aerodigestive tract. We present a case of a patient with a cervical spine defect, including C1 to C3, associated with a posterior pharyngeal wall defect after excision of a chordoma and postoperative radiotherapy. The situation was successfully solved with a free fibula osteo-adipofascial flap. The reconstruction with a fibula osteo-adipofascial flap provided several benefits in comparison with a fibula osteo-cutaneous flap in our case, including an easier insetting of the soft tissue component at the pharyngeal level and less bulkiness of the flap allowing our patient to resume normal deglutition.

  • 28. Smektala, Tomasz
    et al.
    Nysjö, Johan
    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.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Homik, Aleksandra
    Sporniak-Tutak, Katarzyna
    Safranow, Krzysztof
    Dowgierd, Krzysztof
    Olszewski, Raphael
    Three-Dimensional Eyeball and Orbit Volume Modification After LeFort III Midface Distraction2015In: The Journal of craniofacial surgery (Print), ISSN 1049-2275, E-ISSN 1536-3732, Vol. 26, no 5, 1652-1655 p.Article in journal (Refereed)
    Abstract [en]

    The aim of our study was to evaluate orbital volume modification with LeFort III midface distraction in patients with craniosynostosis and its influence on eyeball volume and axial diameter modification. Orbital volume was assessed by the semiautomatic segmentation method based on deformable surface models and on 3-dimensional (3D) interaction with haptics. The eyeball volumes and diameters were automatically calculated after manual segmentation of computed tomographic scans with 3D slicer software. The mean, minimal, and maximal differences as well as the standard deviation and intraclass correlation coefficient (ICC) for intraobserver and interobserver measurements reliability were calculated. The Wilcoxon signed rank test was used to compare measured values before and after surgery. P < 0.05 was considered statistically significant. Intraobserver and interobserver ICC for haptic-aided semiautomatic orbital volume measurements were 0.98 and 0.99, respectively. The intraobserver and interobserver ICC values for manual segmentation of the eyeball volume were 0.87 and 0.86, respectively. The orbital volume increased significantly after surgery: 30.32% (mean, 5.96  mL) for the left orbit and 31.04% (mean, 6.31  mL) for the right orbit. The mean increase in eyeball volume was 12.3%. The mean increases in the eyeball axial dimensions were 7.3%, 9.3%, and 4.4% for the X-, Y-, and Z-axes, respectively. The Wilcoxon signed rank test showed that preoperative and postoperative eyeball volumes, as well as the diameters along the X- and Y-axes, were statistically significant. Midface distraction in patients with syndromic craniostenosis results in a significant increase (P < 0.05) in the orbit and eyeball volumes. The 2 methods (haptic-aided semiautomatic segmentation and manual 3D slicer segmentation) are reproducible techniques for orbit and eyeball volume measurements.

  • 29. Stefanski, Sebastian
    et al.
    Svensson, Börje
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Implant survival following sinus membrane elevation without grafting and immediate implant installation with a one-stage technique: an up-to-40-month evaluation2016In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Various augmentation procedures involving the maxillary sinus, using bone substitutes or bone, have been used to enhance bone support for dental implants. The aim of this study was to retrospectively evaluate the status of implants in patients who had undergone a maxillary sinus lift and immediate implant placement without the addition of graft material.

    MATERIALS AND METHODS:

    Nineteen patients who had required bone augmentation of their maxillary sinus floor were evaluated in this study. After a bone window in the lateral wall of the sinus has been prepared and the Schneiderian membrane had been carefully elevated, dental implants were inserted in the residual bone, creating a membrane elevation. Resorbable collagenous membrane was used to seal the lateral access window of the maxillary sinus after implant placement. Clinical and radiological follow-up was carried out up to 40 months after implant installation.

    RESULTS:

    A total of 28 implants in lengths of 10 and 12 mm were placed in a one-stage healing protocol, with an average residual bone height of 5.25 mm (SD = 1.48). All implants remained stable, with a survival rate of 100%. An increase in mean bone height of 4.75 mm (SD = 1.13) was gained. The marginal bone levels relative to the coronal aspect of the implant shoulder exhibited a mean change of 1.01 mm (SD = 0.49) from the baseline. Of the 19 patients, none showed a plaque index or gingival index greater than 2, and 14 patients showed no presence of plaque.

    CONCLUSION:

    The findings of the study regarding the immediate placement of implants without the use of bone grafts or other bone substitute materials demonstrate a successful approach for new bone formation around implants in the posterior part of the maxilla, when the preoperative height of the subantral bone is moderate and enough to achieve primary stability.

  • 30. Stenport, Victoria Franke
    et al.
    Ortorp, Anders
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Onlay and inlay bone grafts with platelet-rich plasma: histologic evaluations from human biopsies2011In: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 69, no 4, 1079-1085 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to histomorphometrically evaluate biopsies from 1) sinus inlay bone grafts prepared with or without platelet-rich plasma (PRP) and 2) onlay bone grafts in the anterior maxilla with particulate bone and PRP or block bone without PRP after 3 months. Materials and Methods Biopsies were retrieved with a trephine drill, and samples were processed in laboratories to result in nondecalcified cut and ground sections. Light microscopic measurements of total bone area, new bone, number of vessels, and vessel area were performed at 3 regions in each sample. Calculations of ratios of new bone to total bone and vessel area to total area were performed. Results There was a tendency toward higher mean values for total bone area percentage and area of newly formed bone in the PRP-treated inlay biopsies. However, there was no measurable effect on vessel formation in the PRP-treated inlay samples compared with untreated inlay samples. Particulate and PRP-treated onlay bone biopsies showed higher mean values in all measured parameters compared with block bone samples; however, no differences were statistically significant. Conclusion PRP treatment may favor bone formation in grafted bone, and further research is needed to describe the outcome of PRP treatment and grafting techniques in the maxilla.

  • 31. Temmerman, Andy
    et al.
    Rasmusson, Lars
    Kübler, Alexander
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Quirynen, Marc
    An open, prospective, non-randomized, controlled, multicentre study to evaluate the clinical outcome of implant treatment in women over 60 years of age with osteoporosis/osteopenia: 1-year results2017In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, no 1, 95-102 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Osteoporosis has been called a potential risk factor for bone healing around implants.

    AIM:

    The aim of this multicentre study was to verify the clinical performance of fluoridated implants in the maxilla of subjects with diagnosed systemic primary osteoporosis/osteopenia.

    MATERIAL AND METHODS:

    Postmenopausal women in need of 2-8 splinted implants in maxilla underwent bone mineral density measurements in the hip and spine, using dual-energy X-ray absorptiometry scans. Based on their T-scores, they were divided into two study groups: Group O (osteoporosis/osteopenia group) subjects had a T-score ≤-2, Group C (control group) had a T-score of ≥-1, and subjects with a T-score <-1 but >-2 were excluded. Implants were placed with a two-stage procedure and loaded 4-8 weeks after abutment surgery. At 6 months and 1 year after functional loading, clinical parameters (including peri-apical radiographs) were assessed.

    RESULTS:

    One hundred and forty-eight implants were placed in 48 subjects (mean age: 67 years (range [59-83]). Sixty-three implants were placed in 20 osteoporosis subjects (Group O, mean age: 69 years; range [59-83]), and 85 were placed in control subjects (Group C, mean age: 65 years; range [60-74]). The cumulative survival rate, on an implant level, was 99.3% (Group O: 98.4%; Group C: 100.0%). The cumulative survival rate, on a subject level, was 97.9% (Group O: 94.7%; Group C: 100.0%). Marginal bone level (MBL) alterations from functional loading to the 1-year follow-up visit were measured on an implant level and a subject level. The overall MBL alteration on an implant level was -0.01 ± 0.51 mm (Group O: -0.11 ± 0.49 mm; Group C: 0.05 ± 0.52 mm). The overall MBL alteration on a subject level was -0.04 ± 0.27 mm (Group O: -0.17 ± 0.30 mm; Group C: 0.04 ± 0.23 mm).

    CONCLUSION:

    Within the limitations of this prospective, non-randomized, controlled, multicentre study, it can be concluded that oral implant therapy in patients suffering from osteoporosis/osteopenia is a reliable treatment option with comparable integration rates as in healthy patients. Long-term follow of the study groups is necessary to compare marginal bone alterations and treatment outcomes.

  • 32.
    Thor, Andreas
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Delayed removal of a fully intruded primary incisor through the nasal cavity: a case report.2002In: Dent Traumatol, ISSN 1600-4469, Vol. 18, no 4, 227-30 p.Article in journal (Refereed)
  • 33.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Preoperative Planning of Virtual Osteotomies Followed by Fabrication of Patient Specific Reconstruction Plate for Secondary Correction and Fixation of Displaced Bilateral Mandibular Body Fracture2016In: Craniomaxillofacial Trauma & Reconstruction, ISSN 1943-3875, E-ISSN 1943-3883, Vol. 9, no 2, 188-194 p.Article in journal (Refereed)
    Abstract [en]

    This paper describes the course of treatment of a severely diplaced bilateral mandibular body fracture, where the first osteosynthesis failed. The subject developed an open bite due to a posterior rotation of the distal part of the mandible and anterior rotation of the proximal parts of the mandible. This situation was evaluated with CBCT and the facial skeleton was segmented using computer software. Correct occlusion was virtually established by bilateral virtual osteotomies in the fracture areas of the mandible. After segmentation, the mandible was virtually rotated back into position and the open bite was closed. A patient specific mandibular reconstruction plate was outlined and fabricated from the new virtual situation and the plate was thereafter installed utilizing the preoperative plan. Osteotomy-and drill-guides was used and thus simplified the surgery resulting in uneventful healing. Virtual planning and patient specific implants and guides were valuable in this case of secondary reconstructive trauma surgery.

  • 34.
    Thor, Andreas
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Reconstruction of the anterior maxilla with platelet gel, autogenous bone, and titanium mesh: a case report.2002In: Clin Implant Dent Relat Res, ISSN 1523-0899, Vol. 4, no 3, 150-5 p.Article in journal (Refereed)
  • 35.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Birring, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Leiggener, Christoph
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Fracture of the tympanic plate with soft tissue extension into the auditory canal resulting from an unfavorable chewing experience2010In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 26, no 1, 112-114 p.Article in journal (Refereed)
    Abstract [en]

    We present a case where a patient sustained a tympanic plate fracture of the right side while chewing a sandwich. Intense pain with temporomandibular joint (TMJ) symptoms such as restrained painful mouth opening and functional pain in full occlusion followed the incident and the fracture was diagnosed after ocular and CT-examination of the right external auditory canal. Non-ruptured soft tissue could be seen protruding into the external auditory canal and the size of the mass changed during movement of the TMJ. Treatment was not needed to resolve the situation and at 3-year follow-up the patient has no clinical symptoms.

  • 36.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ekstrand, Karl
    Baer, Russell A.
    Toljanic, Joseph A.
    Three-year Follow-up of Immediately Loaded Implants in the Edentulous Atrophic Maxilla: A Study in Patients with Poor Bone Quantity and Quality2014In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 29, no 3, 642-649 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: Immediate loading of implants in the edentulous maxilla has previously been successfully performed and reported. Severe resorption of the maxillary alveolar crest presents a more demanding situation for the restorative team. Thus, it would be valuable to assess outcomes for this immediate loading treatment protocol in subjects with marked maxillary alveolar crest atrophy. This study evaluated the 3-year results of dental implants that were immediately restored with provisional fixed prostheses in atrophic maxillae without previous augmentation. Materials and Methods: Two centers enrolled subjects with resorbed edentulous maxillae (Lekholm and Zarb quality 3 or 4 and quantity C, D, or E). Six implants were placed in each subject and restored with screw-retained fixed provisionals within 24 hours. Impressions were taken for definitive restorations, which were placed 20 to 24 weeks later. Radiographs were used to analyze marginal bone level changes throughout the study. Results: Fifty-one patients received 306 implants. Forty-five patients remained in the study at the 3-year follow-up visit and successfully used their definitive prostheses. Sixty-two percent of the implants were placed in bone quantity C and quality 3 or 4, and 38% were placed in quantity D and quality 3 or 4 bone. Thirteen implants in six subjects were lost, resulting in a cumulative survival rate of 96% after 3 years. The mean marginal bone loss during the first year was -0.4 +/- 0.8 mm (255 implants); at 3 years it was -0.6 +/- 1.1 mm (253 implants). Conclusion: Data from the first 3 years of this study revealed good clinical outcomes. Careful selection of patients and planning by the restorative team can enable successful treatment outcomes for patients presenting with marked resorption of the edentulous maxilla.

  • 37.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Franke-Stenport, V.
    Johansson, C. B.
    Rasmusson, L.
    Early bone formation in human bone grafts treated with platelet-rich plasma: preliminary histomorphometric results2007In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 36, no 12, 1164-1171 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on early and late bone healing after autogenous maxillary sinus grafting. Eleven patients were subjected to sinus augmentation with particulated autogenous bone bilaterally with the addition of PRP in one side. Platelet counts in baseline whole blood and PRP were registered. Biopsies were taken in the grafted bone of the sinus area with trephine at 3 months (nine patients) and simultaneously a micro-implant was installed in the same region. The micro-implants with surrounding bone were retrieved by biopsy at 6 months (seven patients). Undecalcified cut and ground sections were histomorphometrically analysed. Quantification of new and old bone in all biopsies was performed. The results of this histological study showed that significantly more new bone was formed at PRP-treated sites compared to controls after 3 months of healing. After 6 months, this effect could no longer be observed. This is in accordance with previous studies showing that PRP has a rather low regenerative capacity but may influence the early phase of bone healing. The additional value of PRP in autogenous bone grafts in the maxillary sinus is questionable.

  • 38.
    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, 759-768 p.Article 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.

  • 39.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Linder, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Repair of a laryngeal fracture using miniplates2007In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 36, no 8, 748-750 p.Article in journal (Refereed)
    Abstract [en]

    Injuries to the larynx (voice box) can lead to loss of vital functions; the airway may be obstructed, the voice distorted or lost, and the protection of the airway during swallowing may fail. In order to preserve these functions, a stable repair that restores the anatomy as closely as possible is needed. The repair should interfere minimally with the neuromuscular functions of the larynx. The case is described of a 59-year-old male who suffered a severe laryngeal fracture in a work-place accident. Utilizing miniplates, the fracture was reduced and fixed in the correct position. After healing, the patient could be decannulated and has regained his voice, swallows without difficulty and has a patent airway. The results have been sustained over a 2-year follow-up.

  • 40.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Palmquist, Anders
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Biomat, SE-40530 Gothenburg, Sweden; BIOMATCELL VINN Excellence Ctr Biomat & Cell Ther, Gothenburg, Sweden.
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rännar, Lars-Erik
    Mid Sweden Univ, Dept Qual Technol Mech Engn & Math, Ostersund, Sweden.
    Dérand, Per
    SUS, Univ Lund Hosp, Dept Oral & Maxillofacial Surg, Lund, Sweden.
    Omar, Omar
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Biomat, SE-40530 Gothenburg, Sweden; BIOMATCELL VINN Excellence Ctr Biomat & Cell Ther, Gothenburg, Sweden.
    Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate2016In: The Journal of craniofacial surgery (Print), ISSN 1049-2275, E-ISSN 1536-3732, Vol. 27, no 7, 1899-1904 p.Article in journal (Refereed)
    Abstract [en]

    There is limited information on the biological status of bone regenerated with microvascular fibula flap combined with biomaterials. This paper describes the clinical, histological, ultrastructural, and molecular picture of bone regenerated with patient-customized plate, used for mandibular reconstruction in combination with microvascular osteomyocutaneous fibula flap. The plate was virtually planned and additively manufactured using electron beam melting. This plate was retrieved from the patient after 33 months. Microcomputed tomography, backscattered-scanning electron microscopy, histology, and quantitative-polymerase chain reaction were employed to evaluate the regenerated bone and the flap bone associated with the retrieved plate. At retrieval, the posterior two-thirds of the plate were in close adaptation with the underlying flap, whereas soft tissue was observed between the native mandible and the anterior one-third. The histological and structural analyses showed new bone regeneration, ingrowth, and osseointegration of the posterior two-thirds. The histological observations were supported by the gene expression analysis showing higher expression of bone formation and remodeling genes under the posterior two-thirds compared with the anterior one-third of the plate. The observation of osteocytes in the flap indicated its viability. The present data endorse the suitability of the customized, additively manufactured plate for the vascularized fibula mandibular reconstruction. Furthermore, the combination of the analytical techniques provides possibilities to deduce the structural and molecular characteristics of bone regenerated using this procedure.

  • 41.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Biomaterialvetenskap Göteborgs universitet.
    Wennerberg, Ann
    Biomaterialvetenskap Göteborgs universitet.
    Thomsen, Peter
    Biomaterialvetenskap Göteborgs universitet.
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Nilsson, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Clinical Immunology.
    Hong, Jaan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Clinical Immunology.
    The role of whole blood in thrombin generation in contact with various titanium surfaces2007In: Biomaterials, ISSN 0142-9612, E-ISSN 1878-5905, Vol. 28, no 6, 966-974 p.Article in journal (Refereed)
    Abstract [en]

    Understanding of the thrombotic response (activation of the intrinsic coagulation system followed by platelet activation) from blood components upon contact with a titanium dental implant is important and not fully understood. The aims of this study were to evaluate: (1) the thrombogenic response of whole blood, platelet-rich plasma (PRP) and platelet-poor plasma (PPP) in contact with a highly thrombogenic surface as titanium, (2) the thrombogenic response of clinically used surfaces as hydroxyapatite (HA), machined titanium (mTi), TiO2 grit-blasted titanium (TiOB) and fluoride ion-modified grit-blasted titanium (TiOB-F). An in vitro slide chamber model, furnished with heparin, was used in which whole blood, PRP or PPP came in contact with slides of the test surfaces. After incubation (60 min rotation at 22 rpm in a 37 degrees C water bath), blood/plasma was mixed with EDTA or citrate, further centrifuged at +4 degrees C (2200 g at 10 min). Finally, plasma was collected pending analysis. Whole blood in contact with Ti alloy resulted in the binding of platelets to the material surface and in the generation of thrombin-antithrombin (TAT) complexes. With whole blood TAT levels increased 1000-fold compared with PRP and PPP, in which both almost no increase of TAT could be detected. In addition, the platelet activation showed a similar pattern with a 15-fold higher release of beta-TG in whole blood. In the in vitro chamber model with the clinically relevant materials, the fluoride-modified surface (TiOB-F) showed pronounced TAT generation compared with TiOB, mTi and HA. Similar results were achieved for platelet consumption and activation markers of the intrinsic coagulation system. Taken together these results implicate first that whole blood is necessary for sufficient thrombin generation and platelet activation during placement of implants. Second, a fluoride ion modification seems to augment the thrombogenic properties of titanium.

  • 42.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Stenport, Victoria F
    Larsson, Åke
    Boström, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Bone graft and implants in a patient with systemic mastocytosis.2005In: Clin Implant Dent Relat Res, ISSN 1523-0899, Vol. 7, no 2, 79-86 p.Article in journal (Refereed)
  • 43.
    Thor, Andreas
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Wannfors, Karin
    Sennerby, Lars
    Rasmusson, Lars
    Reconstruction of the severely resorbed maxilla with autogenous bone, platelet-rich plasma, and implants: 1-year results of a controlled prospective 5-year study.2005In: Clin Implant Dent Relat Res, ISSN 1523-0899, Vol. 7, no 4, 209-20 p.Article in journal (Refereed)
  • 44.
    Thor, Andreas
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Warfvinge, Gunnar
    Fernandes, Rui
    The course of a long-standing glandular odontogenic cyst: marginal resection and reconstruction with particulated bone graft, platelet-rich plasma, and additional vertical alveolar distraction.2006In: J Oral Maxillofac Surg, ISSN 0278-2391, Vol. 64, no 7, 1121-8 p.Article in journal (Refereed)
  • 45. Toljanic, Joseph A.
    et al.
    Baer, Russell A.
    Ekstrand, Karl
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Implant Rehabilitation of the Atrophic Edentulous Maxilla Including Immediate Fixed Provisional Restoration Without the Use of Bone Grafting: A Review of 1-Year Outcome Data from a Long-Term Prospective Clinical Trial2009In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 24, no 3, 518-526 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: The literature suggests that predictable integration can be achieved when dental implant placement is combined with immediate fixed provisional restoration in a variety of clinical situations. Fewer data are available, however, regarding outcomes for immediate provisional restoration of implants in the edentulous maxilla. This report presents 1-year data acquired from a long-term prospective clinical trial designed to assess outcomes following the immediate provisional fixed restoration of implants in the atrophic edentulous maxilla without the use of bone augmentation. Materials and Methods: Fifty-one subjects diagnosed with an atrophic edentulous maxilla received a total of 306 implants (six implants per subject) followed by fixed provisional restoration within 24 hours of implant placement. No subjects underwent grafting to enhance bone volume in preparation for implant treatment. Data acquired included bone quantity and quality, implant dimensions, implant locations, and implant placement stability. Subjects returned for 1-year follow-up examinations to assess implant integration and restoration function. Periapical radiographs were obtained and compared to baseline images to assess marginal bone height maintenance. Results: At the 3-month follow-up examination, 294 of 306 implants placed in 51 subjects were found to be integrated. This represents a cumulative implant survival rate of 96%. At the 1-year follow-up examination, mean marginal bone loss of 0.5 mm was noted, with no further loss of implants. Conclusions: These results support the contention that predictable long-term outcomes may be obtained for the atrophic edentulous maxilla when treated with an implant rehabilitation protocol that includes immediate fixed provisional restoration without the use of bone grafting. This strategy offers a promising treatment alternative for the patient with an atrophic edentulous maxilla.

1 - 45 of 45
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