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  • 151.
    Reiser, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Holmström, Mats
    Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate2011In: Journal of plastic surgery and hand surgery, ISSN 2000-656X, Vol. 45, no 3, p. 129-135Article in journal (Refereed)
    Abstract [en]

    The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3--4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm<SU2</SU) and volume (cm<SU3</SU) (acoustic rhinometry), air flow resistance (Pa s/cm<SU3</SU) (rhinomanometry), peak inspiratory flow (l/min) (peak nasal inspiratory flow) and number of identified odours (Scandinavian odor-identification test) were assessed in adulthood. The size of the maxillary cleft varied considerably at infancy. The size of the nasal airway and its function on the cleft side in adulthood were reduced compared with the non-cleft side, but no correlations were found between size of the initial cleft in infancy and size and function of the nasal airway in adulthood. In adults born with UCLP, therefore, size of the maxillary cleft in infancy does not seem to affect size and function of the nasal airway in adulthood.

  • 152.
    Reiser, Erika
    et al.
    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.
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Early dimensional changes in maxillary cleft size and arch dimensions of children with cleft lip and palate and cleft palate2013In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 50, no 4, p. 481-490Article in journal (Refereed)
    Abstract [en]

    Objective: To study changes in cleft size and maxillary arch dimensions from infancy to 5 years and evaluate these changes in relation to performed surgical procedures.

    Design: Retrospective longitudinal study.

    Setting:  The Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden.

    Patients: Dental study models of 79 consecutive children, 28 with unilateral cleft lip and palate (UCLP), 39 with cleft palate (CP) and 12 with Pierre Robin Sequence (PRS) were analyzed.

    Interventions: Lip repair at 3-4 months, soft palate repair at 6-10 months and hard palate repair at 25-26 months of age.

    Main Outcome Measures: Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years.

    Results: Cleft widths decreased from infancy up to 2 years, but the antero-posterior cleft length in CP was unchanged. Arch widths at C-C1and T-T1 and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years. 

    Conclusions: Cleft widths decreased after lip closure and/or soft palate closure. The UCLP children had wider maxillary arch dimensions than the CP and PRS children during the first years of life, but after hard palate closure the transverse growth was reduced in the UCLP children. At 5 years the UCLP children had smaller maxillary widths than the CP and PRS children especially at the level of the cuspids.

  • 153.
    Reiser, Erika
    et al.
    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.
    Gerdin, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Association Between Cleft Size and Crossbite in Children With Cleft Palate and Unilateral Cleft Lip and Palate2010In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 47, no 2, p. 175-181Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between cleft size in infancy and crossbite at 5 years of age in children with cleft palate (CP) and unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: University Hospital, Uppsala, Sweden. Patients: Dental study models of 80 consecutive children, 51 children with CP and 29 children with UCLP, born between 1990 and 1999 were analyzed. Interventions: Lip repair at 3 to 4 months in UCLP children. Primary soft palate repair at 6 to 10 months and secondary hard palate closure at 25 to 26 months of age. Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on infancy dental casts. At follow-up at 5 years, crossbite scores were registered on dental study models. Results: The cleft dimensions in infancy showed large interindividual variation. Mean posterior cleft width was larger in UCLP children than in children with CP. The UCLP group also had significantly more crossbite at 5 years than the CP group. No significant association was noted between initial cleft size and crossbite scores at 5 years in the CP group. For the UCLP group, larger cleft widths at the level of the cuspid points were significantly associated with less anterior and posterior crossbite. Conclusions: The findings support the hypothesis that cleft size in infancy affects early outcome with respect to crossbite in children with UCLP, but not in children with CP.

  • 154.
    Reiser, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Svee, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Facial growth in unilateral cleft Lip and palate and cleft palate: associations with maxillary dimensions and cleft size in infancy2011Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To study facial growth from 5 to 19 years of age and the correlation with maxillary arch dimensions and cleft size in infancy in children with unilateral cleft lip and palate (UCLP) and cleft palate (CP).

    Design: Retrospective longitudinal study.

    Setting:  The Cleft Palate Centre, Uppsala University Hospital, Sweden.

    Patients:  Thirty-three consecutive patients with UCLP, 64 with CP (51 with cleft palate only (CPo) and 13 with Pierre Robin Sequence (PRS)) were included in the study. 

    Interventions: Lip repair at 3-4 months in UCLP children. Soft palate repair at 6-7 months and hard palate repair at 2 years in UCLP and CP. Secondary bone grafting at 9 years of age in UCLP.

    Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on dental casts taken in infancy. Cephalometrics was used to study facial growth from 5 to 19 years of age.

    Results: Maxillary arch depths showed positive correlations to SNA and ANB. Cleft width in infancy was negatively correlated to SNA, ANB and NSBa. The growth rates for SNA and ANB were significantly more negative for the UCLP group compared to the CPo group.

    Conclusions: Maxillary arch depths and cleft widths in infancy were associated with maxillary protrusion and sagittal jaw relationships during growth in both UCLP and CP children. Maxillary protrusion and sagittal jaw relation developed less favourably in UCLP compared to CPo.

  • 155.
    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.

  • 156.
    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, p. 105483-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.

  • 157. Rizell, S.
    et al.
    Barrenas, M. -L
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Stecksen-Blicks, C.
    Kjellberg, H.
    Turner syndrome isochromosome karyotype correlates with decreased dental crown width2012In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 34, no 2, p. 213-218Article in journal (Refereed)
    Abstract [en]

    The aim of this project was to study possible influences of Turner syndrome (TS) karyotype and the number of X chromosomes with intact short arm (p-arm) on dental crown width. Primary and permanent mesio-distal crown width was measured on plaster casts from 112 TS females. The influence on crown width of four karyotypes: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, and the number of intact X chromosomal p-arms were investigated. In comparisons between karyotypes, statistically significant differences were found for isochromosome karyotype maxillary second premolars, canines, laterals, mandibular first premolars, and canines, indicating that this karyotype was the most divergent as shown by the most reduced crown width. When each karyotype group were compared versus controls, all teeth in the isochromosome group were significantly smaller than controls (P < 0.01-0.001). The 45,X/46,XX karyotype expressed fewer and smaller differences from controls, while 45,X individuals seemed to display an intermediate tooth width compared with 45,X/46,XX and isochromosomes. No significant difference in crown width was found comparing the groups with one or two intact X chromosomal p-arms. Both primary and permanent teeth proved to have a significantly smaller crown width in the entire group of TS females compared to healthy females. We conclude that the isochromosome group deviates most from other karyotypes and controls, exhibiting the smallest dental crown width, while individuals with 45,X/46,XX mosaicism seemed to have a less affected crown width. An influence of the number of intact p-arms on crown width could not be demonstrated in this study.

  • 158. Rizell, Sara
    et al.
    Barrenas, Marie-Louise
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Stecksen-Blicks, Christina
    Kjellberg, Heidrun
    Palatal height and dental arch dimensions in Turner syndrome karyotypes2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 6, p. 841-847Article in journal (Refereed)
    Abstract [en]

    The aim of this project was to study the impact from Turner syndrome (TS) karyotype and age on dental arch morphology and palatal height and to compare the variables in TS with reference data from non-TS females with normal occlusion. Plaster casts from 76 females with TS (6-50 years) were analysed with respect to dentoalveolar arch dimensions and palatal height. The TS females were divided into the karyotype categories: i) 45, X ii) 45, X/46, XX iii) isochromosome, and iv) other. The 45, X/46, XX karyotype exhibited fewer statistically significant variables differing from the reference group compared with other karyotypes. TS females showed increased dentoalveolar depths, decreased maxillary but increased mandibular width, decreased posterior segments, and decreased mandibular circumference compared with the reference group. In opposition to previous reports, the palatal height did not differ compared with non-TS females. Age had an impact on nine of the variables. We conclude that the present dental arch deviations are reflecting the high frequency of malocclusions reported in TS and the subsequent need for orthodontic treatment, which might possibly be lower in the 45, X/46, XX karyotype. The palatal height did not differ from the reference group, but instead the narrow maxilla might contribute to an illusion of a higher palate. We therefore suggest using the nomination 'narrow palatal vault' instead of the commonly used term 'high palatal vault'.

  • 159. Rizell, Sara
    et al.
    Barrenäs, Marie-Louise
    Andlin-Sobocki, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Stecksén-Blicks, Christina
    Kjellberg, Heidrun
    45,X/46,XX karyotype mitigates the aberrant craniofacial morphology in Turner syndrome2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 4, p. 467-474Article in journal (Refereed)
    Abstract [en]

    The aim of this project was to study the impact on craniofacial morphology from Turner syndrome (TS) karyotype, number of intact X chromosomal p-arms, and age as well as to compare craniofacial morphology in TS with healthy females. Lateral radiographs from 108 females with TS, ranging from 5.4 to 61.6 years, were analysed. The TS females were divided into four karyotype groups: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, as well as according to the number of intact X chromosomal p-arms. The karyotype was found to have an impact on craniofacial growth, where the mosaic group, with presence of 46,XX cell lines, seems to exhibit less mandibular retrognathism as well as fewer statistically significant differences compared to the reference group than the 45,X karyotype. Isochromosomes had more significant differences versus the reference group than 45,X/46,XX but fewer than 45,X. To our knowledge, this is the first time the 45,X/46,XX and isochromosome karyotypes are divided into separate groups studying craniofacial morphology. Impact from p-arm was found on both maxillary and mandibular length. Compared to healthy females, TS expressed a shorter posterior and flattened cranial base, retrognathic, short and posteriorly rotated maxilla and mandible, increased height of ramus, and relatively shorter posterior facial height. The impact of age was found mainly on mandibular morphology since mandibular retrognathism and length were more discrepant in older TS females than younger.

  • 160.
    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, p. 314-318Article 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.

  • 161.
    Runow Stark, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Folktandvården Stockholms län AB.
    Gustavsson, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Horal, Peter
    Kotopouli, Maria
    Gyllensten, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Folktandvården Stockholms län AB.
    Brush Samples of Oral Lesions to FTA Elute Card for High-risk Human Papilloma Virus Diagnosis2021In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 41, no 1, p. 269-277Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the level of agreement between three non-invasive methods for hrHPV diagnosis in oral and oropharyngeal squamous cell carcinoma (OSCC, OPSCC) and in oral mucosal lesions.

    MATERIALS AND METHODS: For hrHPV DNA FTA Elute card™ and Anyplex II HPV28™ were used and for hrHPV mRNA PreTect SEE™ in tumour patients (n=60), non-tumour lesions (n=51), immunosuppression or previous hrHPV-infection (n=32).

    RESULTS: The level of agreement between the DNA-methods was 82.2% (k=0.54, p=0.001). Pair-wise comparison for the FTA Elute card were close to the reference (AUC=0.83, 95% CI=0.73-0.90). hrHPV mRNA was diagnosed in 50% of the tumours, with an agreement level of 58.3%, compared to Anyplex II (k=0.17, p=0.04). The hrHPV positivity in oral lesions was 3.9% for immunosuppression and for previous HPV infection 9.4%.

    CONCLUSION: The FTA card is reliable for hrHPV DNA diagnosis while mRNA gives an insight into viral activity and correlates with severity of the lesion.

  • 162.
    Runow Stark, Christina
    et al.
    Public Dental Health Center of Stockholm County Council, Medicinsk Tandvård, Södersjukhuset Stockholm.
    Gustavsson, Inger M.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Gyllensten, Ulf B.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Darai Ramqvist, Eva
    Dpt of Pathology and Cytology, Karolinska Institute, Stockholm.
    Lindblad, Joakim
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    Wählby, Carolina
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction. Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    Bengtsson, Ewert
    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. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control. Uppsala university.
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Brush Biopsy For HR-HPV Detection With FTA Card And AI For Cytology Analysis - A Viable Non-invasive Alternative2018In: EAOM2018 / [ed] Bengt Hasséus, 2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Oral cancer accounts for about 800-1,000 new cases each year in Sweden and the ratio of cancer related to high-risk human papillomavirus (HR-HPV) is increasing in the younger population due to changes in sexual habits. The most two frequent HR-HPV types 16 and 18 have both significant oncogenic potential.

    Objectives: In this pilot study we evaluate two non-invasive automated methods; 1) detection of HR-HPV using FTA cards, and 2) image scanning of cytology for detection of premalignant lesions as well as eradicate the early stage of neoplasia.

    Material and Methods: 160 patients with verified HR-HPV oropharyngeal cancer, previous ano-genital HR-HPV-infection or potentially malignant oral disorder were recruited for non-invasive brush sampling and analyzed with two validated automated methods both used in cervix cancer screening. For analysis of HR-HPV DNA the indicating FTA elute micro cardTM were used for dry collection, transportation and storage of the brush samples. For analysis of cell morphology changes an automated liquid base Cytology method (Preserve Cyt) combined with deep learning computer aided technique was used.

    Results: Preliminary results show that the FTA-method is reliable and indicates that healthy and malignant brush samples can be separated by image analysis. 

    Conclusions: With further development of these fully automated methods, it is possible to implement a National Screening Program of the oral mucosa, and thereby select patients for further investigation in order to find lesions with potential malignancy in an early stage. 

  • 163.
    Röing, Marta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ways of understanding the encounter with head and neck cancer patients in the hospital dental team - a phenomenographic study2006In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 14, no 10, p. 1046-1054Article in journal (Refereed)
    Abstract [en]

    Introduction: Head and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care. Background: The aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs. Methods: Twenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

  • 164.
    Röing, Marta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Living in a state of suspension - a phenomenological approach to the spouse's experience of oral cancer2008In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 1, p. 40-47Article in journal (Refereed)
    Abstract [en]

    The consequences of oral cancer may affect not only the patient, but also their spouses, as the mouth is vital for communication, social interaction and nutrition. Treatment is complex, lengthy and involves a large number of medical and dental professionals. During the treatment of oral cancer spouses are often present when the patients meet the treatment team. While nursing and medical staff have experience of meeting both patients and spouses, dental teams may not. The aim of this phenomenological study was to describe oral cancer and its treatment as experienced by the patient's spouses. A purposeful sample of seven spouses was interviewed. The existentials of lived relations, lived body and lived space and time were used as interpretive means in analysing the data to illuminate the spouses' everyday experiences during treatment. The findings reveal that the experience of lived relations changes from being spouse to supportive carer, the lived body is neglected and lived space and time becomes restricted. The essence of their lived experience can be described as living in a state of suspension. This knowledge may be useful in the education and organization of supportive communication for multiprofessional caregivers.

  • 165.
    Röing, Marta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    The uncanny mouth - a phenomenological approach to oral cancer2007In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 67, no 3, p. 301-306Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this retrospective qualitative study was to describe how patients with oral cancer experience their sickness and treatment. Methods: A purposeful sample of seven patients with oral cancer was interviewed. Data were analysed using a phenomenological approach outlined by van Manen. Results: The essence of the patients' experiences can be described as embodiment in a mouth that has become unreal, or 'uncanny'. At treatment start the body is invaded by cancer, during treatment there is no escape from a wounded mouth, at treatment end the mouth is disabled. Conclusions: The findings indicate that oral cancer patients' need for support may increase as treatment progresses and may be greatest at end of radiotherapy, as they return home with mouths that have not recovered after treatment and do not function normally. Practice implications: This suggests the importance of understanding the patients' situation during treatment and their desire for a return to normal living and normal mouth functions at treatment end. If possible, plans for oral rehabilitation should be considered in initial treatment planning. As the treatment of oral cancer is multiprofessional, this knowledge may be useful in guiding the organization of oral cancer care and multiprofessional collaboration.

  • 166.
    Röing, Marta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Schuster, Marja
    Making new meanings of being in the world after treatment for oral cancer2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 8, p. 1076-1086Article in journal (Refereed)
    Abstract [en]

    When the mouth is affected by cancer, difficulties in satisfying basic human needs such as eating, tasting, swallowing, and speaking might arise, and the existential significance of the mouth might become obvious. How does it feel to live with these difficulties? What does it mean to be a human being living with the consequences of oral cancer? Five patients with oral cancer were interviewed a median time of 4 years after the beginning of treatment. A hermeneutic research approach was used to understand, explain, and interpret the transcribed interviews and showed how the consequences of oral cancer affected the being-in-the-world of the participants in three ways: existing as oneself, existing in the eyes of others, and existing with others. Against the background of the philosophy of Martin Heidegger, these findings illuminate how essential the mouth is to a human being's identity and existence.

  • 167. Sahebjamiee, Mahnaz
    et al.
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Karimi, Sharare
    Biettolahi, Jalil Momen
    Jabalameli, Fereshteh
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Prevalence of human papillomavirus in oral lichen planus in an Iranian cohort2015In: Journal of Oral and Maxillofacial Pathology, ISSN 0973-029X, E-ISSN 1998-393X, Vol. 19, no 2, p. 170-174Article in journal (Refereed)
    Abstract [en]

    Context: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease with female predominance with the potential for malignant transformation. Human papillomavirus (HPV) is associated with both malignant and benign disease in the head and neck region. Aims: The present study assesses the prevalence of high-risk HPV-16 and HPV-18 in tissue and saliva samples from an Iranian population diagnosed with OLP. Subjects and Methods: Deoxyribonucleic acid was extracted and investigated using polymerase chain reaction from tissue and saliva samples of the same individuals from 40 OLP cases and saliva samples of 40 healthy controls. Statistical Analysis: The prevalence of data was compared using the Chi-square test and inter-group differences were analyzed using Fisher's exact test. Results: OLP specimens were HPV-positive in 11 of 40 (27.5%) cases compared with three of 40 (7.5%) saliva specimens, representing a statistically significant difference (P = 0.0367). HPV-16 and HPV-18 were positive in eight of 40 (20%) OLP tissues and three of 40 (7.5%) saliva samples. Five of the 40 healthy saliva samples were positive for HPV-16. In the OLP patients with dysplasia, four of seven tissue samples were HPV-positive; threeof these four were HPV-16- positive in comparision with seven of 33 HPV-positive samples from OLP patients without dysplasia. Conclusions: Biopsies were more accurate than saliva analysis for evaluating HPV prevalence in OLP patients. HPV prevalence was higher in dysplastic than nondysplastic OLP lesions in this Iranian cohort.

  • 168.
    Saiepour, Daniel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Messo, Elias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hedlund, Anders J. O.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Radiologic and Long-Term Clinical Outcome From Treatment of Isolated Medial Orbital Wall Blowout Fractures2012In: The Journal of craniofacial surgery (Print), ISSN 1049-2275, E-ISSN 1536-3732, Vol. 23, no 5, p. 1252-1255Article in journal (Refereed)
    Abstract [en]

    Blowout fractures in the medial orbital wall may lead to enophthalmos, ocular dysmotility, and diplopia. Ten consecutive patients with unilateral, isolated fractures of the medial orbital wall were retrospectively studied. The radiologic accuracy of the medial orbital wall reconstructions and the long-term clinical outcomes were assessed. All cases were treated through a bicoronal approach and by use of porous polyethylene-titanium implants. The total fracture area and the orbital volume increase from the blowout were measured on computed tomographic scans. Next, we evaluated the reconstruction in the posterior part of the medial wall. This was done by calculating the ratio between the defect area and the implant area located behind the anterior ethmoidal canal. The patients were examined at least 1 year after the operation, and the rates of enophthalmos and diplopia were evaluated. The mean fracture defect area was 2.45 cm(2) (range, 0.41-4.16 cm(2)), and the mean volume increase from the blowout fractures was 1.82 cm(3) (range, 0.53-2.76 cm(3)). The orbital volume was accurately restored in all patients. However, the ratio of implant to defect area behind the anterior ethmoidal canal ranged from 0% to 100% (mean, 47.3%). None of the patients had enophthalmos or diplopia at the long-term follow-up. The results confirm that restoration of orbital volume is important to prevent postoperative enophthalmos in isolated medial orbital blowout fractures. Complete reconstruction of the most posterior part of the medial orbital wall seems to be of lesser importance.

  • 169.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Viruses and oral cancer. Is there a link?2014In: Microbes and infection, ISSN 1286-4579, E-ISSN 1769-714X, Vol. 16, no 5, p. 371-378Article, review/survey (Refereed)
    Abstract [en]

    Oral squamous cell carcinoma (OSCC) is the most common malignant tumour of the oral cavity. The aetiology of epithelial cancer of the head and neck is considered to be a multifactorial, sequential process. DNA viruses are found in many different cancers and are also capable of transforming cells to a malignant phenotype. Human Papilloma Virus (HPV) has been proposed as risk factors in OSCC development and HPV type 16 is the most important subtype. Other oncogenic virus species i.e., Epstein-Barr Virus and Herpes Simplex Virus Type 1 have been proposed to be involved in oral carcinogenesis. However, no convincing evidence exist that they are an established risk factor in OSCC. Therefore more studies are needed in order to clarify the different aspects of virus involvement. Here, we review the existing literature on viral involvement in oral cancer.

  • 170.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Miranda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ibrahim, S.
    Larsson, P. -A
    Hirsch, Jan -M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Virus, genetic alterations and tobacco use in premalignant and malignant oral lesions2012In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 30, no S1, p. S9-S9Article in journal (Other academic)
  • 171.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Miranda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ibrahim, Salah
    Univ Bergen, Dept Biomed, N-5020 Bergen, Norway..
    Hasseus, Bengt
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, Gothenburg, Sweden..
    Ohman, Jenny
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, Gothenburg, Sweden..
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Virus and tobacco use in premalignant and malignant oral lesions2015In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 36, no Supplement: 1, p. S27-S27Article in journal (Other academic)
  • 172.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Miranda M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sapkota, Dipak
    Ibrahim, Salah O
    p53 Codon 72 polymorphism in oral exfoliated cells in a Sudanese population2012In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 26, no 1, p. 59-62Article in journal (Refereed)
    Abstract [en]

    Earlier studies have investigated the tumor suppressor gene p53 as a co-factor in the development of oral squamous cell carcinoma (OSCC). Our previous studies have indicated that chronic use of Sudanese snuff (toombak) and the presence of human papilloma virus (HPV) may be involved in the high prevalence of OSCC in Sudan. This study investigated the prevalence of p53 codon 72 polymorphism in brush biopsies obtained from a Sudanese population. A total of 174 individuals were included in the study; chronic toombak users (n=152) and non-users (n=22). DNA was extracted from all the samples and genotyped for the codon 72 polymorphism by polymerase chain reaction/restriction fragment length polymorphism. The Arg/Pro genotype was found in 53% of the 174 study participants, compared to 21% found with Arg/Arg and 26% found with Pro/Pro. Stratifying by toombak use, 28 (18%), 45 (29%) and 79 (52%) of the 152 samples from toombak users had Arg/Arg, Pro/Pro and Arg/Pro respectively, compared to 9 (41%), 0 (0%) and 13 (59%) found in the 22 samples from non users. The differences between the samples from toombak users and non users in Arg/Arg and Pro/Pro codon 72 polymorphism and HPV infection were statistically significant (p<0.05). Our study indicated that a high prevalence of the genotype Arg/Pro at the p53 codon 72 may contribute to susceptibility to OSCC, especially in combination with the use of carcinogenic tobacco-specific nitrosamine (TSNA)-rich toombak. Our observations warrant an in-depth study for understanding the role of p53 polymorphism in human oral cancers.

  • 173.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Lekerud, Ann-Kristin
    Wallström, Mats
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Local Tolerance of a Sublingual Nicotine Tablet: an Open Single-centre Study2012In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 26, no 3, p. 463-468Article in journal (Refereed)
    Abstract [en]

    Nicotine replacement therapy (NRT) is now widely used in various forms of administration to aid cessation of tobacco use. In this smoking cessation programme, a new tablet formulation has been compared to and found bioequivalent to the existing one. The present trial was performed in order to investigate the local tolerance of the new sublingual tablet. The study was performed as a prospective follow-up study of 16 weeks' duration on smokers using the new tablet, Nicorette (R) Microtab, over a period of 12 weeks. Fifty smokers were included in the study and the oral mucosa was inspected and photographed at each visit. At 12 weeks, participants were asked for their consent to take a biopsy from the site of application. Compliance with tablet use was high, with participants using an average of 12 tablets/day throughout the 12 week treatment period. Adverse events related to treatment were mild and tolerable. The changes observed were classified as being induced by frictional stimuli, with no changes to the deeper layers of the epithelium, and no thickening of the basal layers of the epithelium. The new tablet was considered well tolerated during the course of this study, with a benign local effect on the mucous membrane that was consistent with lesions that are reversible in nature.

  • 174.
    Sand, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wallström, Mats
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Smokeless tobacco, viruses and oral cancer2014In: Oral health and dental management, ISSN 2247-2452, Vol. 13, no 2, p. 372-378Article in journal (Refereed)
    Abstract [en]

    Oral Squamous Cell Carcinoma (OSCC) is the most common epithelial malignancy in the oral cavity. OSCCs and their variants constitute over 90% of oral malignancies, and the disease is associated with poor prognosis. OSCC is a complex malignancy where environmental factors, viral infections, and genetic alterations most likely interact, and thus give rise to the malignant condition. The International Agency for Research on Cancer (IARC) in 2007 concluded: "there is sufficient evidence in humans to establish smokeless tobacco as carcinogenic, i.e. smokeless tobacco causes cancer of the oral cavity and pancreas". ST products contain a large array of carcinogens, although the number found is actually smaller than in cigarette smoke. Worldwide, ST products have many different names depending on the region where it is produced. However, there are two main types of ST, chewing tobacco and snuff. It is estimated that approximately 150 million people in the world use ST. Herein, we review available literature regarding smokeless tobacco and oral Carcinogenesis. We also discuss the role of viral infections in combination with ST in OSCC development.

  • 175. Sarmadi, Roxana
    et al.
    Gabre, Pia
    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.
    Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er2021In: Clinical and Experimental Dental Research, E-ISSN 2057-4347, Vol. 7, no 4, p. 522-530Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.

    MATERIAL AND METHODS: The trial was performed as a prospective, randomized and controlled, single-blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.

    RESULTS: Significant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5-day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.

    CONCLUSION: In the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.

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  • 176.
    Schönning, C.
    et al.
    Publ Hlth Agcy Sweden, Dept Surveillance & Coordinat, S-17182 Solna, Sweden..
    Lundholm, P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Lytsy, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine.
    Reply from the authors and part of the investigation team2017In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 96, no 2, p. 202-203Article in journal (Other academic)
  • 177.
    Sellberg, Felix
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Fredriksson, Fanny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery.
    Engstrand, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Bowden, Tim
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - Ångström, Polymer Chemistry.
    Nilsson, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Hong, Jaan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Knutson, Folke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Berglund, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Polyvinylalcohol-carbazate (PVAC) reduces red blood cell hemolysis2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0225777Article in journal (Refereed)
    Abstract [en]

    Background and objectives: The objective of this study was to investigate whether a soluble polymer and aldehyde-scavenger, polyvinylalcohol-carbazate (PVAC), can inhibit hemolysis in the storage of red blood cells (RBC).

    Study design and methods: The effect of PVAC was assessed over a wide range of concentrations, using absorption spectroscopy to evaluate the level of hemolysis. Moreover, osmotic stability and aldehyde-scavenging potential of RBC were assessed after storage in PVAC.

    Results: After test tube storage for two weeks, red blood cell hemolysis was lower with PVAC compared to controls (mean difference 23%, 95% CI 16-29%, p < 0.001). A higher level of hemolysis led to a pronounced effect with PVAC. RBC stored in PVAC improved both the binding of free aldehydes (p <0.001) and the osmotic stability (p = 0.0036).

    Conclusion: Erythrocytes stored with PVAC showed less hemolysis, which might be explained by the ability of PVACs to stabilize the cell membrane and decrease oxidative injury.

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  • 178.
    Shojaeian Jalouli, Miranda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Oral cancer with special reference to virus detection and quantitative gene expression2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. Head and neck cancers (HNC) are among the most common malignancies worldwide, and about 90–92% of oral neoplasias are oral squamous cell carcinomas (OSCC). Alcohol and tobacco consumption have been recognized as the main risk factors for OSCC development. Oncogenic viruses, such as human papillomavirus (HPV) or Epstein-Barr virus (EBV), as well as genetic alterations may also contribute to tumour formation. 

    Aims. To study the prevalence of HPV, EBV, Herpes simplex type-1 (HSV-1), and HPV-16 and their integration status as well as the molecular mechanisms that can serve as a basis for the development of OSCC.

    Results. In Paper I we reported a statistically significant increase in the prevalence of HPV-16 in oral epithelial dysplasia (OED) and OSCC samples compared to controls. A statistically significant increase was also seen in integrated HPV-16 compared to episomal viral forms when comparing OED and OSCC samples. Paper II reported the detection of HSV-1 in 54% of healthy samples, in 36% of oral leukoplakia samples, and 52% of OSCC samples. However, these differences were not statistically significant. In Paper III we reported a statistically significant increase in the detection of HPV-positive samples when comparing nested polymerase chain reaction (PCR) with single-PCR results in OSCC and fresh oral mucosa. Paper IV reported that the highest prevalence of HPV (65%) was seen in Sudan, while an HSV-1 prevalence of 55% and an EBV prevalence of 80% were seen in the UK. Finally, Paper V reported that the mRNA levels of Bcl-2, keratin 1, keratin 13, and p53 were significantly lower and that the level of survivin was significantly higher in the OSCC samples of the toombak users than in their paired control samples. Significant downregulation in keratin 1 and keratin 13 expression levels was found in the OSCC samples of the non-toombak users relative to their normal control samples.

    Conclusion. HPV-16 integration was increased in oral epithelial dysplasia and OSCC compared to normal oral mucosa. Nested PCR is a more accurate method of establishing HPV prevalence in samples containing low copy numbers of HPV DNA. HPV and EBV may be a risk factor in OSCC development. Our findings confirmed the role of survivin in OSCC carcinogenesis and survivin might be interesting as a biomarker to be monitored. The results presented here provide both clinical and biological insights that will bring us closer to the goal of managing this disease and improving treatment and outcomes for future patients.

    List of papers
    1. Association of Human Papilloma Virus infection in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma
    Open this publication in new window or tab >>Association of Human Papilloma Virus infection in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma
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    2015 (English)In: Journal of Oral Health and Dental Management, ISSN 1583-5588, Vol. 14, no 5Article in journal (Refereed) Published
    Abstract [en]

    Aims: Human papillomavirus (HPV) is an important risk factor for development of oral cancer; however, the integrational status of the virus into the host DNA association between HPV infection and oral squamous cell carcinoma (OSCC) is still uncertain has not been investigated to the same extent. The objective of the present study was to investigate the prevalence of consensus HPV, and HPV-16 and its integration status, in healthy oral mucosa, oral epithelial dysplasia (OED), and OSCC samples.Materials and Methods: The study material consisted of 26 fresh, normal oral mucosa samples, and 53 and 27 paraffin-embedded OED and OSCC samples, respectively. The specimens were DNA extracted and investigated for the presence of HPV, and HPV-16 and its integration status, by polymerase chain reaction (PCR) and DNA sequencing.Results: Thirty-eight (72%) of the 53 paraffin-embedded OED samples, 16 (59%) of the 27 OSCC samples, and 12 (46%) of the 26 control samples were found to be HPV-DNA positive, with nested PCR (NPCR). Further, HPV-16 was detected in 31 (82%), 15 (94%), and 0 (0%) HPV-positive OED cases, HPV-positive OSCC cases, and controls, respectively. Integration was observed in 26/31 (84%) and 13/15 (87%) of the HPV-16-positive OED and OSCC cases, respectively. A statistically significant difference was found comparing prevalence of HPV-16 in controls with that in both OED and OSCC samples (P<0.005). A statistically significant difference was also found comparing prevalence of integrated and episomal viral forms comparing OED and OSCC samples (P<0.005).Conclusion: The high prevalence of HPV and high-risk HPV-16 in OED and OSCC samples suggests a potential aetiologic role for the virus in OSCC.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-265748 (URN)
    Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01
    2. Nested PCR for detection of HSV-1 in oral mucosa
    Open this publication in new window or tab >>Nested PCR for detection of HSV-1 in oral mucosa
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    2015 (English)In: Medicina Oral, ISSN 1698-4447, E-ISSN 1698-6946, Vol. 20, no 6, p. E664-E669Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: It has been estimated that 15%-20% of human tumours are driven by infection and inflammation, and viral infections play an important role in malignant transformation. The evidence that herpes simplex virus type 1 (HSV-1) could be involved in the aetiology of oral cancer varies from weak to persuasive. This study aimed to investigate by nested PCR (NPCR) the prevalence of HSV-1 in samples from normal oral mucosa, oral leukoplakia, and oral squamous cell carcinoma (OSCC).

    MATERIAL AND METHODS: We investigated the prevalence of HSV-1 in biopsies obtained from 26 fresh, normal oral mucosa from healthy volunteers as well as 53 oral leukoplakia and 27 OSCC paraffin-embedded samples. DNA was extracted from the specimens and investigated for the presence of HSV-1 by nested polymerase chain reaction (NPCR) and DNA sequencing.

    RESULTS: HSV-1 was detected in 14 (54%) of the healthy samples, in 19 (36%) of the oral leukoplakia samples, and in 14 (52%) of the OSCC samples. The differences were not statistically significant.

    CONCLUSIONS: We observed a high incidence of HSV-1 in healthy oral mucosa, oral leukoplakia, and OSCC tissues. Thus, no connection between OSCC development and presence of HSV-1 was detected.

    Keywords
    HSV-1; nested PCR; PCR
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:uu:diva-265746 (URN)10.4317/medoral.20630 (DOI)000369435500004 ()26449432 (PubMedID)
    Available from: 2015-11-03 Created: 2015-11-03 Last updated: 2017-12-01Bibliographically approved
    3. Comparison Between Single PCR and Nested PCR in Detection of Human Papilloma Viruses in Paraffin-embedded OSCC and Fresh Oral Mucosa
    Open this publication in new window or tab >>Comparison Between Single PCR and Nested PCR in Detection of Human Papilloma Viruses in Paraffin-embedded OSCC and Fresh Oral Mucosa
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    2015 (English)In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 29, no 1, p. 65-70Article in journal (Refereed) Published
    Abstract [en]

    Background: Infection with human papilloma virus (HPV) has been implicated as one of the risk factors for the development of oropharyngeal cancer. Many different HPV tests exist, and information regarding their specific technical, analytical, and clinical properties is increasing. Aim: This study aimed to compare the level of detection of HPV using two reliable polymerase chain reaction (PCR) methods, nested PCR (NPCR) and single PCR (SPCR), in archival paraffin-embedded oral squamous cell carcinoma (OSCC) samples and fresh oral mucosa specimens. Materials and Methods: The presence of HPV genome in two groups of tissue samples was analyzed: (i) 57 paraffin-embedded OSCC samples from Sudan and (ii) eight healthy fresh oral mucosal samples from Swedish volunteers. The specimens were tested by SPCR with primer pair MY9/MY11 and NPCR using GP5+/GP6+ primer sets. Results: Eighteen (32%) out of the 57 paraffin-embedded OSCC samples, and five (62%) out of the eight fresh clinically healthy samples were found to be HPV-positive with NPCR. With SPCR, four (7%) out of the paraffin-embedded OSCC samples were HPV-positive. A statistically significant difference between HPV-positive and -negative samples was found when comparing NPCR and SPCR in OSCC and fresh oral mucosa (p<0.0001). The comparative test between SPCR and NPCR showed 100% sensitivity and 69% specificity for OSCC. Conclusion: The use of the GP5+/GP6+ nested PCR increased the positivity rate, efficiency rate and sensitivity of HPV detection in oral samples significantly and should be considered as the method of choice.

    Keywords
    HPV, nested PCR, single PCR, paraffin embedded, OSCC, fresh oral mucosa
    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-245198 (URN)000348134300011 ()25600532 (PubMedID)
    Available from: 2015-02-25 Created: 2015-02-25 Last updated: 2017-12-04Bibliographically approved
    4. Human Papilloma Virus, Herpes Simplex Virus and Epstein Barr Virus in Oral Squamous Cell Carcinoma from Eight Different Countries
    Open this publication in new window or tab >>Human Papilloma Virus, Herpes Simplex Virus and Epstein Barr Virus in Oral Squamous Cell Carcinoma from Eight Different Countries
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    2012 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 32, no 2, p. 571-580Article in journal (Refereed) Published
    Abstract [en]

    Oral squamous cell carcinoma (OSCC) is a major health problem in many parts of the world, and the major causative agents are thought to he the use of alcohol and tobacco. Oncogenic viruses have also been suggested to be involved in OSCC development. This study investigated the prevalence of human papillomaviruses (HPV), herpes simplex virus (HSV) and Epstein-Barr virus (EBV) in 155 OSCC from eight different countries from different ethnic groups, continents and with different socioeconomic backgrounds. 41 A total of OSCCs were diagnosed in the tongue (26%) and 23 in the floor of the mouth (15%); the other 91 OSCCs were diagnosed in other locations (59%). The patients were also investigated regarding the use of alcohol and smoking and smokeless tobacco habits. Tissue samples were obtained from formalin-fixed, paraffin-embedded samples of the OSCC. DNA was extracted and the viral genome was examined by single, nested and seminested PCR assays. Sequencing of double-stranded DNA from the PCR product was carried out. Following sequencing of the HPV-, HSV- and EBV-positive PCR products, 100% homology between the sampels was found. Of all the 155 OSCCs examined, 85 (55%) were positive for EBV, 54 (35%) for HPV and 24 (15%) for HSV. The highest prevalence of HPV was seen in Sudan (65%), while HSV (55%) and EBV (80%) were most prevalent in the UK. In 34% (52/155) of all the samples examined, co-infection by two (46/155=30%) or three (6/155=4%) virus specimens was detected. The most frequent double infection was HPV with EBV in 21% (32/155) of all OSCCs. There was a statistically significant higher proportion of samples with HSV (p=0.026) and EBV (p=0.015) in industrialized countries (Sweden, Norway, UK and USA) as compared to developing countries (Sudan, India, Sri Lanka and Yemen). Furthermore, there was a statistically significant higher co-infection of HSV and EBV in samples from industrialized countries (p=0.00031). No firm conclusions could be drawn regarding the relationship between alcohol, tobacco and virus infections. The significance of our findings must be put in relation to other risk factors and these observations warrant further studies to determine the possible role of viral infections and co-infections with HPV, EBV and HSV as risk markers for the development of OSCC.

    Keywords
    Epstein Barr virus, herpes simplex virus, human papilloma virus, oral squamous cell carcinoma
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:uu:diva-169954 (URN)000299985800023 ()22287747 (PubMedID)
    Available from: 2012-03-08 Created: 2012-03-07 Last updated: 2017-12-07Bibliographically approved
    5. Differential Expression of Apoptosis, Cell Cycle Regulation and Intermediate Filament Genes in Oral Squamous Cell Carcinomas Associated with Toombak Use in Sudan
    Open this publication in new window or tab >>Differential Expression of Apoptosis, Cell Cycle Regulation and Intermediate Filament Genes in Oral Squamous Cell Carcinomas Associated with Toombak Use in Sudan
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    2011 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 31, no 10, p. 3345-3351Article in journal (Refereed) Published
    Abstract [en]

    Previously we used microarray genomic hybridization technology to explore genome-wide profiles of chromosomal aberrations in samples of oral squamous cell carcinomas (OSCCs) and paired normal controls. Based on these findings, 9 genes related to apoptosis, cell cycle regulation and intermediate filament proteins were selected and their differential expression status was examined by real-time quantitative RT-PCR in 26 samples of Sudanese OSCCs and their matched normal controls. The findings were correlated with the habit of toombak use. The mRNA levels of Bcl2, keratin 1, keratin 13 and p53 were significantly lower and the level of survivin was significantly higher in the OSCC samples of the toombak users compared to their paired control samples. A significant down-regulation in keratin I and keratin 13 expression levels was found in the OSCC samples of the non-toombak users compared to their normal control samples. The differential expression of genes related to apoptosis, cell cycle regulation and types I and II keratin could be useful diagnostic markers and provide valuable information for the understanding of oral malignancy in relation to toombak use.

    Keywords
    Oral squamous cell carcinomas, toombak, genes, apoptosis, cell cycle regulation, intermediate filament proteins, Sudan
    National Category
    Cancer and Oncology
    Identifiers
    urn:nbn:se:uu:diva-160724 (URN)000295667700030 ()21965745 (PubMedID)
    Available from: 2011-11-01 Created: 2011-10-31 Last updated: 2022-01-28Bibliographically approved
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  • 179. 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, p. 1652-1655Article 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.

  • 180.
    Stefanski, Sebastian
    et al.
    Ostersund Hosp, Dept Oral & Maxillofacial Surg, Ostersund, Sweden.
    Svensson, Börje
    Orebro Univ Hosp, Dept Oral & Maxillofacial Surg, Orebro, Sweden.
    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 evaluation2017In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, no 11, p. 1354-1359Article 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.

  • 181. 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, p. 1079-1085Article 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.

  • 182.
    Sundberg, Jonas
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, POB 450, SE-40530 Gothenburg, Sweden.
    Korytowska, Magdalena
    NAL Hosp, Clin Orofacial Med & Maxillofacial Surg, Trollhattan, Sweden.
    Burgos, Patricia Miranda
    NAL Hosp, Clin Orofacial Med & Maxillofacial Surg, Trollhattan, Sweden.
    Blomgren, Johan
    Sahlgrenska Univ Hosp East, Clin Orofacial Med, Gothenburg, Sweden.
    Blomstrand, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    De Lara, Shahin
    Sahlgrens Univ Hosp, Dept Clin Pathol, Gothenburg, Sweden.
    Sand, Lars
    Univ Oslo, Fac Odontol, Dept Oral Biol, Oslo, Norway.
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Holmberg, Erik
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden.
    Giglio, Daniel
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden.
    Öhman, Jenny
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, POB 450, SE-40530 Gothenburg, Sweden.
    Kovacs, Aniko
    Sahlgrens Univ Hosp, Dept Clin Pathol, Gothenburg, Sweden.
    Horal, Peter
    Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Infect Med, Gothenburg, Sweden.
    Lindh, Magnus
    Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Infect Med, Gothenburg, Sweden.
    Kjeller, Göran
    Univ Gothenburg, Sahlgrenska Acad, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden.
    Hasseus, Bengt
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, POB 450, SE-40530 Gothenburg, Sweden.
    Combined Testing of p16 Tumour-suppressor Protein and Human Papillomavirus in Patients With Oral Leukoplakia and Oral Squamous Cell Carcinoma2019In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 39, no 3, p. 1293-1300Article in journal (Refereed)
    Abstract [en]

    Background: Oral leukoplakia (OL) is a potentially malignant oral mucosal disorder. A casual association between OL, oral squamous cell carcinoma (OSCC) and human papillomavirus (HPV) infection has been suggested, but no conclusive evidence has been presented. p16, a tumour-suppressor protein, is used as a surrogate marker for HPV infection. The aim of this study was to investigate how overexpression of p16 correlates with HPV infection in OL and in OSCC.

    Patients and Methods: Seventy-four patients with OL and 13 with OSCC with p16 overexpressed, were analyzed by immunohistochemistry visualizing p16 and a real-time polymerase chain reaction (PCR) assay targeting HPV types 6, 11, 16, 18, 31, 33, 35, 39, 45, 52, 56, 58 and 59.

    Results: Overexpression of p16 was observed in 18% of patients with OL. None of the HPV subtypes were detected by PCR analysis in patients with OL. In the p16-positive OSCC specimens, 38% were also HPV16-positive.

    Conclusion: Overexpression of p16 was not found to be a reliable biomarker for HPV infection in patients with OL and OSCC.

  • 183.
    Sundberg, Jonas
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, Gothenburg, Sweden..
    Korytowska, Magdalena
    NAL Hosp, Clin Orofacial Med, Trollhattan, Region Vastra G, Sweden..
    Holmberg, Erik
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Bratel, John
    Clin Oral Med, Gothenburg, Region Vastra G, Sweden..
    Wallström, Mats
    Clin Oral & Maxillofacial Surg, Gothenburg, Region Vastra G, Sweden..
    Kjellström, Ebba
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Blomgren, Johan
    Sahlgrenska Univ Hosp East, Clin Oral Med, Gothenburg, Region Vastra G, Sweden..
    Kovacs, Aniko
    Sahlgrens Univ Hosp, Dept Clin Pathol, Gothenburg, Sweden..
    Öhman, Jenny
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, Gothenburg, Sweden..
    Sand, Lars
    Univ Oslo, Fac Odontol, Dept Oral Biol, Oslo, Norway..
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Giglio, Daniel
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol, Gothenburg, Sweden..
    Kjeller, Göran
    Clin Oral & Maxillofacial Surg, Gothenburg, Region Vastra G, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden..
    Hasseus, Bengt
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral Med & Pathol, Gothenburg, Sweden.;Clin Oral Med, Gothenburg, Region Vastra G, Sweden..
    Recurrence rates after surgical removal of oral leukoplakia: A prospective longitudinal multicentre study2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0225682Article in journal (Refereed)
    Abstract [en]

    Oral leukoplakia (OL) is a potentially malignant oral disorder. The Gold Standard treatment is to remove surgically the OL. Despite optimal surgery, the recurrence rates are estimated to be 30%. The reason for this is unknown. The aim of this study was to investigate the clinical factors that correlate with recurrence after surgical removal of OL. In a prospective study data were collected from 226 patients with OL. Forty-six patients were excluded due to incomplete records or concomitant presence of other oral mucosal diseases. Overall, 180 patients proceeded to analysis (94 women and 86 men; mean age, 62 years; age range, 28-92 years). Clinical data, such as gender, diagnosis (homogeneous/non-homogeneous leukoplakia), location, size, tobacco and alcohol use, verified histopathological diagnosis, and clinical photograph, were obtained. In patients who were eligible for surgery, the OL was surgically removed with a margin. To establish recurrence, a healthy mucosa between the surgery and recurrence had to be confirmed in the records or clinical photographs. Statistical analysis was performed with the level of significance set at P<0.05. Of the 180 patients diagnosed with OL, 57% (N = 103) underwent surgical removal in toto. Recurrence was observed in 43 OL. The cumulative incidence of recurrence of OL was 45% after 4 years and 49% after 5 years. Fifty-six percent (N = 23) of the non-homogeneous type recurred. Among snuff-users 73% (N = 8) cases of OL recurred. A non-homogeneous type of OL and the use of snuff were significantly associated with recurrence after surgical excision (P = 0.021 and P = 0.003, respectively). Recurrence was also significantly associated with cancer transformation (P< 0.001). No significant differences were found between recurrence and any of the following: dysplasia, site of lesion, size, multiple vs. solitary OL, gender, age, use of alcohol or smoking. In conclusion, clinical factors that predict recurrence of OL are non-homogeneous type and use of snuff.

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  • 184. Sundberg, Jonas
    et al.
    Öhman, Jenny
    Korytowska, Magdalena
    Wallström, Mats
    Kjeller, Göran
    Andersson, Maria
    Horal, Peter
    Lindh, Magnus
    Giglio, Daniel
    Kovács, Anikó
    Sand, Lars
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Magda Araújo Ferracini, Lais
    de Souza, Ana Carolina Mamana Fernandes
    Parlatescu, Ioanina
    Dobre, Maria
    Hinescu, Mihail-Eugen
    Braz-Silva, Paulo Henrique
    Tovaru, Serban
    Hasséus, Bengt
    High-risk human papillomavirus in patients with oral leukoplakia and oral squamous cell carcinoma-A multi-centre study in Sweden, Brazil and Romania.2021In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 27, no 2, p. 183-192Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Although causal associations between oral leukoplakia (OL), oral squamous cell carcinoma (OSCC) and high-risk human papillomavirus (HR-HPV) have been speculated upon in several reports, conclusive evidence has not been presented. This study investigates whether the number of cases of HR-HPV in OL has increased over time and whether the prevalence of HR-HPV-positive OL differs in various parts of the world.

    PATIENTS AND METHODS: A total of 432 patients with OL from Sweden, Brazil and Romania were analysed. Patients were divided into historical (1992-2002) and contemporary (2011-2017) cohorts from the respective countries. Seventeen patients with OL developed oral squamous cell carcinoma (OSCC). A real-time PCR assay, targeting HPV sub-types 6,11,16,18,31,33,35,39,45,52,56,58 and 59, was performed to detect HR-HPV in patients with OL.

    RESULTS: In the Swedish and Romanian cohorts, none of the investigated HPV sub-types were detected. In the Brazilian cohorts, five patients with OL (3%) were positive for HR-HPV, including four patients from the contemporary cohort (HPV 16, 31, 33) and one from the historical cohort (HPV 11). All the cases of OL that transformed into OSCC were HR-HPV-negative, as were the corresponding tumours.

    CONCLUSIONS: In summary, the prevalence of HR-HPV in OL is low in all the tested countries, and the incidence has not changed over time. HR-HPV in OL does not seem to be a driver of oncogenesis.

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  • 185.
    Temmerman, A.
    et al.
    Katholieke Univ Leuven, KU Leuven & Dent, Univ Hosp, Sect Periodontol,Dept Oral Hlth Sci, Kapucijnenvoer 7, B-3000 Leuven, Belgium.
    Rasmusson, L.
    Univ Gothenburg, Sahlgrenska Acad, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden.
    Kübler, A.
    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.
    Merheb, J.
    Katholieke Univ Leuven, KU Leuven & Dent, Univ Hosp, Sect Periodontol,Dept Oral Hlth Sci, Kapucijnenvoer 7, B-3000 Leuven, Belgium.
    Quirynen, M.
    Katholieke Univ Leuven, KU Leuven & Dent, Univ Hosp, Sect Periodontol,Dept Oral Hlth Sci, Kapucijnenvoer 7, B-3000 Leuven, Belgium.
    A Prospective, Controlled, Multicenter Study to Evaluate the Clinical Outcome of Implant Treatment in Women with Osteoporosis/Osteopenia: 5-Year Results2019In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 98, no 1, p. 84-90Article in journal (Refereed)
    Abstract [en]

    The impact of osteoporosis on implant treatment is still a matter of debate in the scientific community, as it may possibly lead to higher failure rates. As long-term controlled trials are missing, the aim of this study was to verify the long-term outcome of implants placed in patients with systemic osteoporosis. Postmenopausal women in need of implants underwent bone mineral density measurements in hip and spine, using dual X-ray absorptiometry scans. Based on T-scores, they were divided into 2 groups: group O (osteoporosis group) with a T-score <=-2 or group C (control group) with a T-score of >=-1. Implants were placed in a 2-stage manner and loaded 4 to 8 wk after abutment surgery. Six months after loading and thereafter yearly, clinical and radiographical parameters were assessed. In total, 148 implants were placed in 48 patients (mean age: 67 y [range, 59-83]). Sixty-three implants were placed in 20 patients (group O) and 85 implants in 28 patients (group C). After 5 y, 117 implants (38 in group O and 79 in the group C) in 37 patients were assessed. Cumulative survival rate on an implant level was 96.5% (group O: 91.5%; group C: 100.0% [P < 0.05]) and 95.7% (group O: 89.2%; group C: 100.0% [P > 0.05]) on a patient level. The overall marginal bone-level alterations, after 5 y of loading, were -0.09 +/- 0.78 mm (group O: -0.15 +/- 0.50 mm; group C: -0.06 +/- 0.89 mm) on an implant level and -0.09 +/- 0.54 mm (group O: -0.18 +/- 0.43 mm; group C: 0.06 +/- 0.58 mm) on a patient level (P > 0.05). Oral implant therapy in osteoporotic patients is a reliable treatment option with comparable osseointegration rates, implant survival, and marginal bone-level alterations after 5 y of functional loading (ClinicalTrials.gov NCT00745121).

  • 186. 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, p. 95-102Article 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.

  • 187.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Porous Titanium Granules and Blood for Bone Regeneration around Dental Implants: Report of Four Cases and Review of the Literature2013In: Case Reports in Dentistry, ISSN 2090-6447, E-ISSN 2090-6455, Vol. 2013, p. 410515-Article in journal (Refereed)
    Abstract [en]

    A regenerative procedure treating a local osseous defect around titanium dental implant using porous titanium granules is described in four patients. Porous titanium granules represent, for maxillofacial surgery, a new alternative in augmenting osseous defects. Its earliest application was in the field of orthopedics for stabilization of tibia plateau fractures and for reoperations in prosthetic fixation of femoral stems. There is emerging scientific evidence regarding titanium for its potential use in the maxillofacial area and porous titanium granules are now commercially available. The scientific background for the osteoconductive use of porous titanium granules is elucidated in this paper and the supporting literature is reviewed.

  • 188.
    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, p. 188-194Article 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.

  • 189.
    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, p. 112-114Article 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.

  • 190.
    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, p. 642-649Article 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.

  • 191.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Farzad, Payam
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Fracture of the tibia: Complication of bone grafting to the anterior maxilla2006In: British Journal of Oral & Maxillofacial Surgery, ISSN 0266-4356, E-ISSN 1532-1940, Vol. 44, no 1, p. 46-48Article in journal (Refereed)
    Abstract [en]

    Autogenous tibial cancellous bone has been used for reconstructive operations in oral and maxillofacial surgery for over 10 years, and has reduced many of the problems associated with conventional sites of autogenous grafts such as the iliac crest. The ease of access for harvesting, the speed of the operation, and the abundance of bone, are advantages of this donor site. We report a patient who had a graft taken from the proximal tibia and had a displaced fracture 2 weeks later after a fall. Five similar cases have been reported previously, of which none has required surgical intervention.

  • 192.
    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, p. 1164-1171Article 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.

  • 193.
    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.

  • 194.
    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, p. 1899-1904Article 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.

  • 195.
    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, p. 966-974Article 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.

  • 196.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rojas, Rafael Acosta
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Functional reconstruction of the temporomandibular joint with a free fibular microvascular flap2008In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 0284-4311, E-ISSN 1651-2073, Vol. 42, no 5, p. 233-40Article in journal (Refereed)
    Abstract [en]

    By preserving the temporomandibular joint (TMJ) disc in the glenoid fossa at the time of resection, correctly securing the vascularised fibular end in the fossa, and by reattaching the lateral pterygoid muscle, it is possible to maintain normal rotation, translatation, and protrusion in the TMJ and the function of the jaw can be totally restored. We describe four patients in whom good function was achieved in three; this is underlined by extensive remodelling of the condylar head seen at radiological follow-up up to 36 months.

  • 197.
    Thor, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sennerby, Lars
    Hirsch, Jan Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants2007In: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 65, no 7, p. 64-72Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Restoration of lost dentition in the severely artrophic posterior maxilla has for the last 2 decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft material is anticipated to be necessary; however, recent studies have demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants result in bone formation. This study was conducted in order to evaluate simultaneous sinus mucosal lining elevation and installation of dental implants without any graft material. PATIENTS AND METHODS: Twenty patients were consecutively included from November 2001 to June 2004. Forty-four Astra ST dental implants (Astra Tech AB, Mölndal, Sweden) with a diameter of 4.5 mm or 5 mm were installed in 27 sinuses. A sinus lift was performed where a cortical window was removed from the maxillary anterior sinus wall. The sinus mucosal lining was elevated and implants installed in the residual subantral bone. The cortical window was thereafter replaced and the incision closed. The remaining bone height was recorded during surgery as well as perforations of the sinus mucosal lining. After 6 months of healing, abutments were connected (the series included 5 1-stage procedures). Clinical and radiological follow-up after loading was performed up to 4 years after implant installation. RESULTS: Patients tolerated the procedure well as few complications were observed. Firm primary stability was achieved for all implants at installation with bone levels in residual bone of 2 to 9 mm. Perforations of the maxillary sinus mucosal lining occurred in 11 of the 27 operated sinuses (41%). One implant was lost during a mean follow-up of 27.5 months (range, 14 to 45 months) giving an implant survival rate of 97.7%. The average gain of bone at the sinus floor was 6.51 mm (SD = 2.49, 44 implants) including all measured implants after a minimum of 1 year follow-up. Marked bone formation was observed around long implants and also when the residual bone below the sinus was diminutive. CONCLUSIONS: The present study including 20 patients showed consistent bone formation at the maxillary sinus floor following simultaneous mucosal lining elevation and installation of implants. It is suggested that the use of this technique can reduce the risk for morbidity related to harvesting of bone grafts and eliminate costs for grafting materials.

  • 198.
    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, p. 79-86Article in journal (Refereed)
  • 199. 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, p. 518-526Article 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.

  • 200.
    Toljanic, Joseph A.
    et al.
    Midwestern Univ, Coll Dent Med Illinois, 555 31st St, Downers Grove, IL 60515 USA..
    Ekstrand, Karl
    Univ Oslo, Inst Klin Odont, Oslo, Norway..
    Baer, Russell A.
    Univ Associates Dent, Chicago, IL USA..
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation: A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial2016In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 31, no 5, p. 1164-1170Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Successful immediate loading of implants in the edentulous maxilla has been previously reported. The purpose of this 5-year prospective study was to further assess long-term outcomes following immediate loading of implants in the edentulous maxilla with fixed provisional restorations without the use of bone augmentation procedures.

    MATERIALS AND METHODS: Subjects with edentulous maxillary arches each received six implants placed in native bone without augmentation. Where insufficient posterior bone volume existed, angled implant placement was employed. Fixed provisional restorations were delivered within 24 hours of implant placement. Implant placement locations, insertion torque values, and implant dimensions were recorded. Definitive fixed prostheses were placed within 24 weeks following implantation. Baseline implant site marginal bone levels were measured using periapical radiographs. Baseline peri-implant plaque and bleeding scores were obtained. Subjects were examined 6 months after implant placement and then annually for 5 years with follow-up periapical radiographs and plaque/bleeding scores obtained.

    RESULTS: Fifty-one subjects received a total of 306 implants. Forty subjects with 232 implants returned for the final follow-up appointment representing a 5-year implant survival proportion of 93% with a mean marginal bone loss of 0.44 ± 1.25 mm for this group. Thirty-nine of these 40 subjects continued to function with fixed restorations with the remaining subject functioning with a non-implant-retained removable prosthesis.

    CONCLUSION: Within the limitations of this study, predictable long-term implant rehabilitation outcomes were demonstrated for the edentulous maxilla using an immediate loading protocol without bone augmentation.

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