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  • 51.
    Hedenqvist, Patricia
    et al.
    Swedish Univ Agr Sci, Dept Clin Sci, VHC POB 7054, SE-75007 Uppsala, Sweden..
    Trbakovic, Amela
    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.
    Ley, Cecilia
    Swedish Univ Agr Sci, Dept Biomed Sci & Vet Publ Hlth, Div Pathol, POB 7028, SE-75007 Uppsala, Sweden..
    Ekman, Stina
    Swedish Univ Agr Sci, Dept Biomed Sci & Vet Publ Hlth, Div Pathol, POB 7028, SE-75007 Uppsala, Sweden..
    Jensen-Waern, Marianne
    Swedish Univ Agr Sci, Dept Clin Sci, VHC POB 7054, SE-75007 Uppsala, Sweden..
    Carprofen neither reduces postoperative facial expression scores in rabbits treated with buprenorphine nor alters long term bone formation after maxillary sinus grafting2016In: Research in Veterinary Science, ISSN 0034-5288, E-ISSN 1532-2661, Vol. 107, p. 123-131Article in journal (Refereed)
    Abstract [en]

    In connection with bilateral maxillary sinus augmentation, the acute effects of the nonsteroidal anti-inflammatory drug carprofen on facial expressions and long-term effects on bone formation were evaluated in 18 male New Zealand White rabbits. A 10 x 10 mm bone window was drilled in the maxilla, the sinus membrane elevated and a titanium mini-implant inserted. One of two test materials was randomly inserted unilaterally and bovine bone chips (control) on the contralateral side in the created space. Rabbits were randomly allocated to receive buprenorphine plus carprofen (n = 9) or buprenorphine plus saline (n = 9) postoperatively. Buprenorphine was administered subcutaneously every 6 h for 3 days in a tapered dose (0.05-0.01 mg/kg) and carprofen (5 mg/kg) or saline administered subcutaneously 1 h before, and daily for 4 days postoperatively. To assess pain, clinical examination, body weight recording and scoring of facial expressions from photos taken before, and 6-13 h after surgery were performed. Twelve weeks after surgery the rabbits were euthanized and sections of maxillary bones and sinuses were analysed with histomorphometry and by qualitative histology. Carprofen had no effect on mean facial expression scores, which increased from 0.0 to 3.6 (carprofen) and 43 (saline), of a maximum of 8.0. Neither did carprofen have an effect on bone formation or implant incorporation, whereas the test materials had. In conclusion, treatment with 5 mg/kg carprofen once daily for 5 days did not reduce facial expression scores after maxillary sinus augmentation in buprenorphine treated rabbits and did not affect long term bone formation.

  • 52.
    Hillbertz, Nicolette Salmon
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Jalouli, Jamshid
    Jalouli, Miranda M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Viral and Molecular Aspects of Oral Cancer2012In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 32, no 10, p. 4201-4212Article, review/survey (Refereed)
    Abstract [en]

    Squamous cell carcinoma (SCC) is the most common epithelial malignancy in the oral cavity. SCCs 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, virus infections, and genetic alterations most likely interact, and thus give rise to the malignant condition. Herein, we review the available literature regarding high-risk factors such as alcohol and tobacco usage; discuss the roles of human papillomaviruses (HPV), the Epstein-Barr virus, and the human herpes simplex virus (HSV); and evaluate several candidate genes associated with the condition: p53, p16(INK4) and p21(WAF1/CIP1) survivin, B-cell lymphoma-2 (BCL-2), keratins, Fibroblast growth factor 3 (FGF3), FGF4, FGF19, Oral cancer overexpressed gene 1 (ORAOV1), and Cyclin D1 (CCND1).

  • 53.
    Hirsch, Jan M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ahlström, U
    Henrikson, P A
    Heyden, G
    Peterson, L E
    Periapical surgery1979In: International journal of oral surgery, ISSN 0300-9785, Vol. 8, no 3, p. 173-185Article in journal (Refereed)
    Abstract [en]

    A retrospective study of 572 teeth treated with periapical surgery was undertaken in order to evaluate the influence of preoperative, operative and postoperative factors in the healing process as well as the operation method used. It was also the aim to assess whether the histophatological diagnosis of biopsies taken at the operation could be correlated to healing. Statistical analyses by the AID method and conventional cross-classification methods were performed. Factors of importance were found to be the extent of the destrucion, the operation method used, the bone surrounding the destruction, the quality of the orthograde root filling, the age of the patient, and the marginal bone buccally. The operation method was of importance in large destructions where root fillings were considered as not having properly sealed the canals, and when treating inflamed cysts. The histopathological diagnosis could not be ascribed any definite prognostic value.

  • 54.
    Hirsch, Jan M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Brånemark, P I
    Fixture stability and nerve function after transposition and lateralization of the inferior alveolar nerve and fixture installation1995In: British Journal of Oral & Maxillofacial Surgery, ISSN 0266-4356, E-ISSN 1532-1940, Vol. 33, no 5, p. 276-281Article in journal (Refereed)
    Abstract [en]

    Twenty-four posterior mandibular segments in 18 patients were operated on placing implants after mobilisation of the neurovascular bundle. Two different surgical techniques, transposition and lateralization was used. The overall survival rate of fixtures was 92.1%. Performing lateralization resulted in 100% success, while transposition resulted in 80% stable fixtures in the involved segments. The mean time to full restoration of nerve function was 3.8 weeks after lateralization and 5.7 weeks after tranposing the nerve. Three patients exhibited persisting slight hyposthesia, but all, subjectively negligible disturbances in nerve function.

  • 55.
    Hirsch, Jan M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hasséus, B
    Kjeller, G
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Runow Stark, C
    Wallström, M
    Screening kan minska insjuknandet i munhålecancer2017In: Tandläkartidningen, ISSN 0039-6982, no 9, p. 50-53Article in journal (Refereed)
  • 56.
    Hirsch, Jan M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thilander, H
    Snuff-induced lesions of the oral mucosa: an experimental model in the rat1981In: Journal of oral pathology, ISSN 0300-9777, Vol. 10, no 5, p. 342-353Article in journal (Refereed)
    Abstract [en]

    An experimental model in the white rat has been developed in order to study the influence of snuff on oral mucosa. A test canal in the lower lip, with one orifice buccally to the incisors and one on the lip side, was created by surgical means. The connection between the canal and the oral cavity was made to ensure the presence of saliva in the canal so that physiological conditions resembling those of the oral cavity were obtained. The canal was filled with snuff morning and night 5 days a week. The mean value for the maximal retention time of the snuff was 6 h. The animals tolerated the dose and time of exposure without signs of severe toxic symptoms. Histological examination of the canals after 9 months of exposure to snuff showed a mildly to moderately hyperplastic epithelium with hyperorthokeratosis. Locally deep proliferations of epithelium with acanthotic rete pegs could be seen. In the stratum basale hyperplasia with disturbed polarity and hyperchromatic nuclei and single mitosis were noted.

  • 57.
    Hirsch, Jan
    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.
    Leiggener, C
    Messo, Elias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Acosta, Rojas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Krol, Z
    Buitrage-Tellez, CH
    Reconstruction of the temperomandibular joint with free fibula microvascular flaps without and with surgical guides2009In: International Journal of Computer Assisted Radiology and Surgery, ISSN 1861-6410, E-ISSN 1861-6429, Vol. 4, no Suppl 1, p. S226-S227Article in journal (Refereed)
  • 58.
    Hirsch, Jan-Michael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wallström, Mats
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sand, Lars P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Oral cancer in Swedish snuff dippers2012In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 32, no 8, p. 3327-3330Article in journal (Refereed)
    Abstract [en]

    Over recent decades there has been debate over whether or not Swedish snuff is carcinogenic in humans. Animal studies and molecular biological and experimental studies have shown the carcinogenic potential of Swedish snuff, but this has not been proved in prospective randomized studies. We present a case series of patients with oral squamous cell carcinomas diagnosed at the sites where the patients had used Swedish snuff for several years. Sixteen male patients were referred to and treated at Oral and Maxillofacial Surgery Departments and Ear, Nose and Throat clinics at seven different hospitals in Sweden. The mean age of the patients at the time of diagnosis was 72.9 years and the mean time of snuff use prior to cancer diagnosis was 42.9 years. This case series shows that Swedish snuff may not be a harmless alternative to smoking.

  • 59.
    Hirsch, Jan-Michael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Öhrnell, Lars-Olof
    Henry, Patrick J
    Andreasson, Lars
    Brånemark, Per-Ingvar
    Chiapasco, Matteo
    Gynther, Göran
    Finne, Kaj
    Higuchi, Kenji W
    Isaksson, Sten
    Kahnberg, Karl-Erik
    Malevez, Chantal
    Neukam, Friedrich W
    Sevetz, Edward
    Urgell, Juan P
    Widmark, Göran
    Bolind, Pia
    A clinical evaluation of the Zygoma fixture: one year of follow-up at 16 clinics2004In: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 62, no 9(Suppl 2), p. 22-29Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate treatment outcome with Zygoma fixtures (Nobel Biocare, Göteborg, Sweden) with regard to fixture survival, patient satisfaction, and function of prosthesis replacement. MATERIALS AND METHODS: The treatment outcome of 76 patients treated with 145 Zygoma fixtures at 16 centers was evaluated. Patient's and dentist's evaluations of the functional and aesthetic outcome of the treatment were assessed at delivery of prosthesis and at the 1-year follow-up visit. At the 1-year follow-up visit, the status of the peri-implant mucosa around the abutments and the amount of plaque were registered. RESULTS: Sixty-six of the 76 patients, with 124 Zygoma fixtures supporting the prosthetic restorations, were evaluated at the 1-year follow-up. The overall survival rate for the Zygoma fixtures was 97.9% after 1-year of follow-up. Eighty percent of the patients were fully satisfied with both aesthetic and functional outcome at the time of prosthetic insertion and at the 1-year follow-up. All reported data from the dentists, with the exception of one restoration with several abutment screw loosenings, scored from acceptable to excellent for the aesthetic and functional outcome of the treatment. The status of peri-implant mucosa was recorded as normal in approximately 60% of the sites. Plaque, when present, was more often detected on the palatal surfaces compared with the buccal surfaces. CONCLUSION: This 1-year follow-up of Zygoma fixtures has shown good results with an acceptable number of minor complications and a majority of satisfied patients.

  • 60.
    Hong, Jaan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Kurt, Seta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Clinical Immunology.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    A Hydrophilic Dental Implant Surface Exhibit Thrombogenic Properties In Vitro2013In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 15, no 1, p. 105-112Article in journal (Refereed)
    Abstract [en]

    Background:

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

    Purpose:

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

    Methods:

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

    Results:

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

    Conclusions:

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

  • 61.
    Huo, Jinxing
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    Dérand, Per
    Department of Oral and Maxillofacial Surgery, Skåne University Hospital.
    Rännar, Lars-Erik
    Sports Tech Research Centre, Mid Sweden University.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Gamstedt, E. Kristofer
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    Failure location predictoin by finite element analysis for an additive manufactured mandible implant2015In: Medical Engineering and Physics, ISSN 1350-4533, E-ISSN 1873-4030, Vol. 37, no 9, p. 862-869Article in journal (Refereed)
    Abstract [en]

    In order to reconstruct a patient with a bone defect in the mandible, a porous scaffold attached to a plate, both in a titanium alloy, was designed and manufactured using additive manufacturing. Regrettably, the implant fractured in vivo several months after surgery. The aim of this study was to investigate the failure of the implant and show a way of predicting the mechanical properties of the implant before surgery. All computed tomography data of the patient were preprocessed to remove metallic artefacts with metal deletion technique before mandible geometry reconstruction. The three-dimensional geometry of the patient's mandible was also reconstructed, and the implant was fixed to the bone model with screws in Mimics medical imaging software. A finite element model was established from the assembly of the mandible and the implant to study stresses developed during mastication. The stress distribution in the load-bearing plate was computed, and the location of main stress concentration in the plate was determined. Comparison between the fracture region and the location of the stress concentration shows that finite element analysis could serve as a tool for optimizing the design of mandible implants.

  • 62.
    Huo, Jinxing
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Deránd, Per
    Lund University.
    Rännar, Lars-Erik
    Mittuniversitetet.
    Gamstedt, E. Kristofer
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    Finite Element Investigation of the In - Vivo Failure of a Titanium Alloy HumanJaw Implant2014Conference paper (Refereed)
    Abstract [en]

    In order to reconstruct a patient with a bone defect in the right lower jaw, a scaffold attached to a reconstruction plate, both in a titanium alloy, was designed and manufactured using three-dimensional printing technique. Regrettably the implant fractured in situ several months after surgery. This paper is orientated to investigate the reason for the implant’s failure and provide a way of predicting the mechanical properties of the implant before surgery. Preoperative, postoperative and implant-break computed tomography data of the patient were provided by the responsible surgeon. Metallic artifacts introduced by previous dental implants were removed with metallic deletion technique software beforehand. Three-dimensional volume of the patient’s jaw was thereafter reconstructed with trabecular bone removed based on the cleaned computed tomography data. The implant, screws and jaw were assembled together and meshed with triangular elements in Mimics 16.0. The assembly was imported into in-house software with surface mesh converted to linear tetrahedral mesh. Simulations were implemented under simplified but suitable loading conditions with the assumption that jaw was a linear elastic and homogeneous material. The stress distribution on the implant plate was calculated and the location of stress concentration on the plate was determined and then verified by the clinical data of the patient. This validated model could serve in the future as a tool for optimizing the design of jaw implants.

  • 63.
    Huo, Jinxing
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Gamstedt, E. Kristofer
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Mechanics.
    An analytical study of stress distributions around screws in mandibular boneManuscript (preprint) (Other academic)
  • 64.
    Ibrahim, Abdulhakim
    et al.
    Univ Hosp Munster, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Marchiori, Elena
    Univ Hosp Munster, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Eierhoff, Thorsten
    Univ Hosp Munster, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Martens, Sven
    Univ Hosp Munster, Div Cardiac Surg, Dept Cardiothorac Surg, Munster, Germany..
    Motekallemi, Arash
    Univ Hosp Munster, Div Cardiac Surg, Dept Cardiothorac Surg, Munster, Germany..
    Rukosujew, Andreas
    Univ Hosp Munster, Div Cardiac Surg, Dept Cardiothorac Surg, Munster, Germany..
    Oberhuber, Alexander
    Univ Hosp Munster, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany..
    Asciutto, Giuseppe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Univ Hosp Munster, Dept Vasc & Endovasc Surg, Albert Schweitzer Campus 1, D-48149 Munster, Germany.;Uppsala Univ, Vasc Surg Sect, Dept Surg Sci, Uppsala, Sweden..
    Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus2021In: Journal of Thoracic Disease, ISSN 2072-1439, E-ISSN 2077-6624, Vol. 13, no 7, p. 4311-4321Article in journal (Refereed)
    Abstract [en]

    Background: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. Methods: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 degrees C lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/mu L). Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. Results: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5 +/- 8.9 vs. 62.5 +/- 9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011). After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS. Conclusions: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts.

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  • 65. Ibrahim, S O
    et al.
    Johannessen, A C
    Idris, A M
    Hirsch, Jan M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Vasstrand, E N
    Magnusson, B
    Nilsen, R
    Immunohistochemical detection of p53 in non-malignant and malignant oral lesions associated with snuff dipping in the Sudan and Sweden1996In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 68, no 6, p. 749-753Article in journal (Refereed)
    Abstract [en]

    Immunohistochemistry was used to examine the expression of p53 in pre-malignant oral lesions and oral squamous-cell carcinomas (SCCs) from Swedish and Sudanese snuff-dippers, as well as in pre-malignant oral lesions and oral SCCs from non-snuff-dippers from the Sudan, Sweden and Norway. Of the 14 SCCs from Sudanese snuff-dippers, 21% (3/14) expressed p53. Of the 14, 60 and 41 SCCs from non-snuff-dippers from the Sudan, Sweden and Norway, 64% (9/14), 65% (39/60) and 68% (28/41) expressed p53, respectively. A statistically significant difference in expression of p53 was found in SCCs from Sudanese snuff-dippers compared to those from non-snuff-dippers from all/or any of the 3 countries. None of the suspected pre-malignant oral lesions from Sudanese snuff dippers or non-snuff-dippers expressed p53. Only 2 out of the 15 oral fibro-epithelial hyperplastic lesions from Swedish snuff-dippers expressed p53. Some of the oral epithelial dysplastic lesions, as well as the carcinoma in situ lesions from Norwegian non-snuff-dippers, expressed p53, while the oral fibro-epithelial hyperplastic lesions did not. The low relative frequency of p53 expression found in oral SCCs from snuff-dippers compared to those from non-snuff-dippers might suggest differences in mechanisms of oncogenic action induced by snuff. Alternatively, the pathogenesis of malignant oral lesions from snuff-dippers may follow a p53-independent pathway. In view of the unusually high levels of the tobacco-specific nitrosamines (TSNA) found in the type of snuff used in the Sudan, investigations of p53 mutations or oncogenes are needed.

  • 66. Idris, AM
    et al.
    Ibrahim, SO
    Vasstrand, EN
    Johannessen, AC
    Lillehaug, JR
    Magnusson, B
    Wallstrom, M
    Hirsch, Jan M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Nilsen, R
    The Swedish snus and the Sudanese toombak: are they different?1998In: Oral Oncology, ISSN 1368-8375, E-ISSN 1879-0593, Vol. 34, no 6, p. 558-566Article in journal (Refereed)
    Abstract [en]

    In Sweden, snuff (locally known as snus), was introduced since the year 1637. Presently, Sweden has the highest per capita consumption and sale figures of snuff in the world, and the habit is becoming increasingly popular. Snus is manufactured into a dry form used in the nasal cavity and a moist form used in the oral cavity. Snus manufactured for oral use is a moist ground tobacco of Dark Kentucky or Virginia species mixed with an aqueous solution of water and other blending ingredients. This form of snuff is found in two types: (1) loose and (2) portion-bag-packed. These are the most widely used. The loose moist form (1–2 g a quid) is the most popular type consumed by 73% of the males, followed by the portion-bag-packed form (0.5–1 g a quid), consumed by 13% of the males, while 14% of the males are mixed users. The majority of snus users place the quid in the vestibular area of the upper lip, and the prevalence among persons 15 years of age or older is 15.9% among males and 0.2% among females. The pH of snus has declined from a previous range of 8–9 to a range of 7.8–8.5, moisture content ranges 35–60% and nicotine content is in the order of 5–11 mg/g dry wt tobacco-specific N-nitrosamines (TSNAs) in micrograms (N′-nitrosonornicotine: NNN 5–9; 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone: NNK 1–2; N′-nitrosoanatabine: NAT 2–5). In the Sudan, snuff, locally known as toombak, was introduced approximately 400 years ago. It is always processed into a loose moist form, and its use is widespread in the country. Tobacco used for manufacture of toombak is of the species Nicotiana rustica, and the fermented ground powder is mixed with an aqueous solution of sodium bicarbonate. The resultant product is moist, with a strong aroma, highly addictive and its use is widespread particularly among males. Its pH range is 8–11, moisture content ranges 6–60% and nicotine content is from 8 to 102 mg/g dry wt, and TSNAs contents in micrograms (NNN 420–1 550; NNK 620–7 870; NAT 20–290). Snus and toombak dippers develop a clinically and histologically characteristic lesion at the site of dipping. Probably due to control of the TSNAs in snus, this type of snuff is associated with a lower risk of cancer of the oral cavity (relative risk: RR 5–6-fold), whereas the risk for cancer of the oral cavity among toombak users was high (RR 7.3–73.0-fold). In conclusion, the two snuff products significantly differ in many aspects. Most notable differences are tobacco species, fermentation and ageing, nicotine and TSNAs content, pH, expression of the p53 tumour supressor gene, and keratin types 13, 14, and 19. It was, therefore, the object of the present study to highlight the oral health hazards of toombak, and to compare it with snus regarding the aforementioned differences.

  • 67.
    Jabbari, Fatemeh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reconstruction of the alveolar process in cleft patients2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt.

    Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV).

    Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition.

    Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

    List of papers
    1. Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate
    Open this publication in new window or tab >>Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate
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    2015 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 52, no 2, p. 210-218Article in journal (Refereed) Published
    Abstract [en]

    Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions : In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.

    National Category
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-245024 (URN)10.1597/13-118 (DOI)000352143500013 ()24568558 (PubMedID)
    Available from: 2015-02-24 Created: 2015-02-24 Last updated: 2017-12-04Bibliographically approved
    2. Corrlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting
    Open this publication in new window or tab >>Corrlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting
    Show others...
    (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed) In press
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-282012 (URN)
    Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2017-11-30Bibliographically approved
    3. Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth
    Open this publication in new window or tab >>Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth
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    2017 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 139, no 1, p. 137-148Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-282017 (URN)10.1097/PRS.0000000000002910 (DOI)000394051100011 ()28027239 (PubMedID)
    Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2022-01-29Bibliographically approved
    4. Secondary Alveolar Bone Grafting in patients Born with unilateral Cleft Lip and Palate-a 20-years follow-up
    Open this publication in new window or tab >>Secondary Alveolar Bone Grafting in patients Born with unilateral Cleft Lip and Palate-a 20-years follow-up
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-282018 (URN)
    Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2016-04-28
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  • 68.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reiser, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Skoog, Valdemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth2017In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 139, no 1, p. 137-148Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 69.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reiser, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Correlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 1, p. 33-37Article in journal (Refereed)
    Abstract [en]

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

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  • 70.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Reiser, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Corrlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone graftingIn: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed)
  • 71.
    Jabbari, Fatemeh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wiklander, Lila
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Erika, Reiser
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Secondary Alveolar Bone Grafting in patients Born with unilateral Cleft Lip and Palate-a 20-years follow-upManuscript (preprint) (Other academic)
  • 72.
    Jabbari, Fatima
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Skoog, Valdemar
    Reiser, Eicka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate2015In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 52, no 2, p. 210-218Article in journal (Refereed)
    Abstract [en]

    Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions : In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.

  • 73.
    Jabbari, Fatima
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wiklander, Laila
    Eastman Inst, Publ Dent Hlth Serv, Specialist Dent Care, Dept Oral & Maxillofacial Radiol, Stockholm, Sweden..
    Reiser, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Uppsala Cty Council, Publ Dent Hlth, Dept Orthodont, Uppsala, Sweden..
    Hakelius, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate: A 20-Year Follow-up2018In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 55, no 2, p. 173-179Article in journal (Refereed)
    Abstract [en]

    Objective: To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height. Design: Observational follow-up study. Setting: Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden. Patients: 40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate. Interventions: Clinical examination, CBCT, and occlusal radiographs. Main Outcome Measurements: Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up. Results: The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total (P = .045) and by subgroup with dental restoration (P = .0078). This was positively correlated with the gingival bleeding index (GBI) (r = 0.51, P = .0008) and presence of dental restorations in the cleft area (r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT. Conclusion: Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.

  • 74.
    Jalouli, Jamshid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Human Papilloma Virus, Epstein-Barr Virus, and Herpes Simplex Virus Type-1 in Oral Squamous Cell Carcinomas from Three Populations2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Most oral squamous cell carcinoma (OSCC) is believed to develop via a multistep process of cumulative gene damage in epithelial cells. Increasing incidence of OSCC and evidence that traditional risk factors may not be responsible directed us to investigate the prevalence of virus in pre- and malignant samples.The integration of the DNA from human papillomavirus (HPV), Epstein-Barr virus (EBV), and Herpes simplex (HSV) into the human genome is associated with the expression of oncogenes and the down-regulation of tumor-suppressor genes in OSCC carcinogenesis. This thesis compared samples from India and Sudan, two countries on two continents having a documented high incidence of oral cancer, with specimens from Sweden, with its known low incidence of oral cancer. Each region has, in addition to smoking, a unique non-smoked tobacco habits with documented carcinogenic effects. These countries also typify areas of low and high socioeconomic living conditions with their expected impact on disease development. The study populations were selected from tobacco users and nonusers with OSCC, oral sub-mucous fibrosis (India), oral lichen planus (Sweden), oral leukoplakia with and without dysplasia and snuff-induced lesions (Sweden and Sudan). An expedient method was developed for extracting DNA from old formalin-fixed and paraffin-embedded biopsies. The prevalence of HPV, EBV, and HSV was investigated using PCR/DNA sequencing and southern blot hybridization analysis. We found HPV and EBV to be most prevalent in samples of tissue characterized as normal, with decreasing prevalence in dysplastic and malignant lesions. This intriguing finding that prevalence decreases as neoplastic development proceeds warrants further investigation. Our data do not at first sight support the conclusion that viruses and tobacco use jointly interact with cell mechanisms in the development of oral cancer.

    List of papers
    1. High-throughput DNA extraction from old paraffin-embedded biopsies.
    Open this publication in new window or tab >>High-throughput DNA extraction from old paraffin-embedded biopsies.
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    1999 (English)In: Biotechniques, Vol. 27, p. 334-Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-58450 (URN)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2011-01-14
    2. Human papilloma virus DNA in oral lesions
    Open this publication in new window or tab >>Human papilloma virus DNA in oral lesions
    2000 (English)In: Anticancer Res., Vol. 20, p. 1183-Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-58105 (URN)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2011-01-14
    3. Prevalence of viral (HPV, EBV, HSV) infections in oral submucous fibrosis and oral cancer from India
    Open this publication in new window or tab >>Prevalence of viral (HPV, EBV, HSV) infections in oral submucous fibrosis and oral cancer from India
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    2010 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 11, p. 1306-1311Article in journal (Refereed) Published
    Abstract [en]

    Conclusion: There is a high prevalence of human papilloma viruses (HPV) in oral submucous fibrosis (OSMF) and the etiologic implication of this finding warrants further studies. Objective: The prevalence of oral squamous cell carcinoma (OSCC) and OSMF is high in India, and the diseases are partly attributed to high consumption of betel quid containing areca nut and tobacco. This study investigated the prevalence of HPV, herpes simplex virus (HSV), and Epstein-Barr virus (EBV) DNA in two groups of patients using betel quid with tobacco, those with OSMF (n = 12) and those with OSCC (n = 62). Methods: DNA was extracted from all the samples and viral genome was examined by PCR/DNA sequencing. HPV-positive samples were analyzed separately for the high-risk types HPV 16 and 18. Results: HPV DNA, HSV DNA, and EBV DNA were detected in 11 (91%), 1 (8%), and 3 (25%) of the 12 samples from patients with OSMF compared with 15 (24%), 3 (5%), and 18 (29%), respectively, from 62 patients with OSCC. HPV 16 and 18 DNA was detected in 8/12 (67%) in the OSMF group and 10/62 (16%) in the OSCC group. The difference between presence of HPV DNA in OSMF and OSCC groups was statistically significant, while the difference between HSV and EBV DNA content in OSMF and OSCC groups was insignificant.

    Keywords
    areca nut, Betel quid, oral squamous cell carcinoma, tobacco
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-126103 (URN)10.3109/00016481003782041 (DOI)000282898800018 ()20441534 (PubMedID)
    Available from: 2010-06-08 Created: 2010-06-03 Last updated: 2017-12-12Bibliographically approved
    4. Presence of human papilloma virus, herpes simplex virus and Epstein-Barr virus DNA in oral biopsies from Sudanese patients with regard to toombak use
    Open this publication in new window or tab >>Presence of human papilloma virus, herpes simplex virus and Epstein-Barr virus DNA in oral biopsies from Sudanese patients with regard to toombak use
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    2010 (English)In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 39, no 8, p. 599-604Article in journal (Refereed) Published
    Abstract [en]

    J Oral Pathol Med (2010) Using PCR/DNA sequencing, we investigated the prevalence of human papillomavirus (HPV), herpes simplex virus (HSV) and Epstein-Barr virus (EBV) DNA in brush biopsies obtained from 150 users of Sudanese snuff (toombak) and 25 non-users of toombak in formalin-fixed paraffin-embedded tissue samples obtained from 31 patients with oral dysplasias (25 toombak users and 6 non-users), and from 217 patients with oral cancers (145 toombak users and 72 non-users). In the brush tissue samples from toombak users, HPV was detected in 60 (40%), HSV in 44 (29%) and EBV in 97 (65%) of the samples. The corresponding figures for the 25 samples from non-users were 17 (68%) positive for HPV, 6 (24%) positive for HSV and 21 (84%) for EBV. The formalin-fixed samples with oral dysplasias were all negative for HPV. In the 145 oral cancer samples from toombak users, HPV was detected in 39 (27%), HSV in 15 (10%) and EBV in 53 (37%) of the samples. The corresponding figures for the samples from non-users were 15 (21%) positive for HPV, 5 (7%) for HSV and 16 (22%) for EBV. These findings illustrate that prevalence of HSV, HPV and EBV infections are common and may influence oral health and cancer development. It is not obvious that cancer risk is increased in infected toombak users. These observations warrant further studies involving toombak-associated oral lesions, to uncover the possible mechanisms of these viral infections in the development of oral cancer, and the influence of toombak on these viruses.

    Keywords
    Epstein–Barr virus, herpes simplex virus, human, papillomavirus, oral cancer, toombak
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-128907 (URN)10.1111/j.1600-0714.2010.00910.x (DOI)000281550200003 ()20618612 (PubMedID)
    Available from: 2010-08-02 Created: 2010-08-02 Last updated: 2022-01-28Bibliographically approved
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  • 75.
    Jalouli, Jamshid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ibrahim, Salah O.
    Mehrotra, Ravi
    Jalouli, Miranda M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sapkota, Dipak
    Larsson, Per-Anders
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Prevalence of viral (HPV, EBV, HSV) infections in oral submucous fibrosis and oral cancer from India2010In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 130, no 11, p. 1306-1311Article in journal (Refereed)
    Abstract [en]

    Conclusion: There is a high prevalence of human papilloma viruses (HPV) in oral submucous fibrosis (OSMF) and the etiologic implication of this finding warrants further studies. Objective: The prevalence of oral squamous cell carcinoma (OSCC) and OSMF is high in India, and the diseases are partly attributed to high consumption of betel quid containing areca nut and tobacco. This study investigated the prevalence of HPV, herpes simplex virus (HSV), and Epstein-Barr virus (EBV) DNA in two groups of patients using betel quid with tobacco, those with OSMF (n = 12) and those with OSCC (n = 62). Methods: DNA was extracted from all the samples and viral genome was examined by PCR/DNA sequencing. HPV-positive samples were analyzed separately for the high-risk types HPV 16 and 18. Results: HPV DNA, HSV DNA, and EBV DNA were detected in 11 (91%), 1 (8%), and 3 (25%) of the 12 samples from patients with OSMF compared with 15 (24%), 3 (5%), and 18 (29%), respectively, from 62 patients with OSCC. HPV 16 and 18 DNA was detected in 8/12 (67%) in the OSMF group and 10/62 (16%) in the OSCC group. The difference between presence of HPV DNA in OSMF and OSCC groups was statistically significant, while the difference between HSV and EBV DNA content in OSMF and OSCC groups was insignificant.

  • 76.
    Jalouli, Jamshid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ibrahim, Salah O
    Department of Biomedicine, University of Bergen, Bergen, Norway.
    Sapkota, Dipak
    Department of Biomedicine, University of Bergen, Bergen, Norway.
    Jalouli, Miranda M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Vasstrand, Endre N
    Department of Clinical Dentistry – Periodontology, University of Bergen, Bergen, Norway.
    Hirsch, Jan-M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Larsson, Per-Anders
    Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Presence of human papilloma virus, herpes simplex virus and Epstein-Barr virus DNA in oral biopsies from Sudanese patients with regard to toombak use2010In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 39, no 8, p. 599-604Article in journal (Refereed)
    Abstract [en]

    J Oral Pathol Med (2010) Using PCR/DNA sequencing, we investigated the prevalence of human papillomavirus (HPV), herpes simplex virus (HSV) and Epstein-Barr virus (EBV) DNA in brush biopsies obtained from 150 users of Sudanese snuff (toombak) and 25 non-users of toombak in formalin-fixed paraffin-embedded tissue samples obtained from 31 patients with oral dysplasias (25 toombak users and 6 non-users), and from 217 patients with oral cancers (145 toombak users and 72 non-users). In the brush tissue samples from toombak users, HPV was detected in 60 (40%), HSV in 44 (29%) and EBV in 97 (65%) of the samples. The corresponding figures for the 25 samples from non-users were 17 (68%) positive for HPV, 6 (24%) positive for HSV and 21 (84%) for EBV. The formalin-fixed samples with oral dysplasias were all negative for HPV. In the 145 oral cancer samples from toombak users, HPV was detected in 39 (27%), HSV in 15 (10%) and EBV in 53 (37%) of the samples. The corresponding figures for the samples from non-users were 15 (21%) positive for HPV, 5 (7%) for HSV and 16 (22%) for EBV. These findings illustrate that prevalence of HSV, HPV and EBV infections are common and may influence oral health and cancer development. It is not obvious that cancer risk is increased in infected toombak users. These observations warrant further studies involving toombak-associated oral lesions, to uncover the possible mechanisms of these viral infections in the development of oral cancer, and the influence of toombak on these viruses.

  • 77.
    Jalouli, Jamshid
    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.
    Sapkota, Dipak
    Ibrahim, Salah O.
    Larsson, Per-Anders
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Human Papilloma Virus, Herpes Simplex Virus and Epstein Barr Virus in Oral Squamous Cell Carcinoma from Eight Different Countries2012In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 32, no 2, p. 571-580Article in journal (Refereed)
    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.

  • 78.
    Jalouli, Miranda
    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.
    Hasséus, Bengt
    Öhman, Jenny
    Hirsch, Jan M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Nested PCR for detection of HSV-1 in oral mucosa2015In: Medicina Oral, ISSN 1698-4447, E-ISSN 1698-6946, Vol. 20, no 6, p. E664-E669Article in journal (Refereed)
    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.

  • 79.
    Jalouli, Miranda
    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.
    Ibrahim, Salah O.
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Comparison Between Single PCR and Nested PCR in Detection of Human Papilloma Viruses in Paraffin-embedded OSCC and Fresh Oral Mucosa2015In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 29, no 1, p. 65-70Article in journal (Refereed)
    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.

  • 80.
    Jalouli, Miranda M.
    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.
    Sapkota, Dipak
    Ibrahim, Salah O.
    Sand, Lars
    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.
    Differential Expression of Apoptosis, Cell Cycle Regulation and Intermediate Filament Genes in Oral Squamous Cell Carcinomas Associated with Toombak Use in Sudan2011In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 31, no 10, p. 3345-3351Article in journal (Refereed)
    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.

  • 81.
    Jalouli, Miranda M
    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.
    Öhman, J
    Hasseús, B
    Hirsch, Jan M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Association of Human Papilloma Virus infection in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma2015In: Journal of Oral Health and Dental Management, ISSN 1583-5588, Vol. 14, no 5Article in journal (Refereed)
    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.

  • 82. Jawert, Fredrik
    et al.
    Hasseus, Bengt
    Kjeller, Goran
    Magnusson, Bengt
    Sand, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Larsson, Lena
    Loss of 5-Hydroxymethylcytosine and TET2 in Oral Squamous Cell Carcinoma2013In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 33, no 10, p. 4325-4328Article in journal (Refereed)
    Abstract [en]

    Aim: Epigenetic modifications, such as DNA methylation, are considered important in the regulation of target genes in cancer development. 5-Hydroxymethylcytosine (5hmC) was recently discovered to be related to the process of malignant transformation. The influence of DNA methylation in oral squamous cell carcinomas (OSCC) is not fully- understood. Therefore, the aim of the present study was to investigate the DNA methylation pattern in OSCC compared to healthy oral epithelium. Materials and Methods: Oral mucosal samples from patients with OSCC (n=15) and healthy mucosa (n=12) were analyzed using immunohistochemistry with antibodies against 5hmC, 5mC and ten-eleven-translocation-2 (TET2). Results: A significant decrease in 5hmC and TET2 expression was found in OSCC compared to healthy oral epithelium. In contrast, there was a significant increase in 5mC expression in OSCC compared to healthy epithelium. Conclusion: Our results indicate that loss of 5hmC is an epigenetic event of OSCC.

  • 83. Kahnberg, Karl-Erik
    et al.
    Henry, Patric J
    Hirsch, Jan-Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Öhrnell, Lars-Olov
    Andreasson, Lars
    Brånemark, Per-Ingvar
    Chiapasco, Matteus
    Gynther, Göran
    Finne, Kaj
    Higuchi, Kenji W
    Isaksson, Sten
    Malevez, Chantal
    Neukam, Friedrich W
    Sevetz, Edward
    Urgell, Juan P
    Widmark, Göran
    Bolind, Pia
    Clinical evaluation of the zygoma implant: 3-year follow-up at 16 clinics2007In: Journal of oral and maxillofacial surgery (Print), ISSN 0278-2391, E-ISSN 1531-5053, Vol. 65, no 10, p. 2033-2038Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this clinical investigation was to evaluate the treatment outcome with zygoma implants with regard to implant survival, patient satisfaction, and function of prosthesis replacement after 3 years. Patients and Methods: The treatment outcome of 76 patients treated with 145 zygoma fixtures at 16 centers was evaluated with regard to implant survival. Status of peri-implant mucosa and amount of plaque were registered annually. Patients' and dentists' evaluations of the functional and esthetic outcome of the treatment were assessed at delivery of prosthesis and thereafter at each follow-up visit. Results: Sixty of 76 patients were followed for 3 years after prosthetic delivery. Five of 145 placed zygoma implants failed during the course of the study resulting in an overall implant survival rate of 96.3%. At the 3-year follow-up, 75% of the implants sites were registered with normal peri-implant mucosa and 68% with no visible plaque. The patients were fully satisfied with the esthetic and functional outcome of the treatment in 86% and 71%, respectively, at the 3-year follow-up visit. All reported data from dentists scored from acceptable to excellent. Conclusion: The multicenter study showed a high predictability of the zygoma implant-supported rehabilitation.

  • 84.
    Kharazmi, Mohammad
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bjornstad, Lillemor
    Hallberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Wanbro, Jonas
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Habib, Samandar
    Uppsala University.
    Warfvinge, Gunnar
    Mandibular bone exposure and osteonecrosis as a complication of general anaesthesia2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 3, p. 215-216Article in journal (Refereed)
  • 85.
    Kharazmi, Mohammad
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hallberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Mandibular Bone Exposure and Osteonecrosis in a Patient With an Uncomplicated Medical History2015In: The Journal of craniofacial surgery (Print), ISSN 1049-2275, E-ISSN 1536-3732, Vol. 26, no 5, p. 1719-1720Article in journal (Refereed)
  • 86.
    Kharazmi, Mohammad
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hallberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Oral surgery: Prominent bone shelves2014In: British Dental Journal, ISSN 0007-0610, E-ISSN 1476-5373, Vol. 216, no 10, p. 544-545Article in journal (Refereed)
  • 87.
    Kharazmi, Mohammad
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hallberg, Pär
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Modig, Maria
    Bjornstad, Lillemor
    Hirsch, Jan-Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Surgical approach to snus-induced injury of the oral mucosa2014In: Journal of Oral Science, ISSN 1343-4934, E-ISSN 1880-4926, Vol. 56, no 1, p. 91-94Article in journal (Refereed)
    Abstract [en]

    Snus (Swedish moist snuff) causes lesions in the oral mucosa at the location where pinches are regularly placed. In addition, some patients develop irreversible local gingival recession and sometimes ulcers with perforations to the roots. Such injuries lead to denuded roots that are at risk for caries and periodontal disease, with subsequent esthetic consequences. Therapy for irreversible local gingival recession is currently lacking. In the present report, we describe two cases of successful surgical treatment for irreversible lesions caused by snus.

  • 88. Khonsari, R H
    et al.
    Friess, M
    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.
    Odri, G
    Malmberg, Filip
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Nyström, Ingela
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Messo, Elias
    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.
    Cabanis, E A M
    Kunzelmann, K H
    Salagnac, J M
    Corre, P
    Ohazama, A
    Sharpe, P T
    Charlier, P
    Olszewski, R
    Shape and volume of craniofacial cavities in intentional skull deformations2013In: American Journal of Physical Anthropology, ISSN 0002-9483, E-ISSN 1096-8644, Vol. 151, no 1, p. 110-119Article in journal (Refereed)
    Abstract [en]

    Intentional cranial deformations (ICD) have been observed worldwide but are especially prevalent in preColombian cultures. The purpose of this study was to assess the consequences of ICD on three cranial cavities (intracranial cavity, orbits, and maxillary sinuses) and on cranial vault thickness, in order to screen for morphological changes due to the external constraints exerted by the deformation device. We acquired CT-scans for 39 deformed and 19 control skulls. We studied the thickness of the skull vault using qualitative and quantitative methods. We computed the volumes of the orbits, of the maxillary sinuses, and of the intracranial cavity using haptic-aided semi-automatic segmentation. We finally defined 3D distances and angles within orbits and maxillary sinuses based on 27 anatomical landmarks and measured these features on the 58 skulls. Our results show specific bone thickness patterns in some types of ICD, with localized thinning in regions subjected to increased pressure and thickening in other regions. Our findings confirm that volumes of the cranial cavities are not affected by ICDs but that the shapes of the orbits and of the maxillary sinuses are modified in circumferential deformations. We conclude that ICDs can modify the shape of the cranial cavities and the thickness of their walls but conserve their volumes. These results provide new insights into the morphological effects associated with ICDs and call for similar investigations in subjects with deformational plagiocephalies and craniosynostoses.

  • 89.
    Kihlström Burenstam Linder, Lars
    et al.
    Karolinska Univ Hosp, Dept Neurosurg, Clin Neurosci, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden.
    Birgersson, Ulrik
    Karolinska Inst, Div Imaging & Technol, Dept Clin Sci Intervent & Technol, Huddinge, Sweden.
    Lundgren, Kalle
    Karolinska Inst, Stockholm, Sweden;Karolinska Univ Hosp, Dept Mol Med & Surg, Unit Craniofacial Dis, Stockholm, Sweden.
    Illies, Christopher
    Karolinska Univ Hosp, Dept Clin Pathol, Stockholm, Sweden.
    Engstrand, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Patient-Specific Titanium-Reinforced Calcium Phosphate Implant for the Repair and Healing of Complex Cranial Defects2019In: World Neurosurgery, ISSN 1878-8750, E-ISSN 1878-8769, Vol. 122, p. E399-E407Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The reconstruction of complex cranial defects is challenging and is associated with a high complication rate. The development of a patient-specific, titanium-reinforced, calcium phosphate-based (CaP-Ti) implant with bone regenerative properties has previously been described in 2 case studies with the hypothesis that the implant may improve clinical outcome. OBJECTIVE: To identify whether the introduction of CaP-Ti implant has the potential to improve clinical outcome. METHODS: A retrospective review of all patients having undergone CaP-Ti cranioplasty was conducted. Comprehensive clinical data were collected from the hospital computer database and patient records. Bone formation and osseointegration were analyzed in a single retrieval specimen. RESULTS: Fifty patients, with 52 cranial defects, met the inclusion criteria. The patient cohort displayed a previous failure rate of 64% (32/50) with autologous bone, alloplastic materials, or both. At a median follow-up time of 25 months, the explantation rate due to either early postoperative infection or persistent wound dehiscence was 1.9% (1/53) or 3.8% (2/53), respectively. Surgical intervention with local wound revision was required in 2 patients without the need of implant removal. One patient had a brain tumor recurrence, and the implant was explanted 31 months after implantation. Histologic examination showed that the entire implant was partly yet evenly transformed into vascularized compact bone. CONCLUSION: In the present study the CaP-Ti implant appears to have improved the clinical outcomes in a cohort of patients with a high rate of previous cranioplasty failures. The bone regenerative effect may in particular have an impact on the long-term success rate of the implant.

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  • 90.
    Klobas, Luciano
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Stabilization appliance therapy has an equally extensive alleviating effect on jaw pain and frontal headache in patients with myogenous temporomandibular disorders (TMD), with or without chronic whiplash-associated disorders (WAD) grades 2 and 32013Manuscript (preprint) (Other academic)
  • 91.
    Klobas, Luciano
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    The Manifestations and the Treatment of Temporomandibular Disorders in Patients with Chronic Whiplash-associated Disorders Grades 2 and 32013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The main aim of this project was to encircle the subtype of temporomandibular disorders (TMD) present in patients with chronic whiplash-associated disorders (WAD) and study the debut of TMD symptoms, the provoking factors and the outcome of conservative TMD treatments. The results could add to the aetiological discussion about TMD mainly as being part of chronic WAD pain or not.

    The subjects were referred patients with chronic WAD at a specialized rehabilitation centre where they were diagnosed using a standardized classification of WAD diagnosing that resulted in approximately 20% WAD grade 2 and 80% WAD grade 3. In Studies I and II, a total 136 individuals with chronic WAD were found to have a significantly higher prevalence of pain associated with TMD compared to a control group of 66 general dental patients. The symptoms debuted approximately six months after the whiplash injury and were most often provoked by stress. In Study III, the effect of a therapeutic jaw exercise (TJE) program on TMD was studied over six months in patients with chronic WAD and TMD, randomized to TJE (25 subjects) or not (30 subjects). TJE had no effect on TMD. In Study IV, patients with chronic WAD and TMD were found to have a mainly myogenous origin of TMD pain. Five months of stabilisation appliance therapy (SAT) equally resulted in an almost complete perceived reduction of jaw pain and frontal headache in patients with chronic WAD and TMD (n=14) and TMD patients without WAD (n=10). In the long-term, TMD was significantly lower in patients with chronic WAD who were treated compared to patients with chronic WAD and TMD who were not treated (n=9).

    TMD in patients with chronic WAD grades 2 or 3 may be the same kind of musculoskeletal disorder as in TMD patients without WAD, and not primarily part of the WAD pain. A functional TMD examination as well as assessment of perceived stress can be recommended as part of the standardized screening procedure for patients with chronic WAD grades 2 and 3. Patients with symptoms and signs of TMD could be recommended SAT. Patients with symptoms of frontal headache alone should also be considered as candidates for SAT.

    List of papers
    1. Symtoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders
    Open this publication in new window or tab >>Symtoms and signs of temporomandibular disorders in individuals with chronic whiplash-associated disorders
    2004 (English)Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-65938 (URN)
    Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2013-08-30
    2. The precipitation of symptoms of temporomandibular disorders (TMD) in patients with chronic whiplash-associated disorders (WAD)
    Open this publication in new window or tab >>The precipitation of symptoms of temporomandibular disorders (TMD) in patients with chronic whiplash-associated disorders (WAD)
    2013 (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Oral and Maxillofacial Surgery
    Identifiers
    urn:nbn:se:uu:diva-198418 (URN)
    Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2024-04-02
    3. Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders
    Open this publication in new window or tab >>Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders
    2006 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 6, p. 341-347Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. MATERIAL AND METHODS: Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. RESULTS: There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. CONCLUSIONS: In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

    Keywords
    exercise movement techniques, randomized clinical trial, temporomandibular joint disorders, whiplash injuries
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-10458 (URN)10.1080/00016350600825310 (DOI)000242333500003 ()17123910 (PubMedID)
    Available from: 2007-03-26 Created: 2007-03-26 Last updated: 2023-11-13Bibliographically approved
    4. Stabilization appliance therapy has an equally extensive alleviating effect on jaw pain and frontal headache in patients with myogenous temporomandibular disorders (TMD), with or without chronic whiplash-associated disorders (WAD) grades 2 and 3
    Open this publication in new window or tab >>Stabilization appliance therapy has an equally extensive alleviating effect on jaw pain and frontal headache in patients with myogenous temporomandibular disorders (TMD), with or without chronic whiplash-associated disorders (WAD) grades 2 and 3
    2013 (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Oral and Maxillofacial Surgery
    Identifiers
    urn:nbn:se:uu:diva-198419 (URN)
    Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2024-04-02
    Download full text (pdf)
    fulltext
  • 92.
    Klobas, Luciano
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    The precipitation of symptoms of temporomandibular disorders (TMD) in patients with chronic whiplash-associated disorders (WAD)2013Manuscript (preprint) (Other academic)
  • 93.
    Klobas, Luciano
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Axelsson, Susanna
    Tegelberg, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Effect of therapeutic jaw exercise on temporomandibular disorders in individuals with chronic whiplash-associated disorders2006In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 64, no 6, p. 341-347Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate the effect of a specific therapeutic jaw exercise on the temporomandibular disorders of patients with chronic whiplash-associated disorders. MATERIAL AND METHODS: Ninety-four consecutive patients with whiplash-related conditions were referred to and accepted for a treatment period at a center for functional evaluation and rehabilitation during 2001-2002. The patients followed a program of physical therapy, occupational therapy, and pain management. At the start of their stay, they were examined by a physician specialized in rehabilitation medicine and also by a dentist who performed a functional examination of the stomatognathic system. Of the 93 patients who accepted participation in the study, 55 were diagnosed with temporomandibular disorders and chronic whiplash-associated disorders in accordance with the inclusion criteria. They were randomized into a jaw exercise group (n = 25), who performed specific therapeutic jaw exercises, and a control group (n = 30). Both groups undertook the whiplash rehabilitation program at the center. RESULTS: There were no inter- or intra-group differences in symptoms and signs of temporomandibular disorders at baseline, nor at the 3-week and 6-month follow-ups, except for an increase of maximum active mouth-opening capacity in the control group. CONCLUSIONS: In conclusion, the therapeutic jaw exercises, in addition to the regular whiplash rehabilitation program, did not reduce symptoms and signs of temporomandibular disorders in patients with chronic whiplash-associated disorders.

  • 94.
    Klobas, Luciano
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Gambardella, Ugo
    Hansson, Tore L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    A 5-year follow-up of temporomandibular disorder treatment emphasizing condylar asymmetry2006In: Cranio, ISSN 0886-9634, E-ISSN 2151-0903, Vol. 24, no 4, p. 265-273Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the long-term effect of temporomandibular disorder (TMD) treatment giving priority to oral stability, i.e. creating stability for the mandible in the individual retruded position of the mandible (RPM), focusing condylar asymmetry. Twenty-nine (29) patients treated for TMD participated in the study. A standardized TMD examination was executed originally and an identical examination was performed at the follow-up in a private TMD practice. In general, the patients showed a significant increase of their maximum active mouth opening capacity (p < 0.01) and a significant decrease of dynamic and static pain at the performed tests (p < 0.001). Patients initially suffering facial pain showed a significant reduction of their pain with treatment (p < 0.01). The patients with condylar asymmetry > 10%, and who underwent treatment aiming at permanent oral stability, showed the greatest improvement.

  • 95.
    Koriakina, Nadezhda
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Sladoje, Natasa
    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.
    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.
    Ramqvist, Eva Darai
    Pathology and Cytology, Karolinska Institute, Stockholm, Sweden.
    Hirsch, Jan M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Runow Stark, Christina
    Public Dental Service, Södersjukhuset, Stockholm, Sweden.
    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.
    Visualization of convolutional neural network class activations in automated oral cancer detection for interpretation of malignancy associated changes2019In: 3rd NEUBIAS Conference, Luxembourg, 2-8 February 2019, 2019, , p. 1Conference paper (Other academic)
    Abstract [en]

    Introduction: Cancer of the oral cavity is one of the most common malignancies in the world. The incidence of oral cavity and oropharyngeal cancer is increasing among young people. It is noteworthy that the oral cavity can be relatively easily accessed for routine screening tests that could potentially decrease the incidence of oral cancer. Automated deep learning computer aided methods show promising ability for detection of subtle precancerous changes at a very early stage, also when visual examination is less effective. Although the biological nature of these malignancy associated changes is not fully understood, the consistency of morphology and textural changes within a cell dataset could shed light on the premalignant state. In this study, we are aiming to increase understanding of this phenomenon by exploring and visualizing what parts of cell images are considered as most important when trained deep convolutional neural networks (DCNNs) are used to differentiate cytological images into normal and abnormal classes.

    Materials and methods: Cell samples are collected with a brush at areas of interest in the oral cavity and stained according to standard PAP procedures. Digital images from the slides are acquired with a 0.32 micron pixel size in greyscale format (570 nm bandpass filter). Cell nuclei are manually selected in the images and a small region is cropped around each nucleus resulting in images of 80x80 pixels. Medical knowledge is not used for choosing the cells but they are just randomly selected from the glass; for the learning process we are only providing ground truth on the patient level and not on the cell level. Overall, 10274 images of cell nuclei and the surrounding region are used to train state-of-the-art DCNNs to distinguish between cells from healthy persons and persons with precancerous lesions. Data augmentation through 90 degrees rotations and mirroring is applied to the datasets. Different approaches for class activation mapping and related methods are utilized to determine what image regions and feature maps are responsible for the relevant class differentiation.

    Results and Discussion:The best performing of the observed deep learning architectures reaches a per cell classification accuracy surpassing 80% on the observed material. Visualizing the class activation maps confirms our expectation that the network is able to learn to focus on specific relevant parts of the sample regions. We compare and evaluate our findings related to detected discriminative regions with the subjective judgements of a trained cytotechnologist. We believe that this effort on improving understanding of decision criteria used by machine and human leads to increased understanding of malignancy associated changes and also improves robustness and reliability of the automated malignancy detection procedure.

  • 96.
    Korytowska, Magdalena
    et al.
    NÄL Hosp, Publ Dent Serv, Clin Orofacial Med, Uddevalla, Sweden.
    Schwab, Gabriela
    Inst Trop Med Sao Paulo, Sch Med, Lab Virol, Sao Paulo, Brazil.
    Giglio, Daniel
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Oncol, Gothenburg, Sweden.
    Hirsch, Jan-Micháel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Publ Dent Serv Reg Stockholm, Dept Res & Dev, Stockholm, Sweden.
    Holmberg, Erik
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Oncol, Gothenburg, Sweden.
    Kjeller, Göran
    Univ Gothenburg, Inst Odontol, Sahlgrenska Acad, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden.
    Sand, Lars
    Univ Oslo, Fac Odontol, Dept Oral Biol, Oslo, Oslo, Norway.
    Wallström, Mats
    Univ Gothenburg, Inst Odontol, Sahlgrenska Acad, Dept Oral & Maxillofacial Surg, Gothenburg, Sweden.
    Öhman, Jenny
    Univ Gothenburg, Inst Odontol, Sahlgrenska Acad, Dept Oral Med & Pathol, Gothenburg, Sweden.
    Braz-Silva, Paulo
    Inst Trop Med Sao Paulo, Sch Med, Lab Virol, Sao Paulo, Brazil; Univ Sao Paulo, Sch Dent, Dept Stomatol, Sao Paulo, Brazil.
    Hasséus, Bengt
    Univ Gothenburg, Inst Odontol, Sahlgrenska Acad, Dept Oral Med & Pathol, Gothenburg, Sweden; Publ Dent Hlth Serv, Clin Oral Med, Gothenburg, Sweden.
    Patient-reported pain after surgical removal of leukoplakia: an observational 1-year follow-up study2021In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 5, p. 383-389Article in journal (Refereed)
    Abstract [en]

    Objective

    Oral leukoplakia (OL) presents as a white lesion of the oral mucosa and is not typically associated with the sensation of pain. OL should be surgically removed when possible because it is considered a potentially malignant oral disorder (PMOD). This study assessed the pain sensations experienced by patients in association with the occurrence and surgical treatment of OL.

    Methods

    Inclusion criteria were: a clinical diagnosis of OL; biopsy excision; and observation for at least 12 months in the ORA-LEU-CAN study. At the first visit, all the patients were asked about the occurrence of symptoms within the lesion. Ninety-four subjects were assessed over a period of 1 year. All patients underwent complete removal of OL. The patient cohort was divided into three sub-groups: (i) no pain before excision and at the 1-year follow-up; (ii) pain before excision; and (iii) pain at the 1-year follow-up.

    Results

    Overall, pain was reported by 21.3% of the patients at the study start whereas 13.8% of the patients reported pain 1 year after surgical treatment. Patient-reported pain from the lesion at study inclusion was significantly associated with lesions found on the lateral side of the tongue (p=.002). Pain reported by patients one year after surgery was significantly related to female gender (p=.038) and the presence of epithelial cell dysplasia (p=.022).

    Conclusion

    We conclude that surgical removal of OL results in a low risk of long-term post-surgical pain. However, OL located on the lateral side of the tongue and in OL with dysplasia are more likely to be associated with pain.

    Download full text (pdf)
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  • 97.
    Kumar, Vinay V.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Hirsch, Jan M.
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Denture Guided Epithelial Regeneration: metod för att skapa keratiniserad gingiva i anslutning till implantat2020In: Tandläkartidningen, ISSN 0039-6982, no 10, p. 60-65Article in journal (Refereed)
  • 98.
    Kumar, Vinay V.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rometsch, Elke
    AOCID, Dubendorf, Switzerland..
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wolvius, Eppo
    Erasmus Univ Ctr, Dept Oral & Maxillofacial Surg, Rotterdam, Netherlands..
    Hurtado-Chong, Anahi
    AOCID, Dubendorf, Switzerland..
    Segmental Mandibular Reconstruction Using Tissue Engineering Strategies: A Systematic Review of Individual Patient Data2020In: Craniomaxillofacial Trauma & Reconstruction, ISSN 1943-3875, E-ISSN 1943-3883, Vol. 13, no 4, p. 267-284Article, review/survey (Refereed)
    Abstract [en]

    Objective: The aim of the systematic review was to analyze the current clinical evidence concerning the use of tissue engineering as a treatment strategy for reconstruction of segmental defects of the mandible and their clinical outcomes using individual patient data.

    Methods: A systematic review of the literature was conducted using PubMed and Cochrane Library on May 21, 2019. The eligibility criteria included patients in whom segmental mandibular reconstruction was carried out using tissue engineering as the primary treatment strategy. After screening and checking for eligibility, individual patient data were extracted to the extent it was available. Data extraction included the type of tissue engineering strategy, demographics, and indication for treatment, and outcomes included clinical and radiographic outcome measures, vitality of engineered bone, dental rehabilitation, and patient-reported outcome measures and complications.

    Results: Out of a total of 408 articles identified, 44 articles reporting on 285 patients were included, of which 179 patients fulfilled the inclusion criteria. The different tissue engineering treatment strategies could be broadly classified into 5 groups: "prefabrication," "cell culture," "bone morphogenetic protein (BMP) without autografts," "BMP with autografts," and "scaffolds containing autografts." Most included studies were case reports or case series. A wide variety of components were used as scaffolds, cells, and biological substances. There was not a single outcome measure that was both objective and consistently reported, although most studies reported successful outcome.

    Discussion: A wide variety of tissue engineering strategies were used for segmental mandibular reconstruction that could be classified into 5 groups. Due to the low number of treated patients, lack of standardized and consistent reporting outcomes, lack of comparative studies, and low evidence of reported literature, there is insufficient evidence to recommend any particular tissue engineering strategy.

  • 99.
    Kumar, Vinay V.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rometsch, Elke
    AOCID, Dubendorf, Switzerland..
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Wolvius, Eppo
    Erasmus Univ Ctr, Dept Oral & Maxillofacial Surg, Rotterdam, Netherlands..
    Hurtado-Chong, Anahi
    AOCID, Dubendorf, Switzerland..
    Segmental Mandibular Reconstruction Using Tissue Engineering Strategies: A Systematic Review of Individual Patient Data2020In: Craniomaxillofacial Trauma & Reconstruction, ISSN 1943-3875, E-ISSN 1943-3883, Vol. 13, no 4, p. 267-284Article, review/survey (Refereed)
    Abstract [en]

    Objective: The aim of the systematic review was to analyze the current clinical evidence concerning the use of tissue engineering as a treatment strategy for reconstruction of segmental defects of the mandible and their clinical outcomes using individual patient data.

    Methods: A systematic review of the literature was conducted using PubMed and Cochrane Library on May 21, 2019. The eligibility criteria included patients in whom segmental mandibular reconstruction was carried out using tissue engineering as the primary treatment strategy. After screening and checking for eligibility, individual patient data were extracted to the extent it was available. Data extraction included the type of tissue engineering strategy, demographics, and indication for treatment, and outcomes included clinical and radiographic outcome measures, vitality of engineered bone, dental rehabilitation, and patient-reported outcome measures and complications.

    Results: Out of a total of 408 articles identified, 44 articles reporting on 285 patients were included, of which 179 patients fulfilled the inclusion criteria. The different tissue engineering treatment strategies could be broadly classified into 5 groups: "prefabrication," "cell culture," "bone morphogenetic protein (BMP) without autografts," "BMP with autografts," and "scaffolds containing autografts." Most included studies were case reports or case series. A wide variety of components were used as scaffolds, cells, and biological substances. There was not a single outcome measure that was both objective and consistently reported, although most studies reported successful outcome.

    Discussion: A wide variety of tissue engineering strategies were used for segmental mandibular reconstruction that could be classified into 5 groups. Due to the low number of treated patients, lack of standardized and consistent reporting outcomes, lack of comparative studies, and low evidence of reported literature, there is insufficient evidence to recommend any particular tissue engineering strategy.

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

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

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