| 1. |
- Dawson, Victoria
(författare)
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Coronal restoration in root-filled and non root-filled teeth : studies on periapical status, tooth survival, subsequent treatments and treatment decisions
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study the following aspects ofdirect and indirect coronal restoration, primarily of root-filled teeth, withspecial reference to:• periapical health• the natural course of root-filled teeth, particularly furtherclinical intervention• the dentist´s decision-making process for root-filled teeth.The aims of coronal restoration are to restore the function and aestheticsof the tooth, with a tight marginal seal as protection from microbialleakage. A coronal restoration may be either direct, i.e. a direct chairsidecomposite or amalgam filling, or indirect, whereby the restoration,ceramic or a combination of metal and ceramic, is fabricated in alaboratory and then permanently cemented. For the root-filled tooth, acoronal restoration of adequate quality is an important factor for asuccessful outcome of the endodontic treatment, in terms of periapicalstatus. While indirect restoration is often advocated as the treatment of choice for a root-filled tooth, the procedure is nevertheless more timeconsumingand 3 – 4 times more expensive than a direct restoration. InSweden, composite is the predominant material for direct restorationand the majority of root-filled teeth are directly restored. However,some reports suggest an association between composite restoration andan increased risk of periapical disease. In terms of tooth survival, thereare also reports of less favorable endodontic treatment outcomes forteeth with direct restorations than for those with indirect restorations.In Studies I and II clinical and radiographic examinations wereundertaken in a random sample of 440 subjects, living in the county of Skåne, Sweden. No association was disclosed between apicalperiodontitis (AP) and direct composite restorations. In non root-filledteeth, a relationship was found between the type of restoration and AP.Those restored with direct restoration by both composite and amalgamcombined, and indirect restoration were associated with increased riskof AP, indicating that the extent of tooth substance removal rather thanthe type or material of the restoration, was an important factor ofinfluence on periapical status. For root-filled teeth, however, the qualityof the restoration and of the root-filling was more important toperiapical health than the type or material used for the coronalrestoration. In Study III, data from the Swedish Social InsuranceAgency on dental treatments were analyzed. Only minor differences inthe frequency of additional endodontic treatment for root-filled teethrestored with direct versus indirect restoration was disclosed. Theindirectly restored teeth also had a more favorable natural course duringthe 5-year follow-up period. In comparison, teeth restored with directrestorations required further clinical intervention (nonsurgical retreatment, extraction and additional restorations) significantly morefrequently.In Study IV, in-depth semi-structured interviews were conducted withgeneral dental practitioners. Data from 14 interviews were analyzed byQualitative Content Analysis. Study IV revealed that dentists´ decisionmakingprocess underlying the choice of coronal restoration for a rootfilledtooth, was based not only on clinical factors; contextual factorsand patient´s views, if in conflict, were decisive. Thus, despite theindications for an indirect restoration, a direct restoration wasoccasionally chosen. Accordingly, the context in which the dentistmakes decisions may be a factor influencing the fate of the root-filledtooth.It is concluded that concerns that composite restoration poses a riskfor periapical disease are not supported clinically, i.e. the use ofcomposite seems to be safe. While in non root-filled teeth, AP tended tobe associated with extensive restorations, in root-filled teeth the type ofrestoration was not an important factor of periapical health. For teethdirectly restored after root canal treatment, further clinical interventionsmay be expected, especially for restorative failures. This may beattributable in part to the dentist´s decision-making process with respectto the choice of coronal restoration.
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| 2. |
- Hallmer, Fredrik
(författare)
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Medication-related osteonecrosis of the jaw : occurence, risk factors, pathogenesis & treatment
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The antiresorptive drugs bisphosphonates and denosumab arewidely used to preserve bone strength by inhibiting osteoclast mediatedbone resorption. High dose intravenous bisphosphonatesand high dose denosumab are mainly used to treat skeletal relatedevents in patients with metastatic bone disease such as metastaticbreast cancer and metastatic prostate cancer or in patients withmultiple myeloma. In patients with osteoporosis, oral bisphosphonatesare mostly used. Medication-related osteonecrosis of the jaw(MRONJ) is a serious side effect associated both with bisphosphonatesand denosumab treatment. The first report on MRONJ waspublished in 2003. At first, the condition was believed to be a newdisease, but it was later proved to be the same disease, which existedmore than 100 years ago in match factory workers, and phosphateminers, in whom the disease was recognized as phossy jaw. The overall aim of this thesis was to study the occurrence, risk factors,pathogenesis and treatment of MRONJ.Study I describes prevalence, trigger factors and treatment outcomesof MRONJ retrospectively between the years 2003-2010 inRegion Skåne. During this time, 55 patients had been diagnosedwith MRONJ. Of these patients, 31 patients with a malignant diseasewere treated with high dose intravenous bisphosphonates and24 patients with osteoporosis were treated with oral bisphosphonates.The prevalence of MRONJ was estimated to be 0.024% forpatient on oral bisphosphonates and 2.8% for patients on high dose intravenous bisphosphonates. Tooth extraction was the mostcommon trigger factor. After treatment of MRONJ, healing occurredmore frequently in patients with osteoporosis treated withoral bisphosphonates than in patients with a malignant diseasetreated with high dose intravenous bisphosphonates.Study II investigated the association between microflora andMRONJ by using 16S rRNA pyrosequencing technique for the detectionof bacteria in necrotic bone lesions. Included were 18 consecutivepatients with MRONJ, ten with osteoporosis and eightwith metastatic disease. Bone biopsies were retrieved with two separate3 mm sterile trepan burrs from the centre of the necroticbone and from visible healthy bone. The necrotic bone lesions containedmainly anaerobic bacteria, representative for periodontalmicroflora, suggesting that a periodontal infection in combinationwith antiresorptive treatment could initiate the osteonecrosis. Study III is a prospective cohort study where the prevalence andinitiating factors of MRONJ and the outcome of surgical therapywere analysed. All new cases of MRONJ between 2012 and 2015in Region Skåne were included. Fifty-five patients with MRONJwere identified. The prevalence of MRONJ for patients on oralbisphosphonates was 0.043%, on high dose intravenous bisphosphonates1.03% and on high dose denosumab 3.64%. Periodontaldisease preceded development of MRONJ in 41 patients. Fifty patientswere treated surgically and followed up for at least 2months. Lesions progressed to remission or healing in 80.0% ofpatients treated with sequestrectomy and in 92.5% of patientstreated with block resection. In study IV, the aim was to prospectively determine the incidenceand define risk factors for MRONJ in patients with metastaticbreast cancer treated with zoledronic acid and/or denosumab.Breast cancer patients diagnosed between 2012 and 2015 in the regionof Skåne with one or several bone metastases and treated withzoledronic acid or denosumab were included. Systemic risk factors(age, zoledronic acid or denosumab use, treatment time, chemo-therapy or corticosteroid use, diabetes and smoking habits) wererecorded. Sixteen patients of 242 (6.6%) developed MRONJ duringthe 77 months study period (from 1st of January 2012 to 31stof May 2018). The incidence of MRONJ in patients treated withhigh dose zoledronic acid was 4.1%, and for patients with highdose denosumab 13.6%. The risk of developing MRONJ in patientson denosumab was significantly higher compared to patientstreated with zoledronic acid. Corticosteroid use was associatedwith a significant decreased risk of MRONJ and diabetes was associatedwith a significantly increased risk of MRONJ. Chemotherapyor smoking was not associated with a significant increasedrisk of MRONJ. In conclusion, the incidence of MRONJ is more than three timeshigher in breast cancer patients treated with denosumab comparedto breast cancer patients treated with zoledronic acid. The prevalencein patients with osteoporosis on oral bisphosphonates is low,< 0.05%. Corticosteroid use decreases the risk of developingMRONJ whilst diabetes increases the risk. The most common localrisk factor is a periodontal disease. Periodontal bacteria play a centralrole in the pathogenesis and development of MRONJ. Thetreatment outcome of MRONJ demonstrates healing in most patientstreated surgically.
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| 3. |
- Mota de Almeida, Fernando José
(författare)
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Computed tomography in endodontic decision making
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Computed tomography has been used in dentistry as a complement to two-dimensional (2D) imaging since the 1980s. The advent of cone beam computed tomography (CBCT), a more modern computed tomog-raphy technique, meant a revolution in dento-maxillofacial imaging due to sharper images, with less radiation and at a lower cost than with mul-ti-slice computed tomography (MSCT), i.e., conventional medical com-puted tomography. However, CBCT still uses higher radiation doses and is more expensive for the patient than conventional 2D methods. CBCT is generally reported as more accurate than intra-oral radiographs to diagnose pathologies orconditions of interest in endodontics. The diagnostic process is, nevertheless, not only about radiographs and it is not certain that the use of CBCT will provide a different chain of actions, and ultimately result in a health benefit for the patient. There is thus a need to establish whether the added information of computed tomography has an impact on diagnosis and therapy choice in endodontics. Guidelines based on the best available evidence have been issued to as-sist clinicians in how to use CBCT. However, little is known about the decision process that drives dentists to request computed tomography and there is a need for more insight into this process. The aims of this thesis were to assess the influence of CBCT in diagno-ses and treatments choices and to gain insight into dentists’ decision process when requesting CBCT examinations. Study I Cases used were of a fictive standardised clinical history of asympto-matic root-filled maxillary molars from 34 consecutively included pa-tients in which MSCT and intra-oral radiographs taken simultaneously. All cases were analysed by five decision makers. Before and after MSCT assessments were 1-3 months apart. The results showed that MSCT does not improve therapy planning agreement among decision makers but it influences therapy changes within each decision maker, often to more aggressive therapies (e.g. more teeth extractions) Studies II and III The studies were prospective observational studies. The cases were au-thentic clinical scenarios presented to the decision makers who also were the actual caregivers. The same cases were used in both studies II and III involving 53 consecutive patients referred for CBCT using the the evidence based European Commission (EC) guidelines. Seven deci-sion makers in two different clinics participated and made before and after CBCT assessments during normal clinical praxis. The results showed that CBCT significantly influenced changes in diagnoses and therapy plans. The changes in therapies were often towards more ag-gressive therapies and are strongly correlated with changes in diagnoses. CBCT also improved statistically decision makers’ confidence in the assessments. The decision makers felt that CBCT had a positive impact on the patient’s health in a large number of patients, but this could not be controlled, and the assessment was not blinded. Study IV Fourteen strategically selected dentists (informants) that use CBCT for endodontic purposes were interviewed. The interviews were semi-structured. The informants narrated on their last three self-reported CBCT cases. The interviews’ transcripts were analysed by qualitative content analysis. The interpretation of the phenomenon of the decision of using CBCT examinations for endodontic purposes was made at two different levels: the explicit and the implicit content. The explicit con-tent revealed three categories as follows: “visualization as a desire”, “fa-cilitating tough decisions” and “allocation of responsibility”. The im-plict content was interpreted as: dentists working in Sweden seemed to have a clinical common sense that compensates for the unfamiliarity of the guidelines. On the other hand, a “safer than sorry” attitude counter-balanced (e.g when tackling difficult patients) the restriction induced by the common sense approach. There was a belief that the national regula-tory system worked as a gate-keeper for over usage.
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| 4. |
- Nilsson, Helena
(författare)
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Periodontitis and cognitive decline in older adults
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As a result of ongoing demographic transitions, populationsthroughout the world are ageing. Cognitive decline is a leadingcontributor to dependence and disability among older adults. Declinein cognitive abilities can also influence lifestyle factors associatedwith oral health. Increasing evidence suggest that more teethare retained throughout life and therefore an increasing number ofteeth are at risk of oral diseases.Periodontitis is an inflammatory disease affecting the supportivetissues of the teeth resulting in alveolar bone loss and eventuallytooth loss. Associations between periodontitis and systemic diseaseswith an inflammatory profile have been reported.The overall aim of the present thesis was to evaluate a potentialassociation between tooth loss, periodontitis, and cognitive declineand to describe changes in oral health-related parameters amongolder adults in a twelve-year follow-up.In Paper I the impact of tooth loss on the risk for lower cognitivetest score was evaluated in 1147 older adults. An examination includingclinical and radiographic registration of number of teethpresent was performed. Cognitive functioning was evaluated usingMini-Mental State Examination (MMSE) (cut-off <25) and Clocktest(CT) (cut-off <8). Number of teeth was categorised into edentulous,1-19 and ≥20 teeth. The risk for low cognitive test scorewas statistically related to number of teeth. Results from the multiplelogistic regression after adjustments for age and educationdemonstrated a statistically significant impact of being edentulous on cognitive functions. In addition, having 1 to 19 teeth had a significantimpact on the risk for Clock-test
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| 5. |
- Rezende de Jesus, Rainde Naiara
(författare)
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Aspects of oral implant technology and osseointegration
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Behandling med käkbensförankrade tandimplantat är en vanlig metod för att ersätta förlorade tänder hos helt och partiellt tandlösa patienter. Trots att implantatbehandling uppvisar en långsiktigt hög lyckande- och överlevnadsfrekvens (90–95% efter 10 år) så förekommer implantatförluster och marginal benförlust kring implantaten under det första året efter insättning och/eller belastning, vilket kan försämra det estetiska resultatet.För att förhindra tidiga implantatförluster och/eller den marginala benremodelleringen görs olika modifieringar av de topografiska, fysikaliska och kemiska egenskaperna hos implantatytorna i syfte att påskynda och öka benbildningen i kontakt med implantatet (bone-to-implant contact [BIC]). Till exempel uppvisar en hydrofil yta med moderat råhet (höjdavvikelser på omkring 1.5 µm) en snabbare beläggning av blod jämfört med en hydrofob yta, vilket i sin tur påverkar den tidiga läkningen genom migrering och differentiering av benbildande osteoblaster. En annan metod som föreslagits för att förbättra osseointegrationen (beninläkningen) och den marginala bennivån kring implantaten är att öka primärtstabiliteten, d.v.s. den initiala mekaniska fixeringen i käkbenet. Implantatets primärstabilitet påverkas av bentätheten, implantatets design (d.v.s. utformning och gängdesign) och det använda borrprotokollet vid preparation av implantatsätet. Standardborrprotokollen innebär att ostetomien (borrhålet) är mindre än implantatets diameter (”relative implant-final drill discrepancy” [IDD]; 0.2 – 0.5 mm). Studier har visat att en underdimensionerad osteotomi, d.v.s. (IDD > 0.5 mm), kan förbättra osseointegrationen. Samtidigt har överdriven kompression av marginalt ben med hög täthet visat sig orsaka marginal bennekros, vilket ökar benresorptionen och risken för tidig implantatförlust. I gengäld har ”överdimensionering” av osteotomien, antingen med exakt samma dimension som implantatet eller med IDD ≤ –0.1 mm större än implantatet uppvisat kontroversiella resultat. Det primära syftet med avhandlingen var att utvärdera olika aspekter av nuvarande oralimplantatteknologi och dess effekter på osseointegrationen.I delarbete I och II utvärderades hos djur den biologiska responsen (BIC och relativ bendensitet [BD], studie I) och de biomekaniska egenskaperna (maximala momentvärdena vid implantatinsättning [RTV], borttagningsenergi och implantatanslutnings-styvhet, studie II]) på. Resultaten visade att BIC, BD, RTV och borttagningsenergin ökade med tiden i både hydrofoba- och hydrofila-ytor. Emellertid observerades inga signifikanta skillnader mellan de två grupperna avseende de utvärderade parametrarna vid någon av observationstidpunkterna.I delarbete III utvärderades påverkan av implantatsgängans design och ytvätbarhet på osteoklasternas differentiering, aktivering och överlevnad in vitro. Titandiskar framställdes med hydrofoba- och hydrofila-ytor och med gängor bestående av kvadratiska, trapezoid- och stödgeometri (progressiv gänggeometri) eller dubbel-triangulära geometri. Med molekylära analyser mättes osteoklasternas differentiering och livskraft, vidhäftning och morfologi samt expressionsnivåer av olika relaterade gener. Hydrofila ytor modulerade negativt makrofag/osteoklast livskraft. Specifikt ökar hydrofila ytor med dubbel-triangulära gängdesign den cellulära proinflammatoriska responsen, medan hydrofoba ytor och implantatsgängans design inte verkar ha någon tydlig inverkan på osteoklasternas differentiering, aktivering eller överlevnad.I delarbete IV utvärderades de biomekaniska och biologiska effekterna av överdimensionerad, standard och underdimensionerad osteotomi genom en systematisk litteraturöversikt. Utfallet av ITV, RTV, BIC och BD vid olika läkningsperioder testades statistiskt för att upptäcka signifikanta skillnader. Resultat från 12 studier tyder på att överdimensionerade osteotomi verkar minska den marginala benresorptionen, kännetecknad av snabbare och ökad benbildning i de ihåliga utrymmena. Emellertid uppvisar överdimensionerade osteotomier inte vid någon observationstidpunkt några ytterligare fördelar av de mätta osseointegrationsparametrarna jämfört med standardtillvägagångssättet eller underdimensionerade osteotomier.I delarbete V utvärderades, hos djur, den biologiska responsen (BIC och relativ bendensitet [BD]) och MBL av överdimensionerad osteotomi (OD) på avsmalnande implantat med en progressiv gänggeometri i jämförelse med det standard tillvägagångssättet (SD) efter en läkningsperiod på 12 veckor. SD inkluderade ett borrprotokoll med 3-stegsserie av borrar, medan OD omfattade en 5-stegsserie. Även om OD gav ett lågt ITV vid avsmalnande implantat med hydrofil yta så förbättrades osseointegrationen och bendensiteten och MBL bevarades bättre.Sammanfattningsvis indikerar denna avhandling:•Att hydrofila och hydrofoba implantat med en moderat ytråhet uppvisar likartad potential för framgångsrik osseointegration med starka biomekaniska egenskaper.•Att hydrofilicitet modulerar negativ makrofag/osteoklast livskraft, men varken vätbarhet eller gängdesign verkar ha en distinkt påverkan på osteoklast differentiering, aktivering och överlevnad in vitro. •Att överdimensionerad osteotomi uppvisar en stor heterogenicitet och kontrovers när det gäller dess eventuellt positiva effekter på osseointegrationen jämfört med en standard osteotomi, men vid tillfällen av tätt och tjockt marginalt ben förbättrade överdimensionerade osteotomier osseointegrationen och bentätheten jämfört med standardtillvägagångssättet, samt bevarade bättre den marginala bennivån.
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| 6. |
- Sollenius, Ola
(författare)
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Early correction of unilateral posterior crossbite : evidence-based evaluations of oral health related quality of life, cost-effectiveness and 3D treatment effects
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unilateral posterior crossbite (UPC) with functional shift is one ofthe most common malocclusions in mixed dentition. Left untreated,it may cause long-term effects on the growth and development of thejaws and teeth. Early orthodontic intervention is usually undertakento correct the condition at the primary or mixed dentition stage.Quad-helix (QH) or removable expansion plates (EP) are commontreatment alternatives to correct crossbites and treatment ofcrossbite may consume a relatively large part of the total resourcesin orthodontic care. In Sweden the treatment can be performed eitherin specialist orthodontic clinics or in general dentistry. The role ofthe orthodontist in general dental care is essential in diagnostics andtreatment planning, whereas general dentists may often provide apart of the treatment after consultation with, or under the supervisionof, an orthodontist. Economic evaluations have become an integral component of healthservices. The main reason is that resources within the health sector(personnel, time, facilities, equipment, and knowledge) are limited.Nevertheless, studies comparing the costs of orthodontic treatmentsperformed in general versus specialist dentistry are virtuallynon-existent.To date there are no studies evaluating the oral health related qualityof life (OHRQoL) in children with unilateral posterior crossbite. Itis thus important to analyse and compare the OHRQoL betweenchildren with and without malocclusions (children with normalocclusion). When treatment effects of unilateral crossbite correction have beenassessed, most studies have used two-dimensional evaluations suchas linear measurements. However, orthodontic treatment effectsincluding crossbite correction may, if possible, be described in allthree planes. There are no studies in the literature that have explicitlyinvestigated the three-dimensional treatment effects of unilateralcrossbite correction between different appliances and, in this context,related the treatment changes to growth changes associated withuntreated subjects with unilateral posterior crossbite as well as insubjects with normal occlusion and with no or mild orthodontictreatment need. The research questions addressed in this thesis originate fromidentified knowledge gaps and clinical needs in orthodontic care,and to provide as high clinical evidence as possible a multi-centrerandomised control trial (RCT) has been performed as well as acontrolled trial regarding comparisons and the impact differentmalocclusions may have on OHRQoL.The results are expected to be beneficial for the patients who willbe offered the most widely accepted and effective treatment, which isof importance for the dentists for decisions as to which treatment willgive the best outcome, and beneficial for both dental care providersand society in care planning and the allocation of resources.Therefore, this thesis was based on four studies: Paper I: a systematic literature review was undertaken to answer thefollowing questions:• Are there any articles regarding health economics in orthodonticsand is it possible to make any conclusions from thearticles?The literature search spanned from January 1966 to September2014 and was later supplemented and extended to April 2019.Paper II: the aims were to investigate:• The OHRQoL using the Child Perceptions Questionnaire(CPQ8-10) in 93 children with unilateral posterior crossbite,71 children with excessive overjet and 65 children with normalocclusion with no or mild orthodontic treatment need. Paper III and IV: these two papers originated from a multi-centreRCT. The aims were to investigate:• Clinical effectiveness and cost-analysis in specialist and generaldentistry (Paper III)• Three-dimensional evaluations of crossbite correction (PaperIV)Key findings in Paper I and the supplementary search:• Few orthodontic studies have presented both economic andclinical outcomes. There is currently insufficient evidence availableabout the health economics of orthodontic interventions.• Further studies are still warranted and preferably using thesame clinical outcomes. Key findings in Paper II• Children with excessive overjet reported significantly lowerOHRQoL compared to children with unilateral posteriorcrossbite or normal occlusion.• The children generally reported low CPQ scores that imply anoverall fairly good OHRQoL.Key findings in Paper III• Treatment of unilateral posterior crossbite in mixed dentitionis recommended to be performed by a specialist orthodontistusing the quad-helix appliance since the quad-helix treatmentperformed in specialist orthodontic clinics had the highest costeffectiveness. Key findings in Paper IV• Crossbite children had, before treatment, significantly smallerpalatal surface and volume than normal control children.• After treatment, there were no significant differences betweenthe treatment groups and the normal group, which impliesthat the palatal surface and projection area together with thepalatal shell volume for the treatment groups and the normalgroup were equivalent. Conclusions and clinical implications:With a superior success rate and cost-effectiveness, it is concludedthat treatment of unilateral posterior crossbite in mixed dentition isrecommended to be performed by specialist orthodontists using thequad-helix appliance.The unilateral posterior crossbite correction resulted in a normalisationof the occlusion, palatal area and volume.
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| 7. |
- Wallin Bengtsson, Viveca
(författare)
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Periodontitis, carotid calcifications and future cardiovascular diseases in older individuals
- 2019
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Doktorsavhandling (populärvet., debatt m.m.)abstract
- Background. Periodontitis is a chronic inflammatory disease with a microbiological etiology affecting the supporting tissues of the tooth. The disease affects approximately 50% of the adult population. The prevalence of periodontitis increases with age. The complex bacterial infection, as well as an exaggerated host inflammatory reaction, may trigger subclinical atherosclerosis. Aims. The overall aim of the present thesis was to study the associations between periodontitis, cardiovascular diseases and mortality. The specific aims were: I) to evaluate the use and value of panoramic radiographs in assessing carotid calcifications in relation to other used methods (gold standards) and to assess the literature on carotid calcifications defined from panoramic radiographs and concurrent diagnosis of stroke and periodontitis, II) to evaluate if periodontitis is associated with the presence of carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population, III) to assess if carotid calcifications detected on panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10–13 years in individuals between 60 and 96 years, IV) to assess if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases or are at higher risk of death over a period of 17 years. Methods: A literature review based on peer-reviewed studies was performed evaluating the use of panoramic radiographs in assessing carotid calcifications compared to other methods. In study II, III, IV older individuals, 60 years and older participating in the Swedish National Study of Aging and Care (SNAC) were included in the studies. A dental hygienist performed a dental clinical and radiographic examination. Probing depths (PD) and bleeding on probing (BOP) was registered. From radiographic panoramic images, the distances between the alveolar bone level and the cement enamel junction (CEJ) were measured. In study II, a diagnosis of periodontitis was declared, using a composite definition; if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at >10% of sites and PD ≥5 mm at one or more teeth and with BOP >20% of teeth. In study IV, an indicator of a history of periodontal disease was declared if a distance between the alveolar bone level and the CEJ ≥5 mm on panoramic radiographs at ≥30% of sites. Evidence of a radiopaque nodular mass in the intervertebral space at or below the vertebrae C3-C4 was identified as carotid calcification. In addition, a medical research team performed the medical examinations, and a medical doctor (JB) reviewed all medical records for information about events of stroke and ischemic heart diseases. Stroke and ischemic heart diseases were registered according to the ICD 10 codes: ICD 60-69 for stroke and ICD: 20-25 for ischemic heart diseases. Study I was a review of the literature, in study II, a cross-sectional study design was employed. In studies III and IV, a longitudinal prospective studydesign was used. Results: On the use of panoramic radiographs in assessing carotid calcifications in relation to other used methods, the sensitivity and specificity varied between studies published. Furthermore, only a small number of studies were found concerning carotid calcifications and stroke. These studies were primarily retrospective. Four studies were found on the association between periodontitis and carotid calcification. Study II identified that older individuals with periodontitis had a significantly higher prevalence of carotid calcifications than individuals who did not have a diagnosis of periodontitis. In study III, a significant association was found between carotid calcifications on panoramic radiographs and 13- year incidence of stroke using a logistic regression analysis adjusted for confounders (BMI, diabetes type 2, hypertension) in the 60-72 years. A statistically significant crude association between radiographic evidence of carotid calcifications and incidence of ischemic heart diseases was found in individuals between 60-72 years. Such an association was, however, not identified among individuals older than 72 years. In study IV, Cox regression analysis was used, adjusted for confounders (age group, BMI >30, diabetes type 2, gender, hypertension, history of AMI, history of stroke, periodontitis, smoking) and with a definition of periodontitis as having a distance between the alveolar bone level and the CEJ ≥5 mm in panoramic radiographs at ≥ 30% of sites. Periodontitis increased the risk for ischemic heart diseases in all individuals, in women and in the 78-96 years age group (OO). Associations between periodontitis, and mortality were found in all individuals, in men and in the 60-72 years age group (YO) in the long term follow-up. Conclusions: 1. 1. Study I identified that there are studies which have assessed the value of panoramic radiographs in relation to other used methods (gold standards). The sensitivity and the specificity varied, with the specificity being more often higher. Few studies have considered the relationship between radiographic evidence of carotid calcifications and stroke. Four studies identified a relationship between a diagnosis of periodontitis and carotid calcifications on panoramic radiographs. 2. Study II identified a significant association between periodontitis and carotid calcification in individuals 60-96 years. 3. Study III identified that signs of carotid calcifications assessed from panoramic radiographs from the 60-96-year-old individuals were consistent with an incident of stroke and/or ischemic heart diseases over 13 years follow-up. 4. Study IV identified that periodontitis was associated with future ischemic heart diseases in all individuals, in women and in the 78- 96 years age group. Periodontitis was associated with mortality in all indviduals, in men and in the 60-72 years age group.
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| 8. |
- Wiszmeg, Andréa
(författare)
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Cells in Culture, Cells in Suspense : Practices of Cultural Production in Foetal Cell Research
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parkinson’s disease is a neurodegenerative affliction to which researchers have long striven to find a cure. The human embryo is a source of vital cells used in regenerative medicine, as well as a powerful symbol of life. Using foetal cells from aborted embryos for transplantation to the brains of Parkinson patients is an avenue that has been explored by neuroscientists on and off for the last thirty years. This ethnological compilation thesis follows a national branch of a foetal cell transplantation trial through successes as well as challenges in processing foetal material into an effective, transplantable cell suspension. The cell suspension is conceptualized as a bio-object, and explored as something that produces new knowledge, emotions and logistical and ethical negotiations. These products are beyond the scope of trial and biomedical research in general, but they do nonetheless interact with and affect society at large.New biomedical inventions and forms of therapies transgress the limits of life and death and the boundaries of individuals, as well as between species. Such cultural reordering challenges researchers, health care professionals as well patients on a daily basis. Exploring the intersection between instruction and practice, nature and culture as well as between science and ritual, this thesis contributes to a broader understanding of cultural and material conditions of knowledge production. It also offers a methodological elaboration of how a diffractive approach may be fruitful in ethnographic research, when trying to reconcile epistemological differences in cross-disciplinary endeavours.
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