| 1. |
- Bruckmann, Corinna, et al.
(författare)
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Pneumocephalus as result of nonsurgical peri‐implantitis treatment with an air‐polishing device for submucosal debridement : a case report
- 2022
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Ingår i: Clinical and Experimental Dental Research. - : Wiley-Blackwell. - 2057-4347. ; 8:3, s. 632-639
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Tidskriftsartikel (refereegranskat)abstract
- Background: A subcutaneous emphysema is an infrequent but potentially life‐ threatening complication after dental treatment involving instruments functioning with pressurized air. Emphysemata after the use of high‐speed handpieces and air‐ syringes are well documented, however, more recently several reports on emphysemata produced by air‐polishing devices during management of peri‐ implant biological complications have appeared. To the best of our knowledge, direct development of pneumocephalus after a dental procedure has never been reported before. Introduction of air likely contaminated with oral bacteria to the intracranial space bares the risk of developing meningitis.Case Presentation: This case report describes the spreading of a subcutaneous emphysema into the intracranial space (i.e., development of a pneumocephalus) after treatment of a peri‐implantitis lesion with an air‐polishing device equipped with the nozzle for submucosal debridement. A subcutaneous emphysema was noticed during the use of an air‐polishing device and the subsequent computed tomogra- phy (CT) examination revealed a quite unexpected spreading of the emphysema into the intracranial space. The patient was admitted to the hospital for close surveillance, CT follow‐up, and intravenous antibiotics to prevent the development of meningitis due to the introduction of air—likely contaminated with oral bacteria— into the intracranial space. After 3 days, the patient was discharged in good condition without any further complications.Conclusion: In case of an extensive subcutaneous emphysema as result of a dental procedure, a more extended radiographic examination including the mediastinal and cranial space should be considered, to assess the risk for potentially life‐threatening complications.
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| 2. |
- Bertl, Kristina, et al.
(författare)
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A root canal filling per se does not have a significant negative effect on the marginal periodontium
- 2015
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Ingår i: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 42:6, s. 520-529
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the periodontal status of single-rooted endodontically treated teeth (ET), correcting for patient- and tooth-related factors. Methods: Clinical parameters (BoP,PD,CAL) of 240 ET and 240 contralateral vital teeth (VT), before and after non-surgical periodontal treatment, were extracted retrospectively from the journals of 175 patients. Possible patientrelated (age, gender, smoking status) and tooth-related (interproximal restoration, root canal filling’s extent, post, tooth type) confounders were tested. Results: At baseline, frequency of BoP at an interproximal site at ET versus VT was 70.4% versus 65.0%, respectively. The frequency of teeth with interproximal PD ≥5 mm and CAL ≥5 mm was 47.9% versus 42.9% and 54.6% versus 49.6% at ET and VT, respectively. Interproximal PD and CAL at ET versus VT were 3.86 versus 3.61 mm and 4.11 versus 3.95 mm. After correcting for tooth-related factors, no significant differences were observed between ET and VT. An improper restoration had a significant (p < 0.001) negative effect on BoP [OR 3.49 (95%CI: 1.95–6.27)], PD [36.81% (95%CI: 18.52–57.92)] and CAL [27.01% (95% CI: 12.67–43.18)]. No significant differences between ET and VT were observed regarding clinical outcome of non-surgical periodontal therapy. Conclusions: Presence of a root canal filling per se does not have a significant negative influence on the marginal periodontium, when correcting for the quality of the interproximal restoration.
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| 3. |
- Bertl, Kristina, et al.
(författare)
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Adverse reaction after hyaluronan injection for minimally invasive papilla volume augmentation : A report on two cases
- 2017
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Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 28:7, s. 871-876
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To report two cases of adverse reaction after mucosal hyaluronan (HY) injection around implant-supported crowns, with the aim to augment the missing interdental papilla. Material and Methods: Two patients with single, non-neighbouring, implants in the anterior maxilla, who were treated within the frames of a randomized controlled clinical trial testing the effectiveness of HY gel injection to reconstruct missing papilla volume at single implants, presented an adverse reaction. Injection of HY was performed bilaterally using a 3-step technique: (i) creation of a reservoir in the mucosa directly above the mucogingival junction, (ii) injection into the attached gingiva/mucosa below the missing papilla, and (iii) injection 2–3 mm apically to the papilla tip. The whole-injection session was repeated once after approximately 4 weeks. Results: Both patients presented with swelling and extreme tenderness with a burning sensation on the lip next to the injection area, after the second injection session. In one of the cases, a net- like skin discoloration (livedo reticularis) was also noted. The symptoms lasted for up to 7 days, and in both cases, symptoms resolved without any signs of skin or mucosal necrosis or any permanent damage. Conclusion: Most likely, water attraction over time by the highly hygroscopic HY, exerted progressively an external vascular compression and at least partial occlusion of neighbouring blood vessels. An infection or an allergic reaction seems unlikely, since all symptoms gradually disappeared within a week irrespective use of antimicrobials, while an allergic reaction most likely would not have been restricted to one side.
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| 4. |
- Bertl, Kristina, et al.
(författare)
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Bacterial colonization of a power-driven water flosser during regular use : A proof-of-principle study
- 2021
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Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:5, s. 656-663
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The present proof-of-principle study assessed whether daily use of a power-driven water flosser (Sonicare AirFloss; SAF) leads to bacterial colonization in the nozzle and/or the device, resulting in contaminated water-jet.MATERIAL AND METHODS: In five participants, saliva samples at baseline and water-jet samples of devices used daily with bottled water for 3 weeks (test) were collected. Additionally, water-jet samples from devices used daily with bottled water extra-orally for 3 weeks (positive control) and from brand new devices (negative control), as well as samples from newly opened and 1- and 3-week opened water bottles were collected. Colony forming units (CFU) were recorded after 48 h culturing and 20 oral pathogens were assessed by polymerase chain reaction-based analysis.RESULTS: Distinct inter-individual differences regarding the number of detected bacteria were observed; water-jet samples of test devices included both aerobic and anaerobic bacterial species, with some similarities to the saliva sample of the user. Water-jet samples from positive control devices showed limited number of aerobic and anaerobic bacterial species, while the samples from negative control devices did not show any bacterial species. Very few aerobic bacteria were detected only in the 3-week-old bottled water samples, while samples of newly and 1-week opened water bottles did not show any bacterial growth.CONCLUSIONS: The present proof-of-principle study showed that daily use of a power-driven water flosser for 3 weeks resulted in bacterial colonization in the nozzle and/or device with both aerobic and anaerobic, not only oral, species, that are transmitted via the water-jet.
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| 5. |
- Bertl, Kristina, et al.
(författare)
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Can hyaluronan injections augment deficient papillae at implant-supported crowns in the anterior maxilla? A randomized controlled clinical trial with 6 months follow-up
- 2017
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Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 28:9, s. 1054-1061
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The present randomized controlled trial aimed to assess the effect of hyaluronan (HY) injections to augment deficient interproximal papillae at implant-supported crowns in the anterior maxilla. METHODS: Twenty-two patients with a deficient papilla in the anterior maxilla next to an implant-supported crown were randomly assigned to receive twice either HY (test) or saline solution (control) injection. The following parameters were recorded prior to injection (baseline) and 3 and 6 months after injection: distance between the papilla tip and contact point (PT-CP), modified papilla index score (MPIS), and standard clinical periodontal parameters. Pain level after injection was recorded on a visual analogue scale (VAS). The deficient area was evaluated on clinical photographs, and the esthetic appearance was recorded on a VAS. Differences in mucosal volume were assessed after 3 months by intraoral scans. The bone level was assessed on periapical radiographs. RESULTS: No differences were observed between groups, neither at baseline nor at 3 and 6 months post-treatment. Mean PT-CP ranged between 1.8 mm and 2.3 mm without significant differences between groups or over time within groups; MPIS was 2 for all patients at all time points. Similarly, insignificant differences between groups or time points were observed for deficient area, gingival volume changes, bone level, and esthetic appearance. There were no differences in pain level between groups during injection, but discomfort after injection lasted longer in the test group. CONCLUSIONS: Injection of HY adjacent to maxillary anterior implant-supported crowns did not result in any clinical conspicuous volume augmentation of deficient papillae.
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| 6. |
- Bertl, Kristina, et al.
(författare)
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Does the time-point of orthodontic space closure initiation after tooth extraction affect the incidence of gingival cleft development? A randomized controlled clinical trial.
- 2020
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Ingår i: Journal of Periodontology. - : John Wiley & Sons. - 0022-3492 .- 1943-3670. ; 91:5, s. 572-581
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gingival clefts (GC) develop frequently during orthodontic space closure and may compromise the treatment outcome. This study assessed whether the time-point of orthodontic space closure initiation, after permanent tooth extraction, affects the incidence of GC. Methods: In 25 patients requiring bilateral premolar extraction due to orthodontic reasons, one premolar, chosen at random, was extracted 8 weeks before space closure initiation (“delayed movement”, DM), while the contralateral premolar was extracted one week before (“early movement”, EM) (“treatment group”). Presence/absence of GC after 3 and 6 months (“time-point”) was recorded and any association with various parameters (i.e., treatment group, time-point, gender, jaw, craniofacial growth, gingival biotype, buccal bone dehiscence after extraction, space closure) was statistically assessed. Results: Twenty-one patients contributing with 26 jaws were finally included in the analysis. Overall, GC were frequent after 3 (DM: 53.9%; EM: 69.2%) and 6 months (DM: 76.9%; EM: 88.5%). EM (p=0.014) and larger space closure within the study period (p=0.001) resulted in a significantly higher incidence of GC. Further, there was a tendency for GC development in the presence of buccal bone dehiscence (p=0.052) and thin gingival biotype (p=0.054). “Fast movers” (herein cases with a tooth movement ≥ 1mm per month) developed a GC in > 90% of the cases already after 3 months. “Slow movers” developed a GC only in 25 and 70% after 3m and FE, respectively. Conclusions: GC development is a frequent finding during orthodontic space closure and seems to occur more frequently with early tooth movement initiation and in “fast movers”.
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| 7. |
- Bertl, Kristina, et al.
(författare)
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Hyaluronan in Non-Surgical and Surgical Periodontal Therapy. A Systematic Review.
- 2015
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Ingår i: Journal of Clinical Periodontology. - : Wiley. - 1600-051X .- 0303-6979. ; 42:3, s. 236-246
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the effect of hyaluronan (HY) application as monotherapy or as adjunct to non-surgical and/or surgical periodontal therapy. METHODS: Literature search was performed according to PRISMA guidelines with the following main eligibility criteria: (a) English or German language; (b) preclinical in-vivo or human controlled trials; (c) effect size of HY evaluated histologically or clinically. RESULTS: Two preclinical in-vivo studies on surgical treatment and 12 clinical trials on non-surgical and/or surgical treatment were included. Most of the studies were highly heterogeneous, regarding with HY product used and application mode, and of high risk of bias, thus not allowing meta-analysis. The majority of clinical studies described a beneficial, occasionally statistically significant, effect of HY on bleeding on probing (BoP) and pocket depth (PD) reduction (2.28-19.5% and 0.2-0.9mm, respectively), comparing to controls; no adverse effects were reported. CONCLUSIONS: HY application as adjunct to non-surgical and surgical periodontal treatment seems to have a beneficial, generally moderate, effect on surrogate outcome variables of periodontal inflammation, i.e., BoP and residual PD, and appears to be safe. The large heterogeneity of included studies, does not allow recommendations on the mode of application or effect size of HY as adjunct to non-surgical and surgical periodontal treatment.
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| 8. |
- Bertl, Kristina, et al.
(författare)
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Hyaluronan vid parodontal behandling
- 2015
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Ingår i: Tandläkartidningen. - : Sveriges tandläkarförbund. - 0039-6982. ; 10, s. 58-65
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- Hyaluronan (HY) har på grund av sina egenskaper (bakteriostatiska, antiin ammatoriska et cetera) nyligen introducerats för användning i parodon- tal terapi. Denna litteraturgenomgång bygger del- vis på en nyligen publicerad systematisk översikt, och har kompletterats med gingivitstudier och de senast publicerade vetenskapliga arbetena med HY inom parodontitbehandling. Artikeln ger en sammanfattning av de terapeutiska möjligheterna med HY-applikation som monoterapi eller som ett tillägg till behandling av gingivit och parodontit. Vid sökning i tre litteraturdatabaser fann vi 18 kontrollerade studier. I majoriteten av dessa stu- dier beskrivs för HY-testgruppen jämfört med kontrollgruppen ● en statistiskt signi kant förbättring i gingivalin- dex för gingivitpatienter ● en statistiskt signi kant minskning i blödning vid sondering och fickdjup vid icke-kirurgisk parodontal behandling ( gur I), dock i måttligt kliniskt relevant utsträckning. Att erhålla någon ytterligare vinst i klinisk fästenivå av HY-applikation vid parodontal kirurgi verkar inte troligt. Till dags dato saknas rapporter av oönskade bi- verkningar av HY-applikation. På grund av den avsevärda heterogeniteten i studierna (avseende produkter, metoder för applicering, dos och applikationstid) går det inte att dra någon tydlig slutsats om administration och e ektstorlek av HY vid behandling av gingivit eller parodontit.
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| 9. |
- Bertl, Kristina, et al.
(författare)
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Hyaluronanprodukte in der Therapie von Gingivitis- und Parodontitispatienten : Eine Literaturübersicht
- 2015
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Ingår i: Parodontologie. - : Quintessence. - 0937-1532. ; 26:4, s. 423-433
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Tidskriftsartikel (refereegranskat)abstract
- Application of hyaluronan (HY) in periodontal treatment has recently increased due to its bacteriostatic and anti-in ammatory pro- perties. This review is based in part on a recent systematic review and also includes newly published studies such as those on gingivitis patients. It summarizes the thera- peutic possibilities of HY application as a monotherapy and as an adjunct in the treatment of gingivitis and periodontitis. Based on literature searches in 3 databases, 18 controlled trials were identi ed. When comparing the HY test group with the control group, the majority of the clinical trials reported (a) a signi cant improvement in gingival indices of gingivitis patients and (b) a signi cant but clinically moderate reduction in bleeding on probing and probing pocket depth after nonsurgical treatment of periodontitis patients. The effect of HY application on clinical attachment level gain after surgical regenerative treatment remains unclear. Because no unexpected side effects were reported after HY-application, its use can thus be considered safe. However, due to the considerable heterogeneity of the available studies, in terms of product diffe- rences and varying application modalities, no recommendation can be provided re- garding the appropriate HY administration or the effective amount for the treatment of gingivitis or periodontitis.
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| 10. |
- Bertl, Kristina, et al.
(författare)
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Including dental professionals in the multidisciplinary treatment team of head and neck cancer patients improves long-term oral health status
- 2022
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Ingår i: Clinical Oral Investigations. - : Springer. - 1432-6981 .- 1436-3771. ; 26, s. 2937-2948
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo assess in a cross-sectional study the impact of including dental professionals in the multidisciplinary treatment team of head and neck squamous cell carcinoma (HNSCC) patients on the long-term oral health status.Materials and methodsOral health status, dental care behaviours, and oral health-related quality of life were assessed based on a clinical and radiographic examination, interview, and medical records in patients treated for HNSCC ≥ 6 months ago. This patient group (‘cohort 2’) was treated in a multidisciplinary treatment team including dental professionals and compared to a group of HNSCC patients previously treated at the same university, but without dental professionals included in the multidisciplinary treatment team (‘cohort 1’).ResultsCohort 2 consisted of 34 patients, who had received a dental check-up and if necessary, treatment by dental profes- sionals prior to the initiation of cancer treatment. This cohort showed significantly improved oral hygiene habits and a better periodontal health status compared to cohort 1. However, cohort 2 still presented high demand for treatment due to active carious lesions; only a few, statistically insignificant improvements were detected compared to cohort 1.ConclusionIncluding dental professionals in the multidisciplinary treatment team of HNSCC patients has a positive impact on patient oral health status — primarily in terms of periodontal disease — 6 months and longer after finishing cancer therapy.Clinical relevanceA team-based approach including dental professionals specialised in head and neck cancer improves oral health status.
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