| 1. |
- Gustafsson, Nils, 1990-
(författare)
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Calcified carotid artery atheromas in panoramic radiographs : diagnostic reliability and association to cardiovascular disease, diabetes and periodontitis
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Incidental findings of Calcified Carotid Artery Atheromas (CCAA) on Panoramic Radiographs (PRs) of the jaws can be a risk marker for cardiovascular disease. The objectives for the thesis were to investigate the association between CCAA and 1) Myocardial Infarction (MI), 2) periodontitis, 3) diabetes and 4) estimated cardiovascular risk. Also 5) if patients with both CCAA and periodontitis have a higher risk of MI. The final objective was to study 6) General Dental Practitioners (GDPs) ability to detect CCAA on PRs and if a short training programme can improve their diagnostic accuracy.Materials and methods: Paper I-III were part of the Swedish, multicentre (17 hospitals) case- control study Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK). The study included 1610 individuals, 805 cases (151 women) diagnosed with first acute MI, and 805 controls matched for age, sex and residential area. Seventeen participants were not examined with PR and an additional 111 were excluded due to inadequate quality. As a result, 90 participants lost their match. Paper I and II had a case-control design that only included matched cases (n = 696) and controls (n = 696). Paper II and III used a cross-sectional design to evaluate all included cases (n = 738) and controls (n = 744) separately. All participants in PAROKRANK went through a detailed medical and oral health examination, including e.g., oral glucose tolerance, an extensive blood panel, and 4-point pocket probing. All PRs were assessed both for the presence of CCAA and signs of poor oral health, including marginal bone loss. The results from the medical examination were used to estimate risk of future cardiovascular events and death using Systematic COronary Risk Evaluation (SCORE) and Framingham Risk Score (FRS). The results from the oral health examination were used to classify the degree of periodontitis both according to bone loss and clinical periodontal disease index (CPDI). Paper IV used a pre-post design to evaluate 14 GDPs diagnostic accuracy regarding assessment of CCAA on PR before and after participation in a short training programme. The GDPs were evaluated at baseline, 2 weeks and 1 year after training. Comparisons were made with the consensus of 2 experienced oral and maxillofacial radiologists.Results: Paper I: CCAA on PRs was more common among cases with recent first MI, (33.8% with CCAA), compared to controls (27.6%; P = 0.012). Paper II: CCAA and CPDI were associated among cases (OR 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR 1.70; 95% CI, 1.22 to 2.38; P < 0.01). No association was found between CCAA and the degree of bone loss on PR. MI had a stronger association to CCAA combined with periodontitis, than to either condition alone (OR 1.75; 95% CI, 1.11 to 2.74; P = 0.01). Paper III: Elevated risk of a future cardiovascular event estimated with FRS was associated with CCAA, both among cases (OR 1.89; 95% CI: 1.31–2.73, P = 0.001) and controls (OR 1.64; 95% CI: 1.03–2.64, P = 0.04). Elevated risk of cardiovascular death according to SCORE was associated with CCAA among controls (OR 1.58; 95% CI: 1.12–2.23, P < 0.01) but not among cases. Diabetes was more common among controls with than without CCAA (18.0% vs. 11.7%), but this association was not statistically significant after adjustments. Paper I-III included a sex- stratified analysis revealing that the results were mainly applicable on men. Paper IV: An improvement in diagnostic accuracy was observed among GDPs after a short training programme for diagnosing CCAA on PR. The sensitivity increased (41.8% to 55.7%, P = 0.02) without a decrease in specificity. The kappa values also increased (0.66 to 0.71, P = 0.04). At 1 year follow up, the improvements compared to baseline remained.Conclusions: There is an association between CCAA on PR and MI. Clinically diagnosed periodontitis is associated with CCAA on PR, and among participants with both periodontitis and CCAA there is a higher probability of having had MI than among participants with either condition alone. An increased estimated risk of future cardiovascular events and death according to FRS and SCORE is associated with CCAA on PR. These conclusions are mainly applicable on men. Diabetes was not independently associated with CCAA on PR, possibly due to selection bias. A short training programme can significantly and sustainably improve GDPs diagnostic accuracy regarding CCAA. This indicate that GDPs could contribute to prevention of cardiovascular events and death by detecting CCAA on PR and, should be encouraged to refer patients without previous treatment of cardiovascular disease for further medical attention, and if other cardiovascular risk factors are identified, necessary treatment.
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| 2. |
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| 3. |
- Al-Taai, Nameer, et al.
(författare)
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A Superimposition-Based Cephalometric Method to Quantitate Craniofacial Changes
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- To assess the craniofacial changes related to growth and/or to orthodontic and orthognathic treatments, it is necessary to superimpose serial radiographs on stable structures. However, conventional superimposition provides only a graphical illustration of these changes. To increase the precision of growth and treatment evaluations, it is desirable to quantitate these craniofacial changes. The aims of this study were to (1) evaluate a superimposition-based cephalometric method to process numerical data for craniofacial growth changes and (2) identify a valid, reliable, and feasible method for superimposition. Forty pairs of cephalograms were analyzed at T1 and T2 (mean age 9.9 and 15.0 years, respectively). The superimposition-based cephalometric method involved relating the sagittal and vertical measurements on the T2 radiographs to the nasion and sella landmarks on the T1 radiographs. Validity and reliability were evaluated for three superimposition methods: the sella-nasion (SN); the tuberculum sella-wing (TW); and Bjork's structural. Superimposition-based cephalometrics can be used to quantify craniofacial changes digitally. The numerical data from the superimposition-based cephalometrics reflected a graphical illustration of superimposition and differed significantly from the data acquired through conventional cephalometrics. Superimposition using the TW method is recommended as it is valid, reliable, and feasible.
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| 4. |
- Al-Taai, Nameer, et al.
(författare)
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Craniofacial changes from 13 to 62 years of age
- 2022
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Ingår i: European Journal of Orthodontics. - : Oxford University Press (OUP). - 0141-5387 .- 1460-2210. ; 44:5, s. 556-565
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Tidskriftsartikel (refereegranskat)abstract
- Background In long-term studies of orthodontic, orthognathic, and prosthodontic treatments, control subjects are needed for comparison. Objectives To study the craniofacial (skeletal, soft tissue, and dental) changes that occur in untreated subjects with normal occlusion between 13 and 62 years of age. Materials/Methods Thirty subjects with a Class I normal occlusion and harmonious facial profile were studied. X-ray examinations were performed at 13 (T1), 16 (T2), 31 (T3), and 62 (T4) years of age, and data were obtained from cephalograms. In total, 53 angular and linear parameters were measured using superimposition-based and conventional cephalometric methods to describe the craniofacial changes. Results The jaws showed significant anterior growth from T1 to T2, and significant retrognathism from T3 to T4. The anterior face height and jaw dimensions increased significantly until T3. Significant posterior rotation of the mandible and opening of the vertical jaw relation, in addition to significant retroclination of the incisors and straightening of the facial profile, were found from T3 to T4. Limitations Given the small sample size at T4, it was not possible to analyse the gender dimension. Conclusions/Implications Craniofacial changes continue up to the sixth decade of life. These changes are consistent, albeit to a lesser extent, with the adolescent growth patterns for most of the studied parameters, with the exceptions of incisor inclination, sagittal jaw position, vertical jaw relation and inclination, and posterior face height.
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| 5. |
- Al-Taai, Nameer, 1975-
(författare)
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Dentoalveolar and craniofacial changes from early adolescence to late adulthood
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Study I: To evaluate the reliability and validity of different superimposition methods and to increase the precision with which craniofacial growth and treatment can be quantified. Study II: To explore the craniofacial changes that occur from early adolescence to late adulthood. Study III: To assess the impact of premolar extractions on dentoskeletal and facial morphologies up to late adulthood. Study IV: In a 50-year follow-up, to study how early extraction of four premolars affects the development of age-related lower incisor crowding. Materials and Methods: Study I: Forty pairs of cephalograms were analysed at mean ages of 9.9 (T1) and 15.0 (T2) years. Three superimposition methods were assessed: the Sella-Nasion (SN); the Tuberculum Sella-Wing (TW); and Björk’s structural. Björk’s structural method was performed using three techniques: direct, tracing template, and subtraction. Study II: Thirty subjects with a Class I normal occlusion and harmonious facial profile were investigated. Study data were obtained from cephalograms performed at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. The craniofacial changes were assessed using superimposition-based and conventional cephalometric methods. Study III: Two groups were included. The Extraction group (N=30 with Class I crowding malocclusion) had their first premolars extracted at a mean age of 11.5 years, without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Study data were obtained from cephalograms performed at 12 (T1), 15 (T2), 30 (T3) and 62 (T4) years of age. The dentoskeletal and soft tissue changes were assessed using superimposition-based and conventional cephalometric methods. Study IV: Two groups were included. The Extraction group (N=24 with Class I crowding malocclusion) that had their first premolars extracted at mean age of 11.5 years, without subsequent orthodontic treatment. The Control group included 21 untreated subjects with Class I normal occlusion. Study data were obtained from dental casts and cephalograms performed at mean ages of 11.4 and 13.0 years, for the two groups, respectively (T1), and at mean ages of 30.9 years (T2) and 61.7 years (T3).Results: Study I: The numerical data from the superimposition-based cephalometrics reflected a graphical illustration of superimposition and differed significantly from the data acquired using conventional cephalometrics. While there were no significant differences between the TW method and Björk’s three techniques, significant differences were found between the SN method and the other methods. Study II: The maxilla and mandible showed significant anterior growth from T1 to T2, and significant retrognathism from T3 to T4. The anterior facial height and jaw dimensions increased significantly until T3. From T3 to T4, significant posterior rotation of the mandible and opening of the vertical jaw relation were observed, in addition to significant retroclination of the upper incisors, decrease in lip prominence, and straightening of the facial profile. Study III: There were no significant differences between the Extraction and Control groups in terms of the skeletal sagittal relation, incisor inclination and protrusion (or for most of the soft tissue parameters) during the observation period. Study IV: The Extraction group showed significant improvement in the space deficiency of the lower teeth and no changes in the irregularity of the lower incisors up to late adulthood. In contrast, both the space deficiency of the lower teeth and irregularity of the lower incisors were significantly exacerbated in the Control group, up to late adulthood. Conclusions: The superimposition-based cephalometric method accurately generates numerical data for the craniofacial changes. Superimposition using the TW method is valid, reliable, and feasible, and is recommended to be used for superimposition-based cephalometrics. Moreover, craniofacial changes and development of lower incisor irregularity and crowding continue up to late adulthood in untreated subjects who were originally classified as having normal occlusion. For successful long-term outcomes, clinicians should therefore consider age-related changes in patients when planning for orthodontic, orthognathic, and prosthodontic treatments. Treatment with the extraction of four premolars alone in patients with Class I malocclusion with severe crowding does not impact the long-term dentoskeletal and soft tissue profile, and results in unchanged lower incisor alignment.
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| 6. |
- Al-Taai, Nameer, et al.
(författare)
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Dentoskeletal and soft tissue changes after treatment of crowding with premolar extractions: a 50-year follow-up
- 2023
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Ingår i: European Journal of Orthodontics. - : Oxford University Press (OUP). - 0141-5387 .- 1460-2210. ; 45:1, s. 79-87
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Tidskriftsartikel (refereegranskat)abstract
- Background The long-term effects on dentofacial morphology of interceptive treatment with premolar extractions, in the absence of subsequent orthodontic treatment, have not been fully explored. Objective The aim was to investigate the effects of premolar extractions (without subsequent orthodontic treatment) on the dentoskeletal and soft tissue profile of patients aged between 12 and 62 years with Class I malocclusion with severe crowding, as compared to untreated controls. Materials and methods The Extraction group (N = 30 with Class I crowding malocclusion) had their first premolars removed in early adolescence without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Cephalograms were taken at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. A superimposition-based cephalometric method was used to assess the dentoskeletal and soft tissue changes. Results There were no significant differences between the Extraction and Control groups in terms of skeletal sagittal relation, incisor inclination, and protrusion, or most of the soft tissue parameters throughout the observation period. However, significant differences were observed between the groups with respect to the vertical relations in T2-T3, such that the Extraction group showed more-pronounced decreases in the ML/NSL, ML/NL, and Gonial angles and more-pronounced increases in facial heights. Conclusions and implications Treatment for subjects with Class I malocclusion with severe crowding by the extraction of four premolars, without subsequent orthodontic treatment, does not affect the long-term dentoskeletal and soft tissue profile, as compared to an untreated Control group. The degree of crowding, rather than changes in dentofacial morphology, is crucial in deciding on extraction therapy.
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| 7. |
- Barut, Oya, et al.
(författare)
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Calcifications in the neck region of patients with carotid artery stenosis : a computed tomography angiography study of topographic anatomy
- 2020
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 129:5, s. 523-530
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women.Study Design: Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection.Results: Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070).Conclusions: The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.
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| 8. |
- Bladh, Magnus, et al.
(författare)
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Defined shapes of carotid artery calcifications on panoramic radiographs correlate with specific signs of cardiovascular disease on ultrasound examination
- 2024
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Ingår i: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. - : Elsevier. - 2212-4403 .- 2212-4411.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD. Study Design: The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed. Results: All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm2, mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001). Conclusions: Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.
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| 9. |
- de Lange, Thomas, et al.
(författare)
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Students' perceptions of post-exam feedback in oral radiology : a comparative study from two dental hygienist educational settings
- 2024
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Ingår i: European journal of dental education. - : John Wiley & Sons. - 1396-5883 .- 1600-0579. ; 28:2, s. 377-387
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this study was to investigate how students perceive the benefit of participating in a teacher-organised session providing feedback on exams, termed post-exam feedback, in two dental hygienist programmes.Methods: The study was based on interviews with 22 participants, including 18 students and 4 faculty teachers. The data were approached on the basis of thematic analysis, allowing us to generate insights on how the participants reflected on their participation in the post-exam feedback sessions and how they perceived this arrangement as learners.Results: The findings from the study suggest that motivated students consider post-exam feedback to be beneficial in clearing up uncertainties and deepening their understanding of issues not fully understood during the exam, as well as supporting their further learning. Less motivated students mainly consider post-exam feedback to be relevant for students who do not pass the exams.Conclusions: Organised in a student-centred way and with attentiveness to student learning preferences, the results suggest that post-exam feedback can be valuable for enhancing assessment and supporting student learning related to exams.
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| 10. |
- Garoff, Maria, 1979-, et al.
(författare)
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Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs : an independent risk marker for vascular events
- 2019
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Ingår i: BMC Cardiovascular Disorders. - : BioMed Central. - 1471-2261 .- 1471-2261. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events.METHODS: The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death.RESULTS: Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ2). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1-4.5) were independent risk markers for the endpoint.CONCLUSIONS: Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.
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