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1.	Fransson, Helena, et al. (författare) There is a paucity of economic evaluations of prediction methods of caries and periodontitis : A systematic review 2021 Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:3, s. 385-398 Tidskriftsartikel (refereegranskat)abstract Objectives: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). Material and methods: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. Results: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. Conclusions: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.
2.	Andersson, Helena, et al. (författare) Walking football for Health - physiological response to playing and characteristics of the players. 2023 Ingår i: Science and medicine in football. - : Routledge. - 2473-3938 .- 2473-4446. ; , s. 1-8 Tidskriftsartikel (refereegranskat)abstract Walking Football (WF) is one type of recreational football increasing in popularity, targeting older adults. Further knowledge on the intensity and physical workload of WF, characteristics of the players, the social context, and reasons for playing WF is needed. Thus, the aim of the study was to characterize the individuals that regularly play WF and their experience of WF, and the physiological characteristics of the sport. Sixty-three players from three clubs taking part in organised WF in Sweden were included. The players participated in up to four WF-games and underwent performance tests and answered a questionnaire. The participants mean age was 70.9 years, ranging from 63 to 85 years with 71% (n = 27) of the men and 68% (n = 13) of the women having a BMI > 25. Fifty-one percent (n = 27) of the players had hypertension, and 73% (n = 39) regularly used prescription drugs due to illness. During WF, the players covered on average 2,409 m (2,509 m for men and 2,205 m for women, p = .001). Expressed in percentage of their age-estimated maximal heart rate, mean heart rate represented 80 ± 9 and 80 ± 8% of max for men, and 78 ± 9 and 79 ± 9% of max for women in the first and second halves, respectively, hence WF can be considered a moderate intensity activity for older adults. The main reason for WF participation was to socialize. WF includes a considerable number of accelerations and decelerations, making it more energetically and mechanically demanding than walking.
3.	Bakhshandeh, Azam, et al. (författare) Calibration in radiographical diagnostics and removal of carious tissue in deep lesions 2018 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Variations in inter- and intra-examiner agreement were found. Repeated monitoring centre visits are necessary for improved calibration in radiographical diagnostics and performance of carious removal.
4.	Bergström, Malin, et al. (författare) Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent 2018 Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 107:2, s. 294-300 Tidskriftsartikel (refereegranskat)abstract AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.
5.	Bjorndal, Lars, et al. (författare) Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy 2010 Ingår i: European Journal of Oral Sciences. - : Wiley. - 0909-8836 .- 1600-0722. ; 118:3, s. 290-297 Tidskriftsartikel (refereegranskat)abstract Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (−22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.
6.	Bjørndal, Lars, et al. (författare) Randomised clinical trial on deep caries excavation 3-5 yr follow-up 2012 Ingår i: Journal of dental research. - : Sage Publications. ; 91:Spec Iss b Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Objectives: Long term follow-up data based on randomised clinical trials are needed in relation to deep caries treatment. The aim of the present trial is to investigate the beneficial and harmful long term effects of stepwise excavation during two visits versus one completed excavation of deep caries in permanent teeth in adults. Methods: Consecutive patients contacting clinical units in Sweden and Denmark were included. The trial is a centrally randomised patient- and observer-blinded multicenter trial, with two parallel intervention groups. A sample size calculation showed that 134 patients were needed in each group. Taking dropouts into account, a total of 314 patients fulfilled well-defined inclusion and exclusion criteria and were centrally block-randomised stratified by age and pain. Inclusion criteria: (i) Person ≥ 18 yrs having deep caries with or without pain (ii) x-ray showing primary caries into the inner 1/4 of the dentin, with the presence of a radiopaque zone at the pulpal wall. Success was defined as unexposed pulp with sustained pulp vitality without apical radiolucency after follow-up. Blinded evaluation of 1½ follow-up has previously been carried out in 106 patients (stepwise excavation group) and 93 patients (direct complete excavation) (Bjørndal et al. 2010, EJOS). Results: At 3-5 yr follow up there was a statistically significantly higher success with stepwise excavation [difference: 11.5%, 95% confidence interval (0.5; 22.2)] versus a direct complete excavation procedure, being similarly with the short term follow-up data. 53.3% (n = 102) of the material has been controlled and no significant differences were noted between the two intervention groups in terms of patients not yet controlled, lost patients and failures (Table). Conclusion: A stepwise excavation procedure still seems preferable after a long term follow up and presumably related to the reduced risk of exposing the inflamed pulp associated with deep caries.
7.	Bjørndal, Lars, et al. (författare) Randomized Clinical Trials on Deep Carious Lesions : 5-Year Follow-up 2017 Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 96:7, s. 747-753 Tidskriftsartikel (refereegranskat)abstract Deep caries presents a dilemma in terms of which treatment that will render an optimal prognosis by maintaining pulp vitality with absence of apical pathology. Previously, 2 randomized clinical trials were performed testing the short-term effects of stepwise carious tissue removal versus nonselective carious removal to hard dentin with or without pulp exposure. The aim of this article was to report the 5-y outcome on these previously treated patients having radiographically well-defined carious lesions extending into the pulpal quarter of the dentin but with a well-defined radiodense zone between the carious lesion and the pulp. In this long-term study, 239 of 314 (76.2%) patients were analyzed. The stepwise removal group had a significantly higher proportion of success (60.2%) at 5-y follow-up compared with the nonselective carious removal to hard dentin group (46.3%) ( P = 0.031) when pulp exposures per se were included as failures. Pulp exposure rate was significantly lower in the stepwise carious removal group (21.2% vs. 35.5%; P = 0.014). Irrespective of pulp exposure status, the difference (13.3%) was still significant when sustained pulp vitality without apical radiolucency and unbearable pain was considered (95% confidence interval, 3.1-26.3, P = 0.045). After pulp exposure, only 9% ( n = 4) of the analyzed patients were assessed as successful, indicating that the prognosis is highly dubious following conventional pulp-capping procedures (direct pulp capping or partial pulpotomy) in deep carious lesions in adults. In conclusion, the stepwise carious removal group had a significantly higher proportion of pulps with sustained vitality without apical radiolucency versus nonselective carious removal of deep carious lesions in adult teeth at 5-y follow-up (ClinicalTrials.gov NCT00187837 and NCT00187850).
8.	Bjørndal, Lars, et al. (författare) Treatment of vital pulp conditions 2018 Ingår i: Textbook of Endodontology. - : Wiley-Blackwell. - 9781119057314 - 9781119057369 ; , s. 79-100 Bokkapitel (övrigt vetenskapligt/konstnärligt)
9.	Brodén, Joséphine, et al. (författare) Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth 2019 Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:4, s. 2751-7 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. MATERIAL AND METHODS: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. RESULTS: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. CONCLUSIONS: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.
10.	Brodén, Joséphine, et al. (författare) Direct pulp capping procedures versus root canal treatment in young permanent vital teeth with pulp exposures due to caries : A systematic review 2016 Ingår i: American Journal of Dentistry. - : Mosher & Linder. - 0894-8275. ; 29:4, s. 201-206 Forskningsöversikt (refereegranskat)abstract Purpose: To evaluate the available evidence on pulp capping procedures and root canal treatment in young permanent teeth with vital pulps exposed by caries. Methods: The study was conducted as a systematic review of the literature. Three databases, PubMed, Web of Knowledge, and The Cochrane Library were searched. Reference lists of relevant articles were hand searched. The quality of all relevant publications was rated. Results: Ten original scientific studies were included in the review. The quality was rated as low in all studies. The search failed to disclose any article directly comparing pulp capping and root canal treatment. The level of evidence was insufficient to draw any conclusions regarding the effectiveness of the two treatment concepts. High success rates are reported for pulp capping procedures in exposure due to caries, though it is not possible to compare them to success rates of root canal treatment. The review confirms the lack of high quality studies on the treatment of young permanent teeth with cariously exposed pulps.
11.	Brodén, Joséphine, et al. (författare) “Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth 2023 Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Aims: Reflection on a deeper level is recognized as an important skill to learn for undergraduate students since mastering reflection can be helpful throughout their future careers. The aim with this study was to (i) examine if short structured written reflections could stimulate deep reflection among a group of dental students and (ii) explore specifically how the students reflected on clinical experience in relation to uncertainty when assessing the risk for exacerbation of apical periodontitis in root filled teeth.Methods: Short reflections were written by 52 dental students at Malmö University in 2021. All students first answered some questions associated with the risk for exacerbation of apical periodontitis in a case with a root filled tooth with a diffuse widening of the periodontal ligament space. After this, they were asked to write short reflections following prompts developed specifically to stimulate reflection. For each student, the reflections were analyzed and the level of reflection according to the 4Rs framework (Reporting/responding, Relating, Reasoning, Reconstructing) was assessed. The written content in the reflections were analyzed by a qualitative method, Systematic Text Condensation (STC). Results: Thirteen of the students (25%) reached the deepest level of reflection, Reconstructing. Sixteen students (31%), reached only the most superficial level, Report/respond. Two themes about experience and lack of experience were identified in the reflections: Theme 1 “The meaning of clinical experience” and Theme 2 “Differences and similarities”. The themes were subdivided into nine subgroups and described in more detail the relationship between experience and certainty as perceived by the students.Conclusions: A short reflection exercise stimulated deep reflection in a proportion of, but not all, dental students. The students believed that certainty comes with experience even when there is a lack of scientific evidence.
12.	Brodén, Joséphine, et al. (författare) Health economic evaluation of pulp capping versus root canal treatment in young permanent teeth 2018 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objective. There is a lack of knowledge regarding the health economic consequences of pulp capping and root canal treatment in order to treat children’s and adolescents’ permanent teeth with pulp exposures due to caries. Therefore, the aim of this study was to study the cost effectiveness of performing a pulp capping compared to a root canal treatment in children and adolescents with pulp exposures due to caries. Methods. The cost effectiveness was studied by the use of a Markov simulation model where a simulated 12-year-old patient with a pulp exposure in a permanent tooth was followed for 9 years. The probability of making a transition from one health state to another was calculated from data retrieved after literature searches of published clinical studies. The outcome was measured as avoided extractions until the subject was 21 years old. The time spent on the two treatments was studied by sending a survey to general dentists. Costs were discounted with 3% annually. Results. Based on the answers from the general dentists, the cost for a pulp capping as the initial treatment was 138 EUR and the cost for a root canal treatment as the initial treatment was 608 EUR during the 9 years. We found that less teeth were extracted after a pulp capping than after a root canal treatment in this age group. Pulp capping was found to be cost effective (dominant) compared to root canal treatment as the initial treatment.
13.	Brodén, Joséphine, 1979-, et al. (författare) Reflection to enhance students' awareness of and comfort with uncertainty. Annan publikation (övrigt vetenskapligt/konstnärligt)
14.	Brodén, Joséphine (författare) Uncertainty in Endodontics : Strategies for Understanding and Management 2022 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Dentists often experience uncertainty when deciding on the most effective treatment for a particular patient. There are various sources of uncertainty and different strategies for coping with it, such as reducing or accepting it and learning how to make decisions despite feeling uncertain.The overall objectives of the thesis are to contribute with information that reduces uncertainty regarding the treatment of cariously exposed pulps in young permanent teeth and to improve dental education to ensure that future dental students manage well despite uncertainty.By means of a systematic review and a model analysis, the thesis evaluates the available evidence and cost-effectiveness of a pulp capping procedure compared to a root canal treatment to reduce the uncertainty regarding the cost-effectiveness of treatments for young permanent teeth with vital pulps exposed by caries.The thesis also addresses the acceptance of uncertainty. A reflection exercise was developed and tested in a group of dental students. Prompts from an established model were used to stimulate the students to write reflections during the risk assessment of a root-filled tooth. The effect of the reflections on the student’s awareness of and comfort with uncertainty was explored with a repeated questionnaire. The written reflections were analyzed with a qualitative method to explore how dental students reflected on clinical experience in relation to uncertainty.In the systematic review, the success rate for pulp capping in children and adolescents varied between 64 and 100 percent in the included studies. The model indicated that pulp capping procedures are cost-effective compared to root canal treatment in teeth with pulp exposure due to caries. Fewer teeth were extracted after a pulp capping during the 9 years the patients were followed in the model and the cost for the initial treatment and follow-up treatments during this time period was lower compared to a root canal treatment.The reflection exercise had an effect on the students’ responses to the questions regarding how certain they believed an experienced colleague would feel, and how certain they felt of their capacity to handle the case. Most students did not state that they felt certain about assessing the risk for exacerbation of apical periodontitis in root-filled teeth but felt certain of their own capacity to handle the case, as well as comfortable with their ability to handle the situation and do their best for the patient.Three themes about experience and lack of experience were identified in the reflections: “the meaning of clinical experience”, “assumed differences regarding assessment” and “relating to the same risk factors”.The following conclusions were drawn from the four studies:For children and adolescents with pulp exposure due to caries, pulp capping procedures are cost-effective compared to root canal treatment, but there is a lack of prospective studies concerning root canal treatment. Moreover, the existing studies on pulp capping procedures are of low quality.Most final-year dental students participating in a reflection exercise did not feel certain of their risk assessment of root-filled teeth but still felt certain of their capacity to handle the situation, as well as comfortable with their ability to do the best for the patient. The students believed that clinical experience leads to certainty even when the scientific evidence is lacking and experts who meet students have a great responsibility to be transparent with their own uncertainty.
15.	Brodén, Joséphine, et al. (författare) What is the relationship between certainty and experience? : A qualitative study on dental students’ reflections on risk assessment of root filled teeth. Annan publikation (övrigt vetenskapligt/konstnärligt)
16.	Carén, Helena, 1979, et al. (författare) A cluster of genes located in 1p36 are down-regulated in neuroblastomas with poor prognosis, but not due to CpG island methylation. 2005 Ingår i: Molecular cancer. - : Springer Science and Business Media LLC. - 1476-4598. ; 4:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: A common feature of neuroblastoma tumours are partial deletions of the short arm of chromosome 1 (1p-deletions). This is indicative of a neuroblastoma tumour suppressor gene being located in the region. Several groups including our have been studying candidate neuroblastoma genes in the region, but no gene/genes have yet been found that fulfil the criteria for being a neuroblastoma tumour suppressor. Since frequent mutations have not been detected, we have now analyzed the expression and promoter CpG island methylation status of the genes UBE4B, KIF1B, PGD, APITD1, DFFA and PEX14 in the 1p36.22 region in order to find an explanation for a possible down-regulation of this region. RESULTS: The current study shows that gene transcripts in high stage neuroblastoma tumours are significantly down-regulated compared to those in low stage tumours in the 1p36.22 region. CpG island methylation does not seem to be the mechanism of down-regulation for most of the genes tested, since no methylation was detected in the fragments analyzed. One exception is the CpG island of APITD1. Methylation of this gene is also seen in blood from control individuals and is therefore not believed to participate in tumour development. CONCLUSION: The genes UBE4B, KIF1B, PGD, APITD1, DFFA and PEX14 are down-regulated in high stage NB tumours, a feature that can not be explained by CpG island methylation.
17.	Carén, Helena, 1979, et al. (författare) Genetic and epigenetic changes in the common 1p36 deletion in neuroblastoma tumours. 2007 Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. Tidskriftsartikel (refereegranskat)abstract Chromosome 1p is frequently deleted in neuroblastoma (NB) tumours. The commonly deleted region has been narrowed down by loss of heterozygosity studies undertaken by different groups. Based on earlier mapping data, we have focused on a region on 1p36 (chr1: 7 765 595-11 019 814) and performed an analysis of 30 genes by exploring features such as epigenetic regulation, that is DNA methylation and histone deacetylation, mutations at the DNA level and mRNA expression. Treatment of NB cell lines with the histone deacetylase inhibitor trichostatin A led to increased gene transcription of four of the 30 genes, ERRFI1 (MIG-6), PIK3CD, RBP7 (CRBPIV) and CASZ1, indicating that these genes could be affected by epigenetic downregulation in NBs. Two patients with nonsynonymous mutations in the PIK3CD gene were detected. One patient harboured three variations in the same exon, and p.R188W. The other patient had the variation p.M655I. In addition, synonymous variations and one variation in an intronic sequence were also found. The mRNA expression of this gene is downregulated in unfavourable, compared to favourable, NBs. One nonsynonymous mutation was also identified in the ERRFI1 gene, p.N343S, and one synonymous. None of the variations above were found in healthy control individuals. In conclusion, of the 30 genes analysed, the PIK3CD gene stands out as one of the most interesting for further studies of NB development and progression.British Journal of Cancer advance online publication, 16 October 2007; doi:10.1038/sj.bjc.6604032 www.bjcancer.com.
18.	Danesh, Noushin, et al. (författare) Development of criteria for investigation of periapical tissue from root-filled teeth. 2019 Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:4, s. 269-274 Tidskriftsartikel (refereegranskat)abstract Objective: To develop and assess a set of criteria to grade inflammation including relative area of inflammation in periapical lesions in endodontically treated teeth. Material and methods: A set of criteria was developed, encompassing data on: Lymphocytes, denoting chronic inflammation, were graded 0 (occasional) to 4 (heavy/dense inflammation). Polymorphonuclear cells, denoting acute inflammation, were graded 0 (none) to 2 (many). The third parameter, area of inflammation, that is, the relative area of the specimen that was inflamed, was graded 0 (none) to 4 (76–100%). The criteria were tested on 199 consecutive biopsies from 180 patients (aged 31–75 years). Information about symptoms was retrieved from the referrals. Mann–Whitney’s U-test was used to calculate possible differences in average values for the histopathological variables in the two groups of patients: symptomatic or asymptomatic. Results: Using the criteria, varying grades of inflammation were seen in the biopsies. The majority showed few or no PMN cells. There was a correlation between symptoms and the extent of infiltration of lymphocytes and plasma cells (p = .001), PMN cells (p < .001) and the area of inflammation (p = .002): biopsies from the asymptomatic patients exhibited less pronounced and relatively smaller areas of inflammation. Conclusions: Using the criteria on a specific selection of root-filled teeth with persisting apical periodontitis, periapical inflammation was common, but varied in extent and severity. The inflammation was less pronounced and affected a relatively smaller area in asymptomatic teeth, although outliers in both directions were identified.
19.	Dawson, Victoria, et al. (författare) Coronal Restoration of Root-filled Teeth : General Dental Practitioners' Decision-Making Process 2019 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objectives: A better outcome has been shown for teeth restored with laboratory-fabricated crowns. This may not necessarily imply that full crowns are better than direct restorations, as it may be a result of selection bias. The aim was to describe the decision process regarding the choice of coronal restoration on a root-filled tooth from the perspective of the dentist. Methods: A strategic selection of 15 general dental practitioners (GDPs) in Sweden was performed. An absolute inclusion criterion was that the dentist had a recent experience of root canal treatments followed by a decision concerning permanent coronal restoration. The included dentists provided a variation concerning gender, age, work experience, location of undergraduate education and dental service provider. Semi-structured in-depth interviews were conducted with focus on the personal experience of the informant when choosing how to permanently restore the root-filled tooth. The informants were invited to, in their own words, narrate on the two latest occasions when this situation occurred for direct and full crown restorations respectively. The interviews were verbatim transcribed and then analyzed according to Qualitative Content Analysis, to be classified into an overall theme covering the latent content together with categories and subcategories illustrating the manifest content. Results: Preliminary results indicate a pattern, not yet definitely classified, but revealing the GDPs' efforts to take their current theoretical knowledge and clinical experience into consideration in the decision-making process together with an assessment of the residual tooth substance and the patients' oral health conditions. This is done parallel to an evaluation of and with certain emphasis to the patients' economic situation and preferences. Conclusions: The general dental practitioners' decision-making process regarding the choice of coronal restoration on a root-filled tooth was based not only on clinical factors: decisive for the decision was contextual factors comprising a patient centered approach.
20.	Dawson, Victoria, et al. (författare) Coronal restoration of the root filled tooth - a qualitative analysis of the dentists' decision-making process 2021 Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:4, s. 490-500 Tidskriftsartikel (refereegranskat)abstract Aim To describe the decision-making process of the general dental practitioner (GDP) underlying the choice of coronal restoration of a root filled tooth. Methodology GDPs were strategically selected with respect to gender, age, undergraduate dental school, service affiliation and duration of professional experience. Semistructured in-depth interviews were conducted, focusing on the informant's personal experience of the process which leads to a decision as to how to restore a root filled tooth. The informants were invited to describe in their own words the latest two cases involving decisions of direct or full crown restorations respectively. The interviews were digitally recorded and transcribed verbatim. Interviews from 14 informants, aged 27-64 (mean age 46 years), were included and analysed according to Qualitative Content Analysis. Results A theme (latent content) was identified: Clinical factors were considered important but were overruled by context and patient opinions, if in conflict. Three main categories, including seven subcategories (manifest content), were identified. The categories were clinical factors, contextual factors and patient's views. Clinical factors underlying the GDPs' decision included the current dental status and the estimated longevity of the intended restoration. In certain cases, contextual factors were also of importance, either supporting the GDPs' decision or modifying it. However, the patient's views played a decisive role in the final choice of coronal restoration, leading to either mutual acceptance or a compromise, taking into account the patient's economic status and opinions. Conclusions With respect to coronal restoration of a root filled tooth, the GDPs' decision-making process was based not only on clinical factors, but also on decisive contextual factors and consideration of the patients' views.
21.	Dawson, Victoria, et al. (författare) Endodontic complications in teeth with vital pulps restored with composite resins : a systematic review 2015 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 48:7, s. 627-638 Forskningsöversikt (refereegranskat)abstract Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants.
22.	Dawson, Victoria, et al. (författare) Further interventions after root canal treatment in relation to type of coronal restoration and tooth group : a 10-year follow-up of a Swedish dental register 2023 Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Aim: To investigate the frequency of further interventions after root filling during a follow-up of 10 to 11 years, and to compare the outcomes with respect to type of coronal restoration and tooth group.Methods: Data from the Swedish Social Insurance Agency´s register of dental treatments were obtained to identify the teeth registered as root filled in Sweden 2009. Type of coronal restoration within 6 months after root filling, as well as the frequency of further interventions (nonsurgical retreatment, periradicular surgery, extraction, further direct and indirect restoration) were tracked in the data register until December 31, 2019. Descriptive statistics and Chi-square tests were used for statistical analysis.Results: Of the 215 611 teeth root filled in 2009, nonsurgical retreatment, periradicular surgery, and extraction were registered for 3.5%, 1.4% and 20%, respectively. The highest frequency of nonsurgical retreatment was registered for molars (4.2%), and periradicular surgery was most frequent in maxillary canines and incisors (2.3%). The highest frequency of extractions was registered for mandibular molars (25.1%). Directly restored teeth had higher frequency of nonsurgical retreatment (3.9%) and extraction (20.8%), compared to indirectly restored teeth (1.7% and 13.6%, respectively; P < 0.001). Of teeth restored with direct restoration within 6 months after root filling, 41.5% were registered with at least one further direct restoration and 14.7% with an indirect restoration. In the group of indirectly restored teeth, 9.3% and 7.1% underwent further restorative treatment with direct and indirect restoration, respectively. The differences registered between directly and indirectly restored root filled teeth were statistically significant (P < 0.001).Conclusions: The frequencies of nonsurgical retreatment and periradicular surgery were low 10 to 11 years after root filling, despite one in five root filled teeth being registered as extracted. Further interventions were significantly more common for directly restored teeth than for those indirectly restored.
23.	Dawson, Victoria, et al. (författare) Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations 2017 Ingår i: Journal of Endodontics. - : Elsevier BV. - 0099-2399 .- 1878-3554. ; 43:9, s. 1428-1432 Tidskriftsartikel (refereegranskat)abstract Introduction: The aim of this study was to evaluate the frequencies of nonsurgical retreatment, root -end surgery, extraction, and further restoration of root -filled teeth in Sweden in 2009 during a follow-up period of 5 years and to compare the outcomes in teeth restored with direct or indirect restorations. Methods: Data from the Swedish Social Insurance Agency were analyzed, and the frequencies of nonsurgical retreatment, root end surgery, extractions, and further restoration were calculated for all teeth registered as root filled during 2009. Chi-square tests were applied to detect any significant differences in the frequency of further treatment in teeth registered as restored with either a direct or an indirect restoration within 6 months of root filling. Results: Of the 248,299 teeth reported root filled in Sweden in 2009, nonsurgical retreatment was registered in 2.2%, root -end surgery in 1.0%, and extractions in 9.2% during the follow-up period. Of the teeth restored with a direct restoration within 6 months after the root filling, 30.3% were registered as having undergone at least 1 further direct restoration; the corresponding percentage of teeth with indirect restorations was 6.4%. A statistically significant difference in the frequency of nonsurgical retreatment, extraction, and further restoration was found; teeth restored with an indirect restoration within 6 months of root filling had fewer of these treatments than those restored by direct restoration. Conclusions: Low frequencies of nonsurgical retreatment and root -end surgery were reported 5 years after root filling, whereas extraction was more common. Fewer additional treatment procedures were registered for teeth with indirect restorations than for those with direct restorations.
24.	Dawson, Victoria S., et al. (författare) Further Interventions After Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations : A 10–11-Year Follow-Up of the Adult Swedish Population 2024 Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. Tidskriftsartikel (refereegranskat)abstract Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10 to 11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration, and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction.Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and Chi-square tests were used for statistical analysis.Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < 0.001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years.Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite one in five root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.
25.	Dawson, Victoria S., et al. (författare) Further Interventions after Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations : A 10–11-Year Follow-Up of the Adult Swedish Population 2024 Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. Tidskriftsartikel (refereegranskat)abstract Introduction: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10–11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction. Methods: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10–11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. Results: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10–11 years. Conclusions: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.
26.	Dawson, Victoria, et al. (författare) Survival of Root-filled Teeth in Relation to Restoration and Tooth-group 2016 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objectives: To compare the survival of teeth root-filled in Sweden in 2009 in relation to type of restoration and tooth-group.Methods: The database at the Swedish Social Insurance Agency containing information on treatments was used to identify all teeth in Sweden that were root-filled during 2009, by searching for the treatment codes corresponding to root-filling. The completed root-fillings could be linked to a specific tooth in a specific individual. Teeth registered as restored with a direct or indirect restoration within 6 months after completion of the root-filling were tagged and tracked until December 31st 2014. During this period, the treatment codes for extraction were registered for the identified root-filled teeth in order to construct Kaplan-Meier tooth survival analyses.Results: 248,299 teeth were registered as root-filled in Sweden in the year 2009. Of these 142,264 (57.3%) were restored with a direct restoration and 64,092 (25.8%) with an indirect restoration. Survival analysis disclosed that 5-6 years after root canal treatment 93.1% of the teeth with an indirect restoration had survived and 89.6% of the teeth with a direct restoration had survived. In the total material, irrespectively to any coronal restoration, premolars and upper anterior teeth had the highest survival (93.0% respectively 91.4%) and molars the lowest survival (87.6%). The same pattern was observed in sub-group analysis in the group of root-filled teeth with direct restorations. In the group with root-filled teeth with indirect restorations another pattern was observed; upper anterior teeth (92.6%) had a relatively lower survival, equivalent to those of molar teeth (92.6%).Conclusions: 5-6 year survival of root-filled teeth in Sweden were higher in the group with indirect restorations compared to the group with direct restoration. Root-filled upper incisors had an overall high survival, though for root-filled upper anterior teeth with indirect restorations the survival was relatively low.
27.	Djos, Anna, 1983, et al. (författare) Telomere Maintenance Mechanisms in a Cohort of High-Risk Neuroblastoma Tumors and Its Relation to Genomic Variants in the TERT and ATRX Genes 2023 Ingår i: CANCERS. - 2072-6694. ; 15:24 Tidskriftsartikel (refereegranskat)abstract Tumor cells are hallmarked by their capacity to undergo unlimited cell divisions, commonly accomplished either by mechanisms that activate TERT or through the alternative lengthening of telomeres pathway. Neuroblastoma is a heterogeneous pediatric cancer, and the aim of this study was to characterize telomere maintenance mechanisms in a high-risk neuroblastoma cohort. All tumor samples were profiled with SNP microarrays and, when material was available, subjected to whole genome sequencing (WGS). Telomere length was estimated from WGS data, samples were assayed for the ALT biomarker c-circles, and selected samples were subjected to methylation array analysis. Samples with ATRX aberration in this study were positive for c-circles, whereas samples with either MYCN amplification or TERT re-arrangement were negative for c-circles. Both ATRX aberrations and TERT re-arrangement were enriched in 11q-deleted samples. An association between older age at diagnosis and 1q-deletion was found in the ALT-positive group. TERT was frequently placed in juxtaposition to a previously established gene in neuroblastoma tumorigenesis or cancer in general. Given the importance of high-risk neuroblastoma, means for mitigating active telomere maintenance must be therapeutically explored.
28.	Falkenberg, Helena, et al. (författare) Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health : Results from the Whitehall II study 2013 Ingår i: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 70:10, s. 688-696 Tidskriftsartikel (refereegranskat)abstract Objective To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades.Methods Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991–1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997–1999.Results Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997–1999 for those who reported that a major change had happened before 1991–1993. Those who anticipated an organisational change in 1991–1993 still reported more ill-health in 1997–1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group.Conclusions The results indicate that organisational change affects employees’ health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.
29.	Fransson, Göran, 1968-, et al. (författare) Att få syn på sin egen praxis : en introduktion till boken och dess teman 2012 Ingår i: I mötet mellan vetenskap och lärande. - Gävle : Gävle University Press. - 9789197489355 ; , s. 7-18 Bokkapitel (övrigt vetenskapligt/konstnärligt)
30.	Fransson, Helena, et al. (författare) Behandlingar av vital pulpa i tänder med djupa karieslesioner 2023 Ingår i: Tandläkartidningen. - : Sveriges Tandläkarförbund. - 0039-6982. ; 115:2, s. 56-62 Tidskriftsartikel (refereegranskat)abstract Vital pulpabehandling utförs för att bevara pulpans försvarsfunktioner och därmed undvika pulpektomi och rotfyllning som kan vara tekniskt krävande och inte alltid ger önskat resultat. European Society of Endodontology (ESE) har publicerat ett positionsdokument avseende vitalbehandling av tänder med djupa karieslesioner vilket delvis överensstämmer med de nationella riktlinjerna i de nordiska länderna. Det finns svårigheter när det gäller att bedöma pulpans status i tänder med djupa karieslesioner. Så länge karieslesionen inte har nått pulpan rekommenderas behandlingar som utförs för att undvika exponering av pulpan, såsom stegvis exkavering.Å andra sidan, när pulpan exponerats på grund av karies, skiljer sig rekommendationerna något åt mellan ESE och de nationella riktlinjerna i de nordiska länderna. Detta beror troligen på avsaknad av evidens som talar för fördelar av den ena behandlingen framför den andra och på grund av svårigheterna att bedöma vilka exponerade pulpor som är irreversibelt skadade. Minimalinvasiva behandlingsstrategier som använder sig av nyligen utvecklade hydrauliska kalciumsilikatcement visar lovande resultat vid vitalbehandling av pulpa. Vital pulpabehandling vidareutvecklas och förändringar i de kliniska rekommendationerna är att förvänta.
31.	Fransson, Helena, et al. (författare) Demographics of Individuals Extracting Root-filled Teeth in Sweden 2016 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objectives: To study some demographic variables of individuals registered receiving a root canal filling in a tooth that during the subsequent 5 to 6 years was registered as being extracted in comparison of individuals retaining the equivalent root-filled tooth during the same period.Methods: Data from the Swedish Social Insurance Agency were analyzed regarding all teeth that were reported root-filled in Sweden during 2009. The upper first molars were chosen to be a model for the comparisons. A control group was constructed by randomly selecting individuals with upper first molars not extracted. Demographical data on the individuals were received from Statistics Sweden and the groups were studied in regard to gender, age, ethnicity, mean income, educational level and civil status.Results: During 2009 a total of 36,139 upper first molars was registered as being root-filled and during the subsequent 5 to 6 years 4,362 (12.9%) of these teeth were registered as being extracted. The studied demographic variables were almost equal between the individuals who had their root-filled teeth extracted and the individuals in the control group who retained their root-filled teeth. The individuals extracting was in average older (52.7 years) than those retaining (51.1 years). A larger percentage of women (51.8) than men (48.2) was found in the group whose teeth were extracted.Conclusions: Demographic variables differed somewhat in regard to gender and age in individuals extracting root-filled upper first molars compared to individuals retaining their teeth. In regard to ethnicity, mean income, educational level and civil status only minor differences were detected.
32.	Fransson, Helena, et al. (författare) Dentine sialoprotein and Collagen I expression after experimental pulp capping in humans using Emdogain(R) Gel 2011 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 44:3, s. 259-267 Tidskriftsartikel (refereegranskat)abstract Aim To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain®Gel (Biora AB, Malmö, Sweden) – , a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Formation of hard tissue following pulp capping in these teeth has previously been observed and reported. Methodology Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from 9 pairs of contra-lateral premolars, that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. The teeth were extracted 12 weeks after being pulp capped. Results In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. Conclusions The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine.
33.	Fransson, Helena, et al. (författare) DSP and collagen 1 expression in newly formed hard tissue after pulp capping in humans. 2008 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
34.	Fransson, Helena, et al. (författare) DSP and Collagen I Expression After Pulp Capping in Humans 2008 Konferensbidrag (refereegranskat)abstract Formation of hard tissue following treatment of pulp exposures has been observed in both clinical and experimental studies. However it is not known if such tissue has the functions of primary dentin which are likely to be important in protecting the pulp from the oral environment. Objectives: To study the expression of two relatively specific markers for dentin; dentin sialoprotein (DSP) and type 1 collagen (Col I) in human teeth experimentally pulp capped either with Emdogain®Gel (Biora AB, Malmö, Sweden) - a derivative of enamel matrix (EMD) in a propylene glycol alginate vehicle, or with calcium hydroxide. Methods: Nine pairs of contra-lateral premolars scheduled for extraction on orthodontic grounds were experimentally pulp amputated and capped with EMDgel or calcium hydroxide. After 12 weeks the teeth were extracted, prepared for light microscopic examination and stained using affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies. Results: In the EMDgel treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside exposed dentin surfaces and in patches in the adjacent pulp tissue. In the calcium hydroxide treated teeth, the new hard tissue was formed as a bridge. DSP staining was seen in the newly formed hard tissue and in the cells lining it in both groups but was more marked in the EMDgel treated teeth. Col I staining was seen in the newly formed hard tissue in both groups. Conclusion: The expression of DSP and Col I suggests that the new hard tissue formed after pulp capping with EMDgel or calcium hydroxide is dentin. Supported by Biora AB, Malmö, Sweden, the European Society of Endodontology and the Swedish Dental Society.
35.	Fransson, Helena, et al. (författare) Effects of bacterial products on the activity of odontoblast-like cells and their formation of type 1 collagen 2014 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 47:4, s. 397-404 Tidskriftsartikel (refereegranskat)abstract AIM: To study how products released from different bacteria in a deep carious lesion affect the metabolic activity of odontoblast-like cells and their ability to produce the major organic component of dentine, collagen 1. METHODOLOGY: MDPC-23 cells were exposed to supernatants from biofilm cultures of strains isolated from the deepest part of a carious lesion as well as from a clinical isolate of Enterococcus faecalis. Lipoteichoic acid (LTA) and lipopolysaccharide (LPS) were used for comparison. Cell activity was assessed using an methyl-thiazolyl-diphenyl tetrazolium bromide (MTT) assay, and collagen 1 levels were determined by ELISA. RESULTS:The lesion microflora was dominated by Lactobacillus spp. Neither extracellular products from the isolates nor LPS affected the activity of the MDPC-23 cells, whereas extracellular products from E. faecalis and LTA significantly reduced total cell activity (P < 0.01). Enterococcus faecalis had an inhibitory effect upon collagen 1 production by the cells, whereas no such effect or even a slight stimulatory effect was seen for the isolates from the deep carious lesion. CONCLUSIONS: These studies indicate that culture supernatants from E. faecalis reduced the metabolic activity of odontoblast-like cells as shown using the MTT assay. No effect was seen for supernatants from biofilms of bacteria recovered from a deep carious lesion. Different bacteria varied in their effects upon collagen 1 production suggesting that the nature of the bacterial species in a carious lesion may have a direct influence upon the ability of the odontoblasts to produce tertiary dentine.
36.	Fransson, Helena, et al. (författare) Efficacy of lasers as an adjunct to chemo-mechanical disinfection of infected root canals : a systematic review 2013 Ingår i: International Endodontic Journal. - : Wiley-Blackwell. - 0143-2885 .- 1365-2591. ; 46:4, s. 296-307 Tidskriftsartikel (refereegranskat)abstract The aim was to evaluate the efficacy of various types of lasers used as an adjunct to chemo-mechanical disinfection of infected root canals with the outcome measures 'normal periapical condition' or 'reduction of microbial load'. PubMed, CENTRAL and ISI Web of Knowledge literature searches with specific indexing terms and a subsequent hand search were made with stated limits and criteria. Relevant publications were retrieved, followed by interpretation. The quality of each included publication was assessed as high, moderate or low. The initial search process yielded 234 publications. All abstracts of these publications were read, and the reference lists of relevant publications were hand-searched. Ten articles were read in full text and interpreted according to a data extraction form. Five were included in the systematic review and were assessed. A meta-analysis was impossible to perform because the included studies were heterogeneous with regard to study design, treatment and outcome measures. Positive effects were reported; however, no concluding evidence grade could be made because each included study was judged to have low quality, primarily due to lack of a power analysis, blinding and reproducibility. The evidence grade for whether lasers can be recommended as an adjunct to chemo-mechanical disinfection of infected root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies.
37.	Fransson, Helena, et al. (författare) EndoReCo banar väg för ökad kunskap och akademisk meritering 2022 Ingår i: Tandläkartidningen. - : Sveriges tandläkarförbund. - 0039-6982. ; 114:12, s. 46-52 Tidskriftsartikel (refereegranskat)abstract För att minska kunskapsluckorna inom odontologin krävs samarbete mellan lärosätena. Det ger även möjlighet till akademisk meritering, vilket är angeläget då antalet seniora forskare med behörighet för forskningshandledning i Sverige är färre än någonsin. EndoReCo (Endodontic Research Collaboration) är ett skandinaviskt forskningsnätverk i endodonti som kan ta del av just dessa fördelar.
38.	Fransson, Helena, et al. (författare) Factors Associated with Extraction following Root Canal Filling in Adults 2021 Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 100:6, s. 608-614 Tidskriftsartikel (refereegranskat)abstract Essentially, root fillings are performed to preserve natural teeth. Over time, however, some root-filled teeth will inevitably be extracted. The aim of this historical prospective cohort study in the adult Swedish population was to identify factors associated with extractions within 5 y of registration of a root filling. The cohort consisted of all those whose root fillings had been reported to the tax-funded Swedish Social Insurance Agency (SSIA) in 2009. Demographic data on the individuals registered with a root filling (sex, age, country of birth, disposable income, educational level, and marital status) were received from Statistics Sweden or the SSIA. Dental care setting, tooth type, and any registration of subsequent restorations within 6 mo were received from the SSIA. Multivariable regression analysis was used, and P < 0.05 was considered statistically significant. In total, 216,764 individuals had been registered with at least 1 root filling. Individuals (n = 824) without complete data were excluded from the analyses. After 5 y, 9.3% of the root-filled teeth had been registered as extracted. Logistic regression analysis found significant associations for all variables except country of birth, disposable income, and educational level. The highest odds ratios for extractions were associated with the type of restoration: teeth with no registration of any restoration and teeth with a direct restoration combined with a post were 3 times more likely to undergo extraction than teeth restored with an indirect restoration combined with a post and core. Overall, high odds ratios for extractions were associated with any type of composite restoration, including composite fillings and crowns combined with or without any post. In summary, after root filling in the Swedish adult population, several individual- and tooth-specific variables were associated with extraction. The reasons for the extractions remain to be studied further.
39.	Fransson, Helena, et al. (författare) Factors Associated with Extractions Following Root-filling in Swedish Adults 2019 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objectives: Root-fillings are essentially performed to preserve natural teeth. However over time some root-filled teeth will be extracted. The aim of this study was to identify factors associated with extractions within a period of 5 years after completion of a root-filling in the adult Swedish population. Methods: In this registry study, the cohort consisted of all root-fillings reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. Tooth type, any registration of subsequent coronal restorations within 6 months and type of caregiver were recorded. Demographic data (gender, disposable income, age, educational level, civil status and country of birth) were received from Statistics Sweden or the SSIA. Statistical analyses included chi-square test, t-test and logistic regression analysis. P<0.05 was considered statistically significant. Results: The total number of individuals registered with at least one root-filling was 216,764. Not all had a registration of a tooth number or had no registrations at Statistics Sweden (n=824) and were excluded from the analyses. After 5 years, 9.4% of the teeth had been registered as extracted. Preliminary data showed risk factors associated with higher odds for extractions to be molar teeth, teeth with no registration of any permanent coronal restoration within 6 months following the registration of the root-filling, root-fillings performed in the private sector, women, older age-group and widow(er)s or divorcees. Conclusions: Several individual and tooth specific factors were associated with extraction following root-filling in the Swedish adult population. The direct reasons for the extractions remain to be studied further.
40.	Fransson, Helena, et al. (författare) Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans : an updated systematic review 2016 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 49, s. 533-542 Forskningsöversikt (refereegranskat)abstract The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue barrier after pulp capping and partial pulpotomy of experimental exposures in humans. PubMed (01-01-2005 to 01-03-2014) and CENTRAL were searched using specific keywords. Hand searches were made and the level of evidence for each included article was evaluated by the authors. The evidence of the conclusions was graded as strong, moderately strong, limited or insufficient. The initial search in PubMed yielded 215 abstracts. Hand searches of reference lists yielded no additional original scientific articles. After a selection process and interpretation, 22 articles were included and rated for level of evidence: no article was rated as high and seven as moderate. Overall the methodological quality of studies has improved since the previous systematic review was published in 2006. The conclusions are that there is limited scientific evidence that application of calcium hydroxide or mineral trioxide aggregate to an exposed pulp frequently results in formation of a hard tissue barrier, whereas adhesives or enamel matrix derivatives do not. There is insufficient scientific evidence that mineral trioxide aggregate promotes hard tissue formation more frequently than calcium hydroxide.
41.	Fransson, Helena (författare) On the repair of the dentine barrier 2012 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Det övergripande målet för avhandlingen har varit att studera några aspekter av läkningen av tandens huvudsakliga hårdvävnad, dentinet. Vid mycket djupa kariesangrepp där dentinet förstörts och pulpan därmed blottats, rotbehandlas ofta tanden vilket innebär att pulpan tas bort och att rotkanalen fylls med ett rotfyllningsmaterial. Djupare kunskaper om dentinets läkningsförmåga kan leda till att andra mindre invasiva och kostsamma behandlingsmetoder än rotbehandlingar skulle kunna användas vid mycket djupa kariesangrepp. Kroppens ytor har barriärfunktioner för att skydda kroppen mot skadliga ämnen. I tanden svarar pulpans yttersta cell-lager för en viktig del i barriärfunktionen. Dessa celler, odontoblasterna, bildar dentinet och verkar spela en central roll i de skyddsmekanismer som tanden har. När ett kariesangrepp bryter ned tandens hårdvävnader kan bakterier eller deras produkter få möjlighet att tränga in till pulpan vilket leder till ett inflammatoriskt och immunologiskt svar som kan leda till vävnadsdöd av pulpan. Under vissa omständigheter verkar dock pulpan ha förmåga att reparera hårdvävnadsbarriären på ett sådant sätt att den fysiologiska funktionen kvarstår så att vävnadsdöd och därmed invasion av mikroorganismer undviks. Det finns emellertid studier som antyder att den reparerade hårdvävnadens barriärfunktion ger vika och att den inte kan stå emot ny mikrobiell belastning.Pulpaöverkappning är en behandling som används när pulpan blivit blottad i ett försök att bibehålla pulpans vitalitet och funktion. Faktorer som påverkar hårdvävnadsbildningen vid pulpaöverkappningar har studerats i en systematisk litteraturöversikt. Baserat på det begränsade vetenskapliga stödet visade resultaten att kalciumhydroxidbaserade material men inte bondingmaterial ger en hårdvävnadsbildning som täcker pulpasåret då de används som överkappningsmaterial. Det finns inget vetenskapligt stöd för att kunna fastslå att mineraltrioxidaggregat (MTA) skulle ge mer hårdvävnadsbildning jämfört med kalciumhydroxidbaserade material när dessa används som överkappningsmaterial. En gel (Emdogain®Gel) som innehåller amelogenin som man vet är inblandat i processen då dentinet börjar bildas, utvärderades i en klinisk studie med syfte att studera hårdvävnadsbildningen. En större mängd hårdvävnad bildades efter appliceringen av gelen jämfört med kontrollmaterialet. Hårdvävnaden kunde karaktäriseras som att vara likt det ursprungliga dentinet, men den bildades inte i en struktur som skulle kunna utgöra en fysiologisk barriär. Under ett kariesangrepp bör odontoblasterna svara på närvaro av bakterier med försvarsreaktioner såsom bildande av nytt dentin, men kvalitén på det dentinet verkar ibland bli sämre än det ursprungliga dentinet. Produkter från bakterier tagna från ett djupt kariesangrepp användes för att studera dess effekter på odontoblastliknande cellers aktivitet och förmåga att bilda en typ av kollagen som är den huvudsakliga beståndsdelen i nybildat dentin. Vissa bakterier hade en negativ påverkan på odontoblasternas aktivitet och bakteriernas effekt på kollagenproduktionen varierade, vilket skulle kunna tyda på att bakterier kan ha en direkt effekt på odontoblasternas förmåga att upprätthålla dentinets barriärfunktion.Sammanfattningsvis kan man säga att Emdogain®Gel initierade dentinbildning, men inte i en struktur som skulle kunna utgöra en barriär och det förefaller som om bakterier i olika grad kan påverka odontoblasternas förmåga att bilda en dentinbarriär.
42.	Fransson, Helena, et al. (författare) Survival of Root-filled Teeth in the Swedish Adult Population 2016 Ingår i: Journal of Endodontics. - : Elsevier BV. - 0099-2399 .- 1878-3554. ; 42:2, s. 216-220 Tidskriftsartikel (refereegranskat)abstract © 2016 American Association of Endodontists. Introduction The aim was to assess survival in the Swedish population of teeth treated by nonsurgical root canal treatment during 2009. Methods Data from the Swedish Social Insurance Agency were analyzed by Kaplan-Meier analysis to assess cumulative tooth survival during a period of 5-6 years of all teeth that were root-filled during 2009. Results In 2009, 248,299 teeth were reported as root-filled. The average age of the patients at the time of the root filling was 55 years (range, 20-102 years). The teeth most frequently root-filled were the maxillary and mandibular first molars. During the 5- to 6-year period 25,228 of the root-filled teeth (10.2%) were reported to have been extracted; thus 223,071 teeth (89.8%) survived. Tooth survival was highest in the youngest age group (93.2%). The highest survival (93.0%) was for the mandibular premolars, and the lowest (87.5%) was for the mandibular molars. Teeth restored with indirect restorations within 6 months of the root filling had higher survival rates (93.1%) than those restored with a direct filling (89.6%). Conclusions In the adult population of Sweden, teeth that are root-filled by general practitioners under the tax-funded Swedish Social Insurance Agency have a 5- to 6-year survival rate of approximately 90%.
43.	Fransson, Helena, et al. (författare) The Management of Deep Caries Using Selective and Non-Selective Removal of Carious Tissue, Stepwise Excavation and Indirect Pulp Capping 2024. - 1 Ingår i: Vital Pulp Treatment. - Hoboken, USA : John Wiley & Sons. - 9781119930389 - 9781119930419 ; , s. 59-83 Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract For deep carious lesions, there are different treatment modalities that aim to avoid exposing the pulp and, thus, in the long-term root canal treatment. Understanding the biological events in caries pathology will facilitate the choice of treatment and why selective caries removal treatments, in many cases, can be recommended. Before selecting any modality, it is advantageous to know the expected prognosis based on clinical studies. After treatment, the patient should be monitored for signs of pulp disease. Current practice differs between dentists, and this chapter aims to provide evidence-based and consensus recommendations for the treatment of deep carious lesions.
44.	Fransson, Helena, et al. (författare) Tooth survival after endodontic treatment 2023 Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 56:S2, s. 140-153 Forskningsöversikt (refereegranskat)abstract There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. However, we do not know if or how this affects the health of the individual. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ´healthy periapical tissues´ or ´tooth survival´ they are equally important to know. Factors affecting the outcome ´healthy periapical tissues´ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ´tooth survival´ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.
45.	Fransson, Helena, et al. (författare) Vitaalin pulpan hoito hampaissa, joissa on syviä kariesvaurioita 2023 Ingår i: Suomen hammaslaakarilehti. - : Finlands tandläkarförbund. - 0355-4090. ; 30:3, s. 34-41 Tidskriftsartikel (refereegranskat)abstract Vitaalin pulpan hoidon tarkoituksena on säilyttää pulpan puolustustoiminnot sekä välttää juurihoito, joka voi olla teknisesti haastava eikä aina onnistu toivotusti. ESE (European Society of Endodontology) on julkaissut suosituksen liittyen vitaalin pulpan hoitoon hampaissa, joissa on syviä kariesvaurioita. Suositus on osittain yhteneväinen Pohjoismaissa käytössä olevien kansallisten suositusten kanssa.Hampaissa, joissa on syviä kariesvaurioita, pulpan tilan arviointiin liittyy ratkaisemattomia kysymyksiä. Mikäli vaurio ei vielä ulotu pulpaan asti, suositellaan hoitomuotoja, joissa pulpan paljastuminen voidaan välttää, kuten vaiheittaista kariesvaurion poistoa. Tilanteessa, jossa pulpa on jo paljastunut, ESE:n ja pohjoismaisten kansallisten suositusten välillä ilmenee joitakin eroja. Syynä on todennäköisesti näytön puute sen suhteen, että jokin hoito tehoaisi muita paremmin. Lisäksi on vaikea arvioida, milloin paljastunut pulpa on vaurioitunut palautumattomasti.Mini-invasiivisilla menetelmillä, joissa hyödynnetään hiljattain kehitettyjä kalsiumsilikaattisementtejä, on saatu lupaavia tuloksia juurihoidon välttämiseen tähtäävissä vitaalin pulpan hoidoissa. Vitaalin pulpan hoitomenetelmiä kehitetään edelleen, ja kliinisiin suosituksiin on odotettavissa muutoksia.
46.	Fransson, Helena, et al. (författare) Vitale pulpabehandlinger i tænder med profund caries 2023 Ingår i: Tandlægebladet. - : Tandlægeforeningen. - 0039-9353. ; 127, s. 36-44 Tidskriftsartikel (refereegranskat)abstract Vitale pulpabehandlinger udføres med henblik på at bevare pulpas forsvarsfunktioner og undgå pulpektomi og rodfyldning, som kan være teknisk udfordrende og ikke altid fører til det ønskede resultat. The European Society of Endodontology (ESE) har publiceret en statusrapport om vital pulpabehandling i tænder med profunde carieslæsioner, som i et vist omfang stemmer overens med de nationale retningslinjer i de nordiske lande. Der er stadig problemer med at vurdere pulpas tilstand i tænder med profunde carieslæsioner. Så længe carieslæsionen ikke har nået pulpa, anbefales behandlinger, der sigter på at undgå pulpaeksponering, fx gradvis ekskavering. Men når pulpa er eksponeret på grund af caries, er der ikke overensstemmelse mellem anbefalingerne fra ESE og de nordiske landes nationale retningslinjer. Dette skyldes sandsynligvis manglende evidens for bedre effekt af én behandling frem for andre samt vanskeligheder med at afgøre, hvornår pulpa er irreversibelt beskadiget. Minimalt invasive behandlingsstrategier med nyudviklede hydrauliske calciumsilikatcementer har vist lovende resultater af vital pulpabehandling med henblik på at undgå rodkanalbehandling. Konceptet er under stadig udvikling, og man må forvente, at de kliniske anbefalinger på sigt bliver ændret.
47.	Fransson, Petra, et al. (författare) Mycorrhizal associations and soil properties of native Allanblackia stuhlmannii stands in the Eastern Usambara Mountains, Tanzania 2016 Ingår i: Annals of Applied Biology. - : Wiley. - 0003-4746. ; 169, s. 369-383 Tidskriftsartikel (refereegranskat)abstract Allanblackia stuhlmannii is a tree species currently under domestication. Potential mycorrhizal relationships of A. stuhlmannii and soil properties of native stands were investigated to determine the soil-environmental requirements of the species. Roots and soil samples were collected from five sites with A. stuhlmannii stands along an altitudinal transect in Amani Nature Reserve, Tanzania. Mycorrhizal status was investigated by combining microscopy with molecular analysis of the fungal communities. Soil adjacent to the A. stuhlmannii seedlings was analysed for physical and chemical properties and the sites were characterised. We showed that A. stuhlmannii form symbiosis with arbuscular mycorrhizal fungi, and that there was a diverse microbiome associated with the roots. The soils, classified as Ferralsol and Acrisol, were very well drained, had a pH(CaCl2) generally at or below 4, high exchangeable acidity and content of sesquioxides and low effective cation exchange capacity and concentrations of most nutrients. We conclude that A. stuhlmannii is tolerant to high Al availability and possesses mechanisms for acquisition of P and other macronutrients at low soil availability, possibly through mycorrhizal symbiosis. However, being adapted to low-pH soils, it may be less efficient in acquiring Fe, Mn and/or Zn at higher soil pH. Thus, it may be most suited to introduction on farms situated on acid soils.
48.	Fransson, Veronica, et al. (författare) Detection of Perfusion Deficits in Multiphase Computed Tomography Angiography—A Stroke Imaging Technique Based on Iodine Mapping on Spectral Computed Tomography: Initial Findings 2021 Ingår i: Journal of Computer Assisted Tomography. - 1532-3145. ; 45:4, s. 618-624 Tidskriftsartikel (refereegranskat)abstract Objective: The purpose of this study was to explore a novel method forbrain tissue differentiation using quantitative analysis of multiphase computedtomography (CT) angiography (MP-CTA) on spectral CT, to assesswhether it can distinguish underperfused fromnormal tissue, using CT perfusion(CTP) as reference.Methods: Noncontrast CT and MP-CTA images from 10 patients wereanalyzed in vascular regions through measurements of Hounsfield unit (HU)at 120 kV, HU at 40 keV, and iodine density. Regions were categorizedas normal or ischemic according to CTP. Hounsfield unit and iodinedensity were compared regarding ability to separate normal and ischemictissue, the difference in maximum time derivative of the right overleft hemisphere ratio.Results: Iodine density had the highest maximum time derivatives andgenerated the largest mean separation between normal and ischemic tissue.Conclusions: The method can be used to categorize tissue as normal orunderperfused. Using iodine quantification seems to give a more distinctdifferentiation of perfusion defects compared with conventional HU.
49.	Fransson, Veronica, et al. (författare) Image quality of spectral brain computed tomography angiography using halved dose of iodine contrast medium 2023 Ingår i: Neuroradiology. - 0028-3940. ; 65:9, s. 1333-1342 Tidskriftsartikel (refereegranskat)abstract Purpose: Reduction in iodinated contrast medium (CM) dose is highly motivated. Our aim was to evaluate if a 50% reduction of CM, while preserving image quality, is possible in brain CT angiography (CTA) using virtual monoenergetic images (VMI) on spectral CT. As a secondary aim, we evaluated if VMI can salvage examinations with suboptimal CM timing. Methods: Consecutive patients older than 18 years without intracranial stenosis/occlusion were included. Three imaging protocols were used: group 1, full CM dose; group 2, 50% CM dose suboptimal timing; and group 3, 50% CM dose optimized timing. Attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured in the internal carotid artery, M2 segment of the middle cerebral artery, and white matter for conventional images (CI) and VMI (40–200 keV). Qualitative image quality for CI and VMI (50 and 60 keV) was rated by 4 experienced reviewers. Results: Qualitatively and quantitatively, VMI (40–60 keV) improved image quality within each group. Significantly higher attenuation and CNR was found for group 3 VMI 40–50 keV, with unchanged SNR, compared to group 1 CI. Group 3 VMI 50 keV also received significantly higher rating scores than group 1 CI. Group 2 VMI (40–50 keV) had significantly higher CNR compared to group 3 CI, but the subjective image quality was similar. Conclusion: VMI of 50 keV with 50% CM dose increases qualitative and quantitative image quality over CI with full CM dose. Using VMI reduces non-diagnostic examinations and may salvage CTA examinations deemed non-diagnostic due to suboptimal timing.
50.	Granevik Lindström, Maria, et al. (författare) The Antibacterial Effect of Nd:YAG Laser Treatment of Teeth with Apical Periodontitis : A Randomized Controlled Trial 2017 Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554. ; 43:6, s. 857-863 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: The aim of this blind, in vivo, randomized controlled trial was to evaluate the antibacterial effect of Nd:YAG laser irradiation in endodontic treatment of single-rooted teeth with apical periodontitis. The hypothesis was that mechanical enlargement of the root canal and Nd:YAG laser irradiation would yield more negative bacterial samples than conventional treatment. METHODS: Forty-one patients (45 teeth) were allocated to the laser (n = 22) or control (n = 23) group. The teeth in the laser group were instrumented, irrigated with saline, and irradiated with Nd:YAG laser according to a standard protocol. The teeth in the control group were similarly instrumented but irrigated with 1% unbuffered sodium hypochlorite and 15% EDTA solution. Bacterial samples were taken before and after treatment, blinded, and immediately sent for culturing and analysis. RESULTS: The initial bacterial samples were positive in 20 of 22 teeth in the laser group and 18 of 23 (P = .414) in the control group. After the initial treatment, negative bacterial samples were found in 11 teeth in the laser group and 13 (P = .768) in the control group. After 2 to 4 days with no antibacterial dressing in the root canals, 5 teeth in the laser group and 9 (P = .337) in the control group yielded negative bacterial samples. CONCLUSIONS: After intervention, neither the test group nor the control group yielded predictable negative bacterial samples. Thus, the results failed to verify the hypothesis that Nd:YAG laser irradiation would yield significantly more negative bacterial samples than conventional irrigation with 1% unbuffered sodium hypochlorite solution.

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