| 1. |
- Anderud, Jonas, et al.
(författare)
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Guided bone augmentation using a ceramic space-maintaining device
- 2014
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 118:5, s. 532-538
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The purpose of this study was to evaluate 3-dimensionally whether vertical bone augmentation can be achieved using a hollow hydroxyapatite space-maintaining device in a rabbit calvarial model. Furthermore, different inner surface topographies, different permeabilities, and different porosities of the ceramic were tested to determine the optimal conditions for bone regeneration.
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| 2. |
- Hallmer, Fredrik, et al.
(författare)
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Bacterial diversity in medication-related osteonecrosis of the jaw
- 2017
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 123:4, s. 436-444
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim was to study the association between microflora and medication-related osteonecrosis of the jaw (MRONJ) by using culture-independent molecular techniques to detect bacteria in necrotic bone lesions. Study Design. Included were 18 consecutive patients with MRONJ, 10 with osteoporosis and 8 cancer patients. Bone biopsies were retrieved from the center of the necrotic bone and from visually healthy bone, and 16 S rRNA gene fragments from bacterial DNA were amplified with polymerase chain reaction. Results. The study revealed a diversity of bacteria represented by 16 S rRNA sequences in all the necrotic bone samples and in 60% of the visually healthy bone. Eight dominating taxa groups were identified at the genus level: Porphyromonas, Lactobacillus, Tannerella, Prevotella, Actinomyces, Treponema, Streptococcus, and Fusobacterium. Conclusions. The necrotic bone lesions contained mainly anaerobic bacteria, representative of periodontal microflora, suggesting that a periodontal infection in combination with antiresorptive treatment could initiate osteonecrosis.
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| 3. |
- Hallmer, Fredrik, et al.
(författare)
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Incidence of and risk factors for medication-related osteonecrosis of the jaw in women with breast cancer with bone metastasis : a population-based study
- 2020
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 130:3, s. 252-257
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to prospectively determine the incidence of medication-related osteonecrosis of the jaw (MRONJ) and define risk factors in patients with metastatic breast cancer treated with zoledronic acid and/or denosumab.STUDY DESIGN: In a prospective cohort study performed in Region Skåne, Sweden, from January 1, 2012, until December 31, 2015, all patients with breast cancer who had radiographic evidence of bone metastases and were treated with zoledronic acid or denosumab were included and followed up until May 31, 2018.RESULTS: Of the 242 patients, MRONJ developed in 16 (6.6%) during the 77 months of study. The incidence of MRONJ in patients treated with zoledronic acid was 4.1%, and in patients treated with denosumab, it was 13.6%. The risk of MRONJ was higher in patients on denosumab than in those treated with zoledronic acid (P = .011). Corticosteroid use was associated with a decreased risk of MRONJ (P = .008), and diabetes was associated with an increased risk of MRONJ (P = .02).CONCLUSIONS: The incidence of MRONJ is 6.6% (>3 times higher) in denosumab-treated patients with breast cancer compared with that in patients treated with zoledronic acid. Corticosteroid use decreased the risk of MRONJ.
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| 4. |
- Hallmer, Fredrik, et al.
(författare)
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Jaw fractures diagnosed and treated at Malmö University Hospital : a comparison of three decades
- 2010
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Ingår i: International Journal of Oral and Maxillofacial Surgery. - : Elsevier BV. - 0901-5027 .- 1399-0020. ; 39:5, s. 446-451
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to report the distribution, frequency and aetiology of jaw fractures in patients treated at the University Hospital, Malmö, 1993-2003 and to compare two previous studies from 1952-1962 and 1975-1985. In 1993-2003, 461 patients, 137 women (mean age 42 years; range 15-82) and 324 men (mean age 28 years; range 17-59) were diagnosed and treated. Women were significantly older than men (P<0.001). The most frequent cause of jaw fractures was falls in women (45%). In men, interpersonal violence (46%) was most common followed by road traffic accidents (RTAs) (24%) mostly involving bicycles (14%). The frequency of falls in women and men was significantly different (P<0.001) as was the difference between violence in men and women (P<0.001). The proportion of fractures caused by RTAs was significantly higher in 1952-1962 than in 1993-2003 (P<0.001). There was a significant increase in the proportion of fractures caused by violence between the two studies (P=0.007). In 1993-2003 the proportion of fractures in women due to falls was significantly higher than in 1952-1962 (P=0.006). Violence has replaced RTAs as the main cause for jaw fractures in men; for women falling is the commonest cause.
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| 5. |
- Hallmer, Fredrik
(författare)
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Medication-related osteonecrosis of the jaw : occurence, risk factors, pathogenesis & treatment
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The antiresorptive drugs bisphosphonates and denosumab arewidely used to preserve bone strength by inhibiting osteoclast mediatedbone resorption. High dose intravenous bisphosphonatesand high dose denosumab are mainly used to treat skeletal relatedevents in patients with metastatic bone disease such as metastaticbreast cancer and metastatic prostate cancer or in patients withmultiple myeloma. In patients with osteoporosis, oral bisphosphonatesare mostly used. Medication-related osteonecrosis of the jaw(MRONJ) is a serious side effect associated both with bisphosphonatesand denosumab treatment. The first report on MRONJ waspublished in 2003. At first, the condition was believed to be a newdisease, but it was later proved to be the same disease, which existedmore than 100 years ago in match factory workers, and phosphateminers, in whom the disease was recognized as phossy jaw. The overall aim of this thesis was to study the occurrence, risk factors,pathogenesis and treatment of MRONJ.Study I describes prevalence, trigger factors and treatment outcomesof MRONJ retrospectively between the years 2003-2010 inRegion Skåne. During this time, 55 patients had been diagnosedwith MRONJ. Of these patients, 31 patients with a malignant diseasewere treated with high dose intravenous bisphosphonates and24 patients with osteoporosis were treated with oral bisphosphonates.The prevalence of MRONJ was estimated to be 0.024% forpatient on oral bisphosphonates and 2.8% for patients on high dose intravenous bisphosphonates. Tooth extraction was the mostcommon trigger factor. After treatment of MRONJ, healing occurredmore frequently in patients with osteoporosis treated withoral bisphosphonates than in patients with a malignant diseasetreated with high dose intravenous bisphosphonates.Study II investigated the association between microflora andMRONJ by using 16S rRNA pyrosequencing technique for the detectionof bacteria in necrotic bone lesions. Included were 18 consecutivepatients with MRONJ, ten with osteoporosis and eightwith metastatic disease. Bone biopsies were retrieved with two separate3 mm sterile trepan burrs from the centre of the necroticbone and from visible healthy bone. The necrotic bone lesions containedmainly anaerobic bacteria, representative for periodontalmicroflora, suggesting that a periodontal infection in combinationwith antiresorptive treatment could initiate the osteonecrosis. Study III is a prospective cohort study where the prevalence andinitiating factors of MRONJ and the outcome of surgical therapywere analysed. All new cases of MRONJ between 2012 and 2015in Region Skåne were included. Fifty-five patients with MRONJwere identified. The prevalence of MRONJ for patients on oralbisphosphonates was 0.043%, on high dose intravenous bisphosphonates1.03% and on high dose denosumab 3.64%. Periodontaldisease preceded development of MRONJ in 41 patients. Fifty patientswere treated surgically and followed up for at least 2months. Lesions progressed to remission or healing in 80.0% ofpatients treated with sequestrectomy and in 92.5% of patientstreated with block resection. In study IV, the aim was to prospectively determine the incidenceand define risk factors for MRONJ in patients with metastaticbreast cancer treated with zoledronic acid and/or denosumab.Breast cancer patients diagnosed between 2012 and 2015 in the regionof Skåne with one or several bone metastases and treated withzoledronic acid or denosumab were included. Systemic risk factors(age, zoledronic acid or denosumab use, treatment time, chemo-therapy or corticosteroid use, diabetes and smoking habits) wererecorded. Sixteen patients of 242 (6.6%) developed MRONJ duringthe 77 months study period (from 1st of January 2012 to 31stof May 2018). The incidence of MRONJ in patients treated withhigh dose zoledronic acid was 4.1%, and for patients with highdose denosumab 13.6%. The risk of developing MRONJ in patientson denosumab was significantly higher compared to patientstreated with zoledronic acid. Corticosteroid use was associatedwith a significant decreased risk of MRONJ and diabetes was associatedwith a significantly increased risk of MRONJ. Chemotherapyor smoking was not associated with a significant increasedrisk of MRONJ. In conclusion, the incidence of MRONJ is more than three timeshigher in breast cancer patients treated with denosumab comparedto breast cancer patients treated with zoledronic acid. The prevalencein patients with osteoporosis on oral bisphosphonates is low,< 0.05%. Corticosteroid use decreases the risk of developingMRONJ whilst diabetes increases the risk. The most common localrisk factor is a periodontal disease. Periodontal bacteria play a centralrole in the pathogenesis and development of MRONJ. Thetreatment outcome of MRONJ demonstrates healing in most patientstreated surgically.
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| 6. |
- Hallmer, Fredrik, et al.
(författare)
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Osteonecrosis of the jaw in patients treated with oral and intravenous bisphosphonates : experience in Sweden
- 2014
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 118:2, s. 202-208
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the prevalence, inciting factors, and treatment outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) during the 2003-2010 period in southern Sweden (population, approximately 1.2 million people). STUDY DESIGN: Patient records were searched for inflammatory conditions including unspecified inflammation, osteomyelitis, osteonecrosis due to drugs, and other osteonecrosis. Data on underlying disease, type of bisphosphonate (BP), inciting factor, location, stage, treatment, and treatment outcomes were collected. RESULTS: Of the 341 patients identified, 55 had been diagnosed with BRONJ. Those with a malignant disease were treated with intravenous BPs, and those with osteoporosis were treated with oral BPs. All but 5 were treated with antibiotics and 47 with local resection. Healing was recorded in 79% of patients with osteoporosis and in 26% of patients with malignant disease. CONCLUSIONS: Healing in patients with osteoporosis occurred more frequently than in patients with a malignant disease treated with intravenous BPs (P = .00009).
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| 7. |
- Hallmer, Fredrik, et al.
(författare)
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Prevalence, initiating factor, and treatment outcome of medication-related osteonecrosis of the jaw-a 4-year prospective study
- 2018
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 126:6, s. 477-485
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Medication-related osteonecrosis of the jaw (MRONJ) has a wide range of prevalence, and a standard therapy has not yet been established. The aim of this study was to analyze the prevalence and initiating factors of MRONJ and the outcomes of surgical therapy. STUDY DESIGN: In a prospective cohort study, all patients diagnosed with MRONJ in the Region of Skane, in Sweden, were included. Predictor variables (comorbidity, site, stage, gender) and initiating factors (tooth extraction, periodontitis) were recorded. Surgical treatment was sequestrectomy or block resection, and the outcome variable was healing after 2 months. To estimate the prevalence, data on the use of bisphosphonate and denosumab were used. RESULTS: Fifty-five patients with MRONJ were identified. The prevalence of MRONJ was 0.043% among patients treated with oral bisphosphonates, 1.03% among those on intravenous bisphosphonates and 3.64% in those on high-dose denosumab. Periodontal disease preceded development of MRONJ in 41 patients. Fifty patients were treated surgically and followed up for at least 2 months. Remission or healing occurred in 80% of patients treated with sequestrectomy and in 92.5% of patients treated with block resection. CONCLUSIONS: The prevalence of MRONJ in Sweden is low. Periodontitis is the most common initiating factor. The outcome of treatment of MRONJ is healing in most patients treated surgically.
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| 8. |
- Hallmer, Fredrik, et al.
(författare)
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Treatment of diffuse sclerosing osteomyelitis of the jaw with denosumab shows remarkable results-A report of two cases
- 2018
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Ingår i: Clinical Case Reports. - : John Wiley & Sons. - 2050-0904. ; 6:12, s. 2434-2437
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Tidskriftsartikel (refereegranskat)abstract
- Key Clinical Message Denosumab may play a central role in the treatment of diffuse sclerosing osteomyelitis of the mandible. This report describes two patients who had been treated unsuccessfully with antibiotics and steroids for several years. After denosumab treatment, both patients became pain-free and the radiological examination showed less severe osteomyelitis.
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| 9. |
- Nörholt, S.E, et al.
(författare)
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Analgesic efficacy with rapidly absorbed ibuprofen sodium dihydrate in postsurgical dental pain : results from the randomized QUIKK trial
- 2011
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Ingår i: International journal of clinical pharmacology and therapeutics. - : Dustri-Verlag Dr. Karl Feistle GmbH & Co. KG. - 0946-1965. ; 49:12, s. 722-729
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the onset of analgesic effect for a new formulation of ibuprofen sodium dihydrate versus conventional ibuprofen (ibuprofen acid). MATERIALS AND METHODS: In this randomized, double-blind, double-dummy, crossover trial, patients requiring surgical removal of two impacted or partially impacted mandibular third molars received: ibuprofen sodium dihydrate 400 mg plus conventional ibuprofen placebo (Group 1); or conventional ibuprofen 400 mg plus ibuprofen sodium dihydrate placebo (Group 2) following the first surgery. Patients were then crossed over to the alternative treatment. RESULTS: 72 patients were enrolled in Group 1 and 72 patients in Group 2. Ibuprofen sodium dihydrate produced faster initial pain relief than conventional ibuprofen as assessed by time to first pain relief (24.6 vs. 30.5 minutes; p = 0.004), and patient-assessed pain relief at 15 minutes ("some" to "complete" pain relief: 43% vs. 29%; p < 0.001) and 30 minutes (82% vs. 63%; p < 0.001) and pain intensity at 30 minutes (p < 0.001). Substantial pain relief with ibuprofen sodium dihydrate was twice that of conventional ibuprofen at 30 minutes (11% vs. 5%; not significant); 29% and 33% of patients did not reach substantial pain relief at 120 minutes. There were no adverse events leading to treatment discontinuation and only two serious adverse events (oral abscess and facial paresis with conventional ibuprofen) considered unrelated to treatment. CONCLUSIONS: Ibuprofen sodium dihydrate was as effective as conventional ibuprofen, but had a faster onset of initial pain relief and significantly reduced pain intensity within the first 30 minutes after administration, providing rapid clinically meaningful pain relief for patients.
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| 10. |
- Svensson, Roger, et al.
(författare)
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Treatment with local hemostatic agents and primary closure after tooth extraction in warfarin treated patients
- 2013
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 37:2, s. 71-77
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The aim of this retrospective study was to assess the frequency of postoperative bleeding in patients on warfarin after tooth removal followed by a complete soft tissue closure of the surgical site. A total of 124 consecutive patients, 69 males and 55 females with a mean age of 71 years (range 28-95 years) were included in this study. Inclusion criteria were patients on warfarin with an INR
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