| 1. |
- Fransson, Helena, et al.
(författare)
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There is a paucity of economic evaluations of prediction methods of caries and periodontitis : A systematic review
- 2021
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Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:3, s. 385-398
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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.
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| 2. |
- Andersson, Helena, et al.
(författare)
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Walking football for Health - physiological response to playing and characteristics of the players.
- 2023
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Ingår i: Science and medicine in football. - : Routledge. - 2473-3938 .- 2473-4446. ; , s. 1-8
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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.
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| 3. |
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| 4. |
- Bergström, Malin, et al.
(författare)
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Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent
- 2018
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 107:2, s. 294-300
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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.
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| 5. |
- Bjorndal, Lars, et al.
(författare)
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Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy
- 2010
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Ingår i: European Journal of Oral Sciences. - : Wiley. - 0909-8836 .- 1600-0722. ; 118:3, s. 290-297
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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.
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| 6. |
- Bjørndal, Lars, et al.
(författare)
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Randomised clinical trial on deep caries excavation 3-5 yr follow-up
- 2012
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Ingår i: Journal of dental research. - : Sage Publications. ; 91:Spec Iss b
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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.
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| 7. |
- Bjørndal, Lars, et al.
(författare)
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Randomized Clinical Trials on Deep Carious Lesions : 5-Year Follow-up
- 2017
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Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 96:7, s. 747-753
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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).
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| 8. |
- Bjørndal, Lars, et al.
(författare)
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Treatment of vital pulp conditions
- 2018
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Ingår i: Textbook of Endodontology. - : Wiley-Blackwell. - 9781119057314 - 9781119057369 ; , s. 79-100
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Brodén, Joséphine, et al.
(författare)
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Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth
- 2019
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:4, s. 2751-7
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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.
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| 10. |
- Brodén, Joséphine, et al.
(författare)
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Direct pulp capping procedures versus root canal treatment in young permanent vital teeth with pulp exposures due to caries : A systematic review
- 2016
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Ingår i: American Journal of Dentistry. - : Mosher & Linder. - 0894-8275. ; 29:4, s. 201-206
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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.
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| 11. |
- Brodén, Joséphine, et al.
(författare)
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“Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth
- 2023
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Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts.
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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.
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| 12. |
- Brodén, Joséphine, et al.
(författare)
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Health economic evaluation of pulp capping versus root canal treatment in young permanent teeth
- 2018
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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.
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| 13. |
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| 14. |
- Brodén, Joséphine
(författare)
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Uncertainty in Endodontics : Strategies for Understanding and Management
- 2022
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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.
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| 15. |
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| 16. |
- Carén, Helena, 1979, et al.
(författare)
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A cluster of genes located in 1p36 are down-regulated in neuroblastomas with poor prognosis, but not due to CpG island methylation.
- 2005
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Ingår i: Molecular cancer. - : Springer Science and Business Media LLC. - 1476-4598. ; 4:1
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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.
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| 17. |
- Carén, Helena, 1979, et al.
(författare)
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Genetic and epigenetic changes in the common 1p36 deletion in neuroblastoma tumours.
- 2007
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827.
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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.
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| 18. |
- Danesh, Noushin, et al.
(författare)
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Development of criteria for investigation of periapical tissue from root-filled teeth.
- 2019
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:4, s. 269-274
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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.
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| 19. |
- Dawson, Victoria, et al.
(författare)
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Coronal Restoration of Root-filled Teeth : General Dental Practitioners' Decision-Making Process
- 2019
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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.
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| 20. |
- Dawson, Victoria, et al.
(författare)
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Coronal restoration of the root filled tooth - a qualitative analysis of the dentists' decision-making process
- 2021
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 54:4, s. 490-500
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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.
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| 21. |
- Dawson, Victoria, et al.
(författare)
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Endodontic complications in teeth with vital pulps restored with composite resins : a systematic review
- 2015
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 48:7, s. 627-638
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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.
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| 22. |
- Dawson, Victoria, et al.
(författare)
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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
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Ingår i: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts.
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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.
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| 23. |
- Dawson, Victoria, et al.
(författare)
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Further Treatments of Root-filled Teeth in the Swedish Adult Population: A Comparison of Teeth Restored with Direct and Indirect Coronal Restorations
- 2017
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Ingår i: Journal of Endodontics. - : Elsevier BV. - 0099-2399 .- 1878-3554. ; 43:9, s. 1428-1432
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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.
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| 24. |
- Dawson, Victoria S., et al.
(författare)
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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
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Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554.
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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.
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| 25. |
- Dawson, Victoria S., et al.
(författare)
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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
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Ingår i: Journal of Endodontics. - : Elsevier. - 0099-2399 .- 1878-3554.
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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.
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