| 1. |
- Johansson, Anders, et al.
(author)
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Associations between social and general health factors and symptoms related to temporomandibular disorders and bruxism in a population of 50-year-old subjects.
- 2004
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In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 62:4, s. 231-7
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Journal article (peer-reviewed)abstract
- The aim of this epidemiological study was to examine associations between temporomandibular (TMD)-related problems and variables from three domains: (1) socio-economic attributes, (2) general health and health-related lifestyle, and (3) dental attitudes and behaviors. The overall response rate to a questionnaire mailed to the total population of 50-year-old subjects in two Swedish counties (8,888 individuals) was 71%. Among the 53 questions in the questionnaire, those related to social, general health, and health-related factors were used as independent variables in logistic regression models. Three TMD-related symptoms and reported bruxism were used as dependent variables. Impaired general health was the strongest risk factor for reported TMD symptoms. Along with female gender and dissatisfaction with dental care, impaired general health was significantly associated with all three TMD symptoms. A few more factors were associated with pain from the TMJ only. In comparison, reported bruxism showed more significant associations with the independent variables. In addition to the variables associated with TMD symptoms, being single, college/university education, and daily tobacco use were also significantly correlated with bruxism. Besides female gender, impaired general health, dissatisfaction with dental care, and a few social and health-related factors demonstrated significant associations with TMD symptoms and reported bruxism.
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| 2. |
- Widar, Fredrik, et al.
(author)
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A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill-free bone anchor screws for intermaxillary fixation.
- 2012
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In: Dental traumatology. - : Wiley. - 1600-9657 .- 1600-4469. ; 28:2, s. 127-131
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Journal article (peer-reviewed)abstract
- Abstract- Aims:The aim of this study was to retrospectively evaluate iatrogenic dental root damage, caused by two different techniques that utilized bone anchor screws, for intermaxillary fixation (IMF) in orofacial trauma. Materials and methods:The techniques used included either predrilled or drill-free bone anchor screws. A total of 123 patients who required IMF were evaluated (97 men and 26 women). Sixty-four patients were treated in the predrilled group, and 59 patients were treated in the drill-free group. The data were collected over an 8-year period and were analyzed using crosstabs and Fisher's exact test. Results:Injuries to dental roots were found only in the predrilled group. Twenty-nine patients (45.3%) were injured at the time of surgery. One year after surgery, 10 patients (15.6%) had permanently injured dental roots. There was a significant difference in injury rates between the predrilled and drill-free groups 1year after surgery (P<0.001). Conclusion:There is an increased potential risk of iatrogenic injury and permanent damage to the dental roots when a technique that involves predrilled holes for bone anchor screws is used.
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| 3. |
- Widar, Fredrik, et al.
(author)
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Incidence and risk factors predisposing plate removal following orthognathic surgery
- 2017
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In: Oral Surgery Oral Medicine Oral Pathology Oral Radiology. - : Elsevier BV. - 2212-4403. ; 124:3, s. 231-239
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Journal article (peer-reviewed)abstract
- Objective. The aim of this study was to investigate the incidence and reasons for titanium fixation plate removal following orthognathic surgery, identify risk factors predisposing removal, and explore if discomfort was reduced postoperatively. Study Design. Medical records of 404 consecutive cases were retrospectively reviewed. All patients received a questionnaire for follow-up, and 323 patients answered the questionnaire, thus forming the sample group. Results. Of all the responding patients, 15% had plates removed, and 92% of these patients experienced relief from discomfort after removal of the plates. Infection was the most common reason for plate removal (10%). Smoking (hazard ratio 2.74) and surgery performed in the mandible (hazard ratio 2.40) increased the need for plate removal. For each plate added in the mandible, the risk for removal increased by 34%. Conclusions. Smoking, osteotomies, and additional numbers of plates in the mandible resulted in a higher incidence of plate removal. Most of the patients experienced relief from discomfort after plate removal.
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| 4. |
- Widar, Fredrik
(author)
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On Factors Influencing the Clinical Outcome in Orthognathic Surgery
- 2015
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Doctoral thesis (other academic/artistic)abstract
- ABSTRACT Background. Orthognathic surgery means surgical correction of dentofacial and congenital deformities, which includes unsatisfactory facial aesthetics, malpositioned teeth, jaw moutcome osurgery. Developments within the invasive surgery and pharmacological modification of inflammatory responses. However, surgical morbidity after orthognathic surgery is still associated with undesirable sequelae such as damage to teeth, facial oedema, pain, neurosensory disturbances, prolonged recovery time and removal of titanium plates. Intraoperative anchorage of the occlusion is a major keystone in the implementation of the orthognathic planning during surgery. Bone anchor screws are therefore occasionally required in transalveolar positions as reinforced rigid emergency anchor for proper intermaxillary fixation in cases when orthodontic appliances loosen or when preoperative orthodontic treatment isn´t indicated. Furthermore, steroids are recommended to reduce swelling, pain, nausea and vomiting (PONV) and may promote nerve healing after surgery. The multimodal effects of steroids needs further investigation, thus the optimal dosages and the timing of administration is of great interest. Moreover, removal of inserted titanium fixation plates after surgery occur due to plate related complications. The reason for plate removal needs further investigation. Finally, different general anaesthetic protocols influence haemodynamics and subsequently postoperative pain, recovery and hospitalization. It is needed to understand the recovery process and to promote mobilization of the patient after surgery. Objectives. The aim of the first study was to evaluate two types of surgical techniques for insertion of bone anchor screws for intermaxillary fixation, regarding frequency of iatrogenic dental root injuries. The second trial investigated the efficacy of single versus repeated betamethasone doses on facial oedema, pain and neurosensory disturbances after bilateral sagittal split osteotomy (BSSO). The main objective of the third study was to investigate the incidence and reasons for removal of titanium fixation plates following orthognathic surgery, identify risk factors predisposing removal and to explore if the patients discomfort was reduced after removal. The primary objective of the fourth study was to evaluate haemodynamics and recovery parameters in relation to two general anaesthetic protocols; remifentanil-propofol based total intravenous anaesthesia (TIVA) versus fentanyl-sevoflurane based balanced inhalation anaesthesia (BA) in orthognathic surgery. The second objective was to evaluate long duration local anaesthesia on recovery parameters and hospitalization. Material & Methods. Study I: Two surgical techniques were compared retrospectively (n=123). Study II: Two study groups and a control group were compared with a randomized controlled trial (RCT). Repeated dose (4+8+4 mg betamethasone, n=14), single dose (16 mg betamethasone, n=11) and controls (n=12). Study III: Medical records were retrospectively reviewed (n=404) and additionally a questionnaire was used. Totally 323 (80%) patients responded the questionnaire and were subsequently included in the study. Study IV: Medical records were retrospectively reviewed (n=269). Ninety-four patients were audited due to strict inclusion criteria. Results. The first study revealed that the twist drill was hazardous in transalveolar positions since it could cause iatrogenic dental root injuries (p<0.001). The second study showed that steroids inhibited progression of facial oedema the first day after surgery (p=0.017). However, steroids did not reduce neurosensory disturbances over time. Reduced bleeding was associated with improved pain recovery over time (p=0.043). Patients requiring higher dosages of analgesics due to pain had significantly delayed recovery regarding neurosensory disturbances (p<0.001). The third study revealed that smoking, osteotomies perfo
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| 5. |
- Widar, Fredrik, et al.
(author)
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The effects of steroids in preventing facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy: a randomized controlled trial.
- 2015
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In: International journal of oral and maxillofacial surgery. - : Elsevier BV. - 1399-0020 .- 0901-5027. ; 44:2, s. 252-258
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Journal article (peer-reviewed)abstract
- A randomized, prospective, controlled trial was conducted to determine the efficacy of single and repeated betamethasone doses on facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy. Thirty-seven patients (mean age 23.62 years, range 17-62 years) with either mandibular prognathism or retrognathism were enrolled consecutively into the study and divided into three groups: control (n=12), repeated dose 4+8+4mg betamethasone (n=14), single dose 16mg betamethasone (n=11). The intake of diclofenac and paracetamol was assessed individually. Measurements of facial oedema, pain, and sensitivity in the lower lip/chin were obtained 1 day, 7 days, 2 months, and 6 months postoperatively. Furthermore, we investigated the possible influences of gender, age, total operating time, amount of bleeding, postoperative hospitalization, and advancement versus setback of the mandible. A significant difference (P=0.017) was observed in percentage change between the two test groups and the control group regarding facial oedema (1 day postoperatively). Less bleeding was associated with improved pain recovery over time (P=0.043). Patients who required higher postoperative dosages of analgesics due to pain had significantly delayed recovery of the inferior alveolar nerve at 6 months postoperatively (P<0.001). Betamethasone did not reduce neurosensory disturbances over time.
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