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Björksved, Margitha
Publications (10 of 15) Show all publications
Björksved, M., Ryen, L., Lindsten, R. & Bazargani, F. (2021). Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial. European Journal of Orthodontics, 43(5), 498-505
Open this publication in new window or tab >>Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial
2021 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 498-505Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

TRIAL DESIGN: A multicentre, two-arm parallel group randomized controlled trial.

METHODS: One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions. The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown - reaching above the mucosa through a hole punched in the flap - to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa. The trial ended when the PDC was successfully aligned in the dental arch.Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

BLINDING: Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

RESULTS: A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

GENERALIZABILITY AND LIMITATIONS: Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

CONCLUSION: There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02186548.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Dentistry
Identifiers
urn:nbn:se:oru:diva-93628 (URN)10.1093/ejo/cjab052 (DOI)000707779300003 ()34386824 (PubMedID)2-s2.0-85117321477 (Scopus ID)
Available from: 2021-08-16 Created: 2021-08-16 Last updated: 2024-01-02Bibliographically approved
Björksved, M. (2021). Open vs closed exposure of palatally displaced canines: clinical, patient-related outcomes and health economics. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Open vs closed exposure of palatally displaced canines: clinical, patient-related outcomes and health economics
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The maxillary permanent canine usually erupts in the mouth between the ages of 11 and 12 years. Sometimes the canines are displaced toward the palatal side of the dental arch and eruption is disturbed. Palatally displaced canines (PDCs) are a frequent dental anomaly, present in 2% of the young population. If untreated, there is risk of damage to the roots of the adjacent teeth and potential tooth loss. Thus, early interceptive treatment with extraction of the deciduous canine should be undertaken, with the aim to improve the PDC eruption path. If the eruption path does not improve within about a year, surgical exposure and orthodontic treatment is indicated.

The two different main techniques of surgical exposure in PDCs are the open and the closed techniques. Retrospective studies of the exposure techniques have shown differences in outcomes, which high-lights the need for evidence-based research.

The overall aim of this thesis was to compare outcomes of treatment duration, complications and side effects, patients’ perceptions and health economic aspects of the two surgical techniques, in PDCs. Moreover, a comparison of PDC position between the two radiographic methods commonly used in PDC cases; panoramic radiograph and CBCT, aimed to evaluate agreement between the actual measures. 

This thesis was based on a multicentre randomised controlled trial with two parallel groups, including 120 consecutive patients, aged 9 to 16 years, who were randomly allocated to open or closed surgical exposure. 

The following conclusions were drawn:

The agreement of PDC mesiodistal position was fair (weighted kappa 0.36 (95%CI0.24–0.49) and the mean difference in angle to midline was almost 7˚ (95%CI 5.9˚–7.9˚) higher in panoramic radiographs compared with CBCT. Surgery time, treatment time, root resorption or periodontal measures showed no clinically significant differences between the exposure groups. The open group reported higher pain intensity up to one week post surgery. A higher proportion of bilateral open group cases experienced complications, and weremore frequently wakened at night post surgery. The closed group reported higher pain and discomfort during the orthodontic traction. All PDCs were successfully aligned in the dental arch. A cost-minimization analysis showed no differences in healthcare or societal costs.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 124
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 244
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-90894 (URN)978-91-7529-395-0 (ISBN)
Public defence
2021-09-24, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2021-04-07 Created: 2021-04-07 Last updated: 2021-09-06Bibliographically approved
Björksved, M., Arnrup, K., Bazargani, S. M., Lund, H., Magnusson, A., Magnuson, A., . . . Bazargani, F. (2021). Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial. European Journal of Orthodontics, 43(5), 487-497
Open this publication in new window or tab >>Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial
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2021 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 487-497Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs).

TRIAL DESIGN: Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups.

MATERIALS AND METHODS: One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT).

BLINDING: Due to the nature of this trial, only outcome assessors could be blinded to the intervention group.

RESULTS: One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups.

GENERALIZABILITY: Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met.

CONCLUSION: The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

Place, publisher, year, edition, pages
Oxford University Press, 2021
National Category
Dentistry
Identifiers
urn:nbn:se:oru:diva-92328 (URN)10.1093/ejo/cjab015 (DOI)000707779300002 ()34114630 (PubMedID)2-s2.0-85117297057 (Scopus ID)
Note

Funding Agencies:

Regional Research Council in Uppsala-Örebro

Center for Clinical Research Region Sormland

County Council of Sormland

Available from: 2021-06-14 Created: 2021-06-14 Last updated: 2021-12-02Bibliographically approved
Björksved, M., Magnuson, A., Bazargani, S. M., Lindsten, R. & Bazargani, F. (2019). Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?. American Journal of Orthodontics and Dentofacial Orthopedics, 155(3), 380-387
Open this publication in new window or tab >>Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?
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2019 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 155, no 3, p. 380-387Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The early interceptive treatment of palatally displaced canines (PDCs) has for decades been based on their position in panoramic radiographs. In the 1990s, cone-beam computed tomography (CBCT) started to become popular in cases with PDCs. The aims of this prospective study were to evaluate the agreement of PDC sector position and angle to midline between panoramic radiographs and CBCT scans.

METHODS: PDC sector and angle to midline were measured in panoramic radiographs and CBCT scans in 58 consecutive patients with 64 PDCs. Kappa with linear weighting was used to assess the agreement between the measurements of PDC sector position and Bland-Altman limits of agreement to assess the agreement between the PDC angular measurements in the 2 methods.

RESULTS: PDC sector position and angle to midline had systematically higher values in panoramic radiographs compared with those in the CBCT scans. The agreement of sector position between the methods was fair: weighted kappa 0.36 (95% CI 0.24-0.49). The mean difference in angle was almost 7° (95% CI 5.9°-7.9°) higher in panoramic radiographs compared with CBCT.

CONCLUSIONS: Panoramic radiographs overestimate PDC sector and angle to midline position, compared with the use of CBCT scans, but clinically the differences are quite modest. Panoramic radiographs could be considered good enough for rendering PDC position when the need for 3D information is not crucial for treatment planning.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Surgery Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medicine; Radiology
Identifiers
urn:nbn:se:oru:diva-83005 (URN)10.1016/j.ajodo.2018.05.015 (DOI)000459767200013 ()30826041 (PubMedID)2-s2.0-85062150369 (Scopus ID)
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2021-09-06Bibliographically approved
Björksved, M., Magnuson, A., Bazargani, S. M., Lindsten, R. & Bazargani, F. (2019). Authors' response [Letter to the editor]. American Journal of Orthodontics and Dentofacial Orthopedics, 156(1), 9-10
Open this publication in new window or tab >>Authors' response
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2019 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 156, no 1, p. 9-10Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-75609 (URN)10.1016/j.ajodo.2019.04.020 (DOI)000472999100012 ()31256847 (PubMedID)2-s2.0-85067847606 (Scopus ID)
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2020-06-18Bibliographically approved
Björksved, M., Magnuson, A., Bazargani, S. M., Lindsten, R. & Bazargani, F. (2019). Authors' response [Letter to the editor]. American Journal of Orthodontics and Dentofacial Orthopedics, 155(6), Article ID 756.
Open this publication in new window or tab >>Authors' response
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2019 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 155, no 6, article id 756Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging Surgery
Research subject
Medicine; Radiology
Identifiers
urn:nbn:se:oru:diva-83008 (URN)10.1016/j.ajodo.2019.03.012 (DOI)000469314200007 ()31153489 (PubMedID)2-s2.0-85066116282 (Scopus ID)
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2020-12-01Bibliographically approved
Björksved, M., Lindsten, R., Magnusson, A. & Bazargani, F. (2019). CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL. In: : . Paper presented at European Orthodontic Society Congress, Nice, France, 17-22 June, 2019.
Open this publication in new window or tab >>CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-83029 (URN)
Conference
European Orthodontic Society Congress, Nice, France, 17-22 June, 2019
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2020-06-18Bibliographically approved
Björksved, M., Arnrup, K., Lindsten, R., Magnusson, A. & Bazargani, F. (2019). JÄMFÖRELSE AV SLUTEN OCH ÖPPEN KIRURGISK FRILÄGGNING AV PALATINALT FELSTÄLLDA HÖRNTÄNDER: OPERATIONSTID, KOMPLIKATIONER OCH PATIENTERFARENHETER. EN MULTICENTER PROSPEKTIV RANDOMISERAD KONTROLLERAD STUDIE. In: : . Paper presented at Odontologisk riksstämma, Älvsjö, Stockholm, 14 November, 2019..
Open this publication in new window or tab >>JÄMFÖRELSE AV SLUTEN OCH ÖPPEN KIRURGISK FRILÄGGNING AV PALATINALT FELSTÄLLDA HÖRNTÄNDER: OPERATIONSTID, KOMPLIKATIONER OCH PATIENTERFARENHETER. EN MULTICENTER PROSPEKTIV RANDOMISERAD KONTROLLERAD STUDIE
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2019 (Swedish)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-83031 (URN)
Conference
Odontologisk riksstämma, Älvsjö, Stockholm, 14 November, 2019.
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2020-06-18Bibliographically approved
Björksved, M., Bazargani, F., Lindsten, R., Magnusson, A. & Arnrup, K. (2018). CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL. In: : . Paper presented at European Orthodontic Society Congress, Edinburgh, UK, 17-21, 2018..
Open this publication in new window or tab >>CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-83030 (URN)
Conference
European Orthodontic Society Congress, Edinburgh, UK, 17-21, 2018.
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2020-06-18Bibliographically approved
Björksved, M. (2018). Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial. In: Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial: . Paper presented at Nordic Orthodontic Society Congress, Uppsala, 5-7 September, 2018..
Open this publication in new window or tab >>Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial
2018 (English)In: Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial, 2018Conference paper, Oral presentation only (Other academic)
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-83025 (URN)
Conference
Nordic Orthodontic Society Congress, Uppsala, 5-7 September, 2018.
Available from: 2020-06-11 Created: 2020-06-11 Last updated: 2020-06-18Bibliographically approved
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