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  • 1. Bolind, P.
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Johansson, P.
    van Steenberghe, D.
    Albrektsson, T.
    Histologic evaluation of Brånemark clinic oral implants retrieved from grafted sites2006In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 8, no 1, p. 44-53Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this report is to quantitatively and qualitatively describe the bone tissue response to Brånemark implants retrieved from grafted sites in patients. MATERIALS AND METHOD: The material consists of consecutively received Brånemark implants retrieved from grafted sites. Thirty-five of these implants, retrieved from 16 patients, were suitable for the histologic evaluation of undecalcified sections in the light microscope. RESULTS: The unloaded implants were mainly lined with soft tissue, and sparse bone-implant contact was observed only in some sections. The loaded implants, with the exception of one implant removed due to mobility, had mature and new bone-implant contact. Resorption of graft through cutting cone structures was detected. Cement lines were found separating bone-like tissue albeit no cellular content and bone tissue with detectable osteocytes. CONCLUSION: In this heterogeneous group of implants from grafted sites, the unloaded implants showed limited bone-implant contact. The autografts showed seemingly mixed viability as judged by the cell content in the osteocyte lacunae and cement lines separating areas with filled and empty lacunae.

  • 2. Bolind, Pia
    et al.
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Johansson, Petra
    Granström, Gösta
    Albrektsson, Tomas
    Retrieved implants from irradiated sites in humans: A histologic/histomorhpometric investigation of oral and craniofacial implants2006In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 8, no 3, p. 142-150Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this report was to quantitatively and qualitatively evaluate the tissue response to bone-anchored implants retrieved from irradiated sites in patients.

    Materials and Methods The material consists of 23 consecutively received Brånemark® implants (Nobel Biocare AB, Göteborg, Sweden) placed in pre- or postoperatively irradiated sites. Twenty-two of the 23 implants were suitable for histologic evaluation of undecalcified sections in the light microscope.

    Results The oral implants with shorter time in situ demonstrated sparse bone to implant contact with mainly dense connective tissue in the interface. However, for implants with longer time in situ, high amounts of bone-implant contact and bone fill of threads were noted. The mean values of bone-implant contact and bone area within the thread were calculated to 40% (16–94) and 70% (13–96), respectively. The craniofacial implants, with the exception of two implants lined with a capsular formation, demonstrated mature and newly formed bone at the bone-implant interface. The mean value for bone-metal contact was calculated to 45 and 53% for two specimens. The mean value for bone area within the thread ranged from 65 to 88% for three specimens.

    Conclusion The possibility to achieve bone anchorage of implants in irradiated tissue was supported by the findings in this study. However, due to limited material, conclusions with regard to radiation dose and bone tissue response to implants cannot be stated.

  • 3.
    Branzén, Marie
    et al.
    Specialist Clinic of Orthodontics, Public Dental Health Service, Karlstad, Sweden.
    Eliasson, Alf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Prosthetic Dentistry, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dental Research Department, Public Dental Health Service, Örebro County Council, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Implant-Supported Single Crowns Replacing Congenitally Missing Maxillary Lateral Incisors: A 5-Year Follow-Up2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, no 6, p. 1134-1140Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge of the long-term survival of single implants in cases of congenitally missing lateral incisors in the maxilla is limited.

    Purpose: This retrospective study aimed to evaluate the 5-year survival of implants and implant-supported crowns (ISCs) and to assess the functional and aesthetic outcomes from the professional and patient perspectives.

    Materials and Methods: From a total of 46 patients with congenitally missing upper lateral incisors, 36 patients treated with 54 Branemark (R) (Nobel Biocare AB, Goteborg, Sweden) implants and ISCs participated in the study. A clinical examination, California Dental Association (CDA) evaluation, and patient questionnaire were used to rate and compare the objective and subjective evaluations of the ISCs.

    Results: The survival of implants and ISCs was 100%. The CDA ratings were satisfactory for all ISCs, with 70% being rated excellent. The patient rating was also high for the overall satisfaction item, with 21 being completely satisfied and 14 fairly satisfied. However, 12 patients wished for the replacement of their ISCs. Logistic regression analysis indicated that a less optimal embrasure fill was the most discriminating factor though not statistically significant (p = .082).

    Conclusions: One-third of the patients wished for the replacement of their ISCs. Soft tissue adaptation seems to be an important factor for overall satisfaction.

  • 4.
    Cardemil, Carina
    et al.
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Dept Oral & Maxillofacial Surg, Örebro Univ Hosp, Örebro, Sweden.
    Thomsen, Peter
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; BIOMATCELL VINN Excellence Ctr Biomat & Cell Ther, Gothenburg, Sweden.
    Wexell, Cecilia Larsson
    Dept Biomat, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Dept Oral & Maxillofacial Surg, Sahlgrenska Univ Hosp Mölndal, Gothenburg, Sweden; Inst Odontol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Jaw Bone Samples From Bisphosphonate-Treated Patients: A Pilot Cohort Study2015In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 17, p. E679-E691Article in journal (Refereed)
    Abstract [en]

    Osteonecrosis of the jaw (ONJ) is a severe complication of bisphosphonate treatment. PurposeA detailed characterization of sampled peri-necrotic jawbone from bisphosphonate-treated patients was performed at tissue and cellular level (histological analyses and gene expression). Materials and MethodsAlveolar bone samples were collected from patients with (n=5) and without ONJ (n=5). Healthy patients served as controls (n=10). ResultsThe histological analysis demonstrated low to moderate inflammation, displaying areas of inflammatory infiltrate in the bone marrow. Multinuclear giant cells and osteoclasts were found in both groups. Markers of bone formation (alkaline phosphatase, Col1a1, and osteocalcin), bone resorption (receptor activator of NF-kappaB ligand [RANKL], osteoprotegerin [OPG], tartrate-resistant acid phosphatase, and cathepsin K), inflammation (tumor necrosis factor-alpha, interleukin [IL]-1, and IL-6), angiogenesis (vascular endothelial growth factor A), and apoptosis (Casp3, Casp8, p53, and Smac) were evaluated. Nonparametric statistical tests were used to identify differences between the groups. In patients with ONJ, the expression level of the proinflammatory marker IL-1 was strongly up-regulated compared with controls (p=.040). ConclusionsA down-regulated expression of Casp8 compared with controls was observed (p=.014) in patients treated with bisphosphonates. The RANKL/OPG ratios were similar in the three groups. The results indicate a need to further investigate the molecular mechanisms involved in the course of ONJ related to antiresorptive treatment.

  • 5. Franke Stenport, V
    et al.
    Johansson, Carina B
    Örebro University, Department of Health Sciences.
    Evaluations of Bone Tissue Integration to Pure and Alloyed Titanium Implants2008In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 10, no 3, p. 191-199Article in journal (Refereed)
    Abstract [en]

    Purpose: This study was performed for comparisons of tissue integration to commercially pure (CP) and titanium-6-aluminum-4 vanadium (Ti-6-Al-4V) implants using various existing three-dimensional biomechanical and two-dimensional histomorphometrical techniques, and to monitor the loosening torque during in vivo removal torque (RTQ) test with a novel unit not used before in a pilot study in rabbits.

    Materials and Methods: The implants were topographically characterized and inserted in femurs and tibiae of five rabbits (in total 40 implants, 20 per group). After 16 weeks, the implant integration was biomechanically evaluated by: (1) resonance frequency test, and (2) peak RTQ test and the graph from the monitoring curve. Biopsies of the implants in situ were processed to undecalcified cut and ground sections followed by light microscopical quantifications. Shear strength calculations were performed.

    Results: Significantly higher mean value of RTQ (p = .01) and shear strength tests (p = .03) were observed for the CP titanium implants compared to Ti-6-Al-4V implants. The monitoring curve from the RTQ test demonstrated no differences in the shape or form that could provide further information about the differences in the implant-to-bone attachment.

    Conclusions: The CP titanium implants showed increased RTQ and shear strength values compared to the Ti-6-Al-4V implants. The new tool of monitoring the RTQ curve could not demonstrate differences between the two materials. The exact influence of the implant materials on the surrounding tissues needs to be further investigated.

  • 6.
    Johansson, Carina B.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Jimbo, Ryo
    Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy and Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Gothenburg University, Gothenburg, Sweden.
    Stefenson, Per
    School of Health and Medical Sciences, Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Ex vivo and in vivo biomechanical test of implant attachment to various materials: introduction of a new user-friendly removal torque equipment2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 4, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Objective:The removal torque (RTQ) analysis is commonly used for biomechanical evaluation of osseointegration. The overall aim of this study was to verify results obtained with a newly developed equipment for biomechanical testing of osseointegration.

    Methods: Verification of the new equipment for biomechanical tests involved three experiments: Part I, comparison of RTQ between implants placed in four different types of dental synthetic plasters. Part II, comparison of RTQ between custom made, experimentally used implants to self-tapping, commercially available implants molded in the same type of dental plaster. Part III, comparison of RTQ between commercially pure titanium implants to Ti6Al4V implants placed in rabbit bone, 6 weeks after insertion. Briefly, for all experiments, the peak RTQ values and the removal process were recorded every 0.01 seconds up to 10 seconds. After the measurements, peak RTQ values were converted to shear strength.

    Results: The developed equipment sensitively responded to the changes of properties related to the molding plasters, implant topographies, and materials. The monitored graphs corresponded well to the expected properties of the different implants and tested materials.

    Conclusion: The new RTQ equipment proved to be accurate and could add new knowledge in understanding the biomechanical aspects of osseointegration.

  • 7. Summerlad, Susan
    et al.
    Mackenzie, Deborah
    Johansson, Carina B.
    Örebro University, Department of Clinical Medicine.
    Atwell, Rick
    Guided Bone Augmentation around a Titanium Bone-Anchored Hearing Aid Implant in Canine Calvarium: An Initial Comparison of Two Barrier Membranes2007In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 9, no 1, p. 22-33Article in journal (Refereed)
    Abstract [en]

    Background: The placement of a bone-anchored hearing aid (BAHA) implant in young children may be hampered by the presence of thin, poor-quality calvarial bone. The use of extraskeletal guided skull bone augmentation around the titanium implant is one potential solution.

    Purpose: To compare the effectiveness of a collagen membrane BioSISt (Cook Biotech Inc., Lafayette, IN, USA) and a PGA/PLA barrier membrane, Osseoquest (W.L. Gore & Associates, Flagstaff, AZ, USA) in promoting extraskeletal bone formation, when combined with cancellous bone graft, around a titanium implant in the canine calvarium. The quality and quantity of bone tissue was compared.

    Materials and Methods: A 4-mm titanium BAHA implant was placed in the cranial parietal bone of 11 dogs. The implant protruded from the bone surface by a measured distance. Two groups, each of three dogs, received an implant, cancellous bone graft, and either a BioSISt or Osseoquest membrane. Three dogs received implant and bone graft (positive controls), and two received an implant only (negative controls). Samples were retrieved at 3, 6, and 9 months after placement. Undecalcified histologic and histomorphometric assessments were made of the augmented bone thickness, and bone gain factors were calculated for each sample group.

    Results: The process of osseointegration of the implants was ongoing and increased over time. Bone generation occurred with both test membranes and the early trabecular bone that formed, matured, and remodelled to compact bone at 9 months. BioSISt membrane samples showed superior quality and quantity of augmented bone compared with Osseoquest samples that exhibited thinner bone with persistent inflammation. Quantitatively, the BioSISt samples showed statistically greater new bone contact and bone area than both the positive and negative controls, whereas Osseoquest samples did not. The bone gain factor was statistically greater for BioSiSt samples when compared to the positive and negative controls whereas the Osseoquest samples were not.

    Conclusions: In this study, the collagen BioSISt membrane promoted bone formation of superior quality and quantity compared with the polyglycolic/polylactic acid-based Osseoquest membrane and positive and negative controls over 9 months. Further investigation of the use of the collagen BioSISt membrane for cranial bone augmentation is warranted.

  • 8. Telleman, Gerdien
    et al.
    Albrektsson, Tomas
    Hoffman, Maria
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    Vissnik, Arjan
    Meije, Henry J.A.
    Raghoebar, Gerry M.
    Peri-Implant Endosseous Healing Properties of Dual Acid-Etched Mini-Implants with a Nanometer-Sized Deposition of CaP: A Histological and Histomorphometric Human Study2010In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 12, no 2, p. 153-160Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this histological and histomorphometric study was to compare the early peri-implant endosseous healing properties of a dual acid-etched (DAE) surface (Osseotite, Implant Innovations Inc., Palm Beach Gardens, FL, USA) with a DAE surface modified with nanometer-sized calcium phosphate (CaP) particles (NanoTite, Implant Innovations Inc.) in grafted and mature maxillary bone. MATERIALS AND METHODS: Fifteen patients received two mini-implants, 1 with DAE surface (control) and 1 with a DAE + CaP surface (test), to fixate an iliac crest bone graft to the maxilla. A part of each mini-implant was in contact with the grafted bone and a part extended into the native maxillary bone. After a healing period of 3 months, the specimens were harvested and analyzed. RESULTS: Overall, a trend was seen for stronger bone response around the test mini-implants in the native bone of the maxilla. However, only the old bone particles measured by percentages of bone-to-implant contact and bone area were statistically significant (p = .025 and p = .042, respectively). CONCLUSIONS: The NanoTite surface increases the peri-implant endosseous healing properties in the native bone of the maxilla compared with the Osseotite surface, while this difference was not visible in the bone graft area. This might be a result of the lower remodeling process of the graft.

  • 9. Van de Velde, Tommie
    et al.
    Thevissen, Eric
    Persson, Rutger G.
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    De Bruyn, Hugo
    Two-Year Outcome with Nobel Direct® Implants: A Retrospective Radiographic and Microbiologic Study in 10 Patients2009In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 11, no 3, p. 183-193Article in journal (Refereed)
    Abstract [en]

    Introduction: The Nobel Direct® implant (Nobel Biocare AB, Göteborg, Sweden) was developed to minimize marginal bone resorption and to result in "soft tissue integration" for an optimized aesthetic outcome. However, conflicting results have been presented in the literature. The aim of this present study was to evaluate the clinical and microbiologic outcomes of Nobel Direct implants.

    Materials and Methods: Ten partially edentulous subjects without evidence of active periodontitis (mean age 55 years) received 12 Nobel Direct implants. Implants were loaded with single crowns after a healing period of 3 to 6 months. Treatment outcomes were assessed at month 24. Routine clinical assessments, intraoral radiographs, and microbiologic samplings were made. Histologic analysis of one failing implant and chemical spectroscopy around three unused implants was performed. Paired Wilcoxon signed-rank test was used for the evaluation of bone loss; otherwise, descriptive analysis was performed.

    Results: Implants were functionally loaded after 3 to 6 months. At 2 years, the mean bone loss of remaining implants was 2.0 mm (SD ± 1.1 mm; range: 0.0–3.4 mm). Three out of 12 implants with an early mean bone loss >3 mm were lost. The surviving implants showed increasing bone loss between 6 and 24 months (p = .028). Only 3 out of the 12 implants were considered successful and showed bone loss of <1.7 mm after 2 years. High rates of pathogens, including Aggregatibacter actinomycetemcomitans, Fusobacterium spp., Porphyromonas gingivalis, Pseudomonas aeruginosa, and Tanerella forsythia, were found. Chemical spectroscopy revealed, despite the normal signals from Ti, O, and C, also peaks of P, F, S, N, and Ca. A normal histologic image of osseointegration was observed in the apical part of the retrieved implant.

    Conclusion: Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration.

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