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  • 1.
    Nyberg, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    On implant integration in irradiated bone: clinical and experimental studies2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Radiation has an impact on the processes involved in bone- healing, regeneration and remodeling. The mechanisms that cause impaired bone healing of dental implants are not fully understood. Adjunctive treatments to revers radiation effects are limited. Dental implant surgery can be a risk in irradiated jaws and the risk for osteoradionecrosis is of concern. There is no consensus when to install implant after completed radiation therapy or what radiation dosage might cause impaired bone healing. The overall aim of the studies was to investigate bone tissue reactions adjacent to implants after irradiation.

    I. A clinically long-term follow-up study was performed to assess the outcome of 18 dental implants inserted in five patients with and without irradiated fibula-reconstructed mandibles. Bone tissue reactions adjacent to 14 micro-implants were histologically evaluated. In the clinical follow-up, 15 implants were in function, with an overall success rate of 83%. The histomorphometric analyses demonstrated an impaired osseointegration with reduced bone-to-implant contact (BIC) and bone area (BA), in irradiated sides.

    II. In an experimental animal study the aim was to find a critical level for a given single external radiation dosages causing impaired implant osseointegration. 9 rats received a single radiation dose of 2, 5, 10, 20 and 30 Gy, respectively to one hind-leg while the other served as a control. Three days post radiation two implants were inserted in each hind-leg and after a period of 5 weeks the implants (n=36) were harvested for histological examination. BIC and BA were lower for irradiated samples for dosages of 20 Gy and higher.

    III. The aim was to investigate the effects of HBO on osseointegration of titanium implants in irradiated bone. 15 rats received an external single radiation dose of 20 Gy to one hind-leg. 3-days post-irradiation 2 implants were inserted in each hind-leg (n=60). The rats were divided in to 2 groups and one group received hyperbaric oxygen treatment (HBOT) 3 days post-implant insertion (n=8). After 5 weeks the distal implants were harvested for histological examination (n=30) and the proximal implants were used for removal torque tests (n=30). BIC obtained significant higher values for non-irradiated side, independent of HBO or not. BA obtained significant higher values for irradiated sides in the non-HBO group.

    IV. The aim was to investigate gene expression in irradiate bone after implant insertion for bone formation, resorption and remodelling. 8 rats, received a single radiation dose of 20 Gy to one hind-leg and two implants inserted in each hind-leg 8 weeks after completed radiation therapy. After 5 weeks bone samples with implants were collected for gene expression analysis. ALP, OC (formation) and RANKL/OPG (remodelling) were down regulated in irradiated samples.

    Conclusion: Bone-anchored dental bridges can be used in selected oro-mandibular reconstructed patients. Bone quality disturbances with impaired osseointegration for dosages of 20 Gy and more were demonstrated in an animal study model. HBO did not enhance osseointegration of implants placed in rat bone during a five-week follow-up period. Irradiation significant reduces bone formation and remodeling under influence of pro-inflammatory and growth factor cytokines

    List of papers
    1. Titanium implants in free fibula grafts for mandibular reconstruction: Histologic analysis and a long-term clinical follow up
    Open this publication in new window or tab >>Titanium implants in free fibula grafts for mandibular reconstruction: Histologic analysis and a long-term clinical follow up
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Dentistry Surgery
    Identifiers
    urn:nbn:se:oru:diva-46380 (URN)
    Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-10-17Bibliographically approved
    2. Single-dose irradiation followed by implant insertion in rat bone: An investigative study to find a critical level for osseointegration
    Open this publication in new window or tab >>Single-dose irradiation followed by implant insertion in rat bone: An investigative study to find a critical level for osseointegration
    Show others...
    2010 (English)In: Journal of Osseointegration, ISSN 2036-4121, Vol. 2, no 2, 52-60 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim: No general consensus exists regarding the ideal time to insert implants in bone after irradiation or how the various irradiation doses influence implant success. This study aims at investigating integration of implants in pre-irradiated rat bone and find a critical level doses that cause disturbed osseointegration.

    Materials and methods: Single irradiation doses of 2, 5, 10, 20 and 30 Gy were given to one leg of adult rats 3 days prior to insertion of screw-shaped implants whereas the other leg served as a non-irradiated control. The follow up was 5 weeks. Bone implant contact (BIC) and bone area (BA) were measured on undecalcified cut and ground sections in the light microscope. The tissue quality was also examined in the light microscope.

    Results: Doses of 5 and 10 Gy resulted in 25% higher contact values for the irradiated samples compared to non-irradiated controls. The most impaired integration occurred when doses of 20 Gy were given, revealing a 50% difference between the irradiated (25%) and the non irradiated samples (50%). The bone area demonstrated no major quantitative differences albeit the qualitative observations differed substantially being most pronounced in the 20 and 30 Gy irradiated samples.

    Conclusions: The osseointegration was substantially impaired after radiation doses of 20 and 30 Gy. Quantitative data alone are insufficient to describe implant integration in situation like this. Qualitative observations are of utmost importance and require great attention. The importance of judging and describing various grades of tissue damage is complicated but necessary. Based on the results obtained in this study, full scale experiments are now ongoing.

    Place, publisher, year, edition, pages
    Carimate, Italy: Ariesdue, 2010
    National Category
    Dentistry
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-11359 (URN)
    Available from: 2010-07-06 Created: 2010-07-06 Last updated: 2017-10-18Bibliographically approved
    3. Osseointegration of implants in irradiated bone with and without hyperbaric oxygen treatment: an experimental study in rat tibiae
    Open this publication in new window or tab >>Osseointegration of implants in irradiated bone with and without hyperbaric oxygen treatment: an experimental study in rat tibiae
    2013 (English)In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 28, no 3, 739-746 p.Article in journal (Refereed) Published
    Abstract [en]

    Purpose: Hyperbaric oxygen (HBO) has been recommended to enhance implant osseointegration in irradiated bone. The aim of this study was to further investigate the effects of HBO on implant integration in irradiated bone tissue.

    Materials and Methods: The present study was an experimental intraindividual study in 16 rats. A single fraction of 20 Gy external irradiation was applied to one rat hind leg, while the other served as a nonirradiated control. Three days after radiation, two implants were inserted in each tibial tuberosity. The rats were divided into two groups: non-HBO treated (group 1) and HBO treated (group 2). Five weeks after radiation, removal torque tests were performed. Implants with surrounding tissue were processed to undecalcified cut and ground sections for histomorphometric evaluations of bone-to-implant contact and bone area. Retrieved bones were also investigated with dual-energy x-ray absorptiometry.

    Results: The non-HBO treated rats (group 1) demonstrated higher, but not statistically significantly higher, values in the nonirradiated leg for all investigated parameters compared to the HBO-treated rats (group 2). However, the mean value for bone area was significantly higher in the irradiated sides compared to the nonirradiated control sides.

    Conclusions: In the present study, HBO treatment did not have a significant impact on osseointegration of implants in irradiated bone.

    Place, publisher, year, edition, pages
    Quintessence Publishing Co., Inc., 2013
    Keyword
    bone, dental implant, hyperbaric oxygen therapy, osseointegration, radiation therapy
    National Category
    Dentistry
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-30313 (URN)10.11607/jomi.3083 (DOI)000322078500018 ()23748304 (PubMedID)2-s2.0-84898313432 (Scopus ID)
    Note

    Funding agency: Särfonderna, Örebro University Hospital, Örebro, Sweden;  Hjalmar Svenssons Research Fund, Goteborg, Sweden 

    Available from: 2013-08-23 Created: 2013-08-23 Last updated: 2017-12-06Bibliographically approved
    4. Effect of radiotherapy on osseointegration: in vivo gene expression and implant stability after single high-dose irradiation
    Open this publication in new window or tab >>Effect of radiotherapy on osseointegration: in vivo gene expression and implant stability after single high-dose irradiation
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Dentistry
    Identifiers
    urn:nbn:se:oru:diva-46381 (URN)
    Available from: 2015-11-02 Created: 2015-11-02 Last updated: 2017-10-17Bibliographically approved
  • 2.
    Nyberg, Jan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Helenius, Gisela
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital.
    Dahlin, Christer
    Sahlgrenska Academy University of Gothenburg; NU-hospital organization, Trollhättan, Sweden.
    Johansson, Carina B.
    Sahlgrenska Academy University of Gothenburg.
    Omar, Omar
    Sahlgrenska Academy University of Gothenburg.
    Effect of radiotherapy on osseointegration: in vivo gene expression and implant stability after single high-dose irradiationManuscript (preprint) (Other academic)
  • 3.
    Nyberg, Jan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University hospital.
    Hertzman, Sven
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Svensson, Börje
    Örebro University Hospital.
    Johansson, Carina B.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Osseointegration of implants in irradiated bone with and without hyperbaric oxygen treatment: an experimental study in rat tibiae2013In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 28, no 3, 739-746 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: Hyperbaric oxygen (HBO) has been recommended to enhance implant osseointegration in irradiated bone. The aim of this study was to further investigate the effects of HBO on implant integration in irradiated bone tissue.

    Materials and Methods: The present study was an experimental intraindividual study in 16 rats. A single fraction of 20 Gy external irradiation was applied to one rat hind leg, while the other served as a nonirradiated control. Three days after radiation, two implants were inserted in each tibial tuberosity. The rats were divided into two groups: non-HBO treated (group 1) and HBO treated (group 2). Five weeks after radiation, removal torque tests were performed. Implants with surrounding tissue were processed to undecalcified cut and ground sections for histomorphometric evaluations of bone-to-implant contact and bone area. Retrieved bones were also investigated with dual-energy x-ray absorptiometry.

    Results: The non-HBO treated rats (group 1) demonstrated higher, but not statistically significantly higher, values in the nonirradiated leg for all investigated parameters compared to the HBO-treated rats (group 2). However, the mean value for bone area was significantly higher in the irradiated sides compared to the nonirradiated control sides.

    Conclusions: In the present study, HBO treatment did not have a significant impact on osseointegration of implants in irradiated bone.

  • 4.
    Nyberg, Jan
    et al.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Hertzman, Sven
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Svensson, Börje
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Johansson, Petra
    Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Göteborg, Sweden.
    Granström, Gösta
    Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Göteborg, Sweden.
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Single-dose irradiation followed by implant insertion in rat bone: An investigative study to find a critical level for osseointegration2010In: Journal of Osseointegration, ISSN 2036-4121, Vol. 2, no 2, 52-60 p.Article in journal (Refereed)
    Abstract [en]

    Aim: No general consensus exists regarding the ideal time to insert implants in bone after irradiation or how the various irradiation doses influence implant success. This study aims at investigating integration of implants in pre-irradiated rat bone and find a critical level doses that cause disturbed osseointegration.

    Materials and methods: Single irradiation doses of 2, 5, 10, 20 and 30 Gy were given to one leg of adult rats 3 days prior to insertion of screw-shaped implants whereas the other leg served as a non-irradiated control. The follow up was 5 weeks. Bone implant contact (BIC) and bone area (BA) were measured on undecalcified cut and ground sections in the light microscope. The tissue quality was also examined in the light microscope.

    Results: Doses of 5 and 10 Gy resulted in 25% higher contact values for the irradiated samples compared to non-irradiated controls. The most impaired integration occurred when doses of 20 Gy were given, revealing a 50% difference between the irradiated (25%) and the non irradiated samples (50%). The bone area demonstrated no major quantitative differences albeit the qualitative observations differed substantially being most pronounced in the 20 and 30 Gy irradiated samples.

    Conclusions: The osseointegration was substantially impaired after radiation doses of 20 and 30 Gy. Quantitative data alone are insufficient to describe implant integration in situation like this. Qualitative observations are of utmost importance and require great attention. The importance of judging and describing various grades of tissue damage is complicated but necessary. Based on the results obtained in this study, full scale experiments are now ongoing.

  • 5.
    Nyberg, Jan
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hertzmann, S.
    Svensson, Börje
    Örebro University, School of Health and Medical Sciences.
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    Implant integration in irradiated bone2009Conference paper (Refereed)
  • 6.
    Nyberg, Jan
    et al.
    Örebro University, School of Health and Medical Sciences.
    Svensson, Börje
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    Implant integration in compromised bone beds: a pilot study in rat bone2008Conference paper (Refereed)
  • 7.
    Nyberg, Jan
    et al.
    Örebro University Hospital.
    Svensson, Börje
    Örebro University Hospital.
    Johansson, Carina B.
    Sahlgrenska Academy University of Gothenburg.
    Johansson, Petra
    Sahlgrenska Academy University of Gothenburg.
    Dahlin, Christer
    Sahlgrenska Academy University of Gothenburg; NU-hospital organization, Trollhättan.
    Titanium implants in free fibula grafts for mandibular reconstruction: Histologic analysis and a long-term clinical follow upManuscript (preprint) (Other academic)
  • 8.
    Svensson, Börje
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Adell, Ragnar
    Cardemil, Carina
    Felle Persson, Ewa
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    Nyberg, Jan
    Örebro University, School of Health and Medical Sciences.
    Perryd, Tomas
    Hela vårdkedjan i fokus: Forskningen på käkkirurgiska kliniken spänner från planering till rehabilitering2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 4, 64- p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    På Käkkirurgiska kliniken vid Universitetssjukhuset i Örebro (USÖ) har vi inom den högspecialiserade vården utvecklat en flerårig och bred erfarenhet av framför allt käkrekonstruktioner och käkledskirurgi. Utöver den kirurgiska verksamheten är samarbete, både nationellt och internationellt, en viktig del av vår vardag.

  • 9.
    Svensson, Börje
    et al.
    Örebro University, School of Health and Medical Sciences.
    Adell, Ragnar
    Örebro University, School of Health and Medical Sciences.
    Cardemil, Carina
    Felle Persson, Ewa
    Örebro University, School of Health and Medical Sciences.
    Johansson, Carina B.
    Örebro University, School of Health and Medical Sciences.
    Nyberg, Jan
    Örebro University, School of Health and Medical Sciences.
    Perryd, Tomas
    Patientnära forskning ett prioriterat område2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 4, 65-69 p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Käkkirurgiska forskningsenhetens pågående projekt består till stor del av klinisk patientnära forskning, vilket är ett av Örebro universitets prioriterade forskningsområden.

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