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  • 1. Björksved, Margitha
    Behandling av palatinalt retinerade hörntänder2016In: Behandling av palatinalt retinerade hörntänder, 2016Conference paper (Other academic)
  • 2. Björksved, Margitha
    Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial2018In: Closed vs open surgical exposure of palatally displaced canines. A Multicenter Randomized Controlled Trial, 2018Conference paper (Other academic)
  • 3.
    Björksved, Margitha
    Örebro University, School of Medical Sciences.
    Open vs closed exposure of palatally displaced canines: clinical, patient-related outcomes and health economics2021Doctoral 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.

    List of papers
    1. Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?
    Open this publication in new window or tab >>Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?
    Show others...
    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
    2. Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial
    Open this publication in new window or tab >>Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial
    Show others...
    2018 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed) Published
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

    Place, publisher, year, edition, pages
    Oxford University Press, 2018
    National Category
    Dentistry Surgery
    Identifiers
    urn:nbn:se:oru:diva-69578 (URN)10.1093/ejo/cjy070 (DOI)000456177500008 ()30321323 (PubMedID)2-s2.0-85059502726 (Scopus ID)
    Note

    Funding Agencies:

    County Council of Sörmland  DLL-393721 

    Uppsala - Örebro Regional Research Council  RFR-387041 

    Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2023-02-09Bibliographically approved
    3. Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial
    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
    Show others...
    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
    4. Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial
    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
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  • 4.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Centre, Örebro, Sweden .
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Postgraduate Dental Education Centre, Örebro, Sweden; Department of Behavioural and Community Dentistry, Institution of Odontology, University of Gothenburg, Gothenburg, Sweden.
    Homocystinuria and oral health: A report of 14 cases2012In: Swedish Dental Journal, ISSN 0347-9994, Vol. 36, no 2, p. 101-108Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the oral health in Swedish individuals with the diagnosis of homozygote cystathionine beta synthase-deficient homocystinuria (HC), a rare disorder of amino acid metabolism affecting connective tissue, in which the phenotypic abnormalities include dislocation of the optic lens, skeletal abnormalities, thromboembolic events, and sometimes mental retardation. Further aims were to evaluate the oral findings against previous oral observations in a medical case report, such as high narrow palate, mandibular prognathia, crowding and early eruption of teeth. Every hospital in Sweden was contacted, with the inquiry of patients with diagnosis of HC, which resulted in 14 individuals participating in oral clinical examination. The oral findings evaluated against previous medical case reports showed to be partly in accordance with previous observations. Dental health showed to be compromised in a majority of cases. Together with the fact that methionine restriction (low-protein diet) is involved in the treatment of the condition and might result in a diet high in sugars,this points out the role of regular dental checkups and preventive oral care for individuals suffering from HC. In addition, short dental roots were a finding not previously reported in the literature. All the studied cases had central maxillary incisors with short roots, when compared to reference values used.

  • 5.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Postgraduate Dental Education Centre, Department of Orthodontics, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bazargani, Silvia Miranda
    Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.
    Lund, Henrik
    Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Department of Oral and Maxillofacial Radiology, Göteborg, Sweden.
    Magnusson, Anders
    The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Lindsten, Rune
    Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden; The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.
    Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 487-497Article in journal (Refereed)
    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.

  • 6. Björksved, Margitha
    et al.
    Arnrup, Kristina
    Lindsten, Rune
    Bazargani, Farhan
    CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES (PDC): TREATMENT OUTCOME INCLUDING ASPECTS OF COST-BENEFIT AND PATIENTS´PERCEPTIONS2015Conference paper (Other academic)
  • 7.
    Björksved, Margitha
    et al.
    Örebro University, School of Medical Sciences.
    Arnrup, Kristina
    Örebro University, School of Health Sciences.
    Lindsten, Rune
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES (PDC): TREATMENT OUTCOME INCLUDING ASPECTS OF COST-BENEFIT AND PATIENTS´PERCEPTIONS2016Conference paper (Other academic)
  • 8. Björksved, Margitha
    et al.
    Arnrup, Kristina
    Lindsten, Rune
    Magnusson, Anders
    Bazargani, Farhan
    JÄMFÖRELSE AV SLUTEN OCH ÖPPEN KIRURGISK FRILÄGGNING AV PALATINALT FELSTÄLLDA HÖRNTÄNDER: OPERATIONSTID, KOMPLIKATIONER OCH PATIENTERFARENHETER. EN MULTICENTER PROSPEKTIV RANDOMISERAD KONTROLLERAD STUDIE2019Conference paper (Refereed)
  • 9.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lindsten, Rune
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sundell, Anna Lena
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gustafsson, Annika
    Department of Paediatric Dentistry, Postgraduate Dental Education Center, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed)
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 10. Björksved, Margitha
    et al.
    Bazargani, Farhan
    Lindsten, Rune
    Magnusson, Anders
    Arnrup, Kristina
    CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL2018Conference paper (Refereed)
  • 11.
    Björksved, Margitha
    et al.
    Örebro University, School of Medical Sciences.
    Lindsten, Rune
    2Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönkping, Sweden.
    Magnusson, Anders
    2Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönkping, Sweden.
    Bazargani, Farhan
    3Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    CLOSED VERSUS OPEN SURGICAL EXPOSURE OF PALATALLY DISPLACED CANINES: ERUPTION TIME, COMPLICATIONS AND PATIENT PERCEPTIONS; A RANDOMIZED CONTROLLED TRIAL2019Conference paper (Refereed)
  • 12.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Bazargani, Silvia Miranda
    Department of Maxillofacial Radiology, Postgraduate Dental Education Center, Örebro, Sweden.
    Lindsten, Rune
    Department of Orthodontics, Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Are panoramic radiographs good enough to render correct angle and sector position in palatally displaced canines?2019In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 155, no 3, p. 380-387Article in journal (Refereed)
    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.

  • 13. Björksved, Margitha
    et al.
    Magnuson, Anders
    Bazargani, Silvia Miranda
    Lindsten, Rune
    Bazargani, Farhan
    Authors' response2019In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 156, no 1, p. 9-10Article in journal (Refereed)
  • 14. Björksved, Margitha
    et al.
    Magnuson, Anders
    Bazargani, Silvia Miranda
    Lindsten, Rune
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Authors' response2019In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 155, no 6, article id 756Article in journal (Other academic)
  • 15.
    Björksved, Margitha
    et al.
    Örebro University, School of Medical Sciences. Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Lindsten, Rune
    The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden; Centre for Oral Health, School of Health and Welfare, Jönköping University, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
    Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 498-505Article in journal (Refereed)
    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.

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