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BackgroundBase of tongue cancer incidence and patient survival is increasing why treatment sequelae becomes exceedingly important. Osteoradionecrosis (ORN) is a late adverse effect of radiotherapy and brachytherapy (BT) could be a risk factor. Brachytherapy is used in three out of six health care regions in Sweden.AimsInvestigate if patients treated in regions using BT show an increased risk for ORN and whether brachytherapy has any impact on overall survival.Material and MethodsWe used data from the Swedish Head and Neck Cancer Register between 2008-2014. Due to the nonrandomized nature of the study and possible selection bias we compared the risk for ORN in brachy vs non-brachy regions.ResultsFifty out of 505 patients (9.9%) developed ORN; eight of these were treated in nonbrachy regions (16%), while 42 (84%) were treated in brachy regions. Neither age, sex, TNM-classification/stage, p16, smoking, neck dissection, or chemotherapy differed between ORN and no-ORN patients. The risk for ORN was significantly higher for patients treated in brachy regions compared to non-brachy regions (HR = 2,63, p = .012), whereas overall survival did not differ (HR = 0.95, p = .782).Conclusions and SignificanceBrachytherapy ought to be used cautiously for selected patients or within prospective randomized studies.

Purpose In patients who underwent virtual planning and guided flapless implant surgery for teeth missing in the anterior maxilla, we compared buccal bone loss between those treated with and without autogenous bone augmentation. Methods Of 22 patients with teeth missing because of trauma or aplasia, 10 (18 implant sites) were reconstructed with buccally placed bone graft harvested from the mandibular ramus, and 12 were non-reconstructed (16 sites). Baseline cone-beam computed tomography allowed for implant planning using the NobelClinician® software and was performed again at 1 year after functional loading. The marginal bone level was assessed radiographically at post-implant baseline and at follow-up. Results At follow-up, buccal bone loss differed significantly between groups at the central level of the implant (p = 0.0005) but not at the coronal level (p = 0.329). The mean marginal bone level change was 0.6 mm, with no significant between-group difference (p = 0.876). The actual implant position often deviated in the vertical or sagittal plane by an average of 0.3–0.6 mm from the planned position. Conclusion Compared with non-reconstructed patients, reconstructed patients experienced significantly more buccal bone loss at the central level of implants. The groups did not differ at the coronal level or in marginal bone loss, possibly because of the more augmented bone at the central level among reconstructed patients. Differences between planned versus actual implant positions should be considered in situations of limited bone volume at the planned implant site.

Summary Background Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients’ perceptions of different retention strategies is needed. Objectives This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention. Trial design A single centre two-arm parallel-group randomized controlled trial. Methods This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little’s Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4. Results Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years. Limitations It was not possible to perform blinded assessments of digital models at follow-up. Conclusions Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances. Trial registration ClinicalTrials.gov (NCT03070444).

Background: The treatment of head and neck cancer is an intensive multimodal treatment that has a great impact on the individual patient. Aims/Objectives: This study aimed to evaluate acute and long-term complications associated with mandibular resections and reconstructions. Material and Methods: We retrospectively retrieved data on complications and recurrences among patients that underwent mandibular resections and reconstructions for treating oral cavity cancer (n = 190 patients) and osteoradionecrosis (ORN, n = 72). Reconstructions included composite grafts (n = 177), soft tissue flaps (n = 61), or primary closure without any graft (n = 24). Results: Forty-two patients that underwent reconstructions with composite grafts displayed serious complications (Clavien–Dindo ≥ IIIa). The complication rates were similar between patients treated for oral cavity cancer and patients treated for ORN. Patients that underwent a primary closure without any graft, had a significantly lower risk of complications compared to patients that underwent the other treatments. After hospitalization, 181 patients (69%) had at least one complication. Conclusions: A majority of patients undergoing resection and reconstruction due to oral cancer/ORN suffered from postoperative complications regardless of indication, comorbidity status or reconstruction technique. The risk of Clavien–Dindo grade IIIa–V events was significantly lower for patients treated with primary closure without grafts. Significance: The results from this study clarifies the importance of in-depth analyse prior to decision of treatment for patients with head and neck cancer.

Local anaesthesia is taught early in the practical part of dental programs. However, dental students express uncertainty and concern before their practical training in local anaesthesia. The aim of this study was to evaluate how extra educational elements in the teaching of local anaesthesia affect students’ confidence using local anaesthesia. The students were divided into three groups (A, B and C). Group A received the same education that was used the previous year (i.e., four hours of theoretical lectures followed by four hours of practical exercises performed on a fellow student). Group B did their practical training on fellow students in groups of three, with each student taking turns performing, receiving and observing the procedure. Group C received training using an anatomically correct model before their practical training on a fellow student. After each training step, the students completed a questionnaire about their confidence administering local anaesthesia. The students experienced a significant increase in confidence after each educational step. Combining theory and practical instruction, including the use of anatomically correct models and peer instruction, improved students’ confidence in administering local anaesthesia. The greatest increase in confidence was in the students placed in groups of three where each student performed, received and observed the procedure.

Summary Background Evidence concerning the most appropriate retention strategy after orthodontic treatment is still inconclusive. Objective This trial compares the retentive capacity of vacuum-formed Essix C-retainers (VFR) and bonded cuspid-to-cuspid retainers (CTC) in the mandible 6 and 18 months after orthodontic treatment. Trial design A single-centre two-arm parallel-group randomized controlled trial. Methods This study included 104 adolescent patients, computer-generated randomized with sequentially numbered, opaque, and sealed envelopes into two groups and stratified by gender (52 females and 52 males). The patients were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. In the intervention arm, patients received a VFR (n = 52); in the active comparator arm, patients received a CTC (n = 52). Dental casts were obtained at debond (T1), after 6 months (T2), and after 18 months (T3). The casts were digitized. The retentive capacity was evaluated on digital three-dimensional models using Little’s Irregularity Index (LII), overbite, overjet, arch length, and intermolar and intercanine width. Results Baseline values were similar for both groups. Statistically significant increases were noted in LII and overbite, mainly between T1 and T2, but also between T1 and T3 in the VFR group (LII = 0.52 mm, P < 0.001, overbite = 0.51 mm, P < 0.001) and in the CTC group (LII = 0.45 mm P < 0.001, overbite = 0.36 mm, P < 0.001). There were no significant differences between groups. Overjet showed small variations during the observation periods but was overall stable within and between groups after 18 months. Arch length decreased slightly in both groups after 6 and 18 months. Intermolar and intercanine widths remained stable after debond. Limitations Patients, operator, and outcome assessor could not be blinded due to the study design. Conclusions VFR and CTC have the same retention capacity in the mandible after 6 and 18 months. Relapse mainly occurs during the first 6 months of retention, but the post-treatment changes are generally small. Shorter VFRs in the mandible do not cause negative vertical effects. Part-time wear regimen is not associated with increased relapse. Trial registration NCT03070444.

Objectives. To evaluate the outcome of secondary alveolar bone grafting (SABG) in patients with cleft lip and palate (CLP) at 16 years of age, and to identify predictors associated with surgical failure. Study Design. This retrospective follow-up included 91 patients with 100 cleft palates treated with SABG at a mean age of 9.2 years. Analyzed possible predictors for surgical failure were gender, dental development stadium, type of cleft, side, tooth erupting into the graft, cortical boundary, presence of a lateral incisor, extraction, preoperative expansion, oral hygiene, retention device and age. Outcome variable for surgical success was Bergland score I and II. Surgical outcome was analyzed at 16 years of age based on intraoral radiographs, according to the Bergland index. Statistical analyses included estimation of odds ratios for predictor variables. Results. The post-SABG success rate was 91% (Bergland score I and II) with a mean follow-up of 7.2 years. Surgical failure was significantly associated with poor oral hygiene. Conclusions. This study revealed a high success rate (91%) at a mean of 7.2 years post-SABG. Poor oral hygiene significantly increased the risk of surgical failure. This suggests that increased perioperative measures to maintain good oral health could reduce surgical failure.

Summary Objective To compare removable vacuum-formed Essix C retainers with bonded cuspid-to-cuspid retainers (CTCs) regarding patients’ perceptions after debonding and 6 and 18 months of retention. Trial design A single-centre two-arm parallel-group randomized controlled trial. Methods This trial included 104 adolescent patients, computer-generated randomized, with sequentially numbered, opaque and sealed envelopes, into two groups and stratified by gender. They were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. Patients in the intervention arm received a vacuum-formed retainer (VFR) in the mandible (n = 52), and patients in the active comparator arm received a CTC (n = 52). Both groups had a VFR in the maxilla. Treatment outcome satisfaction, quality of care and attention, side-effects during the retention phase, and retainer acceptance and compliance were assessed with questionnaires at baseline (T1, 2 weeks after debond) and after 6 (T2) and 18 months (T3) of retention. Operator was blinded to group assignment during measurements. Results Ninety-five patients completed the questionnaires at all three time points. Patients were overall satisfied with treatment outcome, quality of care and attention, and how their retainers worked at all three time points, with no differences between groups. At T1 and T3, the VFR group reported significantly more pain and discomfort (T1: P = 0.005, T3: P < 0.0001) and soreness (T1: P = 0.001, T3: P = 0.011) in the mandible compared to the CTC group. The CTC group found it easier to get used to their retainers. After 18 months, 70.5 per cent in the VFR group and 73.9 per cent in the CTC group reported the recommended wear-time of the VFRs. Decreased wear-time was correlated to perceived pain and discomfort (rs = −0.421, P < 0.0001). Limitations The results were limited by our retainer design and recommended wear regimen. Conclusions Both groups reported high treatment outcome satisfaction and low levels of side-effects during the retention phase. Nevertheless, the VFR group reported more pain and discomfort at T1 and at T3. Self-reported compliance was the same in both groups. The VFR group was more concerned about relapse. Trial registration NCT03070444 (https://clinicaltrials.gov).

CEOT is a rare benign, but locally aggressive odontogenic tumor, and some authors have claimed that the biologic behavior of the clear cell variant is even more aggressive, with greater propensity to recur. We report a rare case of clear cell calcifying epithelial odontogenic tumor (CEOT) and discuss its possibly aggressive behavior. A 40-year-old woman experienced an asymptomatic expansion of the left posterior mandible. After radiographic examination and biopsy, a block resection was performed. Histologic examination included analysis of Ki-67 reactivity as a marker of tumor growth activity. Ki-67 labeling was pronounced in the non-clear cell population in the tumor periphery but low in the central and clear cell portions. Clinical and radiographic follow-up 6 years after resection has not revealed any signs of recurrence. On the basis of a review of the literature and our own findings, there is no clear data to suggest that clear cell CEOT exhibits more aggressive behavior compared with conventional CEOT.

Innate lymphoid cells (ILCs) are the most recently identified leukocytes of the immune system and these cells are increasingly acknowledged to play important roles in host defence and tissue repair. ILCs are also contributors of inflammatory diseases such as asthma and colitis. We analyzed the presence and relative proportions of the different ILC subsets (ILC1, ILC2 and ILC3) in gingivitis and periodontitis. Further, we investigated if ILCs express receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine crucial for osteoclast differentiation and bone resorption.We collected gingivitis and periodontitis soft tissue and characterized ILC subsets including RANKL expression in single-cell suspensions using flow cytometry.ILCs were detected both in gingivitis and periodontitis. The majority of ILCs, in both conditions, were ILC1s. Furthermore, RANKL expression was detected on a fraction of the ILC1s.Our discovery of the presence of ILCs both in gingivitis and periodontitis and concomitant expression of RANKL on a fraction of the ILC1 population suggest that these cells may be of importance in periodontal disease. In addition, our findings provide a new insight into the field of oral immunology.

Background Lichen planus (LP) is a chronic inflammatory, immunological, mucocutaneous disease can affect skin, genital and oral mucosa. Oral lichen planus (OLP) is the most common noninfectious, chronic inflammatory oral disease affecting 1-2% of the general adult population. World Health Organization (WHO) classifies OLP as a potentially malignant disorder. Epstein Barr virus or human herpesvirus-4, is a member of the herpes virus family and one of the most ubiquitous viruses known to human, infecting approximately 90% of the world’s adult population. The virus often infects B lymphocytes resulting in a wide spectrum of mucocutaneous and systemic diseases, ranging from mild lesions to aggressive malignancies. The aim of this study was to investigate expression of the EBV encoded RNAs EBER1 and EBER2 in oral and genital lichen planus and compare results with normal tissues in situ hybridization which is considered the golden standard for detection of EBER. Material and Methods A total of 68 biopsies, 25 oral LP, 26 genital LP, 10 oral controls and finally 7 genital controls were analysed using situ hybridization. Results All samples had RNA as shown by the control slide, whereas no case contained neither EBER1 nor EBER2. Conclusions Based on results from our study EBV is not involved in aetiology of lichen planus. Key words:Mucosal lichen planus, Epstein - Barr virus.

The case of a 17-year-old female with a benign osteoblastoma in the temporomandibular joint (TMJ) is reported. The patient had a 2.5-year history of reduced mouth opening accompanied by tenderness and swelling in the left TMJ. Initial treatment included stabilization of the occlusion with a splint, jaw exercises, and analgesics. At first the patient's symptoms decreased, but they then increased 18 months later, prompting a cone beam computed tomography (CBCT) evaluation of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications located in the temporal articular tubercle. The lesion was removed under general anaesthesia and sent for histopathological examination. At the 12-month follow-up, the patient had normal TMJ function without clinical symptoms. CBCT examination showed a small recurrence of 3mm. Another 12 months later, CBCT showed a 1-mm increase in the recurrence. Her function was normal, with slight tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annual follow-up. The present case illustrates the importance of initial radiographic examination together with clinical examination in patients with TMJ dysfunction.

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), ...

Strategies in reconstruction of the atrophic maxilla with autogenous bone grafts and endosseous implants.

Orthognathic surgery, a standard procedure used to improve intermaxillary relationship, surgically moves either one or both jaws. However, statistics for frequency and indications for orthognathic ...

The aim of this prospective study was to compare implants placed in grafted and normal non-grafted maxilla by means of resonance frequency analysis (RFA), clinical stability and implant failure. Twenty-nine patients with severe atrophy of the edentulous maxilla were treated with autogenous bone grafts as onlay (24 patients) or as interpositional grafts in conjunction with a Le Fort I osteotomy (five patients) 6 months prior to placement of 222 implants. Ten non-grafted patients treated with 75 Branemark implants in the edentulous maxillae served as a control group. RFA was performed at implant placement, abutment connection and after 6 months of bridge loading. Seventeen (8%) implants were lost in the grafted bone and one (1%) in normal bone. RFA revealed a similar pattern in both grafted and normal maxillae, i.e. increasing resonance frequency (RF) with time (Wilcoxon Signed Rank test for paired data). Twenty implants that were rotation mobile (low primary stability) at the time of insertion showed a significantly lower value at implant placement according to RFA (Mann-Whitney U-test, P = 0.020). The RF for the failed implants revealed a tendency towards lower values (Mann-Whitney U-test, P = 0.072), compared to the successful implants. It is concluded that implants placed in grafted bone when using a two-stage technique achieve a stability similar to that of implants placed in normal non-grafted bone.

The aim of the present study was to histologically analyse the bone graft-titanium implant interface after six and twelve months of healing for a simultaneous approach and after six months for a delayed approach. For this purpose, screw-shaped c.p. titanium microimplants, 2 mm in diameter and 5 mm long, were placed and retrieved at different time intervals in ten consecutive patients with severely resorbed maxillae and treated with iliac cortico-cancellous bone grafts and titanium implants in a two-stage procedure. The histomorphometrical analyses of ground sections of the specimens showed a higher degree of bone-implant contact and more bone filling the implant threads in the delayed approach microimplants. This was probably due to the partly revascularized grafted bone in the delayed approach being able to respond to the surgical trauma, resulting in interfacial bone formation. It is concluded that the results from the present study favour the use of a delayed approach when using free autogenous bone grafts and titanium implants for reconstruction of the severely atrophied maxilla.

To analyze the bone graft-implant interface of titanium microimplants (MIs) placed at the time of bone grafting or after a healing period of 6 months and retrieved after another 6 to 14 months of healing. Integration of MIs placed in interpositional bone grafts (IBGs) in conjunction with a Le Fort I osteotomy was compared with the integration of those placed in onlay/inlay bone grafts (OBGs).The severely atrophied edentulous maxillae of 23 patients (14 women, 9 men) were restored with autogenous bone grafts (either IBG [n=8] or OBG [n=15]) and titanium implants. Six-month periods were allowed between grafting, implant placement, and abutment connection. The bone-implant interface was studied histologically with the use of unloaded titanium MIs.Sixty-eight MIs were either (1) placed simultaneously with grafting and retrieved after 6, 12, or 14 months or (2) placed after 6 months of healing and retrieved after another 6 to 8 months. Histomorphometry indicated equal degrees of osseointegration for the 2 intraoral reconstruction techniques when looking at bone-implant contact, bone area in threads, and newly formed bone (NFB) (Student t test for unpaired observations). There was a significant difference between simultaneous and delayed implant placement with respect to BIC and NFB (Student t test for paired observations). Three additional MIs placed in the nongrafted residual alveolar ridge and retrieved after 6 months showed significantly more bone in threads and NFB (Student t test for paired observations; P = .003 and P = .009, respectively) compared to MIs placed at graft placement (6 months' healing).Timing of implant placement appeared more important than healing time or surgical technique. The delayed approach resulted in better implant integration, probably because of the initial revascularization of the graft.Implant integration was similar in the IBG and OBG groups. Placement of MIs after an initial healing period of 6 months resulted in better integration than placement simultaneously with grafting.

The aim of the present study was to histologically analyse the bone graft-titanium implant interface after six and twelve months of healing for a simultaneous approach and after six months for a delayed approach. For this purpose, screw-shaped c.p. titanium microimplants, 2 mm in diameter and 5 mm long, were placed and retrieved at different time intervals in ten consecutive patients with severely resorbed maxillae and treated with iliac cortico-cancellous bone grafts and titanium implants in a two-stage procedure. The histomorphometrical analyses of ground sections of the specimens showed a higher degree of bone-implant contact and more bone filling the implant threads in the delayed approach microimplants. This was probably due to the partly revascularized grafted bone in the delayed approach being able to respond to the surgical trauma, resulting in interfacial bone formation. It is concluded that the results from the present study favour the use of a delayed approach when using free autogenous bone grafts and titanium implants for reconstruction of the severely atrophied maxilla.