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Faculty of Odontology
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Faculty of Odontology
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Experimental tooth clenching : a model for studying mechanisms of mus... 
Dawson, Andreas : Malmö University, Faculty of Odontology
Swedish Dental Journal Supplement;228 Doctoral dissertation in odontology; (2013)DOCTORAL
THESIS
English abstract: The overall goal of this thesis was to broaden knowledge of pain mechanisms in myofascial temporomandibular disorders (M-TMD). The specific aims were to: • Develop a quality assessment tool for experimental bruxism studies (study I). • Investigate proprioceptive allodynia after experimental tooth clenching exercises (study II). • Evaluate the release of serotonin (5-HT), glutamate, pyruvate, and lactate in healthy subjects (study III) and in patients with M-TMD (study IV), after experimental tooth clenching exercises. In (I), tool development comprised 5 steps: (i) preliminary decisions, (ii) item generation, (iii) face-validity assessment, (iv) reliability and discriminative validity testing, and (v) instrument refinement. After preliminary decisions and a literature review, a list of 52 items to be considered for inclusion in the tool was generated. Eleven experts were invited to participate on the Delphi panel, of which 10 agreed. After four Delphi rounds, 8 items remained and were included in the Quality Assessment Tool for Experimental Bruxism Studies (Qu-ATEBS). Inter-observer reliability was acceptable (k = 0.77), and discriminative validity high (phi coefficient 0.79; P < 0.01). During refinement, 1 item was removed; the final tool comprised 7 items. In (II), 16 healthy females participated in three 60-min sessions, each with 24- and 48-h follow-ups. Participants were randomly assigned to a repetitive experimental tooth clenching task with 10 a clenching level of 10%, 20%, or 40% of maximal voluntary clenching force (MVCF). Pain intensity, fatigue, perceived intensity of vibration (PIV), perceived discomfort (PD), and pressure pain threshold (PPT) were measured throughout. A significant increase in pain intensity and fatigue but not in PD was observed over time. A significant increase in PIV was only observed at 40 min, and PPT decreased significantly over time at 50 and 60 min compared to baseline. In (III), 30 healthy subjects (16 females, and 14 males) participated in two sessions at a minimum interval of 1 wk. Microdialysis was done to collect 5-HT, glutamate, pyruvate, and lactate and to measure masseter muscle blood flow. Two hours after the start of microdialysis, participants were randomized to a 20- min repetitive experimental tooth clenching task (50% of MVCF) or a control session (no clenching). Pain intensity was measured throughout the experiment. Substance levels and blood flow were unaltered at all time points between sessions, and between genders in each session. Pain intensity was significantly higher after clenching in the clenching session compared to the same time point in the control session. In (IV), 15 patients with M-TMD and 15 healthy controls participated in one session and the methodology described above was used. M-TMD patients had significantly higher levels of 5-HT and significantly lower blood flows than healthy controls. No significant differences for any substance at any time point were observed between groups. Time and group had significant main effects on pain intensity. Qu-ATEBS, the 7-item evidence-based quality assessment tool, is reliable, exhibits face-validity, and has excellent discriminative validity. Tooth clenching was associated with pain, fatigue, and short-lasting mechanical hyperalgesia, but not with proprioceptive allodynia. It seems that tooth clenching is not directly related to delayed onset muscle soreness. In healthy subjects and in patients with M-TMD, levels of 5-HT, glutamate, pyruvate, and lactate were unaltered after tooth clenching. But 5-HT levels were significantly higher and blood flows significantly lower in M-TMD patients than in healthy controls at all time points. These two factors may facilitate the release, and enhance the effects, of other algesic substances that may cause pain. Swedish abstract: “I felt like I’d done three rounds with Mike Tyson…all because I was grinding my teeth in my sleep”, så beskrev en patient som intervjuades av Daily Mail i en artikel där det ökade problemet med överbelastning i käkarna beskrevs, vilket kan leda till tandslitage, muskelsmärta, och frakturer på tandmaterial. Det personliga lidandet, och de ekonomiska kostnaderna för både individ och samhälle är stort. Bruxism innebär en daglig och/eller nattlig tandpressning eller tandgnissling och anges med en förekomst av ca 10-20% i befolkningen. Tidigare undersökningar har visat att tandpressning och psykologisk stress är vanligare bland patienter med kronisk muskelsmärta i ansiktet jämfört med friska försökspersoner, och anses kunna bidra till kronisk muskelsmärta i ansiktet, så kallad myofasciell temporomandibulär dysfunktion (M-TMD). Det har även föreslagits att bruxism, t ex tandpressning, kan leda till träningsvärk i tuggmuskulaturen. M-TMD är ett smärttillstånd som kan drabba tuggmuskulaturen och är ungefär dubbelt så vanligt hos kvinnor som hos män. Vanligt förekommande symtom är smärta och ömhet i tuggmuskulaturen, men även en reducerad tuggfunktion. Flera studier har använt sig av experimentella tandpressningsmodeller för att öka förståelsen mellan tandpressning och smärta i tuggmuskulaturen. I dessa studier har olika stor bitkraft använts vid tandpressningen, vilket resulterar i att det blir svårt att jämföra resultaten från dessa studier och dra slutsatser om vilka tandpressningsmodeller som är de mest optimala. 12 Vid tandpressning så kan det bli syrefattigt i tuggmuskulaturen, vilket kan resultera i en frisättning av smärtframkallande substanser, såsom serotonin och glutamat. I tuggmuskulaturen finns det smärtreceptorer som kan aktiveras av dessa substanser. I tidigare studier har man observerat att patienter med M-TMD har en högre halt av dessa substanser i tuggmuskulaturen jämfört med friska individer. Finns det ett samband mellan tandpressning och träningsvärk? Hur kommer det sig att patienter med M-TMD har en högre halt av serotonin och glutamat i tuggmuskulaturen? Denna kunskap saknas idag, således var det övergripande målet med denna avhandling att öka kunskapen om detta. På sikt kan denna kunskap bidra till förbättrade diagnostiska metoder, och behandlingsmodeller. I studie I så utvecklades ett instrument som undersöker kvaliteten på experimentella bruxismstudier, som senare kan användas i en systematisk översikt, så att slutsatser kan dras avseende de mest optimala experimentella bruxism modellerna som inducerar en smärta på friska individer som efterliknar den kliniska smärtan som patienter med M-TMD uppvisar. I studie II undersöktes sambandet mellan tandpressning vid olika bitkraftsnivåer och träningsvärk. Våra resultat antyder att träningsvärk i tuggmuskulaturen inte tycks uppstå efter experimentell tandpressning hos friska individer. I delstudier III och IV undersöktes frisättning av serotonin och glutamat efter tandpressning hos friska individer och patienter med M-TMD med hjälp av mikrodialys. De huvudsakliga fynden var att vi kunde bekräfta tidigare fynd, att patienter med M-TMD har en högre halt av serotonin i tuggmuskulaturen. Däremot utsöndrades dessa substanser inte i samband med tandpressning, varken hos friska individer eller hos patienter. 
Experimental tooth clenching(kappan).pdf
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Oral rehabilitation of tooth loss: a systematic review of quantitativ... Hultin, Margareta; Davidson, Thomas; Gynther, Göran; Helgesson, Gert; Jemt, Torsten; Lekholm, Ulf; Nilner, Krister; Nordenram, Gunilla; Norlund, Anders; Rohlin, Madeleine; Sunnegårdh-Grönberg, Karin; Tranaeus, Sofia
Journal article in The International journal of prosthodontics;6 : Quintessence (2012)peer-reviewed 
scientific
ARTICLE
English abstract: Abstract PURPOSE: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. RESULTS: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. CONCLUSIONS: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied. -
Treatment of adult patients with edentulous arches : a systematic rev... Rohlin, Madeleine; Nilner, Krister; Davidson, Thomas; Gynther, Göran; Hultin, Margareta; Jemt, Torsten; Lekholm, Ulf; Nordenram, Gunilla; Norlund, Anders; Sunnegårdh-Grönberg, Karin; Tranaeus, Sofia
Journal article in The International Journal of Prosthodontics;6 : Quintessence (2012)peer-reviewed
scientific
ARTICLE
English abstract: PURPOSE: This study aimed to evaluate the outcomes of treatment methods used to rehabilitate adult patients with maxillary and/or mandibular edentulism after at least 5 years of follow-up. The risks, adverse effects, and cost effectiveness of these methods were also evaluated. MATERIALS AND METHODS: Three databases as well as the reference lists of included publications were searched using specified indexing terms. Publications that met the inclusion criteria were read and interpreted using pre-established protocols. Quality of evidence was classified according to the GRADE system (high, moderate, low, or very low). RESULTS: The search yielded 2,130 titles and abstracts. Of these, the full-text versions of 488 publications were obtained. After data extraction and interpretation, 10 studies with moderate study quality of evidence and 1 study with low quality of evidence regarding outcomes, risks, and adverse effects remained. Three studies on the economic aspects of treatment were also included (1 with moderate quality and 2 with low quality). Low-quality evidence showed that the survival rate of implant-supported fixed prostheses is 95% after 5 years in patients with maxillary edentulism and 97% after 10 years in patients with mandibular edentulism. The survival rate of implant-supported overdentures is 93% after 5 years (low-quality evidence). In implant-supported fixed prostheses, 70 of every 1,000 implants are at risk of failing in the maxilla after 5 years and 17 of every 1,000 implants in the mandible are at risk after 10 years. Regarding economic aspects, the evidence was insufficient to provide reliable results. CONCLUSIONS: Due to the low quality of evidence found in the included studies, further research with a higher quality of evidence is recommended to better understand the outcomes of treatment for patients with maxillary and/or mandibular edentulism. -
Bone apposition to laminin-1 coated implants : histologic and 3D eval... Bougas, Kostas; Jimbo, Ryo; Vandeweghe, Stefan; Hayashi, Mariko; Bryington, Matthew; Kozai, Yusuke; Schwartz-Filho, H.O.; Tovar, N.; Adolfsson, E.; Ono, D.; Coelho, P.G.; Wennerberg, Ann
Journal article in International Journal of Oral and Maxillofacial Surgery;5 : Elsevier (2013)peer-reviewed
scientific
ARTICLE
English abstract: Laminin-1 has been reported as one of the factors responsible for the nucleation of calcium phosphates and, in vitro, has been reported to selectively recruit osteoprogenitors. This article focused on its in vivo effects, and evaluated the effect of laminin-1 local application on osseointegration. Polished cylindrical hydroxyapatite implants were coated with laminin-1 (test) and the bone responses in the rabbit tibiae after 2 and 4 weeks were evaluated and compared to the non-coated implants (control). Before the samples were processed for histological sectioning, they were three-dimensionally analysed with micro computed tomography (μCT). Both evaluation methods were analysed with regards to bone area around the implant and bone to implant contact. From the histologic observation, new bone formation around the laminin-1 coated implant at 2 weeks seemed to have increased the amount of supporting bone around the implant, however, at 4 weeks, the two groups presented no notable differences. The two-dimensional and three-dimensional morphometric evaluation revealed that both histologic and three-dimensional analysis showed some tendency in favour of the test group implants, however there was no statistical significance between the test and control group results. -
Treatment of adult patients with partial edentulism : a systematic re... Sunnegårdh-Grönberg, Karin; Davidson, Thomas; Gynther, Göran; Jemt, Torsten; Lekholm, Ulf; Nilner, Krister; Nordenram, Gunilla; Norlund, Anders; Rohlin, Madeleine; Tranaeus, Sofia; Hultin, Margareta
Journal article in International Journal of Prosthodontology;6 : Quintessence (2012)peer-reviewed
scientific
ARTICLE
English abstract: PURPOSE: The purpose of this systematic review was to identify and critically appraise published studies of treatment methods used in general practice to rehabilitate adult patients with single tooth loss or partial edentulism, with special emphasis on outcomes reported after at least 5 years of follow-up. MATERIALS AND METHODS: Three databases were searched using specified indexing terms. Publications were included if the study design, research questions, and sample size satisfied pre-established criteria. Reference lists of relevant publications and systematic reviews were also searched. The quality of evidence was classified according to the GRADE system as high, moderate, low, or very low. RESULTS: The search yielded 7,675 titles, of which 1,130 were read in full text. A final total of 15 publications were deemed eligible for inclusion: 5 of moderate quality and 10 of low quality. The five studies of moderate quality were all related to implant-based treatment. The 5-year survival rates for implant-supported single crowns and prostheses were 91% and 94.7%, respectively (implant survival rates: 98.5% and 94.9%, respectively). The underlying scientific evidence was low in quality. No relevant publications were identified regarding the economic aspects of treatment. CONCLUSION: Due to the low scientific evidence of the included studies, it was not possible to compare various treatment methods used for rehabilitation of single tooth loss or partial edentulism.
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