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Oral Diagnostics and Rehabilitation

Our research projects in Oral Diagnostics and Rehabilitation reaches from Oral Biology and Medicine to Orofacial Neuroscience. There is also a project in pedagogy.

Please note that Orofacial Neuroscience has ben divided in Prosthetics Dentistry and Orofacial Pain and Jaw Function to make it easier for you to find the research projects that you are interested in.

Oral Biology, Pathology and Medicine

Odontogenic tumors – Metagenomic studies

To improve molecular diagnostics and therapy of oral and odontogenic tumors. In this project we study tumor-associated mutations, non-coding RNAs, virus genes, and examine how they may contribute to disease severity to improve management of odontogenic tumors such as ameloblastoma.

Principal Investigator

Margaret Sällberg Chen

Collaborators

Haleh Davanian, Carina Kruger Weiner, Robert Heymann, Emilie Hultin, Davit Bzhalava

Apical periodontitis – Microbiome and immune profiling

To improve the understanding of pathogenesis behind apical periodontitis and it's systemic consequences. The project examines the microbiome composition and the phenotypes of innate-like T cells in persistent apical periodontitis.

Principal Investigator

Margaret Sällberg Chen

Collaborators

Haleh Davanian, Mikael Silverberg, Rogier Gaiser, Michal Jacek Sobkowiak, Leif Jansson, Lars Engstrand, Johan Sandberg

Microbiome and metabolome of dental caries

To investigate microbial and metabolomics profiles connecting to caries resistance and progression. The project examines the oral metabolome and microbiome profiles in families with high risk for dental caries.

Principal Investigator

Margaret Sällberg Chen

Collaborators

Rogier Gaiser, Göran Dahllöf, Monica Barr

Microbial markers in early pancreatic cancer and liver cancer

To investigate early biomarkers in pancreatic and liver cancer. The project aims at identifying early microbiome and metabolome alterations associated with development of pancreatic cancer and liver cancer in liquid and tissue biopsies.

Principal Investigator

Margaret Sällberg Chen

Collaborators

Hassan Alkharran, Liyan Lu, Rogier Gaiser, Haleh Davanian, Marco Del Chiaro, Soo Aleman, Vidya Velagapudi, Volkan Özneci

Redirection of cytotoxic T cells against virus-associated cancer

To develop T cell receptor-redirected T cell therapy against viral targets associated with cancer. In this project we develop vector systems to engineer antiviral and cytotoxic T cells from white blood cells from healthy blood donors or individuals at high risk for developing liver cancer. Methods we use include T cell receptor repertoire analysis and transfer, T cell functional analysis by flow cytometry and transcriptome profiling, and in vivo imaging to monitor target cell elimination.

Principal Investigator

Margaret Sällberg Chen

Collaborators

Katie Healy, Haleh Davanian, Soo Aleman, Antonio Bertoletti

Oral manifestations of chronic graft versus host disease (cGVHD)

Projects are focused on the complications that occur following hematopoietic stem cell transplantation, in particular cGVHD. Oral manifestations are one of the most common and debilitating complications and the histopathology poorly understood. Studies aim to define the cGVHD histopathological features and to couple them to clinical presentation, thereby providing improved overall diagnostics. Furthermore, biomarkers for diagnostic, prognostic or predictive purposes are crucially required as an adjunct to clinical and histological criteria, to allow classification of patients into risk groups, refine diagnosis, predict those at risk of developing cGVHD or estimate patient responses to therapy. The studies are also exploring the underlying disease mechanisms, which may help in the development of novel therapeutic approaches.

Principal Investigator

Rachael Sugars

Collaborators

Victor Tollemar, Karin Garming- Legert, Nikolce Tudzarovski, Gunnar Warfvinge, Robert Heymann, Katarina Le Blanc

Artificial intelligence (AI) driven digital pathology for the assessment of oral pathology tissues

Recent advancements in AI, in particular machine learning can now be accurately trained to perform challenging prediction tasks for medical image classification. These have the potential to rapidly become a complement to diagnostic pathology. Using our image analysis dataset we are exploring modern deep learning-algorithms that “learn” predictive models directly from the raw data (supervised learning) for feature recognition and histological patterning. The long-term goal of this project is to integrate all components of histological modules with disease pathophysiology, and prognostic/diagnostic biomarkers into an oral digital pathology platform.

Principal Investigator

Rachael Sugars

Collaborators

Nikolce Tudzarovski, Victor Tollemar, Karin Garming- Legert, Gunnar Warfvinge, Karl Meinke

Oral mucositis in patients treated with different chemotherapy regimens (adult and childhood cancer)

To investigate the incidence, severity and temporal relationship of oral mucositis inpatients treated with different chemotherapy regimens before allogeneic stem cell transplantation. Observational study Clinical management of oral manifestations.

Principal Investigator

Karin Garming- Legert

Collaborators

Göran Dahllöf, Moustapha Hassan

Dental anxiety in adults from the dental personnel’s perspective

To evaluate dental personnel´s ability to assess dental anxiety and to determine which factors affect the assessments, followed by evaluating a system for measuring dental anxiety in the clinical setting.

Ethical application is approved for the first enquiry study among Public dental care in Östergötland where data collection now is closed. Data is analysed for paper writing and the PhD-student will give a report on EAOM in September. An interview study to get a deeper understanding for the answers of the enquiry will start in the autumn of 2018.
Cooperation with The Public dental care in Östergötland, that economically supply the project.

Principal Investigator

Inger Wårdh

Collaborators

Markus Höglund, Mats Bågesund, Shervin Shahnavaz

Oral & Maxiollofacial Surgery

Antibiotic prophylaxis during invasive dental procedures for the prevention of infective endocarditis

Rational for endocarditis prohylaxis in dentistry. Role of viridans streptococci as a causative agent and the influence of restrictive approach.

Epidemiology

Patient quality register in research

Principal Investigator

Aron Naimi-Akbar

Collaborators

Niko Vähäsarja, Bodil Lund, Margareta Hultin, Anders Ternhag, Bengt Götrick

Patient value and health economic aspects of contemporary orthognathic surgery

The majority of malocclusions are managed with orthodontic treatment alone. At large skeletal malocclusions, a combination of orthodontic treatment and orthognathic surgery may be required to achieve a good and sustainable treatment outcome. Today a total of 900 orthognathic operations are performed annually in Sweden. Traditionally these patients have been admitted to hospital for 2–3 days. Current requirements on cost-effective health care and optimal resource utilization have led to the goal of conversion of some these treatments to outpatient surgery and applying the concept of reducing operation time and material costs. Today it is not known if this practice is as safe as in inpatient care or if the treatment is equally good, cost-effective and if the patients are just as satisfied.

This project aims at investigating if the adjustments of orthognathic surgery according to current demands are safe, provides patient satisfaction, and is cost-effective.

EP Dnr: 2017/594-31/2

Principal Investigator

Bodil Lund

Collaborators

Carina Pekkari, Agenta Marcusson, Thomas Davidsson

Prescription pattern and efficacy of short versus long-termed antibiotic prophylaxis during bone augmentation procedures

Bacteria’s resistance to antibiotics is an alarming and increasing problem world-wide seriously threatening modern health care. To date it is of outmost importance to minimize the antibiotic load in health care and dentistry. Therefore the efficacy of antibiotics used on indications based on tradition rather than scientific evidence, needs to be scrutinized. One such area of antibiotic utilization is prophylaxis during bone augmentation procedures in conjunction to oral implant therapy. This field of oral and maxillofacial surgery is currently totally devoid of studies both concerning prescription patterns but also regarding the clinical efficacy of this antibiotic utilization. Since this a common therapy in dentoalveolar surgery, the amount of antibiotics used on this indication may pose a significant contribution to the antibiotic consumption in dentistry. The aim of the project is to investigate the current antibiotic prescription pattern among dental implant surgeons performing bone augmentation procedures and to evaluate the microbiological consequences and the clinical effect of antibiotic prophylaxis.

EP Dnr: 2016/609-31

Principal Investigator

Bodil Lund

Collaborators

Fredrik Holmqvist, Margareta Hultin, Peter Svensson, Nikoo Bazsefidpay, Cecilia Larsson Wexell, Anna Hermansson

Tissue- and clinical characteristics of internal derangement of the temporomandibular joint internal derangement as basis for individual treatment planning, improvement of outcome and biomarkers for novel treatment alternatives

Internal derangements of the temporomandibular joint (TMJ) affects approximately 20% of the population. The main complaint is TMJ pain and impaired function including reduced mouth opening and inability to chew properly. The condition may present as a mechanical or inflammatory disturbance such as monoarthritis or systemic rheumatic disease affecting the TMJ, where it is very frequently observed that the TMJ does not respond to disease-modifying anti-rheumatic drugs (DMARDs). Patients not responding to conservative treatment may be subjected to surgery. The success rate for the TMJ surgery is approximately 80%. There are no means to individually predict the treatment out-come. The group not responding, or deteriorating, after surgical treatment, is largely uncharacterized. This group of patients is commonly resource demanding both for the health care system and for society.
The objective of the study is to characterize the TMJ patients clinically and tissue based to improve diagnostics, treatment planning, prediction of out-come and identify biomarkers for putative nonsurgical treatment alternatives.

EP Dnr: 2013/1575-31/3 and 2014/622-31/1

PrincipaI Investigator

Bodil Lund

Collaborators

Mattias Ulmner, Rachael Sugars, Carina Kruger Weiner

Geriatric Dentistry

The effect of polypharmacy on oral health in elderly people

The project aims to investigate the effects of xerostomic medications on oral health among older people. The ultimate goal is to develop a risk assessment tool for drug-induced adverse effects on oral health. Specifically we will:

  1. Develop risk scores for specific xerostomic medications for adverse effects on oral health in a patient cohort
  2. Apply and validate the risk scores in a general population of older people
  3. Validate the risk score versus clinical data from a dental quality register

PrincipaI Investigator

Gunilla Sandborgh Englund

Collaborators

Pia Skott, Kristina Johnell, Edwin Tan, Duangjai Lexomboon, Johan Fastbom, Maria Eriksdotter

Domiciliary professional oral care for dependent elderly – access to improved oral and general health?

The aim is to evaluate the effect of domiciliary oral care intervention for care dependent elderly, and to establish evidence based recommendations for domiciliary prophylactic professional oral care, a RTC-study where the intervention group is compared with care as usual, supplied with an observational study among the nursing staff. The project is registered in Clinical Trial, has two ethical approvals, one paper published and one poster presented at a congress. The project received SOF- money and dental hygienist Caroline Girestam received money from FTV Stockholm. Three master thesis have originated from the project and we plan for a continuing PhD-project.

PrincipaI Investigator

Inger Wårdh

Collaborators

Pia Skott, Caroline Girestam, Petteri Sjögren, Jesper Dalum

Objective and subjective masticatory performance in older individuals

A PhD-project

To understand which factors that affect an older individual’s objective and subjective masticatory performance and how they can be measured. The following studies are included: Systematic literature review and qualitative interview study, followed by studies where we use clinical collected data. A study protocol is published and two papers under preparation. The systematic review is registered in PROSPERO and the qualitative study has an ethical application approved. The qualitative data has also partly been a base for a master project. The PhD-student is planned to pass the halftime seminar during the end of the year 2018.

PrincipaI Investigator

Inger Wårdh

Collaborators

Per Stjernfeldt Elgestad, Gerd Faxén Irving, Anne-Marie Boström, Mats Trulsson

Oral Radiology

CBCT with ultra-low dose protocol in examination of alveolar bone defect in cleft lip and palate

Will CBCT with ultra-low dose protocol provide adequate information in order to assess necessary clinical questions in the region of the maxillary alveolar cleft compared to normal dose protocol? RCT The assessment of relevant information will be made by experienced specialists in dentomaxillofacial radiology, observational study. All patients with cleft involving the alveolar process, having treatment at Stockholm Craniofacial Centre Karolinska university hospital will be asked to participate in the study.

PrincipaI Investigator

Xie-Qi Shi

Collaborators

Daniel Benchimol, Agneta Karsten, Mattias Lemberger

Computational fluid dynamics study of the upper airway in children with orthodontic treatment

Application of CBCT on evaluation of orthodontic treatment outcome with special focus on changes of respiratory function. Lateral cephalogram CBCT. Rapid maxillary expansion Computational fluid dynamics analysis.

PrincipaI Investigator

Xie Qi Shi

Collaborators

Xin Feng, Xiuzhen Sun, Lin Liu

Potential benefit and radiation risk of cone beam computed tomography on children with impacted canines

  1. How much effective radiation doses do children receive during a CBCT examination?
  2. Do CBCT examinations provide more diagnostic information than 2D images, in regards to impacted canines?
  3. How is orthodontic treatment planning affected by additional information provided by CBCT examinations?

1. The assessment of the effective radiation dosage of CBCT on children, in comparison to 2D images, using a simulated child phantom.
2 + 3. Cross- Sectional Observational study.

Experienced radiology specialists will evaluate different diagnostic variables of impacted canines with and without CBCT images. A team of specialists in the fields of orthodontics, pedodontics and dentomaxillofacial radiology will assess differences in orthodontic treatment planning when provided with CBCT volumes.

PrincipaI Investigator

Xie Qi Shi

Collaborators

Georgios Tsilingaridis, Nils Kadesjö, Randi Lynds

Application of Color coding to enhance pathological changes between sequential 2D and 3D radiographs

To enhance contrast changes in color between radiographic examinations
Subtraction and color coding techniques for intraoral radiographs

PrincipaI Investigator

Xie-Qi Shi

The anatomic relationship between roots of upper posterior teeth and the maxillary sinus

A retrospective study of CBCT-volumes from a sample of a Belgian population analyzing the position of the posterior teeth in the maxilla in relation to the maxillary sinus. The relation will be evaluated in terms of distance between the roots and the maxillary sinus as well as the number of roots with a close relationship to the maxillary sinus.

PrincipaI Investigator

Daniel Benchimol and Reinhilde Jacobs

Collaborators

Tobias Regnstrand, Andres Torres

Prosthetic Dentistry

Optimization of masticatory function in people with dental implants

Develop clinical indicators of optimal rehabilitation and optimize chewing function in elderly rehabilitated with fixed implant prosthesis. Methodology involves measurements of jaw muscle activity, jaw movement kinematics, subjective assessment with Oral Health Impact Profile questionnaire and evaluation of cortical changes with Transcranial Magnetic Stimulation (TMS).

PrincipaI Investigator

Anastasios Grigoriadis

Collaborators

George Homsi, Abhishek Kumar, Peter Svensson, Mats Trulsson

Development of human jaw motor function

Characterizing the normal development of the neural sensory- motor mechanisms involved in the control of biting and chewing in humans.
Methodology includes measurements of bite forces, jaw muscle activity and jaw kinematics during chewing and eating of model food with different hardness, in children.

PrincipaI Investigator

Anastasios Grigoriadis

Collaborators

Nabeel Almotairy, Abhishek Kumar, Peter Svensson, Mats Trulsson

Sensorimotor control and relearning of mastication in oral rehabilitation

Pursue our analysis of the sensorimotor mechanisms controlling masticatory function, identify specific sensorimotor dysfunctions in rehabilitated patients, and initiate studies on motor relearning. Methodology include microneurography, measurement of bite forces, jaw muscle activity and jaw kinematics. Evaluation of chewing function with model food with different rheological properties and effect of training induced cortical plasticity with Transcranial magnetic stimulation (TMS).

PrincipaI Investigator

Mats Trulsson

Collaborators

Anastasios Grigoriadis, Joannis Grigoriadis, Abhishek Kumar, Peter Svensson

Cognitive changes and neural correlates after rehabilitation of mastication in older adults – an intervention study

To evaluate the association between masticatory function in elderly and neurocognitive function. Methodology include tests of cognitive performance and Brain imaging (fMRI) after oral rehabilitation.

PrincipaI Investigator

Mats Trulsson

Collaborators

Linn Hedberg, Pia Skott, Gunilla Sandborgh Englund, Urban Ekman, Eric Westman, Åke Seiger

Orofacial Pain & Jaw Function

Molecular biomarkers in saliva in health and pain states

Saliva contains an extensive collection of potential biomarkers that could play important roles for the pathophysiology of orofacial pain. Studies have suggested that peripheral release of 5HT and glutamate may be involved in the pathogenesis of chronic myalgia, including myofacial TMD. There is further evidence suggesting that 5-HT, nerve growth factor (NGF), substance P (SP), calcitonin gene-related peptide (CGRP) and brain derived neurotrophic factor (BDNF) saliva levels are increased in patients with chronic migraine and headache. The overall aim is to investigate if saliva can be used to sample algogenic substances that can serve as molecular biomarkers for diagnosing TMD.

PrincipaI Investigator

Malin Ernberg

Collaborators

Hajer Jasim, Bijar Ghafouri, Björn Gerdle, Britt Hedenberg-Magnusson

The role of the kynurenine pathway and oral microbiota in chronic myalgia

Whether the integrated mechanisms of tryptophan (TRP), kynurenine (KYN) and microbiota plays a role in chronic myalgia has not been investigated. This project therefore aims to investigate if a shift in the TRP metabolism and salivary microbiome participates in the pathogenesis of chronic myalgia. Due to its high comorbid nature, we hypothesize that there will be an increased upregulation of the KYN pathway in temporomandibular disorder myalgia (TMDM) and fibromyalgia (FM), diverging the TRP metabolism from 5-HT synthesis. Further, salivary microbiota in chronic myalgia will differ compared to controls, establishing specific microbiota in TMDM and FM. As a result this may propose, new potential biomarkers for the disorder.

PrincipaI Investigator

Malin Ernberg

Collaborators

Golnaz Barjandi, Britt Hedenberg-Magnusson, Eva Kosek, Sofie Erhardt, Georgios Belibasakis

Expression of pain receptors and proteomics in healthy and painful human muscle tissue

In this project pain receptors, their mRNA levels and the proteomic signature will be explored in muscle biopsies in healthy men and women, patients with chronic jaw myalgia (TMD) as well as in a human experimental study of muscle hyperalgesia (NGF-injection). The focus will be on co-expression of 5-HT3A-receptors and TTX-insensitive sodium channels (NaV1.8 a-subunit), NR2B-receptors and SP; and the expression of TrkA/B and TRPV1, as well as their mRNA levels and the protein pattern in the masseter muscle. Immunohistochemistry, in-situ hybridization and two-dimensional differential gel electrophoresis (2D-DIGE) with mass spectrometry for the identification of proteins will be used for the analyses.

PrincipaI Investigator

Nikolaos Christidis

Collaborators

Abdelrahman Alhilou, Brian Cairns, Malin Ernberg, Akiko Shimada

Sensory-motor regulation of human chewing and biting behavior in painful orofacial conditions

Many of the patients suffering from acute or chronic pain in the orofacial muscles or temporomandibular joints report impaired chewing, pain upon chewing, biting difficulties. Also, one of the treatment outcomes for this group is improved chewing/biting ability. Therefor this study will explore how acute or chronic pain in the orofacial muscles or temporomandibular joints affect the human biting and chewing behavior. The focus is on chewing performance as well as jaw motion during acute as well as chronic pain and to compare with healthy pain-free controls. The acute pain will be experimentally induced using intramuscular injections with hypertonic saline. And the chronic pain patients will have either a diagnosis of myalgia or arthralgia according to DC/TMD, a pain duration for at least 3 months and a pain intensity for at least NRS 3. A bite-force transducer will be used to assess both high forces as well as fine-motor function. A jaw tracker with an EMG recorder to assess muscle activity as well as jaw movements and the chewing performance by assessing the size of the parts remaining when the participant is satisfied with the chewing.

PrincipaI Investigator

Nikolaos Christidis

Collaborators

Samaa Al-Sayegh, Anastasios Grigoriadis, Krister Svensson, Abhishek Kumar, Lars Fredriksson, Annie Borgwardt

Evaluation of different treatment modalities in children with myalgia or arthralgia in the temporomandibular region – a randomized, single- blinded, controlled, multicenter study

One of the most commonly used treatments for TMD are occlusal appliances and the use of occlusal appliances in managing TMD pain is supported by evidence in the literature, but only for adults. In addition, there are no reports of if occlusal appliances affect the mandibular growth. In this randomized controlled study the effectiveness and of a soft occlusal appliance will be compared to standardized jaw exercises in children with TMD myalgia regarding pain-reduction and mandibular growth. Further, the effectiveness of the soft occlusal appliance will be compared to either standardized jaw exercises or non-steroidal anti-inflammatory drugs (NSAIDs) for treatment of TMJ arthralgia.

PrincipaI Investigator

Nikolaos Christidis

Collaborators

Ragdah Abduljabbar, Georgios Tsilingaridis, Britt Hedenberg-Magnusson, Agneta Karsten

Prediction of disease activity and temporomandibular joint involvement in patients with juvenile idiopathic arthritis

Evaluation of disease activity in children with juvenile idiopathic arthritis (JIA) is primarily based on clinical examination and conventional parameters of inflammation. However, having validated clinical tools is crucial since early detection of disease plays a significant role in successful clinical treatment and monitoring of the disease. In this project we will evaluate the potential usefulness of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD) in combination with panoramic and Computer Tomography (CT) imaging in monitoring disease activity and severity in Temporomandibular joint involvement in children and adolescents with JIA. We also aim to valuate if analyses of potential salivary biomarkers can be a useful tool in monitoring disease activity in JIA in general.

PrincipaI Investigator

Britt Hedenberg- Magnusson

Collaborators

Malin Collin, Nikolaos Christidis, Malin Ernberg

Pedagogy

Dental Students' Academic Writing

The aim of this project is to scrutinise Swedish dental students’ writing in academic setting: what these students are expected to read and write, how they are expected to do this, and for what purposes they read and write. For the overall project, the data produced are of three types: (i) curricular documents, including information given in study guides to the students; (ii) ethnographic data from lectures and clinical work (sound-recordings and field-notes during lectures, textbooks, hand-outs from the lectures, student notes from the given lectures, multiple-choice questions from the digital examination and clinical instructions); as well as (iii) interviews with students and teachers. Literacy events, i.e. what students read or write, and text-related communication are mapped throughout all activities (lectures, clinical work, and examinations). During clinical work, only field-notes were taken and only one of the researchers that also were teachers in the programme took the notes since clinical work also involves patients.

PrincipaI Investigator

Nikolaos Christidis

Collaborators

Viveca Lindberg, Sofia Louca Jounger, Maria Christidis