Clark's Technique Research Articles

N02 Our life is a roller-coaster! A qualitative phenomenological study exploring the impact of IBD on family members

Abstract Background IBD significantly impacts individuals’ and their family members’ physical, psychosocial and emotional wellbeing. These then reduce quality of life. Whilst there are studies exploring the impact of IBD on children and their families, little is known about the impact of IBD on family members of adults with IBD. This study explored the impact of IBD on family members of adults diagnosed with IBD, what coping strategies they use and what support they need to manage the psychosocial and emotional burdens associated with supporting patients in managing their IBD. Methods An interpretive phenomenological study conducted, using an individual in-depth, semi-structured online interviews via MS Team, Zoom, or telephone. The interviews were audio recorded and transcribed verbatim. An inductive and deductive reflexive thematic analysis followed the Braun and Clark technique. Results Forty-three participants, including 17 people with IBD and 26 family members (parents, children, siblings, partners), were purposively selected. Three main themes and accompanying subthemes were created: (1) “Life is a roller coaster” (2) “There have been a lot of bridges to cross along the way” and (3) “My life would be better if...” Participants revealed that the impact of IBD on family members has better and worse aspects in terms of emotional wellbeing, relationship, pressure around roles and responsibilities, day-to-day burden, and siblings’ suffering. Positive coping strategies such as creating meaningful social networks, learning through living with the condition, and open communication were used by some. However, many used negative coping strategies such as avoidance, denial, and “battling on” without asking for help. To mitigate the negative impact of IBD, many family members expressed the need for support. This included proactive and effective communication from healthcare professionals, referral to meaningful sources of information and support, and support groups. Conclusion IBD impacts the emotional and psychosocial wellbeing of family members in both positive and negative ways. Some family members were able to use positive coping strategies, however many developed negative coping which affected their daily life. Interventions that support families to communicate better about the impacts of the condition on their wellbeing and/or provide psychosocial support will help family members of people with IBD better cope with disease and have a more fulfilling life. Health professionals need to understand the impact of IBD on family members and support them to cope with the psychosocial and emotional demands of the condition as well as the physical implications.

Detection of vertical root fractures in the presence of artefacts by digital radiography and cone beam computed tomography

The correct diagnosis of vertical root fractures (VRF) in the presence of artifacts is a challenge for clinicians and endodontists. Moreover, there is controversy about which imaging technique is best for this purpose. In an in vitro model, we evaluated the diagnosis of VRF in teeth treated endodontically with and without intraradicular metal posts, using the Clark technique and cone beam computed tomography (CBCT), as well as the interference of artifacts with the diagnosis. Twenty-two first or second maxillary or mandibular premolars were included. Teeth were randomly allocated to three groups: G1 (two teeth without fracture with endodontic treatment and one with an intraradicular metal post); G2 (10 fractured teeth with endodontic treatment); and G3 (10 fractured teeth with endodontic treatment plus a metal post). The examiners recorded the presence or absence of fracture and its location and classified its type. There was no statistically significant difference between image acquisition systems. When differentiating the teeth (first vs. second premolars), there was a statistically significant difference among the examiners (p=0.020). However, when comparing the values obtained by the examiners regarding the visualization of the fracture site as well as the presence of fracture correlated with the presence of a metal post and angulation, there were no statistically significant differences (p>0.05). Digital radiographs and CBCT were similar for the diagnosis of VRF. High sensitivity was observed by CBCT image reconstructions. Therefore, the presence of metal posts generated artifacts, resulting in low sensitivity, specificity and accuracy.

Comparison of Vestibular Depth Relapse and Wound Healing After Reconstructive Preprosthetic Surgery Using Cryopreserved Amniotic Membrane and Acellular Dermal Matrix - A Comparative Study.

Introduction:The significance of membranes as wound dressing in oral surgeries has been reported by previous studies. The aim of the present split-mouth randomized clinical study was to assess and compare the wound dressing properties of acellular dermal matrix (ADM) and cryopreserved human amniotic membrane (AM) after reconstructive preprosthetic oral surgery.Materials and Methods:Twenty-eight patients with complete mandibular edentulism and resorbed alveolar bone were included. After taking mandibular impression, a clear acrylic splint with increased labial flange height was created. In each participant, labial vestibular depth was elevated using the Clark's technique. Subsequently, half of the exposed periosteum was covered with ADM while the other half was covered with cryopreserved human AM. Vestibule depth and relapse in the two sides were measured immediately after vestibuloplasty and at the end of the 1st week, 2nd week, 1st month, and 3rd months with graduations of 0.1 mm. Furthermore, after 3 and 7 days, samples were collected from graft material, and the macrophage population was analyzed by flow cytometry.Results:There was no significant difference in the relapse of vestibule depth between the two grafts at different time intervals. However, the frequency of wound-infiltrating macrophages (CD68+ cells) was significantly higher in areas covered by ADM after 3 and 7 days.Discussion:ADM is as effective as cryopreserved AM in terms of maintaining the postoperative vestibular depth. On the other hand, our results suggested that the onset of healing phase in ADM-covered areas occurs faster compared to the periosteum covered with cryopreserved human AM. This clinical trial showed significantly faster postoperative healing onset when ADM was used than when cryopreserved human AM was applied on the periosteum.

Comparison of vestibular sulcus depth in vestibuloplasty using standard Clark′s technique with and without amnion as graft material

Introduction:A number of materials are used as grafts in vestibuloplasty like mucosal and skin grafts with several advantages and disadvantages. To circumvent the disadvantages of these grafts, biological membranes such as amnion membranes are often recommended.Materials and Methods:The objective of this study was to clinically assess the vestibular sulcus depth in vestibuloplasty using Clark's technique with and without amnion as graft material. Twenty edentulous patients underwent mandibular labial vestibuloplasty using Clark's technique. Amnion was used as graft material in 10 patients (group I) and no grafts used in remaining 10 patients (group II). The vestibular depth was evaluated at time intervals of 1 week, 2 weeks, 1 month and 3 months, postoperatively.Results:Mean postoperative vestibular depth after 3 months in group I and II were 10.0 ± 3.13 mm and 7.8±0.63 mm, respectively. Mean of 2.2 ± 2.50 mm increase in depth was achieved after 3 months in Group I.Conclusion:Amnion graft is a viable and reliable option that promotes early healing and maintains postoperative vestibular depth.

Vestibuloplasty: allograft versus mucosal graft

The aim of the present study was to compare the application of alloderm and mucosal graft for vestibuloplasty. This randomized controlled trial with split mouth design was carried out on 20 edentulous patients. Patients underwent vestibuloplasty surgery with the Clark technique. Half of the prepared bed in each patient was covered with alloderm and the other half with mucosal graft. Vestibule depth (width of fixed tissue) and relapse in the two sides immediately after surgery, and 1, 3 and 6 months after surgery were measured and compared. Statistical analysis was carried out using the Kolmogorov–Smirnov, Student's paired t and Friedman tests. The width of the fixed tissue in the alloderm graft at 1, 3 and 6 month intervals was significantly lower than that in the autograft (P<0.05). The difference in relapse between the two grafts was not statistically significant at any time. The results of the study suggest that alloderm is as effective as mucosal grafts in vestibuloplasty.

Use of amnion as a graft material in vestibuloplasty: a clinical study

The need to cover the exposed periostium has meant that a number of materials including mucosal and skin grafts are regarded as suitable for grafting in oral and maxillofacial surgery. To circumvent the disadvantages of other materials such as skin, biological membranes have been suggested as options, including fetal membrane. The objective of the present study was to evaluate the clinical efficacy of amnion as a graft material for vestibuloplasty, to increase the depth of the sulcus for complete rehabilitation with dentures in 10 patients with a follow up period of 3 months. Ten patients with deficient depth of the mandibular vestibular sulcus who were referred from the Department of Prosthodontics were listed for mandibular labial vestibuloplasty using Clark's technique followed by grafting with amnion over the denuded periostium. The vestibular depth was evaluated at the end of the 1st week, 2nd week, 4th week, and 3rd month postoperatively, and compared with the preoperative vestibular depth. We had no cases of graft necrosis either complete or partial. However, the reduction in the depth of the labial vestibule ranged from 17% to 50% after 3 months’ follow up. A mean (SD) labial vestibular depth of 13.3 (1.8)mm was achieved immediately postoperatively, and 10.0 (3.1)mm at 3 months’ follow up. We conclude that grafts of amniotic membrane are viable and reliable for covering of the raw surface, prevent secondary contraction after vestibuloplasty, and maintain the postoperative vestibular depth.

Effectiveness of Human Amnion as a Graft Material in Lower Anterior Ridge Vestibuloplasty: A Clinical Study

The aim of this study is to evaluate the clinical use of amnion as a biodegradable graft material for lower anterior ridge vestibuloplasty. Ten patients who had been referred for preprosthetic surgery underwent mandibular anterior ridge vestibuloplasty using Clark's technique and amniotic membrane as a graft material. Preoperative vestibular depth was measured. Fresh amniotic membrane was placed in the surgical site and sutured with 4-0 vicryl. In all ten cases suction catheter stent was used and was secured in the depth of the vestibule by using 1-0 mersilk percutaneous sutures. Vestibular depths were measured using a divider and a scale. Post operative measurements were taken at the end of 10th day, 1st month and 3rd month. And an average gain of 4-6mm in the depth of the labial vestibule was noted. Amniotic membrane can be a favorable graft material for vestibuloplasty, promoting healing and preventing relapse. It is easily available and preserved and a cost effective material.

Finite difference procedures for solving a problem arising in modeling and design of certain optoelectronic devices

Several finite difference schemes are discussed for solving the two-dimensional Schrodinger equation with Dirichlet’s boundary conditions. We use three fully implicit finite difference schemes, two fully explicit finite difference techniques, an alternating direction implicit procedure and the Barakat and Clark type explicit formula. Theoretical and numerical comparisons between four families of methods are described. The main advantage of the alternating direction implicit finite difference technique is that the bandwidth of the sets of equations is a fixed small number that depends only on the nature of the computational molecule. This allows the use of very efficient and very fast techniques for solving the resulting tridiagonal systems of linear algebraic equations. The unique advantage of the Barakat and Clark technique is that it is unconditionally stable and is explicit in nature. Numerical results are presented followed by concluding remarks.

Use of amnion as a graft material in vestibuloplasty: a preliminary report

Objective The aim of this study was to evaluate the clinical use of amnion as a biodegradable graft material for vestibuloplasty. Study design Seven subjects who had been referred for preprosthetic surgery underwent mandibular vestibuloplasty using Clark's technique and amnion as graft material. Fresh amniotic membrane was placed in the area and an acrylic splint was used with soft liner and 0.4-mm wires to cover the surgical site. The area was reexamined after 1 week, 2 weeks, 4 weeks, 3 months, and 6 months. Results A white necrotic soft tissue layer could be seen with underlying hyperemic tissue and an average reduction of 1 to 3 mm in the depth of the labial vestibule after a week. By the end of the second week, the necrotic layer had disappeared, leaving slightly hyperemic mucosal tissue under. By the third week, the graft area could be noticed but the amnion had completely degenerated and disappeared. After 4 weeks, the subjects could be referred for their prosthodontic treatment. The reduction in the depth of the buccal vestibule ranged from 17% to 40% after 6 months' follow-up. Conclusion Amnion might be used as a potential graft material for vestibuloplasty.

Comparative evaluation ofcontraction and sulcus depth achieved by Clark's technique vestibuloplasty operations using full-thickness skin grafts and solvent dehydrated human pericardium

Comparative evaluation ofcontraction and sulcus depth achieved by Clark's technique vestibuloplasty operations using full-thickness skin grafts and solvent dehydrated human pericardium

Depigmentation: Its significance in patients with melanoma

Malignant melanoma is the leading cause of death from tumors of the skin, and its incidence is rising at an alarming rate.1,2 The American Cancer Society estimated that melanomas account for 1–2% of all cancer deaths.3 The prognosis for a malignant melanoma is directly related to the thickness of the tumor as measured by the Breslow or Clark technique.4 Although the incidence of melanoma has increased, fortunately there also has been an improved survival rate. Patients with clinical stage 1 disease (no clinical evidence of tumor in regional lymph nodes) and a tumor depth of less than 0.75 mm have a 95–100% 5-year survival rate5 if the malignancy is properly excised. The improvement in cure rates or longer survivals probably results from earlier diagnosis made possible by public awareness campaigns, rather than from advances in medical or surgical therapy.62,73 Those patients with a deep tumor and/or advanced disease (stage 2, regional lymph node metastases; stage 3, distal metastases) have a dismal prognosis. Treatment of patients with metastatic melanoma is disappointing. Surgical ablation of tumor in regional lymph nodes (clinical stage 2) gives a 20% 5-year survival rate, but even these patients cannot be assured of a cure. Melanomas can recur as long as 20 years after excision.There have been numerous isolated reports of depigmentation occurring in association with cutaneous or ocular melanomas.8–18 This is a rather paradoxical association. Melanoma is an uncontrolled proliferation of malignant melanocytes. In contrast, depigmentation is an abnormal destruction of benign melanocytes. That the two phenomena occur together has attracted attention in recent years.20–23 It has been suggested that patients with metastatic disease who develop a vitiligo-like depigmentation survive for longer periods than might ordinarily be expected. This observation led to speculation that induction of vitiligo might be considered after resection of the primary melanoma to prevent metastases and to enhance survival.24In this chapter, the literature on the subject of melanoma and depigmentation is reviewed. Also, the question of whether their joint occurrence influences the longevity of survival is examined. Various examples of similar observed phenomena within the animal kingdom are reviewed. Lastly, some attempt is made to explain the pathogenesis of this interesting phenomenon.