Biomedical subjects

Randall J Harris

Publications and source records attributed to Randall J Harris.

15 recordsLinked to original sources

PubMed2005

A comparison of three techniques to obtain root coverage on mandibular incisors.

BACKGROUND: Multiple variations on the subepithelial connective tissue graft have been shown to produce good clinical results. The goal of this study was to compare three variations in the treatment of recession on mandibular incisors. METHODS: An a priori analysis was done to determine the sample size. Three groups of patients received root coverage procedures on mandibular incisors. Each group was treated with a different variation of a subepithelial graft. The first group received a connective tissue (CT) graft with a coronally positioned flap (CPF) (CPF + CT). The second group received a connective tissue graft with a double pedicle (DP) graft (DP + CT). The third group received a connective tissue graft with a tunneling (TUN) procedure and a laterally positioned (LAT) pedicle (TUN-LAT + CT). The clinical results of these procedures were compared to determine if one procedure offered an advantage over the other procedures. RESULTS: All of the procedures produced a statistically significant improvement in the clinical parameters. The groups treated with the DP + CT and TUN-LAT + CT had greater mean root coverage (95.5% and 90.5%, respectively) than the CPF + CT group (80.2%). Additionally, DP + CT produced a greater increase in keratinized tissue (3 mm) than CPF + CT (1.4 mm) or TUN-LAT + CT (1.9 mm). There was no statistically significant difference in the mean root coverage of any technique treating defects <3 mm deep (CPF + CT, 90.9%; DP + CT, 96.4%; and TUN-LAT + CT, 92.1%) or the defects >3 mm deep treated with DP + CT (95.4%) or TUN-LAT + CT (88.3%). However, the CPF + CT produced less mean root coverage (68.4%) when treating defects > or =3 mm deep. When defects treated as isolated defects were compared to cases where multiple defects were treated, the cases with multiple defects treated with the CPF + CT had less mean root coverage (77%) than cases where single defects were treated with the CPF + CT (90.3%), DP + CT (isolated, 96.7% and multiple, 95.6%), and TUN-LAT + CT (isolated, 97.2% and multiple, 87.8%). CONCLUSIONS: All three of the procedures were effective in obtaining root coverage and improved clinical parameters on mandibular incisors. Overall, the DP + CT and TUN-LAT + CT procedures had greater mean root coverage than the CPF + CT technique. Based on this study, when treating defects > or =3 mm deep, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. Additionally, when treating multiple defects at a time, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. In cases where an increased amount of keratinized tissue is desired, based on this study, the DP + CT may be the best procedure to use.

Adult↗

PubMed2005

Complications with surgical procedures utilizing connective tissue grafts: a follow-up of 500 consecutively treated cases.

The goal of this study was to evaluate the incidence and severity of the complications that occur after connective tissue grafts are used. Five hundred consecutively treated patients, for whom connective tissue grafts were used for root coverage or gingival augmentation, were included in this study. Complications did occur, but the rates and intensities seemed clinically acceptable. There was no pain reported in 81.4% of the patients, no bleeding in 97.0% of the patients, no infection in 99.2% of the patients, and no swelling in 94.6% of the patients. None of the factors evaluated in this study were associated with a statistically significant increase in the rate or intensity of complications. These factors included: age, sex of patient, smoking status, purpose of the graft (ie, for root coverage or for gingival augmentation), size of the recipient area, and the location of the defect being treated. Based on the results of this study, the incidence and severity of complications seemed to be clinically acceptable.

Adolescent↗

PubMed2004

Clinical evaluation of a composite bone graft with a calcium sulfate barrier.

BACKGROUND: The goal of this study was to evaluate the effectiveness of a composite bone graft (demineralized freeze-dried bone allograft, calcium sulfate, tetracycline, and porous hydroxyapatite) and calcium sulfate barrier to treat non-furcation osseous defects. METHODS: One hundred patients were treated with the technique. The preoperative measurements were compared to the postoperative measurements (mean 5.2 months) to determine whether the technique had a statistically significant effect. Various factors were evaluated to determine whether they could be related to improved or diminished results. RESULTS: The surgical procedure produced a statistically significant change in the clinical measurements. The mean recession increased from 0.8 to 1.8 mm; the mean probing depth decreased from 8.5 to 3.8 mm; and the attachment level improved from 9.3 to 5.5 mm. Non-smokers, defects in the mandibular arch, defects with deeper probing depths, or defects with greater attachment loss had statistically significant changes in one or more of the clinical parameters evaluated. CONCLUSION: The technique examined in this study (composite bone graft + calcium sulfate barrier) was an effective method to improve the clinical measurements.

Adult↗

PubMed2004

A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft.

BACKGROUND: Obtaining predictable and esthetic root coverage has become important. Unfortunately, there is only a limited amount of information available on the long-term results of root coverage procedures. The goal of this study was to evaluate the short-term and long-term root coverage results obtained with an acellular dermal matrix and a subepithelial graft. METHODS: An a priori power analysis was done to determine that 25 was an adequate sample size for each group in this study. Twenty-five patients treated with either an acellular dermal matrix or a subepithelial graft for root coverage were included in this study. The short-term (mean 12.3 to 13.2 weeks) and long-term (mean 48.1 to 49.2 months) results were compared. Additionally, various factors were evaluated to determine whether they could affect the results. This study was a retrospective study of patients in a fee-for-service private periodontal practice. The patients were not randomly assigned to treatment groups. RESULTS: The mean root coverages for the short-term acellular dermal matrix (93.4%), short-term subepithelial graft (96.6%), and long-term subepithelial graft (97.0%) were statistically similar. All three were statistically greater than the long-term acellular dermal matrix mean root coverage (65.8%). Similar results were noted in the change in recession. There were smaller probing reductions and less of an increase in keratinized tissue with the acellular dermal matrix than the subepithelial graft. None of the factors evaluated resulted in the acellular dermal graft having a statistically significant better result than the subepithelial graft. However, in long-term cases where multiple defects were treated with an acellular dermal matrix, the mean root coverage (70.8%) was greater than the mean root coverage in long-term cases where a single defect was treated with an acellular dermal matrix (50.0%). CONCLUSIONS: The mean results with the subepithelial graft held up with time better than the mean results with an acellular dermal matrix. However, the results were not universal. In 32.0% of the cases treated with an acellular dermal matrix, the results improved or remained stable with time.

Adult↗

PubMed2004

Gingival augmentation with an acellular dermal matrix: human histologic evaluation of a case--placement of the graft on periosteum.

The goal of this case report is to evaluate the effectiveness of gingival augmentation with an acellular dermal matrix. The acellular dermal matrix was placed on a periosteal bed. Clinically, the procedure did not result in an increase in the amount of keratinized tissue. There was an increase in the tissue bulk, but the importance of this increase is unknown. Histologic evaluation revealed that the acellular dermal matrix did not slough and was involved in healing. Based on this evaluation, the technique of placing an acellular dermal matrix on a periosteal bed does increase the bulk of tissue in the area. However, the procedure does not seem to be an effective method to increase the amount of keratinized tissue.

Aged↗

PubMed2003

Untreated periodontal disease: a follow-up on 30 cases.

BACKGROUND: Many studies have shown that periodontal disease can be successfully treated. However, there is limited documentation as to what happens when periodontal disease is left untreated. This study examined patients in a private practice who were diagnosed with periodontal disease and did not complete any treatment. The goal was to see what happened to this group of untreated patients. METHODS: Thirty patients with periodontal disease were included in this study. After a mean period of 2.1 years without periodontal treatment, the patients were re-examined and the changes which occurred evaluated. RESULTS: There was a statistically significant increase in probing depth (3.43 mm to 3.95 mm) and attachment loss (4.19 mm to 4.77 mm) and a statistically significant decrease in the number of teeth present (23.37 to 22.67). Twenty-one teeth were lost, which was 3.0% of the teeth present at the time of initial diagnosis. The rate of tooth loss was 0.32 teeth/patient/year. The teeth that were lost had deeper recession, probing depths, and attachment loss than the teeth that were retained. Patient factors evaluated could not be associated with statistically significant changes in the clinical parameters, except that smokers had a greater number of sites gaining > or = 2 mm of attachment and patients with the poorest oral hygiene had a greater percent of sites breaking down. However, certain site specific variables could be associated with statistically significant changes in the clinical parameters. These included sites: with bleeding on probing, associated with molar furcations, on interproximal surfaces, at posterior teeth, with probing depths > or = 3.43 mm, with probing depths > or = 7 mm, attachment loss > or = 7 mm, and teeth with increased mobility. CONCLUSIONS: This group of patients with untreated periodontal disease had greater breakdown and tooth loss than one would expect to see in a group of patients if their periodontal disease was treated.

Adult↗

PubMed2003

Root coverage in molar recession: report of 50 consecutive cases treated with subepithelial connective tissue grafts.

BACKGROUND: The purpose of this study was to evaluate root coverage of molar recession defects. METHODS: Fifty patients with a molar recession defect on one molar were treated with a subepithelial connective tissue graft. The procedure was performed as previously reported. RESULTS: Complete root coverage was obtained in 29 of the 50 defects (58%). A mean root coverage of 91.1% was obtained. There was a statistically significant decrease in recession depth (4.4 mm to 0.5 mm), increase in quantity of keratinized tissue (0.9 mm to 3.1 mm), decrease in probing depth (3.0 mm to 2.3 mm), and decrease in attachment level loss (7.4 mm to 2.8 mm). CONCLUSION: The subepithelial connective tissue graft is an effective method to obtain root coverage of recession defects on molars.

Adult↗

PubMed2003

Soft tissue ridge augmentation with an acellular dermal matrix.

The goal of this case report was to evaluate the use of an acellular dermal matrix for soft tissue ridge augmentation. The technique used was a modification of the procedure proposed by Langer and Calagna and involved reflecting a partial-thickness pedicle, placing an acellular dermal matrix, and covering the acellular dermal matrix with the pedicle. The increases in the quantity of tissue obtained were adequate to permit placing an esthetic fixed restoration in four of the five cases treated. In one of the five cases, the acellular dermal matrix became exposed and partially sloughed. This resulted in less of an increase in tissue than in the other cases. Histologic evaluation of this case showed that the entire acellular dermal matrix did not slough; part of the acellular dermal matrix was incorporated into the result. The use of an acellular dermal matrix for soft tissue ridge augmentation is a clinically valuable technique.

Adult↗

PubMed2003

Histologic evaluation of connective tissue grafts in humans.

The goal of this study was to evaluate the histologic composition of connective tissue grafts removed from the area palatal of the first molar through the premolars. In spite of attempts to remove the epithelium, it remained in 24 of 30 grafts (80%). The incisal portion of the connective tissue graft was comprised of lamina propria. The mean depth of the lamina propria was 3.2 mm (65.2% of the graft). Apical to the lamina propria was the submucosa, which was primarily composed of adipose tissue. The mean depth of the submucosa was 2.0 mm (34.8% of the graft). There was no statistically significant difference in the composition of the grafts based on smoking or age. The grafts were successful in producing root coverage. There were 27 patients with Class I or II recession defects in this study; this group had a mean root coverage of 97.9%. This study demonstrated that most connective tissue grafts are not uniform in composition and quite often contain some epithelium. However, all of the grafts were clinically usable and produced a clinically successful result.

Adipose Tissue↗

PubMed2002

Formation of a cyst-like area after a connective tissue graft for root coverage.

BACKGROUND: Many techniques have been developed to obtain root coverage. There have been few complications reported with these techniques. This case report chronicles the development of a cyst-like area after a connective tissue partial-thickness double pedicle graft was used to obtain root coverage. METHODS: The root coverage procedure was performed as previously reported. Postoperatively, in the surgical area, the patient developed occasional swelling. It was possible to express a white material from the area. A biopsy was taken to determine the cause of the clinical findings. RESULTS: Histological evaluation revealed the development of a cyst-like area. CONCLUSION: The development of cysts does not seem to be a common event. However, this case report demonstrates that they are a possible complication of root coverage procedures.

Adult↗

PubMed2002

Root coverage with connective tissue grafts: an evaluation of short- and long-term results.

BACKGROUND: Subepithelial connective tissue grafts have been shown to be effective in obtaining root coverage. However, little is known about the long-term results. The goal of this study was to evaluate and compare the short-term (13.0 weeks) and long-term (27.5 months) root coverage results obtained with subepithelial connective tissue grafts. METHODS: One-hundred patients with 146 Miller Class I or Class II recession defects were treated with subepithelial connective tissue grafts to obtain root coverage. The changes in the clinical measurements were compared between the preoperative and short-term results, between preoperative and long-term results, and between short-term and long-term results. RESULTS: The mean root coverage at 13.0 weeks was 97.1% and 98.4% at 27.5 months. This difference was statistically significant. There was a statistically significant decrease in recession and probing depth, reduction in attachment loss, and increase in quantity of keratinized tissue between the preoperative and short-term results and between the preoperative and long-term results. There was a statistically significant decrease in recession, increase in the quantity of keratinized tissue, increase in probing depth, and increase in attachment loss between short-term and long-term results. CONCLUSIONS: The results of this study demonstrate that the subepithelial connective tissue graft is an effective method to cover exposed roots. The mean root coverage tended to improve with time.

Adolescent↗

PubMed2002

GTR for root coverage: a long-term follow-up.

The purpose of this study was to evaluate the long-term stability of the results obtained when guided tissue regeneration (GTR) is used to obtain root coverage. A mean root coverage of 92.3% was obtained at 6 months postoperative. However, at the final postoperative visit (mean 25.3 months), the mean root coverage was reduced to 58.8%. This difference was statistically and clinically significant. There was a statistically significant increase in recession (1.4 mm) and a statistically significant loss in attachment levels (1. 7 mm) between the 6-month and final postoperative evaluations. The results of this study question the long-term stability of the result when GTR is used for root coverage.

Adult↗

PubMed2002

Cellular dermal matrix used for root coverage: 18-month follow-up observation.

The goal of this study was to evaluate the long-term stability of the root coverage results obtained with an acellular dermal matrix. The mean root coverage at 12 weeks postoperative was 91.7%. The mean root coverage at the final postoperative evaluation (mean 18.6 months) was 87.0%. This difference was not statistically or clinically significant. The root coverage results obtained with an acellular dermal matrix were predictable, esthetic, and stable over time.

Adult↗

PubMed2002

Treatment of furcation defects with an allograft-alloplast-tetracycline composite bone graft combined with GTR: human histologic evaluation of a case report.

The purpose of this study was to histologically evaluate furcation defects in humans treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for guided tissue regeneration (GTR). Three teeth with Class II furcation involvement on the buccal aspects were included in this study. A notch was placed in calculus during the procedure to serve as a reference point for histologic evaluation. The defects were then treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for GTR. At 6 months postoperative, the teeth were extracted with conservative block sections and processed for histologic evaluation. Regeneration (new bone, cementum, and connective tissue attachment) coronal to a notch could be seen in one of the three defects treated. In the other two defects, a new connective tissue attachment was demonstrated (new connective tissue attachment into new cementum) in the notch placed in calculus. In this study, regeneration of a furcation defect in a human was documented with histology.

Absorbable Implants↗

PubMed2002

Connective tissue grafts combined with either double pedicle grafts or coronally positioned pedicle grafts: results of 266 consecutively treated defects in 200 patients.

The purpose of this study was to evaluate two variations of the subepithelial graft. Two hundred consecutively treated patients received subepithelial grafts to obtain root coverage. One hundred patients were treated with connective tissue grafts combined with double pedicle grafts. The other 100 patients were treated with connective tissue grafts combined with coronally positioned pedicle grafts. The mean root coverages were 97.6% and 96.1%, respectively. When the overlying pedicle was a double pedicle, there was a larger increase in the amount of keratinized tissue (3.0 mm versus 1.8 mm). When the preoperative recession depth was 5.0 mm or greater and a connective tissue graft was combined with a coronally positioned pedicle, there was less mean root coverage. The results of this study confirm that the subepithelial graft is an effective method to obtain root coverage. Additionally, the type of pedicle used to cover the connective tissue graft can affect the results.

Adolescent↗