- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02720016
Cognitive-Behavioral Conjoint Therapy (CBCT) Project (CBCT)
An Integrative Technology Approach to Home-based Conjoint Therapy for PTSD
Study Overview
Status
Conditions
Detailed Description
Anticipated Impact on Veterans' Healthcare: This project addresses the mental health and functioning needs of Veterans and their families by increasing the access to an established treatment using telemental health technology.
Project Background: Veterans and their families experience the deleterious effects of posttraumatic stress disorder (PTSD) and associated negative sequelae. PTSD is related to a variety of comorbid mental health symptomatology and psychosocial impairment, including high rates of intimate relationship problems which impact Veterans' recovery and functioning. Despite available couple-based interventions, barriers to care such as stigma regarding mental health treatment, travel time to receive care, and transportation costs, make it difficult for Veterans and their families to access specialty PTSD treatments necessary for rehabilitation. Home-based clinical video teleconferencing (CVT) delivers specialized mental health treatments to clients in the ease of their own home, which allows clinicians to directly observe the client's home environment and family milieu. Cognitive-Behavioral Conjoint Therapy (CBCT), a couple-based treatment designed to target PTSD symptoms and improve individual and relationship functioning, has shown evidence of improvements in clinical symptom outcomes in research conducted with Veterans and their partners.
Project Objectives: This is a 4-year randomized controlled trial. The primary objective of this study is to compare the clinical efficacy (PTSD symptoms, relationship distress, and functional impairment) of CBCT delivered via an office-based (CBCT-OB) or a home-based CVT (CBCT-HB) delivery modality to the PTSD Family Education control condition (PFE). In addition, this study will estimate and compare the difference in clinical efficacy between CBCT delivered via an office-based (CBCT-OB) or a home-based CVT (CBCT-HB) delivery modality if indicated by results of the primary objective. This study will also compare process outcomes (therapeutic alliance, enrollment and dropout rates, and treatment satisfaction) for CBCT-OB, CBCT-HB, and PFE.
Project Methods: Participants will be 180 intent-to-treat couples in which one partner is a PTSD-positive Veteran. Couples will be randomly assigned to receive treatment through one of the three treatment delivery modalities: CBCT-OB, CBCT-HB or PFE. Assessments will be conducted at baseline, mid- and post-treatment, and 3- and 6-months post-treatment. The primary outcome variables of clinical efficacy will be measures of PTSD symptom severity, relationship distress, and functional impairment. Secondary outcome variables include PTSD diagnostic status, self- reported PTSD symptoms, depression, anger, and relationship conflict. Additionally, primary process outcomes will include measures of treatment retention, attendance, therapeutic alliance, and treatment satisfaction. Variability in scores for each of the primary and secondary outcome measures will be examined individually in a series of separate multilevel models. The results will provide evidence that can be used to further increase the clinical efficacy, ease of access to, and utilization of specialty PTSD treatment to Veterans and their families.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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San Diego, California, United States, 92161
- VA San Diego Healthcare System, San Diego, CA
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Be a Veteran (age 18 or older) with a current Diagnostic and Statistical Manual-5 (DSM-5) diagnosis of PTSD (as assessed by the CAPS) no less than 3 months after the index trauma occurred (to allow for potential natural recovery)
- Be on a stable psychoactive medication regimen for at least 2 months (if eligible)
- Be an intimate partner (age 18 or older) who is willing to participate in the intervention.
- Be randomized into any of the three treatment conditions
- Have assessment and treatment sessions audio recorded
- Agree not to receive other individual or conjoint psychotherapy for PTSD during the treatment portion of the study
- Consistent with home-based clinical trials and actual clinical practice
Participants enrolled into the study will need to have access to internet via Digital Subscriber Line (DSL) or a cable provider in case they are randomized into the home-based condition.
- The frequency of occurrence of no internet service will be tracked
- If the PTSD-positive Veteran is currently receiving treatment at the VA, study staff will consult with their primary clinician prior to their inclusion in the study
Exclusion Criteria:
- Current substance dependence in either member of the couple not in remission for at least 3 months, as assessed by the Alcohol Use Disorders Identification Test (AUDIT)108 and Drug Abuse Screening Test (DAST)
- Any current uncontrolled psychotic disorder in either member of the couple
- Imminent suicidality or homicidality in either member of the couple
- Any severe cognitive impairment in either member of the couple
Any perpetration of severe physical or sexual relationship aggression in the past year (as assessed by the Conflict Tactics Scale-2 [CTS-2]).
- Participants who do not meet study criteria will be offered referrals to alternate services, as well as assistance in contacting the referral sites as needed
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: CBCT-Home Based (CBCT-HB)
Couples in CBCT-HB will receive 8 sessions of standardized Cognitive-Behavioral Conjoint Therapy (CBCT), a manualized couple-based intervention for PTSD designed to simultaneously reduce PTSD and enhance relationship and functioning.
The psychotherapy is administered over 8 to 15 weeks to the Veterans home via home-based clinical video teleconferencing (CVT).
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Couples in CBCT-HB will receive 8 sessions of standardized Cognitive-Behavioral Conjoint Therapy (CBCT), a manualized couple-based intervention for PTSD designed to simultaneously reduce PTSD and enhance relationship and functioning.
The psychotherapy is administered over 8 to 15 weeks to the Veterans home via home-based clinical video teleconferencing (CVT).
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Active Comparator: CBCT-Office Based (CBCT-OB)
Couples in CBCT-OB will receive 8 sessions of standardized Cognitive-Behavioral Conjoint Therapy (CBCT), a manualized couple-based intervention for PTSD designed to simultaneously reduce PTSD and enhance relationship and functioning.
The psychotherapy is administered over 8 to 15 weeks in-person in the therapist's office.
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Couples in CBCT-OB will receive 8 sessions of standardized Cognitive-Behavioral Conjoint Therapy (CBCT), a manualized couple-based intervention for PTSD designed to simultaneously reduce PTSD and enhance relationship and functioning.
The psychotherapy is administered over 8 to 15 weeks in-person in the therapist's office.
|
Active Comparator: PTSD Family Education (PFE)
Couples in the PFE condition will receive 8 sessions of standardized PTSD Family Education, a manualized psychoeducational program designed to help couples learn more about posttraumatic stress disorder and related difficulties.
This psychotherapy is administered over 8 to 15 weeks and is delivered in-person in the therapist's office.
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Couples in the PFE condition will receive 8 sessions of standardized PTSD Family Education, a manualized psychoeducational program designed to help couples learn more about posttraumatic stress disorder and related difficulties.
This psychotherapy is administered over 8 to 15 weeks and is delivered in-person in the therapist's office.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinician Administered PTSD Scale (CAPS)
Time Frame: Baseline
|
The CAPS-5 is a 30-item clinician administered interview designed to diagnose current and lifetime PTSD and to assess PTSD symptom-severity over the past week. The interview assesses 20 DSM-5 PTSD symptoms as well as onset, duration, distress, and functional impact, overall validity, PTSD severity, and presence of dissociation. Prior to assessing symptoms, the clinical interviewer works with the patient to establish an index-trauma and each follow-up question focuses on symptoms as they relate to the index trauma. *Score range: 0-80 with higher score indicating greater symptom severity |
Baseline
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Clinician Administered PTSD Scale (CAPS)
Time Frame: 1 Month Post Treatment
|
The CAPS-5 is a 30-item clinician administered interview designed to diagnose current and lifetime PTSD and to assess PTSD symptom-severity over the past week. The interview assesses 20 DSM-5 PTSD symptoms as well as onset, duration, distress, and functional impact, overall validity, PTSD severity, and presence of dissociation. Prior to assessing symptoms, the clinical interviewer works with the patient to establish an index-trauma and each follow-up question focuses on symptoms as they relate to the index trauma. *Score range: 0-80 with higher score indicating greater symptom severity |
1 Month Post Treatment
|
Clinician Administered PTSD Scale (CAPS)
Time Frame: 3-Months Post Treatment
|
The CAPS-5 is a 30-item clinician administered interview designed to diagnose current and lifetime PTSD and to assess PTSD symptom-severity over the past week. The interview assesses 20 DSM-5 PTSD symptoms as well as onset, duration, distress, and functional impact, overall validity, PTSD severity, and presence of dissociation. Prior to assessing symptoms, the clinical interviewer works with the patient to establish an index-trauma and each follow-up question focuses on symptoms as they relate to the index trauma. *Score range: 0-80 with higher score indicating greater symptom severity |
3-Months Post Treatment
|
Clinician Administered PTSD Scale (CAPS)
Time Frame: 6- Months Post Treatment
|
The CAPS-5 is a 30-item clinician administered interview designed to diagnose current and lifetime PTSD and to assess PTSD symptom-severity over the past week. The interview assesses 20 DSM-5 PTSD symptoms as well as onset, duration, distress, and functional impact, overall validity, PTSD severity, and presence of dissociation. Prior to assessing symptoms, the clinical interviewer works with the patient to establish an index-trauma and each follow-up question focuses on symptoms as they relate to the index trauma. *Score range: 0-80 with higher score indicating greater symptom severity |
6- Months Post Treatment
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Couples Satisfaction Index (CSI)
Time Frame: Baseline
|
The Couples Satisfaction Index is a 32-item self-report survey assessing several domains of relationship satisfaction.
Higher sum scores (range 0 to 161) represent higher relationship satisfaction.
|
Baseline
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Couples Satisfaction Index (CSI)
Time Frame: Mid Treatment (Approximately week 5 of all treatment conditions)
|
The Couples Satisfaction Index is a 32-item self-report survey assessing several domains of relationship satisfaction.
Higher sum scores (range 0 to 161) represent higher relationship satisfaction.
|
Mid Treatment (Approximately week 5 of all treatment conditions)
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Couples Satisfaction Index (CSI)
Time Frame: 1 Month Post Treatment
|
The Couples Satisfaction Index is a 32-item self-report survey assessing several domains of relationship satisfaction.
Higher sum scores (range 0 to 161) represent higher relationship satisfaction.
|
1 Month Post Treatment
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Couples Satisfaction Index (CSI)
Time Frame: 3- Months Post Treatment
|
The Couples Satisfaction Index is a 32-item self-report survey assessing several domains of relationship satisfaction.
Higher sum scores (range 0 to 161) represent higher relationship satisfaction.
|
3- Months Post Treatment
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Couples Satisfaction Index (CSI)
Time Frame: 6- Months Post Treatment
|
The Couples Satisfaction Index is a 32-item self-report survey assessing several domains of relationship satisfaction.
Higher sum scores (range 0 to 161) represent higher relationship satisfaction.
|
6- Months Post Treatment
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Inventory of Psychosocial Functioning (IPF)
Time Frame: Baseline
|
The Inventory of Psychosocial Functioning (IPF) is an 80-item self-report measure designed to assess multiple dimensions of functional impairment related to psychiatric disturbances.
Higher sum scores (range 0 to 100) indicate more functional impairment.
|
Baseline
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Inventory of Psychosocial Functioning (IPF)
Time Frame: Mid Treatment (Approximately week 5 of all treatment conditions)
|
The Inventory of Psychosocial Functioning (IPF) is an 80-item self-report measure designed to assess multiple dimensions of functional impairment related to psychiatric disturbances.
Higher sum scores (range 0 to 100) indicate more functional impairment.
|
Mid Treatment (Approximately week 5 of all treatment conditions)
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Inventory of Psychosocial Functioning (IPF)
Time Frame: 1 Month Post Treatment
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The Inventory of Psychosocial Functioning (IPF) is an 80-item self-report measure designed to assess multiple dimensions of functional impairment related to psychiatric disturbances.
Higher sum scores (range 0 to 100) indicate more functional impairment.
|
1 Month Post Treatment
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Inventory of Psychosocial Functioning (IPF)
Time Frame: 3- Months Post Treatment
|
The Inventory of Psychosocial Functioning (IPF) is an 80-item self-report measure designed to assess multiple dimensions of functional impairment related to psychiatric disturbances.
Higher sum scores (range 0 to 100) indicate more functional impairment.
|
3- Months Post Treatment
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Inventory of Psychosocial Functioning (IPF)
Time Frame: 6- Months Post Treatment
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The Inventory of Psychosocial Functioning (IPF) is an 80-item self-report measure designed to assess multiple dimensions of functional impairment related to psychiatric disturbances.
Higher sum scores (range 0 to 100) indicate more functional impairment.
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6- Months Post Treatment
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Client Satisfaction Questionnaire (CSQ)
Time Frame: 1 Month Post Treatment
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Client Satisfaction Questionnaire (CSQ) is an 8-item measure about satisfaction with treatment rated on a 4-point Likert scale.
Higher mean scores (range 0 to 4) represent higher satisfaction with treatment services.
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1 Month Post Treatment
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Working Alliance Inventory- Short Form (WAI-S)
Time Frame: Approximately week 3 of all treatment conditions
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This adaptation of the Working Alliance Inventory- short form (WAI-S) includes 14 items assessing therapeutic alliance as reported by the patient on a 7-point Likert scale.
Higher sum scores (14 to 98) represent higher patient-reported working alliance.
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Approximately week 3 of all treatment conditions
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Working Alliance Inventory- Short Form (WAI-S)
Time Frame: Approximately week 8 of all treatment conditions
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This adaptation of the Working Alliance Inventory- short form (WAI-S) includes 14 items assessing therapeutic alliance as reported by the patient on a 7-point Likert scale.
Higher sum scores (14 to 98) represent higher patient-reported working alliance.
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Approximately week 8 of all treatment conditions
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PTSD Checklist-5 (PCL-5)
Time Frame: Baseline
|
The PCL-5 is a 20 item self report questionnaire assessing symptoms of PTSD based on DSM-V criteria.
Scores range from 0 to 80, with higher scores representing more severe symptoms.
|
Baseline
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PTSD Checklist-5 (PCL-5)
Time Frame: Mid Treatment (Approximately week 5 of all treatment conditions)
|
The PCL-5 is a 20 item self report questionnaire assessing symptoms of PTSD based on DSM-V criteria.
Scores range from 0 to 80, with higher scores representing more severe symptoms.
|
Mid Treatment (Approximately week 5 of all treatment conditions)
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PTSD Checklist-5 (PCL-5)
Time Frame: 1 Month Post Treatment
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The PCL-5 is a 20 item self report questionnaire assessing symptoms of PTSD based on DSM-V criteria.
Scores range from 0 to 80, with higher scores representing more severe symptoms.
|
1 Month Post Treatment
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PTSD Checklist-5 (PCL-5)
Time Frame: 3- Months Post Treatment
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The PCL-5 is a 20 item self report questionnaire assessing symptoms of PTSD based on DSM-V criteria.
Scores range from 0 to 80, with higher scores representing more severe symptoms.
|
3- Months Post Treatment
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PTSD Checklist-5 (PCL-5)
Time Frame: 6-Months Post Treatment
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The PCL-5 is a 20 item self report questionnaire assessing symptoms of PTSD based on DSM-V criteria.
Scores range from 0 to 80, with higher scores representing more severe symptoms.
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6-Months Post Treatment
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Beck Depression Inventory-II (BDI-2)
Time Frame: Baseline
|
The BDI is a 21-item self report questionnaire assessing symptoms of depression.
Scores range from 0 to 63, with higher scores representing more severe symptoms.
|
Baseline
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Beck Depression Inventory-II (BDI-2)
Time Frame: Mid Treatment (Approximately Week 5 of all treatment conditions)
|
The BDI is a 21-item self report questionnaire assessing symptoms of depression.
Scores range from 0 to 63, with higher scores representing more severe symptoms.
|
Mid Treatment (Approximately Week 5 of all treatment conditions)
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Beck Depression Inventory-II (BDI-2)
Time Frame: 1 Month Post Treatment
|
The BDI is a 21-item self report questionnaire assessing symptoms of depression.
Scores range from 0 to 63, with higher scores representing more severe symptoms.
|
1 Month Post Treatment
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Beck Depression Inventory-II (BDI-2)
Time Frame: 3- Months Post Treatment
|
The BDI is a 21-item self report questionnaire assessing symptoms of depression.
Scores range from 0 to 63, with higher scores representing more severe symptoms.
|
3- Months Post Treatment
|
Beck Depression Inventory-II (BDI-2)
Time Frame: 6-Months Post Treatment
|
The BDI is a 21-item self report questionnaire assessing symptoms of depression.
Scores range from 0 to 63, with higher scores representing more severe symptoms.
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6-Months Post Treatment
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State-Trait Anger Inventory (STAXI)
Time Frame: Baseline
|
The STAXI-2 is a self-report questionnaire assessing state and trait anger.
The State subscale (15 items) ranges from 15 to 60, and the Trait subscale (10 items) ranges from 10 to 40, with higher scores representing more anger.
|
Baseline
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State-Trait Anger Inventory (STAXI)
Time Frame: Mid Treatment (Approximately week 5 of all treatment conditions)
|
The STAXI-2 is a self-report questionnaire assessing state and trait anger.
The State subscale (15 items) ranges from 15 to 60, and the Trait subscale (10 items) ranges from 10 to 40, with higher scores representing more anger.
|
Mid Treatment (Approximately week 5 of all treatment conditions)
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State-Trait Anger Inventory (STAXI)
Time Frame: 1 Month Post Treatment
|
The STAXI-2 is a self-report questionnaire assessing state and trait anger.
The State subscale (15 items) ranges from 15 to 60, and the Trait subscale (10 items) ranges from 10 to 40, with higher scores representing more anger.
|
1 Month Post Treatment
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State-Trait Anger Inventory (STAXI)
Time Frame: 3- Months Post Treatment
|
The STAXI-2 is a self-report questionnaire assessing state and trait anger.
The State subscale (15 items) ranges from 15 to 60, and the Trait subscale (10 items) ranges from 10 to 40, with higher scores representing more anger.
|
3- Months Post Treatment
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State-Trait Anger Inventory (STAXI)
Time Frame: 6-Months Post Treatment
|
The STAXI-2 is a self-report questionnaire assessing state and trait anger.
The State subscale (15 items) ranges from 15 to 60, and the Trait subscale (10 items) ranges from 10 to 40, with higher scores representing more anger.
|
6-Months Post Treatment
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Conflict Tactics Scale Short Form- (CTS-2S)
Time Frame: Baseline
|
20-item self-report inventory yielding 5 scales.
Most widely used measure of its kind.
Scores on the Psychological Aggression and Negotiation subscales range from 0 to 24, with higher scores representing more Psychological Aggression and more Negotiation.
|
Baseline
|
Conflict Tactics Scale Short Form- (CTS-2S)
Time Frame: Mid Treatment (Approximately week 5 of all treatment conditions)
|
20-item self-report inventory yielding 5 scales.
Most widely used measure of its kind.
Scores on the Psychological Aggression and Negotiation subscales range from 0 to 24, with higher scores representing more Psychological Aggression and more Negotiation.
|
Mid Treatment (Approximately week 5 of all treatment conditions)
|
Conflict Tactics Scale Short Form- (CTS-2S)
Time Frame: 1 Month Post Treatment
|
20-item self-report inventory yielding 5 scales.
Most widely used measure of its kind.
Scores on the Psychological Aggression and Negotiation subscales range from 0 to 24, with higher scores representing more Psychological Aggression and more Negotiation.
|
1 Month Post Treatment
|
Conflict Tactics Scale Short Form- (CTS-2S)
Time Frame: 3- Months Post Treatment
|
20-item self-report inventory yielding 5 scales.
Most widely used measure of its kind.
Scores on the Psychological Aggression and Negotiation subscales range from 0 to 24, with higher scores representing more Psychological Aggression and more Negotiation.
|
3- Months Post Treatment
|
Conflict Tactics Scale Short Form- (CTS-2S)
Time Frame: 6-Months Post Treatment
|
20-item self-report inventory yielding 5 scales.
Most widely used measure of its kind.
Scores on the Psychological Aggression and Negotiation subscales range from 0 to 24, with higher scores representing more Psychological Aggression and more Negotiation.
|
6-Months Post Treatment
|
Collaborators and Investigators
Investigators
- Principal Investigator: Leslie A. Morland, PsyD, VA San Diego Healthcare System, San Diego, CA
Publications and helpful links
General Publications
- Morland LA, Knopp KC, Khalifian CE, Macdonald A, Grubbs KM, Mackintosh MA, Becker-Cretu JJ, Sautter FJ, Buzzella BA, Wrape ER, Glassman LH, Webster K, Sohn MJ, Glynn SM, Acierno R, Monson CM. A randomized trial of brief couple therapy for PTSD and relationship satisfaction. J Consult Clin Psychol. 2022 May;90(5):392-404. doi: 10.1037/ccp0000731.
- Khalifian CE, Bosch J, Knopp K, Delay C, Sohn MJ, Morland LA. Adverse childhood experiences, mental health, and relationship satisfaction in military couples. J Fam Psychol. 2022 Jun;36(4):630-635. doi: 10.1037/fam0000952. Epub 2022 Jan 27.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- D2093-R
- H150181 (Other Identifier: VA HRPP)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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