Publications by authors named "Mariana A Rojas"

15 Publications

  • Page 1 of 1

Healing of intrabony defects following regenerative surgery by means of single-flap approach in conjunction with either hyaluronic acid or an enamel matrix derivative: a 24-month randomized controlled clinical trial.

Clin Oral Investig 2021 Feb 10. Epub 2021 Feb 10.

Section of Periodontology, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, 6 Caserta Street, 00161, Rome, Italy.

Objectives: The aim of this randomized controlled clinical trial was to compare the clinical outcomes obtained in intrabony defects following regenerative periodontal surgery using the single-flap approach (SFA) in conjunction with either hyaluronic acid (HA) or enamel matrix derivative (EMD).

Materials And Methods: Thirty-two intrabony defects in 32 healthy subjects were randomly assigned: HA (test group) or EMD (control group). Clinical attachment level (CAL), probing depth (PD), gingival recession (REC), and bleeding on probing (BOP) were recorded at baseline,12, 18, and 24 months after surgery.

Results: At 24 months, both treatments resulted in statistically significant clinical improvements evidenced by PD-reduction and CAL-gain (p<0.001). The mean CAL-gain was 2.19±1.11 mm in the test and 2.94±1.12 mm in the control sites (p=0.067). PD-reduction was statistically significantly higher for the control group (4.5±0.97 mm) than the test group (3.31±0.70 mm), (p=0.001). CAL-gain ≤ 3 mm was observed in 87.5% and in 62.5% of the test and control sites, respectively. Test sites showed slightly lower REC values than the control sites. No statistically significant differences were found for BOP between treatments.

Conclusions: The present findings indicate that both treatments led to statistically significant clinical improvements compared to baseline, although the application of EMD resulted in statistically significantly higher PD-reduction compared to the use of HA.

Clinical Relevance: The use of HA in conjunction with a SFA resulted in significant PD-reduction and CAL-gain, pointing to the potential clinical relevance of this material in regenerative periodontal surgery.
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http://dx.doi.org/10.1007/s00784-021-03822-xDOI Listing
February 2021

The staging and grading system in defining periodontitis cases: consistency and accuracy amongst periodontal experts, general dentists and undergraduate students.

J Clin Periodontol 2021 02 14;48(2):205-215. Epub 2020 Dec 14.

Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system.

Methods: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy.

Results: Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy.

Conclusions: Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
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http://dx.doi.org/10.1111/jcpe.13406DOI Listing
February 2021

Bilaminar Palatal Connective Tissue Grafts Obtained With the Modified Double Blade Harvesting Technique: Technical Description and Case Series.

Clin Adv Periodontics 2020 12 20;10(4):186-194. Epub 2020 Sep 20.

Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy.

Introduction: The purpose of this case series is to present a technique to harvest palatal connective tissue grafts (CTGs) that concurrently provides several advantages over previously described techniques when applied to treat gingival recessions.

Case Series: Twenty patients were treated with root coverage procedures using CTGs harvested with the modified double blade harvesting technique (MDBHT). A double blade knife with two surgical blades set 1 mm apart was used in this case series. The palatal connective tissue was accessed through a horizontal incision and an envelope flap that was closed by primary intention. The grafts were measured immediately after harvesting with a periodontal probe. The overall mean length was 28.8 ± 7.8 mm and graft thickness was homogeneous and near to 1 mm in all the cases. Graft mean apicocoronal height was 5.0 ± 0.8 mm and 5.3 ± 1 mm at the molar and premolar levels, respectively. Clinical wound healing was evaluated at 7 days post-surgically and showed a modified early-wound healing index mean value of 3.0 ± 1.0.

Conclusions: The introduced MDBHT consistently rendered grafts of uniform thickness and sufficient dimensions, while excluding epithelial tissue and the deeper aspects of the submucosa, thus avoiding rich fatty and glandular tissues. MDBHT allowed for donor site healing with minimal discomfort and without complications.
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http://dx.doi.org/10.1002/cap.10124DOI Listing
December 2020

A retrospective pilot study of correlation of first maxillary premolar root trunk length with age and gender: a cone beam computed tomography study.

Minerva Stomatol 2020 Feb 16;69(1):27-36. Epub 2020 Mar 16.

Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy -

Background: Root trunk length (RTL) plays an important role in the diagnosis, prognosis and treatment of periodontitis. The aim of this retrospective pilot study was to evaluate the RTL of first maxillary premolar and to study the correlation with age and sex in this value.

Methods: The sample included 110 cone beam computed tomography (CBCT) images comprising 220 maxillaries first premolars from systemically healthy patients aged between 18 and 70 years. The tooth length (TL), root length (RL) and RTL were measured (dependent variables). Age and sex were considered as independent variables.

Results: No statistically significant correlation was found between the RTL and the TL. Longer RL and longer RTL were observed in younger patients than older subjects only in the left maxillary premolars. On the other hand, the sex of the patients had no effect on either of the dependent variables. The single rooted maxillary premolars were more frequent (relative to those with two roots) in woman and in elderly patients.

Conclusions: A correlation between the age and the RTL and RL has been found but only in left premolars. Sex seemed to have only a slight correlation on the frequency of single-rooted teeth of the right side of the mouth. Further studies should be addressed to clarify the significance of the asymmetries observed in the present study between the two sides of the mouth with the aim of deepening the knowledge and understanding of the different variables that could be correlated with the RTL.
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http://dx.doi.org/10.23736/S0026-4970.19.04228-6DOI Listing
February 2020

Treatment of an Advanced Gingival Recession Involving the Apex of the Tooth: Periodontal Plastic, Endodontic Surgical Approach With a Laterally Stretched Flap and a Connective Tissue Graft.

Clin Adv Periodontics 2019 06 23;9(2):70-76. Epub 2019 Jan 23.

Department of Periodontics, University of Buenos Aires, Buenos Aires, Argentina.

Introduction: This case report presents the successful multidisciplinary treatment of a maxillary lateral incisor with a deep and narrow recession involving the root apex associated with pulpal necrosis. The tooth initially considered with a hopeless prognosis, was treated with a combined periodontal plastic, regenerative, and endodontic surgical procedure.

Case Presentation: A recently reported technique, the laterally stretched (LAST) flap with a connective tissue graft (CTG) technique for root coverage, was combined with enamel matrix derivative (EMD) for periodontal regeneration of the periapical lesion, that complemented an apicoectomy with retrograde sealing. The 6-year follow-up evidenced root coverage (RC) of 91.6% and increased keratinized tissue. Clinical and radiographic evaluation showed resolution of the periapical process.

Conclusions: A severe gingival recession with endodontic involvement can be repaired if adequate control of the endodontic infection is obtained. The LAST flap, originally described for lower anterior teeth, was used successfully in a maxillary tooth, under extreme circumstances.
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http://dx.doi.org/10.1002/cap.10054DOI Listing
June 2019

Surgical Treatment of a Cemental Tear-Associated Bony Defect Using Hyaluronic Acid and a Resorbable Collagen Membrane: A 2-Year Follow-Up.

Clin Adv Periodontics 2019 06 6;9(2):64-69. Epub 2019 Feb 6.

Section of Periodontics, Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy.

Introduction: A cemental tear (CeT) is a special type of surface root fracture that may cause periodontal and even periapical tissue destruction. Unfortunately, there is limited knowledge as to how these rare cases can effectively be treated. The present case is believed to be the first reported in the literature treating a bony defect caused by a cemental tear with hyaluronic acid (HA) and a collagen membrane. The aim of this case report is to present a regenerative surgical approach with clinical and tomographic success and stability at 2-year follow-up.

Case Presentation: A 61-year-old patient presented with spontaneous pain and gingival swelling over his right central maxillary incisor. Radiographically, a radiolucent area was observed in the medial third between both central incisors. The tomographic evaluation showed a buccal bone dehiscence and a bony defect. Once the differential diagnosis with an endodontic-periodontal lesion and root fracture was performed, CeT was the presumptive diagnosis. During the exploratory flap surgery, a small root fragment (CeT) on the mesial side of the tooth was founded and removed. The bony lesion was treated with hyaluronic acid (HA) and a resorbable collagen membrane. At 2-year follow-up clinical, radiographic, and tomographic success was observed.

Conclusion: A CeT-associated bony defect could be successfully treated after removing cemental fragments and performing a regenerative approach using HA and a resorbable collagen membrane.
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http://dx.doi.org/10.1002/cap.10053DOI Listing
June 2019

Laterally Stretched Flap With Connective Tissue Graft to Treat Single Narrow Deep Recession Defects on Lower Incisors.

Clin Adv Periodontics 2019 03 28;9(1):29-33. Epub 2018 Sep 28.

Department of Periodontics, University of Buenos Aires, Buenos Aires, Argentina.

Introduction: Gingival recession (GR) is one of the most common esthetic concerns for patients, and several surgical procedures have been developed for its treatment. It has been widely demonstrated that root coverage of shallow Miller class I and II areas of gingival recession is generally predictable, but the treatment of deep recessions associated with lack of attached keratinized tissue remains a challenge even for skilled surgeons. Although this type of recessions can be treated with tunneling procedures, because of their size, covering the connective tissue grafts (CTGs) with displaced flaps provide better graft nutrition and improve the outcome. The purpose of this case series is to present an alternative treatment to the traditional laterally displaced flap and tunneling techniques used for deep narrow recessions: The "laterally stretched flap" (LSF) with CTG.

Case Presentation: Five healthy patients with isolated Miller Class II narrow deep gingival recessions were included in the case series. All the defects were treated with LSF and CTG. Complete root coverage (CRC) was achieved in 80% of the cases (4/5). Keratinized tissue increase was obtained in all the cases. The follow-up was between one and three years.

Conclusions: Within the limitations of this case series, LSF + CTG demonstrated to be a promising technique for the treatment of narrow deep recessions. The lack of vertical incisions and an envelope approach renders a more stable wound with minimal scar formation and patient discomfort.
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http://dx.doi.org/10.1002/cap.10046DOI Listing
March 2019

Histological evaluation of subepithelial connective tissue grafts harvested by two different techniques: Preliminary study in humans.

Acta Odontol Latinoam 2019 Apr;32(1):10-16

Universidad de Buenos Aires, Facultad de Odontologia, Cátedra de Periodoncia , Buenos Aires, Argentina.

Subepithelial connective tissue graft (SCTG) is an essential therapeutic tool in periodontal plastic surgery and implantology. The aim of this preliminary study was to observe and make a histological and histomorphometric comparison of the composition of subepithelial connective tissue grafts (SCTGs) harvested from the palatal mucosa by two different harvesting techniques: mucoperiosteal (lamina propria and complete submucosa including periosteum) and mucosal (lamina propria and a portion of the submucosa). The main hypothesis proposes that SCTG harvested with the mucosal technique contains a greater proportion of connective tissue proper (CTP) and a lower proportion of adipose tissue (AT) than the mucoperiosteal technique. Twenty healthy patients who required SCTG for different purposes were selected and assigned to one of the two following groups: group A (n=10; mucoperiosteal harvesting technique) and group B (n=10, mucosal harvesting technique). The histological sample was obtained by removing a 2 mm thick slice from the most distal portion of the graft. The proportions of adipose tissue (AT), connective tissue proper (CTP) and vascular tissue (VT) were evaluated. In group A, histomorphometric analysis showed that CTP accounted for 58.2% of the graft while AT accounted for 32.64%. In group B, the proportions of CTP and AT were 79.86% and 11.93%, respectively. The differences between groups were statistically significant for both tissues (p< .05). In contrast, no statistically significant difference was observed in the proportion of VT. Within the limitations of this study, the results show that the SCTGs harvested by the mucosal technique contain a greater proportion of CTP and a lower proportion of AT than those obtained by the mucoperiosteal technique, whereas the proportion of VT does not differ. Further long-term clinical and histological studies with more samples are needed to evaluate the clinical implications of SCTG composition.
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April 2019

Histologic and Histomorphometric Analyses of De-epithelialized Free Gingival Graft in Humans.

Int J Periodontics Restorative Dent 2019 Mar/Apr;39(2):221-226

A graft's histologic composition depends on the harvesting technique used, and different connective tissue-harvesting procedures have been described in the literature. Some authors suggest the submucosal tissue not be incorporated into the graft because it may interfere with the graft revascularization. In those cases, the de-epithelialized gingival graft (DGG) is obtained with a superficial harvesting technique that leaves the deep portion of the submucosa and the periosteum excluded from the graft. The aim of this case series was to histologically and histomorphometrically evaluate the tissue obtained with this technique. The findings demonstrated that the DGG was mainly composed of connective tissue, and adipose tissue was in minimal proportions. However, epithelium was found in all of the samples.
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http://dx.doi.org/10.11607/prd.3544DOI Listing
July 2019

Furcation Involvement Classification: A Comprehensive Review and a New System Proposal.

Dent J (Basel) 2018 Jul 23;6(3). Epub 2018 Jul 23.

Section of Periodontology, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome 00161, Italy.

Various classification systems have been proposed to describe furcation lesions and Glickman's classification for many years seems to have been the most widely utilized in the sole clinical diagnosis with no reference to the prognostic value of the lesion itself. This article reviews the previous classification systems and proposes a new method to classify furcation lesions based on the position of the gingival margin and its relationship with the furcation area (clinically exposed/non-exposed furcation area) providing significant aid for a better understanding of furcation involvements and increases the prognostic value of treatments in the long term.
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http://dx.doi.org/10.3390/dj6030034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162379PMC
July 2018

Correction to: Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial.

Clin Oral Investig 2018 11;22(8):2961-2962

Section of Periodontology, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.

The figure 2 of the original version of this article was incorrect. Correct figure is presented below.
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http://dx.doi.org/10.1007/s00784-018-2567-yDOI Listing
November 2018

Effectiveness of adjunctive hyaluronic acid application in coronally advanced flap in Miller class I single gingival recession sites: a randomized controlled clinical trial.

Clin Oral Investig 2019 Mar 30;23(3):1133-1141. Epub 2018 Jun 30.

Section of Periodontology, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.

Objectives: The aim of this randomized controlled clinical trial was to evaluate the possible advantages of adjunctive hyaluronic acid (HA) application in the coronally advanced flap (CAF) procedure in single Miller class I/recession type 1 (RT1) gingival recession treatment.

Material And Methods: Thirty patients with one recession were enrolled; 15 were randomly assigned CAF + HA and 15 to CAF alone. The recession reduction (RecRed), clinical attachment level gain (CAL-gain), changes in probing pocket depth (PPD) and in the width of keratinized tissue (KT), complete root coverage (CRC), and mean root coverage (MRC) were calculated after 18 months. Post-operative morbidity (pain intensity, discomfort, and swelling) was recorded 7 days after treatment using visual analogue scale (VAS).

Results: After 18 months, RecRed was statistically significantly higher in the test group (2.7 mm [1.0]) than in the control group (1.9 mm [1.0]; p = 0.007). PPD were found to be slightly but statistically significantly increased in both groups. No statistically significant difference was found for KT gain between treatments. CRC was 80% for test and 33.3% for control sites (p < 0.05). A MRC of 93.8 ± 13.0% for test and 73.1 ± 20.8% for control sites was calculated (p < 0.05). The test group reported lower swelling and discomfort values 7-days post-surgery (p < 0.05). Statistically significant difference was not found for pain intensity.

Conclusions: The adjunctive use of HA was effective in obtaining CRC for single Miller class I/RT1 gingival recession sites.

Clinical Relevance: Adjunctive application of HA in the coronally advanced flap procedure may improve the reduction of the recessions and increase the probability of CRC in Miller class I recessions.
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http://dx.doi.org/10.1007/s00784-018-2537-4DOI Listing
March 2019

Morphological characteristics of the facial bone wall related to the tooth position in the alveolar crest in the maxillary anterior.

Acta Odontol Latinoam 2017 Aug;30(2):49-56

Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Periodoncia, Argentina.

The purpose of this study was to analyze whether the position of the tooth in the alveolar ridge influences the thickness of the facial bone wall and the distance between the cemento-enamel junction (CEJ) and osseous zenith (OZ). Cone-beam computed tomography (CBCT) scans from fifty four dentate patients were included in the study (22 male and 32 female, mean age 41. 5 years). The measurements taken included: (1). The Facial bone thickness at 7 different equidistant levels -measuring levels (ML 1-7) - between OZ and the root apex (A). (2) The CEJ -OZ distance. (3) Facial position of the tooth (FPT) relative to a straight line traced from mesial to distal interproximal depressions of the alveolar plate at the level of the CEJ. The Facial bone wall thickness ranged between 0 mm and 3. 8 mm, with greater values at more apical levels. Mean values were smaller than 1 mm at every level except ML7. The CEJ-OZ distance varied between 0. 5 mm and 6. 9 mm (mean 2. 9 mm). The Mean of FPT value was 0. 6 mm. No statistically significant correlation was found between FPT and the CEJ-OZ distance. Weak negative statistically significant correlations were found between FPT and the thickness of the facial bone wall at MP1 and MP3. Within the limits of this study, no clinically relevant correlation between FPT and facial bone thickness - CEJ-OZ distance was found. More studies should be conducted to evaluate a greater number of teeth, especially those that may present misalignment with greater FPT values.
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August 2017

Adjunctive use of an ethyl lauroyl arginate-(LAE-)-containing mouthwash in the nonsurgical therapy of periodontitis: a randomized clinical trial.

Minerva Stomatol 2018 Feb 31;67(1):1-11. Epub 2017 Oct 31.

Section of Periodontics, Department of Dentistry and Maxillofacial Surgery, Sapienza University, Rome, Italy -

Background: This randomized clinical trial evaluated the clinical and microbiological effects of 0.147% ethyl lauroyl arginate (LAE)-containing mouthwash compared to 0.12% chlorhexidine (CHX) mouthwash in the treatment of periodontitis.

Methods: Subjects were randomized to use 0.147% LAE and 0.12% CHX mouthwash after professional mechanical plaque removal (PMPR) twice daily 1 hour after brushing for 4 weeks. Periodontal pocket depth (PPD), bleeding on probing (FMBS) and dental plaque (FMPS) were measured at baseline, 4 weeks and 3 months. Microbiological samples were taken at baseline, at 4 weeks and 3 months after plaque recording and prior to PPD and BoP measurements.

Results: Forty subjects were randomized to treatment. Both therapies resulted in reduced FMPS, FMBS and residual pockets at 4 weeks and 3 months. The differences were not statistically significant. There were no treatment-related adverse events. Total bacterial count and the specific pathogens were reduced at 4 weeks and 3 months by both mouthwashes with no statistical differences between them at neither period of time.

Conclusions: A mouthwash containing 0.147% LAE could be an alternative to the use of 0.12% CHX in the non-surgical therapy of periodontitis considering the similar clinical effects, more stable microbiological improvement and absence of adverse effects.
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http://dx.doi.org/10.23736/S0026-4970.17.04084-5DOI Listing
February 2018

Alveolar dimensional changes relevant to implant placement after minimally traumatic tooth extraction with primary closure.

Acta Odontol Latinoam 2016 Sep;29(2):105-114

Department of Periodontics, School of Dentistry University of Buenos Aires, Buenos Aires, Argentina.

The purpose of this study is to evaluate the dimensional changes that occur in the alveolar ridge after minimally traumatic tooth extraction by means of computed tomography (CT), with special focus on the portion of bone supporting the gingival zenith. Twenty subjects with indication for singlerooted tooth extraction and preserved alveolar walls were selected for this study. After a minimally traumatic extraction, two CT scans were performed; the first within 24 hours postextraction (TC1) and the second 6 months (TC2) later. A radiographic guide with a radiopaque marker was used to obtain references that enabled accurate measurements over time, in both vertical and horizontal directions. The bone crest immediately apical to the gingival zenith was identified and termed "osseous zenith". The displacement of the osseous zenith in horizontal and vertical direction was analyzed and correlated with several alveolar anatomical variables with the aim of identifying possible predictors for bone remodeling. Dimensional changes that occur in postextraction sockets within a 6month period showed significant vertical and horizontal displacement of the osseous zenith (p<0.001). Mean vertical resorption was 2.1 ± 1.7 mm, with a median of 1.9 mm and a range of 0.2 to 7.5 mm. Mean horizontal resorption was 1.8 ± 0.8 mm with a median of 1.7 mm and a range of 0.6 to 4.4 mm. However, no correlation was found between the width of the facial alveolar crest and the displacement of the osseous zenith. The results of the present study showed that if the width of the facial crest at the apicalcoronal midpoint is less than 0.7 mm, a high degree of displacement of the osseous zenith (> 3 mm) should be expected. The present study suggests that the width of the alveolar crest at its midlevel, rather than crestal width, may be correlated with the displacement of the osseous zenith.
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September 2016