One of the strongest influential factors of achieving acceptable esthetic orthodontic results is attributed to soft tissue outcomes. Most patients seek orthodontic treatment due to their dissatisfaction of aesthetics. Thus, successful orthodontic treatment is typically measured with proper teeth alignment and soft tissue outcomes such as lack of recession or black triangles. This prospective cohort study evaluates the effects of orthodontic rotation and proclination of teeth in the esthetic zone (canine to canine) on the alveolar bone housing and soft tissue parameters, keratinized tissue width, midfacial recession, papilla height and width, and soft tissue biotype during the first 6 and 12 months of treatment. The patients enrolled in the study are from the University of California, San Francisco postgraduate orthodontic clinic receiving orthodontic treatment. These patients were measured immediately prior to beginning orthodontic treatment, 6 and 12 months after the start of treatment. During the first 12 months of orthodontic treatment, this study found that 1) rotation of the tooth into proper alignment is correlated with a decrease in alveolar housing width at the level of S1; 2) orthodontic rotation has minimal impact on the periodontium in the aesthetic anterior region; 3) changes in the upper centrals inclination are correlated with a decrease in midfacial recession; 4) There is also a positive correlation with an increase in KTW at the level of S1.

Objective: The aim of this retrospective study is to investigate the association between splinted implant-supported restorations and marginal bone levels in partially edentulous ridge.Materials and Methods: Data from January 2000 to February 2021 was collected from the electronic charts of patients at the UCSF School of Dentistry with implant-supported prostheses and with radiographs at least twelve months after restoration. Five types of restorations were included: 1) two single adjacent crowns, 2) two splinted adjacent crowns, 3) 3-unit bridges, 4) three single adjacent crowns, and 5) three splinted adjacent crowns. Measurements included vertical distance between adjacent implant platforms, radiographic bone loss (RBL) around implants, and emergence angle of restorations. Odds ratios (ORs) and 95% confidence interval (95% CI) of implants with ≥1mm RBL between different type of restorations were calculated. Results: When there was a vertical distance of ≥ 0.5 mm between adjacent implant platforms, the majority (66.67%) of three splinted crowns had at least one implant with ≥ 1 mm RBL, followed by two splinted crowns (58.97%), 3-unit bridges (25.93%), two single crowns (24.24%), and three single crowns (18.18%). When the vertical distance between adjacent implant platforms was ≥ 1 mm, there was a greater percentage of implants with ≥ 1 mm RBL. The highest group was three splinted adjacent crowns (70.00%), followed by two splinted crowns (61.11%), three single crowns (22.22%), and 3-unit bridges and two single implants (21.05%). Three splinted crowns were significantly associated with ≥ 1mm RBL when compared to three single crowns and 3-unit bridges (OR= 6.67, 95% CI= 1.14 to 38.83 and OR= 6.56, 95% CI= 1.59 to 27.07, respectively). Similarly, two splinted crowns were significantly associated with ≥ 1 mm RBL when compared to 2 single crowns (OR= 2.50, 95% CI= 1.08 to 5.79). When the emergence angle of an implant restoration was >30, the incidence of ≥ 1 mm RBL was 90.01% for three splinted implants. This was followed by two splinted crowns (62.07%), two single crowns (58.33%), 3-unit bridges (41.67%), and three single implants (40.00%). For these four categories, RBL was only detected for bone-level implants. When an implant restoration had an emergence angle >30, there was a significant association of ≥ 1 mm RBL for three splinted crowns when compared to 3-unit bridges and three single crowns (OR= 14.00, 95% CI= 1.33 to 147.43 and OR= 13.33, 95% CI= 1.05 to 169.56, respectively), and two splinted crowns when compared to two single crowns (OR= 4.40, 95% CI= 1.05 to 18.36). Conclusion: Within the limitations of this study, two or three adjacent implants, when splinted together, are associated with higher incidence of RBL ≥ 1 mm than non-splinted restorations. In addition, a vertical distance of ≥ 0.5 mm between adjacent implant platforms or an emergence angle of >30 significantly increased the risk of peri-implant bone loss.

Objective: This short-term prospective pilot study aims to assess the validation of the patient-centered implant risk assessment tool in patients recruited at the University of California, San Francisco (UCSF) School of Dentistry.Materials and Methods: Patients seen in the university periodontal clinics were enrolled into the study based on their eligibility for dental implant treatment. Dental surgeons completed a survey tool, called the Implant Risk Assessment Questionnaire (RAQ), for each implant placed. After at least 6 months of loading with the implant final prosthesis, patients were seen for a recall visit at which point, the implant was diagnosed as healthy or having peri-implant disease. Peri-implant disease was subcategorized as peri-implant mucositis, and peri-implantitis. The survey output classifies the implant as low, medium, or high aggregate risk, which was correlated to diagnoses of healthy, peri-implant mucositis, or peri-implantitis respectively. The RAQ scores and diagnoses were used to compute sensitivity, specificity, positive and negative predictive values to determine the tool validity.

Results: Forty-two subjects with 116 implants were recruited into the study. Thirty-eight of these implants were restored by the conclusion of the study, and of those, 28 were seen for follow-up at least 6 months after final prosthesis delivery. Eleven implants were diagnosed as healthy, sixteen as peri-implant mucositis, and one as peri-implantitis with a follow up between 6 -14 months (mean follow-up of 7.71 months). Four implants had early failures prior to the prosthesis delivery. Sensitivity, specificity, positive and negative predictive parameters were initially low, indicating a low predictive value of the RAQ tool. These parameters were improved by omitting questions which were lowering the predictive ability of the test within this time frame. Questions on restoration type, biologic width, treated periodontitis, tissue phenotype, maxillary posterior implant position, and clinician experience were removed to improve validity parameters for this short-term pilot study. Sensitivity was maintained at 82.4%, specificity improved from 0 to 45.5%, positive predictive value increased from 57.7% to 70%, and negative predictive value increased from 0% to 62.5% when comparing before and after the omission of these questions. Conclusion: In a short-term context, the RAQ survey tool may have limited utility in its original form to identify cases of health and disease, but if modified to omit certain risk categories, its predictive capacity may be increased. These risk questions or categories may regain relevance for their contribution to peri-implant disease as the study follow-up is extended.

Objective: This short-term prospective pilot study aimed to assess the validation of the patient-centered implant risk assessment tool in patients recruited at the University of California, San Francisco (UCSF) School of Dentistry.Materials and Methods: Patients seen in the university periodontal clinics were enrolled in the study based on their eligibility for dental implant treatment. For each implant placed, dental surgeons completed a survey tool, called the Implant Risk Assessment Questionnaire (RAQ). After at least one year of loading with the implant final prosthesis, patients were seen for a recall visit at which point, the implant was diagnosed as healthy or having peri-implant disease. The peri-implant disease was subcategorized as peri-implant mucositis and peri-implantitis. The survey output classifies the implant as low, medium, or high aggregate risk, which was correlated to diagnoses of healthy, peri-implant mucositis, or peri-implantitis respectively. The RAQ scores and diagnoses were used to compute sensitivity, specificity, and positive and negative predictive values to determine the tool's validity. Results: In total, seventy-three patients with 187 implants were initially recruited for the study. However, only thirty-three patients, representing eighty-seven implants, participated in the one-year follow-up and were consequently included in the study results. Among these implants, fifty-four were diagnosed as healthy, ten as peri-implant mucositis, and six as peri-implantitis. Additionally, four implants experienced early failures before the delivery of the prosthesis. Initially, the sensitivity, specificity, and positive and negative predictive values of the RAQ tool were low, indicating a limited predictive value within this timeframe. However, these parameters were notably improved by omitting questions that were found to diminish the predictive ability of the test. Specifically, questions related to treated periodontitis, smoking, tissue phenotype, maxillary posterior placement, clinician experience, and restoration emergence angle were removed to improve the validity parameters for this short-term study. Following the omission of these questions, there was a significant increase in sensitivity from 22.22% to 74.07%, while specificity decreased from 100.0% to 62.5%. The positive predictive value also experienced a shift from 100.0% to 86.96%, whereas the negative predictive value showed improvement from 27.59% to 41.67%. When comparing the results before and after the exclusion of these questions predictive value also increased from 0% to 62.5%. Conclusion: In a short-term context, the RAQ survey tool might have limited utility in its original form to identify cases of health and disease, but if modified to omit certain risk categories, its predictive capacity could be increased. A long-term follow-up study is necessary to evaluate the validity of the original RAQ survey tool across different risk categories.

Recently, dental implants have become a popular treatment to replace missing dentition. Peri-implant hard tissue, such as bone dimensional changes, has been widely investigated. New research regarding peri-implant soft tissue has emerged in the recent years focusing on the association between peri-implant soft tissue phenotype and implant health. Current evidence shows that thin gingival phenotype and a lack of adequate keratinized mucosa around dental implants are associated with recession and peri-implant diseases. However, there is still a lack of evidence evaluating the remodeling process of peri-implant soft tissue during implant treatment. This prospective pilot study aimed to investigate the change of peri-implant soft tissue phenotype and keratinized tissue width at three specific timepoints during implant treatment. Gingival thickness at 2, 4, and 6 mm from the free gingival margin and keratinized tissue width were measured in six patients receiving single implant placement in the maxillary esthetic zone at the time of tooth extraction and ridge preservation, implant placement, and implant restoration. Data analysis showed no statistically significant differences in peri-implant soft tissue measurements among the three timepoints during implant treatment. The present pilot study did not find significant changes in gingival thickness or keratinized tissue width in sites receiving dental implants throughout the different treatment timepoints.

Objective: To retrospectively analyze local and systemic factors that resulted in the short-term tooth loss that were previously assigned a favorable prognosis in patients who were seen and treated at the University of California San Francisco (UCSF) School of Dentistry over an observational five-year period.Materials and Methods: This retrospective study included the records of patients who had a minimum of two dental exams at least twelve months apart at the UCSF School of Dentistry over a 5 year period. This study investigated extracted teeth with an initially favorable periodontal prognosis that were then divided into one of four categories based on the reason for extraction: caries, periodontal disease, endodontic reason, or fracture. Patient and tooth related factors associated with the extracted teeth were recorded: crown-to-root ratio, initial pocket depth, initial periodontal diagnosis, maintenance interval, presence of existing restoration, furcation involvement, and systemic conditions. Data analysis was performed using a linear mixed model. Results: A total of 50 patients with 111 teeth met the inclusion criteria for this study. A higher odds ratio (OR) for tooth loss due to caries, endodontic reason, and fracture were found in teeth with a history of root canal treatment with an OR of 3.61, 3.86, and 2.52, respectively. For tooth loss due to periodontal disease, higher ORs were found in patients who were on anti-depressants (OR= 4.28) and patients who had an initial diagnosis of Stage III/IV periodontitis (OR= 2.66). In addition, teeth with initial probing depths ≥ 5 mm (OR= 4.32) and with furcation involvement (OR= 1.93) also showed a higher OR for tooth loss due to periodontal disease. Conclusion: Within the limitations of this study, previously root-canal treated teeth present a higher OR for early loss due to caries, recurrent endodontic lesions, or fracture. In addition, patients with anti-depressant medication use, sporadic maintenance, initial probing depths ≥5 mm, and furcation involvement represent significantly higher OR of tooth loss due to periodontal disease even for initially favorable teeth.

Periodontium is defined as the tissues that surround and provide support to the natural dentition. Throughout orthodontic tooth movement, the forces on the teeth cause periodontal soft tissue and hard tissue remodeling. Degree of orthodontic rotation and proclination, keratinized tissue width (KTW), mid-facial recession, tissue phenotype and interdental papilla dimension are the main parameters of interest in this study as they affect the esthetic outcomes of not only orthodontic treatment, but also, other restorative dental procedures. Thus, the purpose of the study is to analyze the effect of orthodontic rotation and proclination produced by low levels of orthodontic force on the periodontium in the esthetic zone (canine to canine) during the first six months of treatment. This study is a prospective cohort study. Patients of the University of California, San Francisco (UCSF) postgraduate orthodontic clinic receiving orthodontic treatment with full fixed appliances or removable clear aligners are included. The variables measured for this study are the degrees of rotation of each tooth before and after orthodontic alignment, KTW, mid-facial recession, tissue phenotype and interdental papilla dimension. During the first six months of treatment, this study found: 1) An increase in orthodontic rotation is significantly correlated with a decrease in the alveolar housing width at the level of S1, or 3 mm apical to the cementum enamel junction (CEJ). 2) Orthodontic rotation has minimal impact on soft tissue changes in the anterior dentition. 3) Changes in degree of upper incisor inclination are correlated with an increase in papilla height and width, a decrease in midfacial recession, and a decrease in alveolar housing at the level of S1.

Objective: The purpose of this study was to investigate the effect of a new chlorine dioxide-based oral rinse, Ultra-sensitive CloSYS, in conjunction with mechanical debridement to resolve peri-implant mucositis.Materials and Methods: Patients who were diagnosed with peri-implant mucositis at the UCSF postgraduate periodontal clinic were included in this study. Peri-implant mucositis was defined as bleeding on probing and/or suppuration without radiographic bone loss around implants with pocket depths less than or equal to 4 mm. Diagnoses were made by a periodontal resident and verified by a board-certified faculty member. Patients were randomly assigned to 3 groups: the CloSYS rinse group, the chlorhexidine rinse group, and the water rinse group (control group). All groups received full mouth mechanical debridement and thorough oral hygiene instructions. Bleeding on probing (BOP), plaque index (PI), staining index (SI), and pocket depths (PD) were measured at baseline and after 4 weeks, 8 weeks, and 12 weeks from the baseline by the principal investigator, who was blinded as to the treatment group assignments for each patient. Analysis of variance (ANOVA) was used to compare the clinical measurement changes. Results: A total of 10 subjects with 21 implants were recruited for this study. A total of 4 patients were in the water rinse group (control group), 3 patients were in the chlorohexidine rinse group, and 3 patients were in the CloSYS rinse group. The p-values obtained from ANOVA generally exceeded the 0.05 threshold associated with a 95% confidence interval when comparing the rinse groups, indicating no statistical significance between the different rinses, but with two exceptions. The two exceptions with p-values below the 0.05 threshold, indicating a statistically significant result, included an apparent increase in SI after 4 weeks when using chlorhexidine rinse and increased BOP after 12 weeks when using CloSYS rinse. Regarding increased SI with chlorhexidine rinse, there was no statistical significance between rinse groups initially or after 8 or 12 weeks and additional ANOVA of only the chlorhexidine rinse group to evaluate the effect of time was statistically insignificant (p-value = 0.36, >0.05), so the apparent increase in SI at 4 weeks is likely a Type I error and not actually statistically significant. Regarding increased BOP after 12 weeks when using CloSYS rinse, the result can likely be explained by a higher tendency for bleeding on probing during the baseline measurements. There was a 14-16% higher mean number of sites with bleeding on probing on implants at the baseline within the CloSYS rinse group compared to the other two rinse groups. This is within the 17% resolution of individual measurements (1 out of 6 sites) and therefore significantly increases the likelihood of a Type I error. Other ANOVA results on the impact of time indicated a reduction in PI and BOP after the initial visit for all rinse groups, but not thereafter. Conclusion: There were no apparent differences of using Ultra-sensitive CloSYS rinse in conjunction with mechanical debridement on the resolution of peri-implant mucositis when compared to the other two rinse groups. The primary benefits appear to come from mechanical debridement alone.