Leila Jahangiri

Current perspectives in residual ridge remodeling and its clinical implications: A review

PURPOSE This article reviews the current understanding of the biology of tooth extraction wound healing and residual ridge remodeling. METHODS The review of the biology of tooth extraction wound healing involves a discussion of the different cells populating the tooth extraction wound, the matrix formation, and the control of the repair process in the short-term. Defects in socket matrix formation or cellular activity will lead to stalled healing. The review of residual ridge remodeling describes the long-term result of tooth extraction and formation of residual ridges, in which the quantity of bone tissue continuously decreases. This may suggest that any potential regulatory factors of residual ridge resorption should have an adverse effect either on the increased catabolic activity by osteoclasts or on the decreased anabolic activity by osteoblasts. Both short-term tooth extraction healing and long-term residual ridge remodeling processes are interdependent. Furthermore, any potential genetic and environmental regulatory factors can affect the quality and quantity of bone by altering the gene expression events taking place in bone cells. RESULTS The intent of this article was to review the current progresses of biologic research on residual ridge remodeling and to relate the changes at molecular, cellular, and tissue levels. The understanding of residual ridge remodeling may provide a sound scientific basis for improved restorative and therapeutic treatments of the edentulous population.

Zebrafish second heart field development relies on progenitor specification in anterior lateral plate mesoderm and nkx2.5 function.

Second heart field (SHF) progenitors perform essential functions during mammalian cardiogenesis. We recently identified a population of cardiac progenitor cells (CPCs) in zebrafish expressing latent TGFβ-binding protein 3 (ltbp3) that exhibits several defining characteristics of the anterior SHF in mammals. However, ltbp3 transcripts are conspicuously absent in anterior lateral plate mesoderm (ALPM), where SHF progenitors are specified in higher vertebrates. Instead, ltbp3 expression initiates at the arterial pole of the developing heart tube. Because the mechanisms of cardiac development are conserved evolutionarily, we hypothesized that zebrafish SHF specification also occurs in the ALPM. To test this hypothesis, we Cre/loxP lineage traced gata4+ and nkx2.5+ ALPM populations predicted to contain SHF progenitors, based on evolutionary conservation of ALPM patterning. Traced cells were identified in SHF-derived distal ventricular myocardium and in three lineages in the outflow tract (OFT). We confirmed the extent of contributions made by ALPM nkx2.5+ cells using Kaede photoconversion. Taken together, these data demonstrate that, as in higher vertebrates, zebrafish SHF progenitors are specified within the ALPM and express nkx2.5. Furthermore, we tested the hypothesis that Nkx2.5 plays a conserved and essential role during zebrafish SHF development. Embryos injected with an nkx2.5 morpholino exhibited SHF phenotypes caused by compromised progenitor cell proliferation. Co-injecting low doses of nkx2.5 and ltbp3 morpholinos revealed a genetic interaction between these factors. Taken together, our data highlight two conserved features of zebrafish SHF development, reveal a novel genetic relationship between nkx2.5 and ltbp3, and underscore the utility of this model organism for deciphering SHF biology.

Effect of ovariectomy on the local residual ridge remodeling

STATEMENT OF PROBLEM Osteoporosis and edentulism are two disease processes that affect a large group of elderly people in the United States (24 and 25 million, respectively). These two diseases are independent of each other; however, they have several pathologic symptoms in common, such as reduction in bone mass. PURPOSE The purpose of this study was to determine whether estrogen deficiency or its replacement therapy have any effect on the phenomenon of residual ridge remodeling. MATERIAL AND METHODS Three animal groups were formed that consisted of six female Sprague-Dawley rats each. The two groups had ovariectomy and received either a vehicle solution or a daily dose (1.5 micrograms/day) of 17 beta-estradiol delivered through osmotic pumps. The control group underwent sham surgery and received a vehicle solution. Animals were pair fed throughout the experiment. Unilateral molar extraction was performed in the maxilla, which produced a suitable site for examination of histologic characteristics and molecular biologic analyses. At the 4-week postextraction period the bone remodeling activity was noted at the surface of the residual ridge in the control group. RESULTS The ovariectomized group showed increased bone resorption activity, whereas the surface of the residual ridge alveolar bone of the ovariectomized and estrogen-treated group was covered by a layer of hyaline tissue. Poly(A)+ ribonucleic acid samples were isolated from the remodeling residual ridge tissues. Expression of alpha 2(I), alpha 1(II), alpha 1(IX), and alpha 2(X) collagens were examined by ribonucleic acid transfer dot blots. Compared with the control group, ovariectomized animals showed a reduction in bone formation with decreased expressions of type I and II collagens. In contrast, the estrogen-treatment group showed decreased formation of type I collagen with a much increased expression of type II collagen. Further examination of type II collagen formation on the ovariectomized and estrogen-treated group by means of in situ hybridization revealed the notable labeling by the type IIA collagen probe, which was associated with the surface tissue of the residual ridge alveolar bone. CONCLUSION These findings suggest that estrogen deficiency and its replacement therapy seem to affect the activity of residual ridge bone remodeling at the molecular level.

Heart field origin of great vessel precursors relies on nkx2.5-mediated vasculogenesis.

The pharyngeal arch arteries (PAAs) are transient embryonic blood vessels that make indispensable contributions to the carotid arteries and great vessels of the heart, including the aorta and pulmonary arteries. During embryogenesis, the PAAs appear in a craniocaudal sequence to connect pre-existing segments of the primitive circulation after de novo vasculogenic assembly from angioblast precursors. Despite the unique spatiotemporal characteristics of PAA development, the embryonic origins of PAA angioblasts and the genetic factors regulating their emergence remain unknown. Here, we identify the embryonic source of PAA endothelium as nkx2.5+ progenitors in lateral plate mesoderm long considered to adopt cell fates within the heart exclusively. Further, we report that PAA endothelial differentiation relies on Nkx2.5, a canonical cardiac transcription factor not previously implicated in blood vessel formation. Together, these studies reveal the heart field origin of PAA endothelium and attribute a new vasculogenic function to the cardiac transcription factor Nkx2.5 during great vessel precursor development.

Severe and rapid erosion of dental enamel from swimming: a clinical report.

The diagnosis and treatment of a patient with excessive and rapid erosion of enamel is presented. Although the Center for Disease Control and the dental literature have reported on dental enamel erosion resulting from swimming pool chlorination, the awareness of such etiology among dental professionals may be limited. Common findings in these reports include cold sensitivity, a distinctive appearance resembling laminate veneer preparations of the facial surfaces of anterior teeth, occurrence of diastemas, and at times, a rough or gritty texture of the remaining tooth structure. Clinical presentations of erosive lesions can be diagnosed and the best course of treatment determined.

The AP-1 transcription factor component Fosl2 potentiates the rate of myocardial differentiation from the zebrafish second heart field

The vertebrate heart forms through successive phases of cardiomyocyte differentiation. Initially, cardiomyocytes derived from first heart field (FHF) progenitors assemble the linear heart tube. Thereafter, second heart field (SHF) progenitors differentiate into cardiomyocytes that are accreted to the poles of the heart tube over a well-defined developmental window. Although heart tube elongation deficiencies lead to life-threatening congenital heart defects, the variables controlling the initiation, rate and duration of myocardial accretion remain obscure. Here, we demonstrate that the AP-1 transcription factor, Fos-like antigen 2 (Fosl2), potentiates the rate of myocardial accretion from the zebrafish SHF. fosl2 mutants initiate accretion appropriately, but cardiomyocyte production is sluggish, resulting in a ventricular deficit coupled with an accumulation of SHF progenitors. Surprisingly, mutant embryos eventually correct the myocardial deficit by extending the accretion window. Overexpression of Fosl2 also compromises production of SHF-derived ventricular cardiomyocytes, a phenotype that is consistent with precocious depletion of the progenitor pool. Our data implicate Fosl2 in promoting the progenitor to cardiomyocyte transition and uncover the existence of regulatory mechanisms to ensure appropriate SHF-mediated cardiomyocyte contribution irrespective of embryonic stage. Summary: Early embryonic heart muscle differentiates in phases from two progenitor populations. AP-1 promotes the progenitor-to-cardiomyocyte transition specifically during the second phase.

Scan-layered reconstructions: A pilot study of a nondestructive dental histoanatomical analysis method and digital workflow to create restorations driven by natural dentin and enamel morphology

OBJECTIVE This work aims to present a pilot study of a non-destructive dental histo-anatomical analysis technique as well as to push the boundaries of the presently available restorative workflows for the fabrication of highly customized ceramic restorations. MATERIALS AND METHODS An extracted human maxillary central incisor was subject to a micro computed tomography scan and the acquired data was transferred into a workstation, reconstructed, segmented, evaluated and later imported into a Computer-Aided Design/Computer-Aided Manufacturing software for the fabrication of a ceramic resin-bonded prosthesis. RESULTS The obtained prosthesis presented an encouraging optical behavior and was used clinically as final restoration. CONCLUSION The digitally layered restorative replication of natural tooth morphology presents today as a clear possibility. New clinical and laboratory-fabricated, biologically inspired digital restorative protocols are to be expected in the near future. CLINICAL SIGNIFICANCE The digitally layered restorative replication of natural tooth morphology presents today as a clear possibility. This pilot study may represent a stimulus for future research and applications of digital imaging as well as digital restorative workflows in service of esthetic dentistry.

Electronic laboratory quality assurance program: A method of enhancing the prosthodontic curriculum and addressing accreditation standards

STATEMENT OF PROBLEM An electronic quality assurance (eQA) program was developed to replace a paper-based system and to address standards introduced by the Commission on Dental Accreditation (CODA) and to improve educational outcomes. This eQA program provides feedback to predoctoral dental students on prosthodontic laboratory steps at New York University College of Dentistry. PURPOSE The purpose of this study was to compare the eQA program of performing laboratory quality assurance with the former paper-based format. MATERIAL AND METHODS Fourth-year predoctoral dental students (n=334) who experienced both the paper-based and the electronic version of the quality assurance program were surveyed about their experiences. Additionally, data extracted from the eQA program were analyzed to identify areas of weakness in the curriculum. RESULTS The study findings revealed that 73.8% of the students preferred the eQA program to the paper-based version. The average number of treatments that did not pass quality assurance standards was 119.5 per month. This indicated a 6.34% laboratory failure rate. Further analysis of these data revealed that 62.1% of the errors were related to fixed prosthodontic treatment, 27.9% to partial removable dental prostheses, and 10% to complete removable dental prostheses in the first 18 months of program implementation. CONCLUSIONS The eQA program was favored by dental students who have experienced both electronic and paper-based versions of the system. Error type analysis can yield the ability to create customized faculty standardization sessions and refine the didactic and clinical teaching of the predoctoral students. This program was also able to link patient care activity with the students laboratory activities, thus addressing the latest requirements of the CODA regarding the competence of graduates in evaluating laboratory work related to their patient care.

Interventions for missing teeth: Removable prostheses for the edentulous mandible

Oral anticoagulation therapy (OAT) with vitamin K inhibitors protects the patients from thromboembolic events. It may however lead to excessive hemorrhage during and after an oral surgery procedure. The aim of this systematic review was to evaluate the justifications to reduce, withdraw, or alter OATs prior to minor oral surgery procedures to manage bleeding events. A systematic MEDLINE search was conducted for clinical studies in English or German language from 1994 to 2014 comparing patients treated with OAT, without OAT, as well as patients with altered OAT for oral surgery purposes. Relevant outcome parameters were: postoperative local hemostasis, bleeding episodes, occurrence of thromboembolic events, and other complications due to the anticoagulation medication. A hand search for references cited in the identified publications completed the review. After screening of 1755 abstracts, 16 clinical studies were identified according to the selection criteria. Due to the heterogeneity of the obtained data, aggregation and synthesis were not possible. There was no significant difference in bleeding events comparing patients under continued OAT to those with reduced, altered, and/or discontinued OAT medications. Minor bleeding events in the test and control groups were successfully stopped with local measures. However, no superiority of a single hemostatic measure could be identified. Neither the international normalized ratio (INR), within the therapeutic range (2-4), nor the extent of the minor oral surgery procedure had an influence on postoperative bleeding episodes. There is strong evidence that OAT patients undergoing minor oral surgery should not discontinue their medication

Use of forced eruption to enhance a pontic site in the anterior maxilla

Extraction of teeth leads to bone resorption that can result in asymmetrical hard and soft tissue topography. This article describes a technique to enhance a pontic site in the anterior maxilla by using forced eruption as an alternative to conventional hard and soft tissue augmentation surgeries. Forced eruption is a well-known procedure and its use in developing a pontic site for a fixed dental prosthesis is described in this clinical report.