Evidence Of Root Resorption Research Articles

Local administration of prostaglandins to accelerate the orthodontic movement. A literature review

The search to optimize tooth movement and reduce treatment time is of great interest to the orthodontist, as it involves innovating new materials and procedures to achieve the treatment objectives in the short term. The administration of prostaglandins has been studied, and their effect on accelerating tooth movement when administered locally has been proven. The objective of this study was to evaluate the latest achievements concerning the effects of local administration of prostaglandins to accelerate tooth movement for orthodontic purposes. A search was conducted in four databases (PubMed, SciELO, Cochrane, Google Scholar) and three specialized journals (AJODO, Angle Orthodontics, Journal of Clinical Orthodontics) until August 2023. The methodological quality of the studies was analyzed using the PRISMA checklist. The study had 14 articles. Local administration of prostaglandins accelerates the speed of tooth movement and increases the number of osteoclasts. Evidence of root resorption has been reported concerning high doses of prostaglandins via the submucosal route and a reduction in root resorption by administering prostaglandins with calcium gluconate. Local administration of prostaglandins via the submucosal route produces mild to moderate pain, and inoculation with a local anesthetic is recommended. However, oral administration of the analogous compound Misoprostol does not produce pain or evidence of root resorption. Sufficient scientific evidence has not been found to support the local administration of prostaglandins as a safe method to accelerate tooth movement in humans.

Radiographic imagery of aggressive plexiform-type ameloblastoma in the mandible: a case report

Objectives: This case report aims to describe the radiographic characteristics of plexiform ameloblastoma and its impact on surrounding tissues in a middle-aged female patient using panoramic radiography and CBCT, along with case management. Case Report: A 43-year-old female patient presented to the Dental Radiology Unit of RSGMP UNHAS with a panoramic referral letter, diagnosed clinically with anterior mandibular ameloblastoma. Extraoral examination revealed an asymmetrical facial appearance with anterior mandibular enlargement. Intraoral examination showed mucus membrane enlargement in the anterior mandible region (teeth 37-45), soft consistency, absence of crepitus, no palpation tenderness, and mobility in several anterior mandibular teeth. The first panoramic radiograph (March 16, 2022) exhibited a unilocular radiolucent lesion, well-defined, with scalloped margins in the anteroposterior mandibular region. The second panoramic examination (May 23, 2022) indicated a more aggressive lesion expansion, with evidence of root resorption and destruction of the inferior mandibular cortex approaching the mandibular angle. CBCT findings demonstrated a hypodense/radiolucent lesion extending anteroposteriorly, superiorly, and inferiorly, leading to displacement, root resorption, and destruction of the inferior mandibular cortex in the inferior direction. Conclusion: Based on the characteristics and structure of the lesion observed through various radiographic examinations, a unilocular ameloblastoma was suspected. Histopathological examination confirmed the plexiform-type ameloblastoma.

Success of replantation of avulsed teeth using human colostrum as an interim storage medium

ObjectivesTooth avulsion is defined as total tooth displacement from the alveolar socket; the best treatment is replantation of the tooth. Human milk influences body health, growth, and development related to the presence of micro and macro nutrient components. This study assessed the effects of human colostrum as a storage medium on the success of tooth replantation. MethodsThe upper left incisor of 30 adult male Wistar rats was extracted, and the rats were divided into three groups according to the storage medium of the extracted tooth for replantation: Hank's balanced salt solution (HBSS), tap water, and colostrum groups. The MTT cell viability assay was conducted, and histological evaluation and histomorphometric analyses were performed on postoperative day 45 for identification of pulp necrosis, periodontal hyalinization, percentage of resorbed area, and the periodontal ligament attachment. ResultsThe colostrum medium showed a higher percentage of cell viability followed by HBSS with statistical significance. Histological findings of the replanted avulsed tooth that soaked in tap water as storage medium showed obvious external and internal root resorption. Pulp necrosis and periodontal ligament hyalinization and with a significant differences values in comparison to HBSS and colostrum groups (p > 0.05), whereas the colostrum group showed new well-reattached periodontal ligament with normal pulp and no evidence of root resorption. ConclusionTooth loss is minimized by using human colostrum as storage medium in replantation of an avulsed tooth after a 1 h period compared to HBSS and water.

Successful traction of a mesially 90° dilacerated root of impacted maxillary canine: A case report

Background: Impacted maxillary anterior teeth are a problem that has a significant impact on the aesthetics of the smile, dental arches, and occlusion. Teeth that have higher tendencies to get impacted are third molars, maxillary central incisors, maxillary canines, and mandibular premolars. Impacted teeth with severe root dilacerations are usually extracted surgically, then the space will be closed by orthodontic treatment or using a prosthesis. Purpose: This study aims to report the successful orthodontic traction of mesially 90° dilacerated root of impacted maxillary canine. Case: A 15-year-old female patient with the chief complaint of an unerupted left maxillary canine. Intraoral examination showed a class I molar relationship on both sides, a unilateral crossbite on the right side, 8 mm spacing between the maxillary left lateral incisor and the premolar. Also, mild crowding was found on both upper and lower anterior segments. CBCT results showed a left maxillary canine was palatally semi-vertical impacted and had a mesially 90° dilacerated root. A significant stress concentration occurred at the middle and apical of the dilacerated root apex when exposed to orthodontic force; this tends to be a higher potential for resorption. Case Management: The impacted dilacerated canine was successfully moved to the proper position by combining crown exposure surgery, orthodontic traction using continuous light force, and gingivectomy. Furthermore, traction was held using a gold chain combined with an elastic thread tied initially to a modified stainless-steel main archwire; this was followed by piggyback tandem wire and a vertical 3/16” light elastic traction. Conclusion: The patient showed successful traction of the canine in less than six months. In addition, the unilateral posterior crossbite was corrected and functional occlusion was achieved. That canine showed good orthodontic and periodontal stability at one-year follow-up, without any evidence of root resorption.

FINITE ELEMENT ANALYSIS OF ROOT RESORPTION ASSOCIATED WITH TOOTH MOVEMENT: A SYSTEMATIC REVIEW”

Background: The purpose of this systematic review was to examine the available evidence of root resorption during orthodontic treatment with different force systems using nite element analysis. Methods: The following electronic databases were searched for literature till June 2021 : Pro-Quest Dissertation Abstracts and Thesis database, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Google Scholar, Embase, US National Library of Medicine, and National Research Register. Root resorption studied under orthodontic forces, which simulated under various technique of nite element method (3D FEM) models were included in the study. The selected studies were assessed for the risk of bias using the Cochrane Collaboration risk of bias tool. The “trafc plot” and “weighted plot” risk of bias distribution were designed using the ROBVIS tool. The authors extracted and analyzed the data. Results: Fourteen studies fullled the inclusion criteria. The risks of biases were high for all studies.Data on quantity and direction of force applied, different type of root morphology and its various surface inuence on root resorption were extracted. The outcomes of the included studies were heterogeneous. Conclusion: Based on the current available literature, for reducing root resorption the excessive force may accelerate root resorption when it exceeds the typical human capillary blood pressure. Root resorption occurs more when extrusion/intrusion and tipping occur than when teeth actually move. A tooth with little or no orthodontic force load hardly shows any root resorption compared to one that has orthodontic force.

CENTRAL GIANT CELL GRANULOMA IN A PATIENT WITH NEUROFIBROMATOSIS TYPE 1

<h3>BACKGROUND</h3> Neurofibromatosis type 1 (NF1) is an autosomal dominant, inherited, multisystemic disease caused by a mutation in the NF1 gene. A second mutation in this gene can lead to central giant cell granulomas (CGCGs) in the jaws of patients with NF1. In this case, we describe a patient with NF1 and the presence of a CGCG in the mandible. <h3>CASE REPORT</h3> A 24-year-old female patient with relevant medical/dental history of attention deficit hyperactivity disorder, developmental delay, hypothyroidism, congenital heart defect, NF1, and multiple missing teeth presented to the University of Florida College of Dentistry for implant evaluation. A cone beam computed tomography scan was performed where root resorption on tooth 11 was noted and a well-defined, multiloculated, radiolucent entity in the left parasymphyseal region was seen. This entity extended from tooth 20 beyond the midline and from the alveolar crest to the inferior third of the mandible. The alveolar crest and the buccal cortex were mainly resorbed. The root of tooth 21 was distally displaced without evidence of root resorption. The surrounding bone was sclerotic. A thin septum dividing the lesion from the left mental foramen was noted. Given the radiographic appearance and the history of NF1, a CGCG and neurofibroma were considered as differential diagnoses. Histopathologic evaluation was recommended. <h3>DISCUSSION/CONCLUSIONS</h3> A biopsy confirmed the lesion to be a CGCG. The treatment options suggested by the oral surgeon were (1) nonsurgical: Intralesional injection of corticosteroid or (2) surgical: Enucleation and Curettage (E&C) with likely mandibular resection. Owing to concerns regarding anesthesia, a nonsurgical approach was chosen. The relationship between CGCG and NF1 is rarely seen but is well described in the literature and should be considered as a differential diagnosis in patients with NF1 and tumor-like lesions in the jaws. Intralesional injection of corticosteroids has shown good efficiency in complete remission of CGCGs or substantial shrinkage of the lesion, avoiding large surgical resections.

External Root Resorption after Orthodontic Treatment with Invisalign®: A Retrospective Study

AIM: To measure the incidence and severity of root resorption after orthodontic treatment with Invisalign.&#x0D; &#x0D; MATERIAL AND METHODS: This retrospective study was conducted at Riyadh, Saudi Arabia from June 2017 to January 2018. Pre- treatment and post-treatment Orthopantographs were obtained from orthodontic records of 29 patients managed with aligners (Invisalign&amp;reg;, Align Technologies, Santa Clara, CA, USA) at different dental clinics in Riyadh City. The selected sample was fulfilled the following criteria: (1) Class I malocclusion, (2) Mild to moderate crowding, (3) Non-extraction orthodontic treatment, (3) No evidence of root resorption before orthodontic treatment, (4) No root abnormalities or dilaceration, and (5) Good quality of pre- and post-treatment Orthopantographs. One examiner performed the measurements directly on the Orthopantographs using electronic digital caliper (Mitutoyo Manufacturing Co. Ltd., Tokyo, Japan) with an accuracy of 0.01mm. The measurements were performed on maxillary and mandibular central incisors, lateral incisors, and canines pre- and post-operatively, resulting in a total of 696 measurements. The crown length was measured from incisal edge to cemento- enamel-junction, while the root length from cemento-enamel-junction to root apex.&#x0D; &#x0D; RESULTS: In our study, 72% of the teeth demonstrated root resorption, in regard to the severity of root resorption, we found that mild root resorption &amp;gt; 0% up to 2% in all the affected teeth. Upper Anterior teeth have more significant resorption rate than lower anterior teeth P&amp;lt;0.05.&#x0D; &#x0D; CONCLUSION: The present study showed that incidence of root resorption was high after orthodontic treatment with Invisalign&amp;reg;, however the severity is very low and it is limited to the surface resorption only.

A multidisciplinary approach to an unusual cystic lesion of the maxilla – A case report

A large cyst in the maxilla in relation to a nonvital tooth is not a common occurrence. The present case report demonstrates an unusual case of a giant cyst in the right maxillary antrum region extending from the anterior to posterior right maxilla with no intraoral bony and soft tissue expansion of a healthy 31-year-old female. However, bone erosion was noted and integrity of important anatomical structures of the right maxillary sinus was affected. The adjacent teeth were nonvital without any evidence of root resorption. Conventional root canal treatment together with surgical enucleation of the affected teeth at 6 months follow-up resulted in the successful resolution of the cyst with complete bone regeneration.

Odontogenic Myxoma of the Maxilla: Diagnostic Considerations, Surgical Resection and Prosthetic Rehabilitation

A 15-year-old female with a history of orthodontic treatment was referred by her general dental practitioner (GDP) to the Oral and Maxillofacial Surgery (OMFS) department after noticing a right buccal maxillary swelling during a routine check-up. Examination and radiographic investigations revealed a lesion extending from UR3 to UR6 causing bony expansion with no evidence of root resorption. Following biopsy and histopathological analysis, a diagnosis of Odontogenic Myxoma (OM) was made. Treatment involved a segmental resection and fitting an immediate partial denture. Options for long-term rehabilitation include removable and implant-supported prostheses. CPD/Clinical Relevance: This case highlights the importance of thorough clinical and radiographic examination, and joint treatment planning between the Restorative and OMFS departments.

Orthodontic extrusion of Ellis Class VIII fracture of maxillary lateral incisor – The sling shot method

The aim of this paper is to evaluate the efficacy of forced extrusion using the sling shot elastic. A 21 year adult patient reported with an Ellis Class VIII fracture of the maxillary right lateral incisor. Root canal treatment followed by a fiber reinforced composite post was placed and core build up was done. A metal button was bonded to the tooth. Begg brackets were placed from the second premolar on one side to the second premolar on the opposite side. 0.016″ × 0.025″ stainless steel was placed in ribbon mode. The ligature wire was placed as a sling shot from the button on the fractured tooth to the two adjacent teeth. 4 mm of extrusion was achieved and there was no evidence of root resorption. Forced extrusion was achieved in four months. The sling shot method is a very effective method of ligation. Light forces are delivered over a long duration with definitive results as compared to the inconsistent force delivery with conventional extrusion mechanics.

Impaction of both maxillary central incisors and a canine

This case report describes the treatment of a 14-year-old adolescent patient who had 2 impacted maxillary central incisors with distoangular root dilacerations. He also had an impacted maxillary left canine, with the crown completely overlapping the root of the lateral incisor, and insufficient space. The general dentist referred this patient because the maxillary central incisors had still not erupted 2 years after extraction of the retained deciduous incisors. A unilateral expander with a modified vestibular arch and an attachment spring on the right side was used to correct the posterior crossbite on the right side and improve the positions of the teeth. The expansion appliance was also applied as a high anchorage device to move the central incisors and the left canine into position during the initial stages. After this phase, fixed appliances were used to redistribute the space in the anterior maxillary region to create enough space for repositioning the impacted teeth. This procedure restored the normal appearance of the maxillary arch, with good periodontal health and without evidence of root resorption, apart from the distoangular root dilacerations of the 2 maxillary central incisors.

Current concepts in hypophosphatasia: case report and literature review

BACKGROUND. Hypophosphatasia (HP) is characterized by defective mineralization of bone and teeth because of deficient alkaline phosphatase activity. There are generally six recognized clinical forms, of which the most severe is often lethal prenatally or early in life. In milder forms, such as odontohypophosphatasia (OHP), premature exfoliation of primary teeth may be the only clinical manifestation. CASE REPORT. A 20-month-old girl was referred to the Specialist Paediatric Salaried Dental Service within the Harrogate and District NHS Foundation Trust with mobility of tooth numbers 71 and 81. Clinical examination revealed grade III mobile 71 and 81, with minimal gingival inflammation and plaque deposits. There were no other dental findings and no significant medical history. Tooth numbers 71 and 81 exfoliated prematurely with no evidence of root resorption, shortly after presentation. Haematological and urinary investigations showed no abnormalities. Histological examination showed a complete absence of cementum. A diagnosis of OHP was made. After 10 months of dental follow-up, no further teeth have increased mobility. CONCLUSION. Odontohypophosphatasia should be included as a differential diagnosis in children presenting with early loss of primary teeth. The dentist may be the first health care professional to whom the patient presents.

Clinical–Pathological Conference: Case 4

Clinical PresentationA 9-year-old male with a non-contributory medical historypresented with left mandibular swelling. His mother hadfirst noticed swelling in the area 2 months earlier, butstated that it seemed to resolve, only to develop again overthe last 2 weeks. The boy had no complaints of pain, ten-derness or altered sensation of his lower lip.Extraoral examination revealed mild facial asymmetrywith enlargement of the body region of the left posteriormandible. The overlying skin lacked erythema or warmthand no anesthesia or paresthesia of the left lower lip wasdetected. Intraoral examination showed marked bucco-lingual expansion of the mandible centered on tooth #19with vertical enlargement to the height of the occlusalplane; tooth #19 appeared ‘‘engulfed.’’ The mucosa wasintact and of normal color (Fig. 1).The panoramic radiograph showed a normal pattern oftooth development and eruption. A solitary 3.5 cm mixedradiolucent/radiopaque lesion was noted surrounding theroots of tooth #19 (Fig. 2a, b). The lesion was composed ofa central opacity exhibiting a fine, radiating trabecularpattern and a relatively well-defined radiolucent periphery.Expansion of the inferior border of the mandible as well asposterior displacement of teeth #18 and #19 was observed,without evidence of root resorption. Vertical extension oflesional tissue above the height of the surrounding alveolarbone was seen. A computed tomography (CT) imagerevealed prominent expansion of the left mandible withdiscontinuity of the buccal and lingual cortices but noevidence of soft tissue involvement (Fig. 3).Differential DiagnosisBased on the clinical history and radiographic findings, adiagnosis of osteoblastoma was favored. The differentialdiagnosis included osteosarcoma, juvenile active ossifyingfibroma, and calcifying epithelial odontogenic tumor.Osteoblastoma is a rare primary bone tumor that typi-cally occurs in patients under the age of 30, with a slightfemale predominance and a predilection for the mandible,particularly the posterior segments [1, 2]. Pain and swellingwith bone expansion are common clinical features [1, 3].While no discomfort was reported in the present case,recent literature indicates that significantly fewer patientsexperience pain associated with this neoplasm than waspreviously suggested [1]. The radiographic features ofosteoblastoma can vary from a well-demarcated to ill-defined osteolytic lesion with variable internal structurethat can range from entirely radiolucent to our finding of acentral radiopacity with radiolucent periphery [1–3].Osteosarcoma is a rare primary malignancy of bone thatmost often affects the long bones around the knee in teen-agers or young adults. While patients with jaw lesions areusually older, all age groups have been affected [4]. Apainful swelling is the most common clinical presentation,with paresthesia and loosening of teeth also frequent find-ings [5, 6]. Radiographically, the radiating pattern of tra-beculation noted within the current case supportedconsideration of osteosarcoma, although only 25% of gna-thic osteosarcomas demonstrate a radiating or ‘‘sunburst’’

Intentional replantation of a mandibular molar: case report and 14-year follow-up

This case report describes the nonsurgical endodontic treatment and intentional replantation of a mandibular molar and its nearly 14-year follow-up. A 56-year-old woman sought treatment with complaint of discomfort and sensitivity in the mandibular left area. The radiographic examination showed that the mandibular left first molar was endodontically treated, with over-instrumentation of the distal root and unsatisfactory obturation on the mesial root. A large periapical lesion was observed surrounding the roots. In view of the patient's limited interocclusal space and objection to undergo an apical surgery, intentional replantation was suggested as an alternative. The patient returned for clinical and radiographic follow-up at 15 days, 40 days, 6 months, 12 months, and once yearly thereafter. At the last visit, after 14 years, no painful symptomatology was reported, probing depth was no greater than 3 mm, the periradicular area had normal appearance and no evidence of root resorption or periapical lesion.

Periodontal regeneration of transplanted rat molars after cryopreservation

The effects of cryopreservation on periodontal regeneration of transplanted rat molars were investigated histologically and histochemically in rats. Bilateral first and second maxillary molars of 4-week-old Wistar rats were gently extracted and transplanted into the abdominal subcutaneous connective tissue immediately or after cryopreservation in liquid nitrogen overnight. Donor teeth were slowly frozen by a rate-controlling freezer (program freezer) using 5% dimethylsulfoxide (DMSO) and 6% hydroxyethyl starch (HES) as cryoprotectants. One–four weeks after transplantation, they were carefully excised with the surrounding tissues. Regeneration of acellular cementum, periodontal ligament, and alveolar bone were observed 2 weeks after immediate transplantation. The pulp was repaired by the ingrowth of granulation tissue from the root apex followed by the formation of calcified tissue. The regenerated periodontal ligament was positive for alkaline phosphatase (ALP). Small or mononuclear tartrate resistant acid phosphatase (TRAP) positive cells were scattered on the newly formed alveolar bone and on the hard tissue in the pulp, but there was no external or internal progressive root resorption at 4 weeks. Cryopreserved teeth had acellular cementum with a rough surface at 1 week, but with the increase of cementoblasts and the appearance of periodontal ligament and alveolar bone, the surface became smooth at 3 weeks. Epithelial rests of Malassez (ERM) also revived. After regeneration of the periodontal tissues at 4 weeks, there was no evidence of root resorption. Although the process proceeded slowly, the cryopreserved teeth showed the periodontal regeneration substantially similar to that of the immediately transplanted teeth without progressive root resorption, indicating that they could be applicable for clinical use.

Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year follow-up

Several authors have suggested that interdental wiring may have an adverse effect on the teeth and surrounding tissues. In the present study we examined 250 teeth that had been subjected to wiring and 142 adjacent teeth that had not been wired (controls). During the wiring period, and after a minimum of 1 year following treatment of the jaw fracture, the teeth and periodontal tissues were examined by periodontal probing, percussion sound test, mobility test, sensitivity test, and radiography. One tooth showed temporary increased mobility. Periodontal health was clinically and radiologically fully restored after a year in all teeth. Progressive caries was seen in 2 patients and was treated. Loss of sensitivity was seen in 3 teeth adjacent to the fracture site and in one tooth adjacent to a titanium cortical screw. However, these pulpal changes either recovered spontaneously or were treated endodontically. There were few late problems in the teeth and surrounding tissues. In 243 teeth (97%), completely healthy conditions were found in pulp and periodontium. There was no evidence of root resorption or dentoalveolar ankylosis. We conclude that late deleterious effects on the teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures were uncommon 1 year after the removal of the interdental wiring.

Histologic evaluation of periodontal healing in humans following regenerative therapy with enamel matrix derivative. A 10-case series.

Enamel matrix derivative (EMD) has been developed as a stimulus of periodontal regeneration. Human histology following its use has not been evaluated on pathologically altered root surfaces. Ten intrabony defects in 8 patients were evaluated at 2 centers. Teeth with advanced adult periodontitis that were treatment planned for extraction were treated with sulcular incisions; full-thickness flap reflection; debridement of granulomatous tissue from the defect; placement of a notch in the root at the apical extent of calculus; mechanical root planing; conditioning with citric acid; application of EMD; wound closure with sutures; and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of small block section biopsies at about 6 months. The biopsies were fixed, decalcified, step-serial sectioned at 6 microns to 8 microns, and stained with hematoxylin and eosin or Masson's trichrome. Histologic evaluation of the region coronal to the base of the calculus notch showed evidence of regeneration (new cementum, new bone, and new periodontal ligament) in 3 specimens, new attachment (connective tissue attachment/adhesion only) in 3 specimens, and a long junctional epithelium in 4 specimens. No evidence of root resorption, ankylosis, or untoward inflammation was seen. The results of this study fulfill the proof of principle that use of EMD can result in periodontal regeneration on previously diseased root surfaces in humans, but on an inconsistent basis.

Current Status of the Polymer Tooth Implant Concept

After 10 years of investigation following the introduction of plastic implants by Flohr,27 we have progressed from exploratory studies to the proven feasibility of the polymer tooth implant concept. There has been no evidence of toxicity, no evidence of neoplasia, and no evidence of rejection in implants studied for up to 10 years. The polymeranorganic-bone mixture does result in apparent immunologic rejection if over 30 per cent anorganic bone is used. The implants withstand masticatory stresses and integrate well into the functional occlusion. The implants can be made esthetically acceptable — in fact superior to present crown restorations, since there is no irritating margin of a restoration. The implants present excellent stability and no evidence of root resorption, since the polymer does not resorb. The polymer dental implant fits all criteria set forth for successful tooth transplants.28 The evidence to date suggests that it will be the optimal means for replacement of single teeth. Through variations in the process may come the optimal means of creating abutments for bridgework and for dentures. To date, the significant part of these studies is the presentation of the concept. Improvements in the actual form of the polymer implants as well as their composition may develop as continuous study and evaluation proceed.

Giant-cell tumor of the mandible associated with hyperparathyroidism and osteitis fibrosa cystica generalisata

1. 1. The clinical, roentgenographic, and histologic oral findings for a case of primary hyperparathroidism are recorded. The outstanding observations and laboratory determinations are as follows: 1.1. (a) Clinically, a firm, smooth, tender swelling (brown tumor) could be palpated on the right side of the mandible unattributable to dental origin. The teeth in the region of tumefaction were markedly mobile. 1.2. (b) Roentgenographically, extensive osteoporosis of the right side of the mandible was apparent. The buccal and lingual cortices were expanded. The lamina dura was visible about several anterior teeth while within the osteo-porotic area it was undetectable. Considerable displacement of the teeth occurred due to the growth of the tumor, but without evidence of root resorption. 1.3. (c) Laboratory studies of the blood and urine revealed the characteristic biochemical syndrome of hypercalcemia, hypophosphatemia, hypercalciuria, and a rise in the alkaline phosphatase level. 1.4. (d) Histologically, there was a replacement of the original bone trabeculae of the right side of the mandible by a young connective tissue stroma. Numerous multinucleated giant cells were scattered throughout the fibrotic marrow cavity. 2. 2. Bones or areas of bones, such as the jaws which are continuously in a state of active bone growth as a result of stimulation by strong functional stresses and strains, seem most likely to be implicated in the disease. 3. 3. Early recognition of the condition is imperative if serious skeletal and renal complications are to be avoided. 4. 4. The impetuous and unnecessary removal of sound functional teeth can be averted in this disease, if the cooperation of an internist is sought in corroborating the diagnosis in patients with jaw involvement before oral surgical procedures are injudiciously undertaken.

Federation Dentaire Internationale (F. D.I.)

The aim of this paper is to evaluate the efficacy of forced extrusion using the sling shot elastic. A 21 year adult patient reported with an Ellis Class VIII fracture of the maxillary right lateral incisor. Root canal treatment followed by a fiber reinforced composite post was placed and core build up was done. A metal button was bonded to the tooth. Begg brackets were placed from the second premolar on one side to the second premolar on the opposite side. 0.016″ × 0.025″ stainless steel was placed in ribbon mode. The ligature wire was placed as a sling shot from the button on the fractured tooth to the two adjacent teeth. 4 mm of extrusion was achieved and there was no evidence of root resorption. Forced extrusion was achieved in four months. The sling shot method is a very effective method of ligation. Light forces are delivered over a long duration with definitive results as compared to the inconsistent force delivery with conventional extrusion mechanics.