Artesunate suppresses inflammation and oxidative stress in a rat model of colorectal cancer.

Anti-inflammatory drugs are well known to reduce the risk of colon cancer and prophylactic use of such agents is gaining acceptance as a cancer prevention therapy. As artesunate, an antimalarial drug, has been shown to exhibit chemopreventive properties, the present study was carried out to evaluate its inhibitory effect on oxidative stress and inflammation in a rat model of colon carcinogenesis. A chemical carcinogen, 1,2-dimethylhydrazine was injected twice at an interval of 1 week to induce preneoplastic lesions in the colon and the parameters indicating oxidative stress and inflammation were evaluated after 8 weeks. Artesunate (50 and 150 mg/kg) and aspirin (60 mg/kg) were administered orally throughout the study. Analysis of colon tissue revealed that both the drugs preserved histoarchitecture, inhibited cellular influx, decreased the levels of oxidative stress and inflammatory markers, downregulated cyclooxygenase-2, inducible nitric oxide synthase, nuclear factor κB, and interleukin 1ß in comparison to the experimental control. Suppression of oxidative stress and pro-inflammatory signaling by both the drugs were found to contribute to inhibition of colon carcinogenesis. The protection afforded by these drugs was found to be comparable. Our study shows that like aspirin, use of artesunate could also reduce the risk of colon cancer and it has a potential for further evaluation for the treatment purpose.

Effect of roxithromycin on mucosal damage, oxidative stress and pro-inflammatory markers in experimental model of colitis.

OBJECTIVE AND DESIGN: Roxithromycin, a macrolide antibiotic, exhibits anti-inflammatory property. The present study was designed to evaluate its protective effect in a rat model of colitis. METHODS: The anti-inflammatory property of roxithromycin was first validated in rat paw edema model at 5 and 20 mg/kg doses where it produced 19 and 51% inhibition of paw swelling induced by carrageenan. The efficacy of roxithromycin was evaluated at these doses in a rat model where colitis was induced by intra-colonic instillation of acetic acid. Rats were divided into six groups viz. normal control, experimental control and drug-treated groups: roxithromycin 5 and 20 mg/kg, diclofenac 10 mg/kg and mesalazine 300 mg/kg. All drugs were given orally 1 h before induction of colitis. The macro and microscopic changes, mean ulcer score, mucus content and markers of oxidative stress and inflammation were evaluated in all the groups after 24 h. RESULTS: Pretreatment with roxithromycin markedly decreased hyperemia, ulceration, edema and restored histological architecture. The protection afforded by roxithromycin was substantiated by dose-dependent increase in mucus content, normalization of markers of oxidative stress (GSH and TBARS) and levels of TNF-α, PGE2 and nitrite along with marked decrease in expression of NFκB (p65), IL-1ß and COX-2. The protective effect of roxithromycin was found to be comparable to mesalazine while diclofenac was found ineffective. CONCLUSION: Our study demonstrates that roxithromycin ameliorates experimental colitis by maintaining redox homeostasis, preserving mucosal integrity and downregulating NFκB-mediated pro-inflammatory signaling and suggests that it has a therapeutic potential in inflammatory conditions of the colon.

Correlation of mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with different growth pattern.

Aim and Objective: To evaluate, compare, and correlate the mandibular third molar orientation and available retromolar space with arch length discrepancy in subjects with skeletal class II malocclusion and different growth pattern. Material and Method: A total of 250 patients (age >18 yrs) having skeletal class II malocclusion (based on YEN angle and WITS appraisal) were divided into two groups. Both the groups (Group I with erupted mandibular third molars {N = 150} and Group II with impacted mandibular third molars {N = 100}) were subdivided into subgroups IA (n = 71), IB (n = 19), IC (n = 71) and Group IIA (n = 54), IIB (n = 30) and IIC (n = 16) for normo-, hypo- and hyperdivergent growth patterns, respectively (based on Jarabak ratio and Sn-Go-Gn angle). Four parameters, that is, retromolar space, width of third molar, third molar angulation, and mandibular incisor angulation were measured on orthopantomogram whereas arch length discrepancy was calculated with the help of lateral cephalogram and study model. Intragroup, intergroup comparisons (using unpaired Student's 't' test), and Pearson's correlation coefficient for assessed parameters were obtained. Result: Third molar angulation and retromolar space were significantly higher in Group I than in Group II (hyperdivergent pattern of Group II had highest value). The width of third molar was less than retromolar space in Group II and vice versa for Group I. Mandibular incisor angulation and arch length discrepancy were more in Group II than in Group I, but difference was statistically nonsignificant. Strong positive correlation was observed for mandibular third molar angulation and available retromolar space in normo- and hyperdivergent growth patterns. Conclusion: Lack of retromolar space along with increased amount of arch length discrepancy and mandibular incisor angulation is responsible for increased chances of third molar impaction in some subjects with class II malocclusion.

Double bonding system for deeply impacted tooth--a technic clinic.

Close eruption technique is preferred in deep, buried, intraosseous and labially impacted teeth to provide healthy and fuinctional attached gingiva but in this technique failure of bonded attachment usually means, repeat exposure of the impacted tooth. This article describes an innovative method for bonding two attachments (Double Bonding System) in combination instead of one. It provides the safe and determinate system for ortho-eruption, avoid the trauma of patient from re-exposure and enhance the comfort as well the confidence of the operator.

Anti-inflammatory and antioxidant effect of methanol extract of latex of Calotropis procera in rat model of colorectal cancer.

ETHNOPHARMACOLOGICAL RELEVANCE: Preparations derived from the plant Calotropis procera, have been used for medicinal purpose though the plant is known for its toxic effects. The aerial parts of the plant contain latex in plenty and have been found effective in treating disorders of gastrointestinal system and cancer. AIM OF THE STUDY: This study evaluated the efficacy of C. procera dried latex extract prepared in methanol (MeDL) against inflammation and oxidative stress in experimental model of colorectal carcinoma (CRC). MATERIALS AND METHODS: Two subcutaneous injections of chemical carcinogen, 1,2-dimethylhydrazine (DMH; 150 mg/kg) were given at an interval of one week to induce CRC in rats. The MeDL (50 and 150 mg/kg) and aspirin (60 mg/kg) were given daily and their effect was evaluated on markers of oxidative stress and inflammation after completion of 8 weeks following second injection of carcinogen. A comparison was made with normal and experimental control groups. The colon tissue levels of glutathione (GSH), thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), nitrite and myeloperoxidase (MPO) were determined. Enzyme-linked immunosorbent assay was performed to determine the levels of prostaglandin E2 (PGE2) and tumor necrosis factor-alpha (TNF-α) and immunohistochemical analysis was performed for IL-1ß. RESULTS: Induction of cancerous changes in the colon resulted in altered oxidative homeostasis as evident from a reduction in GSH level and SOD activity and rise in TBARS level when compared with normal rats. Elevated levels of nitrite, MPO, TNF-α, PGE2 and immunoreactivity of IL-1ß were also observed in these rats. The levels of these markers were normalized when the rats were treated with MeDL or anti-inflammatory drug, aspirin. CONCLUSION: This study demonstrates that suppression of oxidative stress and inflammation contributes to the beneficial effect of MeDL in rat model of colon carcinogenesis.

Protective effect of methanol extract of latex of Calotropis procera in an experimental model of colorectal cancer.

ETHNOPHARMACOLOGICAL RELEVANCE: The plant, Calotropis procera, has been used for treating various gastrointestinal disorders and cancer. Some of these medicinal properties have been attributed to the latex produced by the plant. AIM OF THE STUDY: To evaluate the efficacy of methanol extract of air-dried latex (MeDL) of C. procera in the rat model of colorectal cancer (CRC). MATERIALS AND METHODS: CRC was induced in the rats by 1,2-dimethylhydrazine (DMH) and the effect of MeDL was evaluated at two doses (50 and 150 mg/kg). MeDL and reference drug aspirin (60 mg/kg) were administered orally starting from 1 h before injecting DMH till 8 weeks after the second dose of DMH. The study also included experimental and normal control groups. Microscopic analysis was carried out to determine the count for aberrant crypt foci (ACF) and histology score whereas enzyme-linked immunosorbent assay and immunohistochemical analyses were performed for markers of carcinogenesis and angiogenesis. Other parameters that were evaluated include deoxyribonucleic acid (DNA) fragmentation, laddering, Bcl2 and Bax immunoreactivity, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) positivity. RESULTS: Subcutaneous injection of DMH induced pre-neoplastic changes in the colon of rats with the appearance of ACF with multiple crypts (1-3, 4-6 or >6). In the experimental control group, total ACF count was 3.49 ± 0.23/cm of the colon length and the median histology score was 2.0 for architectural abnormalities, 2.0 for dilatation of crypts and 1.5 for hyperplasia/dysplasia against 1.0 for all the characteristics in normal rats. Oral administration of MeDL similar to aspirin, led to a reduction in ACF count and histology score of CRC concomitant with a decrease in the levels of markers of carcinogenesis - ß-catenin and proliferating cell nuclear antigen (PCNA); markers of angiogenesis - matrix metallopeptidase-9 (MMP-9) and vascular endothelial growth factor (VEGF), and an increase in apoptotic DNA fragmentation. CONCLUSION: MeDL confers protection in the rat model of CRC and the study suggests its therapeutic potential in this condition.

Predictive accuracy of estimating mandibular growth potential by regression equation using cervical vertebral bone age.

INTRODUCTION: The maturational changes both in size and shape of cervical vertebrae had been widely used not only to assess skeletal maturity but also to predict the same using regression equation. Thus, the aim of this cross-sectional study was to check the predictive accuracy of estimating mandibular growth potential in the North Indian population by regression equation of Mito et al. MATERIALS AND METHODS: A total of 200 subjects divided into two groups, Group I had 100 adult subjects (18-20 years) and Group II had 100 young subjects (9-14 years) were subdivided according to the gender (50 subjects in each group). Seven linear parameters on cervical vertebral bodies of C3 and C4 were measured to derive cervical vertebral age and applied to the regression equation to estimate the mandibular growth potential in Group II. The mandibular length was measured for both the groups from Co-Gn. The mean value of the actual mandibular length in Group I was statistically evaluated against the corresponding mean value of the predicted mandibular growth potential of Group II. RESULTS: The actual mandibular length (Group I) and calculated mandibular length obtained by adding mandibular growth potential (from regression equation) to the mandibular length of Group II did not differ significantly for both males and females. Chronological age showed a statistically significant difference and poor correlation with bone age, in Group II. CONCLUSION: The regression equation of Mito et al. using cervical vertebral bone age has proven to be applicable and accurate in predicting mandibular growth potential in growing young Indian individuals and can be of diagnostic and prognostic value in growth modification procedures in Orthodontics.

Protection afforded by methanol extract of Calotropis procera latex in experimental model of colitis is mediated through inhibition of oxidative stress and pro-inflammatory signaling.

Calotropis procera, a latex producing plant is known to possess medicinal properties including its beneficial effect in gastrointestinal disorders. The anti-inflammatory effect of its latex in various experimental models is noteworthy and in light of this the present study was carried out with an objective to evaluate its efficacy in ulcerative colitis, an inflammatory condition of the colon. Colitis was induced in rats by acetic acid and the rats were divided into four groups where one group served as experimental control and the other groups were treated with two doses of methanol extract of dried latex of C. procera (MeDL; 50 and 150 mg/kg) and mesalazine (MSZ; 300 mg/kg). The study also included normal control (NC) group for comparison of various parameters related to colon like macroscopic changes, ulcer score, adherent mucus content, weight/length ratio, small intestinal transit, oxidative stress and inflammatory markers, tissue histology and immunoreactivity of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS) and nuclear factor kappa beta (NFκB) subunit p65. Treatment of colitic rats with MeDL produced a significant reduction in colonic mucosal damage as revealed by macroscopic and microscopic evaluation and normalization of tissue levels of oxidative stress markers and pro-inflammatory mediators. The protection afforded by MeDL was also evident from its restorative effect on tissue histology and expression of COX-2, iNOS and NFκB(p65). This study shows that by targeting oxidative stress and NFκB(p65) mediated pro-inflammatory signaling, the latex of C. procera affords protection in colitis and its effect was comparable to that of mesalazine. This study suggests that latex of C. procera could serve as a promising therapeutic option for treating inflammatory conditions of the colon.

Artesunate affords protection against aspirin-induced gastric injury by targeting oxidative stress and proinflammatory signaling.

BACKGROUND: Prolonged use of aspirin, a commonly prescribed non steroidal anti-inflammatory drug, is well known to produce gastrointestinal toxicity which could be minimized by various anti-secretory agents. The present study was carried out to evaluate the protective effect of artesunate against aspirin induced gastric injury in rats. METHODS: Gastric injury was induced in fasted Wistar rats by oral administration of aspirin. The effect of 50 and 150mg/kg of artesunate was studied on macroscopic changes, gastric secretions, histology, oxidative stress and inflammatory markers in the stomach tissue after 5h of induction of gastric injury. Immunohistochemical analysis for the expression of IL-1ß, IL-6, NF-κB(p65) and COX-2 was also carried out. The effect of artesunate was compared with that of standard anti-ulcer drug famotidine (20mg/kg). RESULTS: Artesunate pretreatment produced a dose-dependent reduction in aspirin induced gastric injury and restored the gastric juice parameters. It normalized the tissue levels of oxidative stress markers (glutathione, malondialdehyde and superoxide dismutase activity) and mediators of inflammation (myeloperoxidase and TNF-α). The protection afforded by artesunate was evident from the histoarchitecture of stomach tissue and marked reduction in tissue expression of IL-1ß, IL-6, NF-κB(p65) and COX-2. The effect of artesunate was found to be comparable to that of standard drug famotidine. CONCLUSION: Artesunate markedly ameliorated aspirin induced gastric injury in rats by targeting oxidative stress and COX-2 dependent as well as COX-2 independent proinflammatory signaling pathways and could have a therapeutic potential in gastric ulcer disease.

Metformin maintains mucosal integrity in experimental model of colitis by inhibiting oxidative stress and pro-inflammatory signaling.

Metformin, an antidiabetic drug, is well known for its multifarious properties and its ability to modulate inflammatory cascade. Ulcerative colitis (UC) is an inflammatory condition of the colon where drugs exhibiting anti-inflammatory property have been shown to induce and maintain remission. The objective of the present study was to evaluate the efficacy of metformin against acetic-acid induced colitis in rat. The study included five groups of rats namely normal control, experimental control, drug treated groups (50 and 500mg/kg of metformin, MET50, MET500 and 300mg/kg of mesalazine, MSZ300). Parameters like small intestinal transit and colonic macroscopic changes, ulcer score, weight/length (W/L) ratio, levels of oxidative stress and inflammatory markers, tissue histology and expression of COX-2, iNOS, NFκB(p65) were evaluated. The results of this study show that treatment with metformin significantly decreased colonic mucosal damage, maintained oxidative homeostasis and normalized intestinal transit and W/L ratio in a dose-dependent manner. The restorative effect of metformin on colonic mucosa was accompanied by a marked reduction in the tissue levels of pro-inflammatory mediators and immunoreactivity of COX-2, iNOS and NFκB(p65). Further, its protective effect was found to be comparable to that of mesalazine. This study shows that metformin targets oxidative stress and down regulates transcription factor NFκB(p65) mediated pro-inflammatory signaling and has a therapeutic potential in treating inflammatory conditions of the colon.

Chemoprevention by artesunate in a preclinical model of colorectal cancer involves down regulation of ß-catenin, suppression of angiogenesis, cellular proliferation and induction of apoptosis.

Use of anti-inflammatory drugs is well known to decrease the risk of colorectal cancer, one of the most common causes of cancer related mortality. In view of anti-inflammatory property of artesunate reported in various experimental models, the present study was carried out to evaluate its efficacy in rat model where colon carcinogenesis was induced by 1, 2 dimethylhydrazine (DMH). A time course study revealed that two injections of DMH given at an interval of one week resulted in appearance of multiple plaque lesions and aberrant crypt foci in the colon with a peak effect occurring at the end of 8 weeks. An efficacy study carried out with daily oral administration of artesunate (50 and 150 mg/kg) and aspirin (60 mg/kg) showed a marked reduction in pre-neoplastic changes with a significant decrease in the number of aberrant crypt foci, crypt multiplicity and restoration of histoarchitecture. Both the drugs down regulated ß-catenin signaling, reduced the levels of angiogenic markers like VEGF, MMP-9 and inhibited cellular proliferation. The anti-cancer effect of these drugs was concomitant with the pro-apoptotic effect as revealed by increased DNA fragmentation, TUNEL positivity and Bax/Bcl2 immunoreactivity. This is the first study to evaluate the inhibitory effect of artesunate on pre-neoplastic changes in colon where its chemopreventive effect was found to be comparable to that of aspirin. Our study strengthens the previous findings and shows that it has a preventive and therapeutic potential in the treatment of colon cancer.

Attenuation of gastric mucosal damage by artesunate in rat: Modulation of oxidative stress and NFκB mediated signaling.

A number of factors like alcohol consumption, stress, use of non steroidal anti-inflammatory drugs and acidity are well known to increase the risk of development of gastric ulcers. The present study was carried out to investigate the protective effect of artesunate against gastric injury induced in rats by oral administration of ethanol and by pylorus ligation in independent sets of experiments. The groups included in each set (n = 6 per group) were normal control, experimental control and drug treated groups: artesunate 50 and 150 mg/kg (ART 50 and ART 150) and famotidine 20 mg/kg (FAM 20). Artesunate and famotidine were given orally 1 h before induction of gastric ulceration and the macroscopic changes, median ulcer score, gastric juice parameters (volume, pH and acidity), markers of oxidative stress and inflammation (GSH, SOD, TBARS and MPO) and tissue histology were evaluated in both the models. The study was extended further for determination of tissue levels of TNF-α and expression of IL-1ß, IL-6 and NFκB (p65) in ethanol induced gastric ulcer model. The results of the present study show that pretreatment with artesunate significantly decreased hemorrhagic lesions and mucosal damage with marked reduction in median ulcer score in both the models. The protective effect of artesunate was concomitant with dose-dependent normalization of gastric juice parameters, markers of oxidative stress and lipid peroxidation. The ameliorative effect of artesunate was also supported by restoration of histological architecture. Furthermore, artesunate pretreatment also alleviated the gastric mucosal inflammation as revealed by significant decrease in the tissue level of pro-inflammatory cytokine TNF-α (p < 0.01) and tissue expression of IL-1ß, IL-6 and NFκB (p65). The protective effect of artesunate was found to be comparable to that of famotidine. Conclusively, artesunate afforded significant gastroprotection in rat due to its anti-oxidant and anti-inflammatory properties with transcription factor NFκB(p65) and its downstream inflammatory cascade as a plausible target for its action.

Ortho-surgical management of skeletal Class III malocclusion.

Class III malocclusions are considered to be one of the most difficult problems to treat. Establishment of the treatment plan is based on the efficacy and thoughtful application by the clinician and easy acceptance by the patient. We are presenting a case report of an adult male patient with skeletal Class III malocclusion who was treated by orthosurgical approach in Department of Orthodontics in collaboration with Department of Oral and Maxillofacial Surgery. The treatment was complete with a positive overbite and acceptable occlusion and satisfactory facial esthetics using a combination approach.

A rare syndrome with unusual dental findings: Oculo-facio-cardio-dental syndrome.

Radiculomegaly of a tooth is a rare condition. When it is associated with other dental abnormalities, facial dysmorphism and congenital cataracts, the condition is named as oculofaciocardiodental (OFCD) syndrome. This is an X-linked dominant trait, reported only in women, suggesting that it is lethal in males. The most consistent and pathognomic dental finding of OFCD is radiculomegaly (extremely long roots), particularly of the canines and occasionally of other teeth including premolars and incisors, which can easily be diagnosed on dental panoramic radiographs by a dentist or an orthodontist. Till date, 21 cases have been reported worldwide. The aim of this report is to present a new case of a 24 year old female affected by this syndrome and to evaluate it from a dental perspective to call the attention of dentists to this rare anomaly.

Cephalometric norms for orthognathic surgery in North Indian population using Nemoceph software.

BACKGROUND: Cephalometric norms, useful in providing guidance to orthodontist during diagnosis and treatment planning are subjected to variability in morphologic characteristics in different ethnic and racial groups, hence norms established for one population group are not applicable for all. AIMS AND OBJECTIVES: To compare and correlate the established hard tissue cephalometric norms for orthognathic surgery (COGS analysis) given by Legan and Burstone with norms obtained for North Indian population. METHODS: Pre-treatment digital lateral cephalograms of 100 orthodontically untreated subjects having pleasing profile and normal occlusion in the age range of 18-25 yrs (mean age of 21 ± 2.62 years) were selected. 16 linear and 6 angular hard tissue parameters of COGS analysis were analyzed using nemoceph software for the males and females separately. The data obtained were compared with previously established norms for Orthognathic Surgery using SPSS Version 15.0. RESULTS: North Indian males and females had smaller anterior cranial base length with prognathic maxilla and mandible, protrusive chin with poor chin form, decreased facial height, decreased posterior maxillary height with anticlockwise rotation of mandible, increased anterior and posterior maxillary dental heights, decreased ramal and corpus length, clockwise rotation of occlusal plane, presence of sagittal discrepancy between maxillary and mandibular denture bases in comparison to Caucasian males and females respectively. North Indian females had more proclination of mandibular incisors than Caucasian females. Sexual dimorphism was also evident in the present study with males exhibiting significantly larger cranial base length, greater middle third facial height and posterior maxillary height, counterclockwise rotation of mandibular plane, greater anterior and posterior mandibular dental heights and longer ramal and corpus length in comparison to females. CONCLUSION: North Indian population showed significant differences in facial morphology as compared to Caucasians population. Sexual dimorphism was also evident in North Indian populations. Thus the need to develop separate Orthognathic Surgical norms for better treatment planning of North Indian population is justified.

Comparison of esthetic outcome after extraction or non-extraction orthodontic treatment in class II division 1 malocclusion patients.

INTRODUCTION: The extraction of premolars as a practical form of orthodontic therapy has been accepted for many years, but there remains a controversy regarding the effect of premolar extraction to improve esthetics as well as dentoskeletal relationship. The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or non-extraction treatment, particularly in borderline patients. This cephalometric study was undertaken to compare the post-treatment soft-tissue profiles of successfully managed Class II, Division 1 malocclusions treated with either all first premolar extractions or treatment with a non-extraction therapy. MATERIALS AND METHODS: The sample consisted of 100 post-pubertal female patients of Class II Division I malocclusion. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post-treatment lateral cephalometric radiographs were evaluated. The pre-treatment to post-treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and non-extraction groups of Class II malocclusion samples with t-tests. RESULTS: The soft-tissue facial profiles of the extraction and non-extraction samples were the same following active treatment except for a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. CONCLUSIONS: The extraction or non-extraction decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

Comparative assessment of soft-tissue changes in Class II Division 1 patients following extraction and non-extraction treatment.

BACKGROUND: The extraction of teeth for orthodontic purpose has always been a controversial subject in the speciality. The aesthetics impact of the soft-tissue profile might play a key role in deciding on premolar extraction or non-extraction (NE) treatment, particularly in borderline patients. The purpose of this cephalometric study was to examine the soft-tissue treatment effects of Class II Division 1 malocclusion undergoing extraction of all first premolars in comparison with patients undergoing treatment with a NE approach. MATERIALS AND METHODS: Hundred post-pubertal female patients of Class II Division 1 malocclusion were selected. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post-treatment lateral cephalograms of the patients were obtained. The pre-treatment and post-treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and NE groups of Class II malocclusion samples with t tests. The levels of significance tested were P < 0.05 and P < 0.01. RESULTS: The main soft-tissue differences between the groups at the end of treatment were a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. CONCLUSION: In Class II Division 1 patients, the extraction or NE decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

Management of a transmigrated mandibular canine.

The purpose of this article is to report the management of a transmigrated mandibular canine with emphasis on saving the tooth as natural part rather than surgical removal of the transmigrated tooth. There are several treatment options proposed for impacted mandibular canines including surgical removal, exposure and orthodontic alignment, intra-alveolar tooth transplantation (surgical repositioning of a tooth in its alveolar socket) and observation. The technique, surgical repositioning of a tooth involves the surgical extraction of impacted tooth and fixation in the correct position in the dental arch after surgical preparation (correction) of the alveolar socket. It is especially valuable in cases of difficult-to-treat impaction. A repositioned tooth is better substitute than fixed or removable prostheses, and the technique is more cost effective than other methods. Patients with excellent oral hygiene should be considered as preferred candidates for surgical repositioning of tooth. Disadvantages include the invasiveness of surgery, the difficulty of projecting long term stability due to chances of root resorption and loss of gingival attachment.