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After organ transplantation, severe osteoporosis is occasionally seen, and the use of immunosuppressants is thought to be one of the causes of such osteoporosis. In the present study, we investigated the effects of FK506 monotherapy on bones and determined the mechanism of onset of osteoporosis, both by assessing chronological changes in bone metabolism and by identifying factors that facilitate bone resorption. In 8-week-old male Sprague-Dawley rats, FK506 (1 mg/kg) was injected intraperitoneally every day for 5 weeks (FK506-treated group), and for comparison, physiological saline was administered in the same manner in a control group of rats. Serum and urine samples were collected at weeks 0, 1, 3, and 5 of administration. The femur and tibia were collected within 24 h of the final administration. When compared to the control group, findings on three-dimensional micro-computed tomography of the femur for the FK506-treated group showed a significant decrease in trabecular bone volume. The level of serum osteocalcin in the FK506-treated group at week 1 of administration was significantly higher than the control. Throughout the administration period, the sum of urinary pyridinoline (PYD) and deoxypyridinoline (Dpd) was significantly higher in the FK506-treated group. Of the various bone resorption factors tested, the level of serum parathyroid hormone (PTH) in the FK506-treated group was significantly higher than the control at week 3 of administration. The results of the present study confirmed that FK506 monotherapy in rats induced high-turnover osteoporosis. Soon after the start of FK506 administration, bone formation and resorption were elevated, and PTH appeared to have been involved in the maintenance of the elevated bone resorption.

Introduction: The pathogenetic features of rheumatoid arthritis of the temporomandibular joint (TMJ) are not well defined. In this paper the histological features of TMJs affected by rheumatoid arthritis, and the detection of secondary amyloidosis and macrophage populations in the TMJs of two patients with progressive rheumatoid arthritis are described. Methods: In two patients (64-year-old man and 61-year-old woman) with rheumatoid arthritis total TMJ replacement were performed. The surgical specimens were studied histologically. Results: It was found that the articular cartilage had been completely replaced by proliferating fibrous tissue. Congo red staining and polarizing microscopy revealed amyloid deposition in the connective tissue of the joint space. Immunohistochemical staining showed CD 68 positive macrophages around the amyloid deposition in the proliferating soft tissue. Conclusion: TMJ involvement in rheumatoid arthritis followed the same destructive pathway as in other joints. Amyloid deposition and macrophage populations were detected in two TMJs affected by rheumatoid arthritis.

Grafted periosteum has a rich potential to induce heterotopic bone formation. In the current study the authors investigate whether autogenous periosteal grafts can regenerate the mandibular head in a rabbit model. They removed the mandibular head of Japanese white rabbits and grafted tibial periosteum to the cut surface of the mandible. Grafted periosteum was observed histologically and radiographically at day 7, 14, 21, and 45 after surgery. At day 7 after grafting, grafted tissue showed remarkable cell proliferation. By 14 days these cells had differentiated into chondrocytes to form cartilage, and endochondral ossification took place after 21 days. At 45 days after surgery, soft X-ray findings showed a newly formed mandibular head, which was similar histologically to that of a normal mandibular head. The cut mandible without periosteal graft showed no regeneration. These findings indicate that grafted periosteum can regenerate the mandibular head without special procedures such as bone fixation in a rabbit model, and suggest that this technique may be useful clinically.

The expression of the connective tissue growth factor ( ctgf) gene increases along with the differentiation of growth cartilage cells, and the highest expression is observed in the hypertrophic stage. Similarly, recent reports demonstrated c- fos expression in chondrocytes in the early hypertrophic zone of growth cartilage, and suggested that the c- fos gene may play a crucial role in the regulation of hypertrophic differentiation. A chondrocytic human cell line, HCS-2/8, is known to retain a variety of chondrocytic phenotypes. When such cells were kept overconfluent, they expressed increasing levels of c- fos transcripts along a time course phenotypically similar to that of hypertrophic differentiation. Moreover, by using a competitive electromobility-shift assay, we found that AP-1, a Fos/Jun heterodimer, in HCS-2/8 was capable of binding not only to a typical AP-1-binding DNA fragment but also to the enhancer fragment of the ctgf gene. Based on the findings above, we hypothesize that, prior to hypertrophic differentiation, AP-1-related oncogenes are activated and that their gene products subsequently activate ctgf gene expression, which might eventually induce hypertrophy.

We performed total TMJ replacement to improve respiratory status and correct occlusion in six patients with destruction of the temporomandibular joint (TMJ) caused by rheumatoid arthritis. Morphological changes were evaluated on lateral cephalograms before and after surgery. Respiratory function and mandibular movement were assessed with the use of an apnea-monitor and an LED mandibular tracking device, respectively. After surgery, symptoms such as snoring and daytime sleepiness improved, and solid food could be masticated. Postoperative cephalograms showed that both the posterior airway space and ramal height were significantly improved by surgery. Postoperative records of mandibular movement indicated stability of the occlusion and improvement of mandibular movement, as compared with the preoperative records. Mean oxygen saturation significantly improved 1 month after surgery, whereas apnea and apnea-hypopnea indices did not change significantly.

Cisplatin (CDDP) is a useful drug for the treatment of malignant solid tumors of the head and neck. Because CDDP includes the heavy metal platinum as a component, it is thought metallothionein (MT) may be involved in CDDP-resistance. However, functional differences between the four MT isoforms (MT-I, II, III and IV) remain unclear. The aim of this study was to investigate the relationship between MT isoform expression and CDDP-resistance. Two human tongue squamous cell carcinoma cell lines not exposed to anticancer chemotherapy were studied. The cell lines were subjected to reverse transcriptase-polymerase chain reaction (RT-PCR) analysis before and after CDDP-treatment. Both cell lines expressed MT-I/II and MT-IV isoforms but not the MT-III isoform. Following CDDP treatment, MT-I/II mRNA levels were induced only in the CDDP-resistant cell line. Our results showed that expression of the MT I/II isoform was induced by CDDP treatment, and may play an important role in CDDP-resistance in squamous cell carcinoma of the human tongue.

Normal human epidermal keratinocytes (NHEK) died after 5 days of co-culture with an oral carcinoma cell line (HSC-4). However, the HSC-4 cells did not change in either mitotic character or shape. We analyzed the changes in the mitotic activity and DNA synthetic activity of NHEK in co-culture with the HSC-4 cells. The mitotic index of the NHEK decreased gradually with the presence of human beta-defensin-2 (HBD-2) in the media. However, the mitotic index (MI) of the HSC-4 cells did not change. The shape of the NHEK cells did not change during co-culture. The time changes of the labeling index (LI) measured by BrdU incorporation, and the LI decreased in neither NHEK nor in HSC-4 cells in the presence of HBD-2. Moreover, in co-culture with an anti-HBD-2 antibody, the MI of both NHEK and HSC-4 cells did not change. These results indicate that HBD-2 might not lead to apoptosis or necrosis, but rather to cellular reproductive death in NHEK cells. However, HSC-4 cells might be more tolerant of HBD-2, so that HBD-2 does not cause cellular reproductive death. HBD-2 does not diminish the DNA synthesis rate but decreases the mitotic activity in NHEK cells in vitro. HBD-2 diminishes neither the DNA synthesis rate nor the mitotic activity in HSC-4 cells.

A 4-day-old female with a Tessier No.3 facial cleft on the left was accompanied to us. Her cleft arose from left medial canthus, ran downward obliquely through medial side of the lachrymal point and the nasolabial groove along the lachrymal fissure, turned round the alar base and went into the nasal floor linking with the cleft lip, the alveolar cleft and the cleft palate. Complete defect of the maxillary frontal process was observed. She was bilateral microphthalmia and had no visual acuity, too. The plastic operation for the facial cleft was performed 6 months after birth. The Cronin's method was applied similarly for the lip, the buccal cutaneous flap was rotated and advanced for the facial cleft, and the Z-plasty was applied on the eyebrow to improve the lower displacement of medial canthus.

Introduction: There are numerous methods of repairing a cleft lip. In our institution, two methods have been used for primary lip repair, the triangular flap method, and the rotation-advancement plus small triangular flap method. The purpose of this study was to compare postsurgical anthropometric results following these two surgical methods. Patients: Twenty children with a unilateral complete cleft lip, alveolus and palate (UCLAP) were selected for this study. Ten underwent primary lip repair by the triangular flap method (Triangular Group), and the other 10 underwent repair by the rotation-advancement plus small triangular flap method (Rotation Group). Method: They were documented with a three-dimensional optical scanner, and analysed with computer-aided anthropometric method reported previously (Comput. Methods Programs 58: 159–173, 1999a; J. Cranio-Maxillofac Surg 27: 345–353, 1999b). Results: The shapes of the nose and nostril were a little better in the Rotation Group. However, in the Rotation Group, differences between good and poor cases were more extreme than in the Triangular Group. The shape of Cupid's bow was good shortly after surgery in the Triangular Group. A good shape of Cupid's bow was also obtained in the Rotation Group, but the improvement was more delayed. On the non-cleft side, the length of Cupid's bow was more extended in the Triangular Group. Certain deformities were common to both groups, such as deviation of the columella and a flattened ala on the cleft side. Conclusion: Rotation-advancement plus the small triangular flap method was thought to produce somewhat better results, however, further improvements in the technique are needed. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

We have previously reported the presence of human beta-defensin-2 (HBD-2), a peptide with antimicrobial and cytotoxic properties, in oral squamous cell carcinomas. The aim of the present study was to measure the concentration of HBD-2 in abnormal tissues such as oral squamous cell carcinomas. HBD-2 was extracted from tissue samples in the presence of retinoic acid and subjected to reversed-phase HPLC. The fraction representing peak 17 (P17) was obtained by elution using a linear gradient of acetonitrile. Amino acid sequencing and homology studies were subsequently performed, and the molecular weight of P17 was calculated to be 432702 daltons. This molecular weight was consistent with HBD-2. The concentration of HBD-2 in the oral squamous cell carcinoma samples was 3.85+/-1.87 microg/mg which was much higher than in normal oral epithelium (0.04+/-0.02 microg/mg).

We isolated a small segment of the 3'-untranslated region (3'-UTR) in the mouse connective tissue growth factor (ctgf/fisp12) gene and evaluated its functionality. Comparison of the nucleotide sequences of human and mouse ctgf 3'-UTRs revealed a conserved small segment of 91 bases. The corresponding segments of the 3'-UTRs shared as much as 82.4% homology, whereas the overall homology between the 3'-UTRs was 71.8%. To study the functionality of the conserved segment, the corresponding region of mouse ctgf cDNA was amplified from NIH3T3 cells. When it was fused downstream of a marker gene, it showed remarkable repressive effects on gene expression. The repressive effect of the sense form was more prominent than that of the antisense form. Computer analyses of these sequence predicted stable secondary structures, suggesting that they act at the RNA level. The predicted structures of the sense and antisense forms appeared to be slightly different, which is consistent with the difference in repressive function. These findings defined the conserved small element in the mouse ctgf gene as a potent negative regulator of gene expression, which may act at a posttranscriptional level.

Objective To evaluate the efficacy of presurgical orthopedic treatment three dimensionally, we previously developed a novel measuring system and described the efficacy of the treatment until 18 months of age. The aim of this study was to compare palatal configuration in complete unilateral cleft lip and palate (UCLP) infants fitted with a Hotz plate to those without it until four years of age using the same measuring system. Patients Twenty complete UCLP infants were divided into two groups. A Hotz plate was used with 12 patients who first visited our clinic from January 1990 to March 1992 and was not used with an additional eight patients who first visited from April 1992 to July 1993. Main outcome Measures Palatal casts taken from birth until four years of age were measured three dimensionally and were compared between the two groups. Results and Conclusions The width of the palate was larger in the group with a Hotz plate than in the group without it at four years of age. No difference was observed between the anteroposterior distance of the palate in the two groups at four years of age. Similarly, the alveolar arch form did not differ between the two groups. The degree of curvature of the palatal surface was smaller in the group with a Hotz plate than in the group without it. These data were similar to data obtained at 18 months of age.

The present study evaluates the effect of insulin-like growth factor I (IGF-I) administration on bone formation following grafted periosteum. Twenty-four Japanese white rabbits were randomly assigned into one IGF-I administered group (1 mg for 14 days) and a second control group. Grafted periosteum taken from the tibia was placed under the submandibular muscles. At 14, 21, and 28 days following the operation, the grafted periosteum was extirpated and examined. Throughout all stages of the experiment, active bone formation was confirmed histologically and radiographically in both control and experimental groups. In addition, a micro-CT scan was used to observe three-dimensional micro structures in newly formed bone and to measure the trabecular bone thickness as a marker of bone development. As a result, a significant increase in bone formation in the IGF-I group was observed when compared with the findings in the control group. Trabecular bone thickness in the IGF-I group was significantly greater when compared with the control group at 14 days and 21 days following grafting (P

OBJECTIVES AND DESIGN: A preceding paper has noted a detection of defensin-I (HNP-I), a peptide with antimicrobial and cytotoxic properties, in the saliva of patients with oral squamous cell carcinoma. The present study deals with the presence of HNP-I in the saliva of patients with various oral diseases. METHODS: Whole saliva samples were obtained from the patients. HNP- I in the saliva was isolated and purified by HPLC and the amino acid sequence of the peptide was determined. The molecular weight of HNP-I was measured by mass spectrometry. The concentration of HNP-I in saliva was determined by comparing the height of eluted HNP- with that of a synthetic HNP- standard. RESULTS: The concentrations of HNP-I in the saliva of patients with oral lichen planus (n = 5), leukoplakia (n = 4), and glossitis associated with iron deficiency (n = 4) were 8.3 ± 4.3 μg ml -1 , 13.2 ± 7.9 μg ml -1 , and 11.4 ± 4.9 μg ml -1 , (mean ± s.d.), respectively. These concentrations were significantly higher than those in healthy subjects (0.8 μg ml -1 ) (P < 0.01). In contrast, salivary HNP-1 concentrations in patients with glossodynia (n = 4) and oral discomfort (n = 4) were similar to those in healthy subjects. CONCLUSIONS: Since HNP- I is a non-specific defensive peptide present in neutrophils, it may play an important role in the protection against diseases such as oral lichen planus, leukoplakia, and glossitis associated with iron deficiency.

A fourth patient suspected of having Pai syndrome is described. The female baby had a median cleft of the upper lip, a polypoid skin mass in the right nostril, and a conjunctival lipoma in the right eye. A median alveolar cleft was in the oral cavity. The polypoid skin mass was attached to the nasal septum, and a histologic examination disclosed mature adipose tissue with normal skin and no cartilaginous tissue. A computed tomographic scan revealed a lipoma of the corpus callosum. However, the patient was neurologically normal, and her electroencephalogram was also normal. Her growth and development have been within normal limits, and no convulsions have occurred.

A noncontact three-dimensional measuring system (liquid crystal range finder system) is described. Three-dimensional facial surface data (more than 30,000 points) could be obtained in 1 second, and the resolution was approximately 0.4 mm. The reliability and repeatability of the results were validated with a calibrating apparatus and a highly accurate contact-type three-dimensional digitizer. Consequently, the average of the measurement errors on a facial plaster model was 0.3 mm. Repeatability in measuring human faces was approximately 0.3 mm. Therefore, the total error in measuring human faces was approximately 0.5 mm. Because of the shortness of measuring time, this system was capable of scanning faces of infants without the need for sedation. The output of the liquid crystal range finder was demonstrated on an infant with cleft lip. The surface points improved by cheiloplasty, and the residual deformities were observed clearly. This system was thought to be the most suitable apparatus for measuring faces of infants (especially infants with cleft lip) and enabled us to analyze facial surface structure both qualitatively and quantitatively.

Objective To align the protruding premaxilla in infants with bilateral cleft lip and palate (BCLP), an intraoral appliance (i.e., Hotz plate) and an extraoral appliance consisting of a band covering the head and elastics are used as a presurgical orthopedic treatment in our clinic. The aim of this study was to analyze the configuration and position of the premaxilla and the vomer in infants with BCLP and to investigate the factors generating deviation and bending of the vomer and twisting of the premaxilla. Patients Palatal casts were obtained serially from 10 infants with complete BCLP from 1 to 3 months of age. Measurements These casts were automatically measured using a highly accurate contact-type measuring apparatus. After three-dimensional wire frame models generated from the serial casts were automatically superimposed, the magnitude and direction of the shift were calculated. A discriminant analysis was used for investigation of predictor variables generating the twisting or bending vomer. Results and Conclusions The vomer was found to be bent in two infants and the premaxilla was twisted in three infants. In the infants whose vomers were bent, the magnitude of the posterior shift of the premaxilla was greater than that of the inferior shift. A discriminant analysis indicated that at 1 month of age, a greater inclination and a smaller deviation of the vomer and a longer distance between the cleft edges of the lateral segments had a tendency to be associated with bending of the vomer or twisting of the premaxilla.

Objective:The purpose of this study was to analyze the three-dimensional configuration of the premaxilla, vomer, and lateral segments in bilateral cleft lip and palate (BCLP) infants and to investigate the early changes in the configuration following one- and two-stage cheiloplasty.Methods:This study consisted of 10 complete BCLP infants. One-stage operations were performed in five patients according to Manchester's method at 4 months of age. Two-stage operations were done for the remaining five patients using a triangular flap according to Tennison's method, at 4 and 8 months of age. Serial plaster models before and after the cheiloplasty were measured with a computer-controlled, highly accurate, contact-type measuring apparatus. Temporal changes in the configuration and form of the premaxilla were observed using an automatic superimposition method. The inclination and deviation of the vomer were evaluated using an approximation technique to a straight line with least squares. The distance between the lateral segments and a three-dimensional coordinate of the incisal point were also measured.Results and Conclusions:The following differences in palatal configuration between the one- and two-stage cheiloplasties were observed: 1) In the two-stage group, the premaxilla shifted toward the cleft edge where the cheiloplasty was performed in both first- and second-stage operations. After the two-stage operation, the premaxilla did not shift greatly, and the premaxilla in cases 4 and 5 shifted downward and toward the cleft edge of the lateral segments where the first operation was performed. Protrusion of the premaxilla remained in the two-stage group. 2) In the one-stage group, the premaxilla in case 4 descended downward and backward without twisting or bending. The premaxillae of the other patients descended downward with twisting and bending. 3) Patients in the two-stage group had a stronger tendency toward medial collapse of the lateral segments than did those in the one-stage group.

To overcome the disadvantages of metallic osteosynthetic devices that should remove after the operation, bioabsorbable, ultra high strength poly-L-lactid osteosynthetic devices were developed, and have been applied to the treatment of bone fractures[1.5.6]. On the other hand, it is not known how much stress is actually generated on these devices when an external force was added and minor segment was displaced. In order to know the stress distribution generated in the devices, using 3-dimensional-CAD software, we created the solid model of these devices and the blocks, and assembled these parts just as the two blocks were fixed with these devices. We simulated of fixed one block in the two blocks, and moved a constant amount in four directions to the other block, and analyzed the stress generated in these devices using 3-dimensional stress analysis software. In these simulations, the biggest stress was generated when the plate was tensiled.

We report here 2 cases of patients with Sjogren's syndrome with dry mouth that were successfully treated with cevimeline hydrochloride. The first case was diagnosed as Sjogren's syndrome at our clinic, and the saliva secretion increased by more than three-fold following oral cevemeline hydrochloride. The second case was diagnosed at another hospital, and the saliva secretion was increased by more than two-fold by the medication.

Summary Three patients with an oblique facial cleft are described. One patient displayed ring constriction, lymphoedema, distal pseudosyndactyly and an occipital encephalocele to which an amniotic band was attached at birth. Therefore, it was obvious that the oblique facial cleft was accompanied by an amnion rupture sequence. These signs were not apparent in the other patients. However, one of the other patients demonstrated various anomalies, amongst which syndactyly on the right foot, scoliosis, microcephaly, microphthalmia and corneal opacity suggested that the patient may have been affected by the amnion rupture sequence, except for polydactyly on the left foot, cleft hand and vertebra plana.

A three-dimensional measuring system was developed to analyze changes in palatal forms of UCLP infants. This system quantified the change of the curved surface on a palate by automatically superimposing two wireframe models obtained from casts at different stages of growth. It also analyzed the curvature of the palatal surface. This system was used to study the palates of 20 infants with unilateral cleft tip and palate (UCLP), from the first to fourth months after birth (12 with Hotz's plate and 8 without, selected at random). Both major and lesser maxillary segments without Hotz's plate remained anterior and lateral although those with Hotz's plate moved mesially during the fourth month after birth. In addition, the degrees of curvature on the palatal surfaces with Hotz's plate were less than those without Hotz's plate.

Rheumatoid arthritis (RA) patients with micrognathia caused by destruction of the temporomandibular joint (TMJ) may develop obstructive sleep apnea (OSA). 1 Tracheotomy is thought to be an effective treatment of this condition. 2,3 We performed bilateral total replacement of the TMJs in a tracheotomized OSA patient with RA using alloplastic TMJ components. This treatment resulted in dilation of the upper airway, permitted closure of the tracheal stoma, and improved masticatory function.

Background The chondrosarcoma-derived HCS-2/8 has been known to be an excellent model of human articular chondrocytes. By mimicking the arthritic conditions through the treatment of HCS-2/8 cells with cytokines, we estimated the gene expression response of ccn1 and ccn2 during the course of joint inflammation in vitro. Results In order to mimic the initiation of inflammation, HCS-2/8 cells were treated with tumor necrosis factor (TNF)-α. To induce pro-inflammatory or reparative responses, TGF-β was employed. Effects of an anti-inflammatory glucocorticoid were also evaluated. After stimulation, expression levels of ccn1 and ccn2 were quantitatively analyzed. Surprisingly, not only ccn2, but also ccn1 expression was repressed upon TNF-α stimulation, whereas both mRNAs were uniformly induced by transforming growth factor (TGF)-β and a glucocorticoid. Conclusion These results describing the same response during the course of inflammation suggest similar and co-operative roles of these 2 ccn family members in the course of arthritis.

Mandibular ramus sagittal split osteotomy is widely used for the treatment of dentofacial deformities of the mandible. The condylar position after this operation is thought to have a great influence on the occurrence of short-term relapse and/or temporomandibular joint disorders. ~3 Therefore, it is very important that the condyles remain in their planned position after the operation. A technique that can be used to keep the condyles in position involves fixing each proximal segment to an upper molar with a positioning plateJ We have improved this system by adding a prefabricated orthodontic face bow. This method shortens the operation time and results in accurate condylar positioning.

Lesch-Nyhan syndrome (LNS) is a disorder caused by congenital absence of a purine metabolic enzyme, hypoxanthine guanine phosphoribosyl-transferase (HGPRT). This syndrome is characterized clinically by hyperuricemia and neurologic features including choreoathetoid spasticity, self-mutilation, and mental retardation. We report on a patient in whom self-mutilation of the lower lip was suppressed with the help of a mouth guard made from soft resin.

Lipoma is a benign tumor derived from nonepithelial origin and may occur almost anywhere on the body. In the oral cavity, however, lipoma is a relatively rare tumor.In this report, 30 cases of lipomas treated in our department during past 24 years are reviewed.1) The incidence of lipoma in our department is 4.1% of all benign tumor. Salivary gland tumors and epulis are excluded in this report.2) 16 patients were male and 14 female.3) Age ranged from 47-day-old baby to an 82-year-old man; mean age was 47.9 years.4) 11 cases were in the buccal mucosa, 4 in the mucogingival junction, 3 in the retromolar pad, 3 in the tongue, etc.5) Tumor size ranged fron 5×5mm to 50×50×40mm in the oral cavity, and from 25×25mm to 80×50mm out of the oral cavity.6) 24 tumors were histologically diagnosed as lipoma, 5 as fibrolipoma, and 1 as angiomyolipoma.

Effects of local single irradiation on lung metastasis of VX2 carcinoma transplanted in maxillary sinus of rabbits were evaluated. When an inadequate irradiation for complete regression was given, the rate of pulmonary metastases in irradiated groups was remarkably increased compared with non-irradiated one, although tumor growths in irradiated ones were apt to be inhibited corresponding to the given dose. Three parameters detected in the study related to general conditions were not so significantly different among the groups although those in irradiated groups were apt to be worse than those in control. Histologically most remarkable difference between in control and irradiated groups was stromal respose. However, on the question of whether stromal response could react as a diffensive or promotive mechanisms against tumor metastases, further studies would be needed including analysis of infiltrative cells.

Osteochondroma or osteocartilageous exostosis is a common disease in the osseoustissue.However, osteochondroma occurring in the coronoid process is relatively rare, and is interesting in differential diagnosis when resulting from trauma, developmental malformation, temporomandibular dysfunction syndrome and others, and causality of this disease.This paper described a female patient, 54 years old, whose presenting problem was a chronic limitation of mandibular movement caused by the osteochondroma of coronoid process, and she was treated surgicaly. The problem disappeared following the operation, and the prognosis is favorable.

Cleido-cranial dysostosis (CCD) is a congenital anomaly with clavicle and cran osteogenesis imperfecta. In this disease various dental treatments were reported by many authoRecently, we experienced a case of CCD in a 15 year old female who complained of delay shedding of decidious teeth and failure of eruption of the permanent dentition. In this ca eighteen impacted and supernumerary teeth were present in both maxilla and mandible. MI extraction of decidious and supernumerary teeth, we tried surgical exposure of part of crowns a: orthodontic traction to bring the impacted permanent teeth into the line of the dental arch consideration of her chief complaint and age.The patient is at present in a careful follow-up study.