Orthodontic Elastic Embedded in Gingiva for 7 Years

Dental materials especially orthodontic elastics often get embedded in gingival tissues due to iatrogenic factors. If retained for a long time, inflammatory response starts as asymptomatic crestal bone loss and may progress to severe periodontal abscess. Unsupported orthodontic elastics used for diastema closure may result in exfoliation of teeth, while elastic separators may get embedded in interdental gingiva if banding is performed without removing it. These cases of negligence are detrimental for survival of affected teeth. This paper highlights a case of orthodontic elastic embedded in interproximal gingiva of a 23-year-old healthy female for 7 years after completion of fixed orthodontic treatment. Surprisingly, there was no clinical sign of inflammation around elastic band and it was removed easily without any local anaesthesia. However, mild crestal bone loss was observed on periapical radiograph. The gingiva healed completely after sub gingival debridement. 1. Introduction The presence of foreign bodies in gingiva, leading to inflammatory response, is unusual but not a rare condition. Most of the cases in the literature have been reported to be iatrogenic, commonly associated with use of elastic bands and separators for orthodontic treatment [1–3]. Other dental materials like amalgam, composite, cements, and prophylaxis paste have also been found to be embedded in gingiva [4]. The resulting inflammatory response varies from asymptomatic mild crestal bone loss to severe periodontal destruction causing abscess formation [5, 6]. Most of the cases in literature have been reported to be most common in mandibular posterior region (34%), followed by maxillary posterior (29%) and maxillary anterior regions (26%). Probably this incidence correlates with more dental treatments received in these regions [7]. Unsupported orthodontic elastics creeping into gingival sulcus have been reported frequently in the literature [8–10]. Some authors have also reported the presence of elastic separators in interproximal area that are used for relieving contact before band placement [5, 6, 11–13]. This report describes a case of intact orthodontic elastic found embedded in interproximal gingiva between mandibular first and second molars, 7 years after completion of orthodontic treatment. 2. Case Presentation A 23-year-old female reported for routine oral prophylaxis. She complained of occasional bleeding from gums on brushing. There was no history of pain; however she reported to have noticed a yellow growth on gingiva between right mandibular posterior teeth, for last