You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
giant cell granuloma is described as a benign lesion affecting the mandible and maxilla that consists of a massive fibrohistiocytic proliferation with numerous heavily hemosidrin laden multinucleated giant cells .
jaffe in 1953 described central giant cell granulomas ( cgcg ) as an idiopathic non - neoplastic proliferative lesion .
cgcg is known to occur in individuals less then 30 years of age with definite female predeliction ( 2:1 ) .
many times it may be totally asymptomatic and a coincidental finding during a routine radiographic examination .
they are more prevalent in the mandible , particularly the anterior region than the maxilla .
apart from jaw bones , cgcg has also been reported to occur in small bones of hands and feet .
radiographically it presents usually as multilocular , expansile radiolucency displacing the teeth , sometimes causing root resorption and cortical perforation .
the conservative treatment approach includes intralesional calcitonin , intralesional steroids , antiangiogenic therapy , and radiotherapy .
we report an unusual case of cgcg in the maxillary anterior region associated with a congenitally missing tooth mimicking an adenomatoid odontogenic tumor .
a 15-year - old girl came to the department of oral medicine and radiology with the chief complaint of a swelling on the left upper anterior teeth region .
she gave a history of noticing a peanut sized , assymptomatic swelling 2 months back which was gradually growing .
she also gave history of noticing mobility and dull pain in the teeth associated with the swelling .
the patient consulted a dentist with the above complaint following which root canal treatment was done in two teeth related to the swelling .
on general examination she was moderately built and nourished , alert , responsive , and cooperative .
vital signs were all within the normal range with no signs of pallor , cyanosis , icterus , clubbing , and edema .
extraorally , a solitary ill - defined swelling was noticed unilaterally on the left side of the face in the region of ala of the nose .
swelling was roughly oval in shape , measuring approximately 2.5 cm in diameter , extending superoinferiorly from 0.5 cm above the ala of nose to the vermillion border of upper lip , mediolaterally 0.5 cm lateral to corner of mouth to the nasolabial fold , causing mild asymmetry of face .
on palpation the swelling was bony hard , nontender , not compressible , and not reducible .
intraorally , a well - defined solitary swelling was noticed in the left anterior maxilla , measuring 3 cm in its greatest dimensions , involving both the labial and palatal aspect .
swelling was completely obliterating the labial vestibule [ figure 1 ] with respect to 21 , 22 , 23 , 24 , extending palatally to involve the midpalatine raphe [ figure 2 ] .
swelling obliterating the labial vestibule swelling extends palatally till the midline on palpation the swelling over the labial vestibule was bony hard and not mobile .
palatally , the swelling was soft in consistency , nontender , nonmobile , noncompressible , nonreducible with no areas of eggshell crackling , or fluctuance .
a total of 21 and 23 were mobile , mildly tender , and endodontically treated .
on summarizing the clinical findings , a young patient with the swelling in the maxillary anterior region associated with congenitally missing lateral incisors causing the bicortical expansion , mobility of associated teeth , lead us to give a provisional diagnosis of dentigerous cyst .
differential diagnosis considered were radicular cyst , calcifying epithelial odontogenic cyst , adenomatoid odontogenic tumor , fibrous dysplasia , desmoplastic ameloblastoma , and central giant cell granuloma .
considering the occurrence of this swelling associated with a missing tooth in a young female patient , the adenomatoid odontogenic tumor was included in the differential diagnosis .
monostotic fibrious dysplasia was considered as it is known to have a definite female predeliction and presents as an asymptomatic bony swelling commonly affecting maxilla , causing expansion , and deviation of associated teeth . calcifying the epithelial odontogenic tumor
was also considered in the differential diagnosis as it has wide age distribution and occurs equally in both the jaws usually anterior to 1 molar .
fine needle aspiration was done by using 20-gauge needle which gave negative aspiration indicating the absence of fluid within the swelling .
radiographic investigations included panoramic radiograph , occlusal radiograph , and intraoral periapical radiograph which revealed an inverted pear shaped radiolucency with ill - defined and irregular borders in the maxillary anterior region on the left side measuring approximately 3cm2 cm .
it involved the entire alveolar bone in between 21 and 23 ( 22 was missing ) , extending from the medial aspect of 23 to the mid - palatine suture [ figure 3 ] . internal appearance of
the associated teeth , i.e. , 21 and 23 , were endodontically treated , tilted toward each other occlusanally with no evidence of external root resorption .
these radiological features ruled out the possibility of fibrous dysplasia , calcifying epithelial odontogenic tumor , and desmoplastic ameloblastoma .
panoramic radiograph showing the extensions of the lesion intraoral periapical radiograph revealing inverted pear - shaped radiolucency further investigations planned for the case were a complete hemogram , serum calcium , phosphate , and alkaline phosphatase which were found to be within normal limits . based on history , clinical features , radiological features , and other investigations we considered a diagnosis of the adenomatoid odontogenic tumor .
an excisional biopsy was done along with the extraction of 21 and 23 under local anesthesia .
the patient was prescribed antibiotics and analgesics and recalled after 7 days for suture removal .
excisional biopsy of the lesion histopathological examination of the specimen revealed the presence of numerous multinucleated giant cells .
giant cells were irregular in shape , contained 420 nuclei approximately , and were dispersed throughout the lesional tissue .
spindle - shaped cells and cells with vesicular nucleus were also seen surrounding the giant cells [ figure 6 ] .
normal levels of serum calcium , phosphorous , and alkaline phosphatase in this case ruled out hyperparathyroidism .
histology of the specimen revealing numerous irregular giant cells dispersed throughout the lesional tissue sutures were removed after 7 days .
a follow - up of the case was done every 2 months for 1 year .
no signs of recurrence of the lesion were noticed clinically or radiologically even after 1 year [ figure 7 ] .
after 1 year of follow - up a fixed partial denture was fabricated with 11 and 24 as abutment teeth .
cgcg is diagnosis of exclusion and can be confirmed only histologically as we saw in this case . what made our case very peculiar was occurrence of cgcg in maxillary anterior region which is the less common site in association with a missing tooth .
the association of two endodontically treated teeth with the lesion made it all the more interesting .
a thorough literature review does not provide any information regarding the relationship between cgcg and congenitally missing tooth .
conducted a 10-year review of occurance and treatment of cgcg and reported various presentations of the lesion such as pain , swelling , paresthesia , asymmetry , as periapical pathology , malocclusion , mobility of teeth , and as assymptomatic lesion but did not mention about concurrent occurrence of cgcg with congenitally missing tooth .
site predilection for cgcg in the mandibular anterior lesion mostly occurring on the right side whereas in our case it occurred on the left maxillary anterior region .
trauma is considered an important etiological factor whereas in our case there was no such history .
the unusual case of cgcg in the anterior maxilla associated with the congenitally missing tooth shows us yet another unique way in which these lesions may present in oral cavity .
therefore , it also suggests that cgcg should be considered in the differential diagnosis of swellings of jaws .
further a possible etiology of cgcg as odontogenic in origin can also be suggested and further research can be planned in this direction .
central giant cell granulomas are non - neoplastic lesions of unknown etiology . 
 they affect females more than males with the mandibular anterior region being the most common site of occurrence . 
 clinically central giant cell granulomas present as asymptomatic , expansile swellings causing deviation of associated teeth . 
 radiologically they usually presents as multilocular lesions causing expansion or perforation of cortical bone . 
 central giant cell granulomas are usually confused as other lesions both clinically and radiologically , and a definitive diagnosis can be made only histologically . 
 we report here a rare case of central giant cell granuloma in association with congenitally missing tooth which was misdiagnosed to be an adenomatoid odontogenic tumor both clinically and radiologically . 
 this case report also highlights yet another unique presentation of central giant cell granulomas that is in association with a congenitally missing maxillary lateral incisor .