Polymorphous low-grade adenocarcinoma (PLGA) is difficult to diagnose due to its indolent clinical presentation and due to its morphological diversity that includes several microscopic patterns. Distinguishing it from high-grade tumors of salivary gland is important, as the management and prognosis of this tumor differ. We report a considerably rare case of PLGA in retromolar area highlighting various diagnostic challenges caused by the overlap of clinical and microscopic features between PLGA and other salivary gland neoplasms and discuss current management strategies.

Glass ionomer cement is a widely used luting agent for indirect restorations but presents inferior mechanical properties compared to resin cement due to its low elastic modulus. This study evaluated the mechanical and adhesion properties of glass ionomer luting cements reinforced with nano-sized hydroxyapatite particles (HA). The nano-sized HA particles were synthesized using the co-precipitation technique and the resulting precipitate was characterized using X-ray diffraction analysis (XRD), field emission scanning electron (FESEM) and transmission electron microscopy (TEM). HA particles were incorporated into the glass powder (FUJI I, GC) and the luting agent was manipulated in a liquid to powder ratio of 3:1 into 6% by weight after determining the best ratio. The flexural strength of the luting agent and shear bond strength of dentin were analyzed and compared to other luting agents namely, (a) glass ionomer (FUJI I), (b) resin-modified glass ionomer (RelyX Luting Plus) and (c) adhesive resin cement (RelyX U200). Failure types after debonding from dentin were evaluated under SEM. Flexural strength and bond strength data were analyzed using one-way ANOVA and Tukey's tests (alpha = 0.001). Addition of 6 w % HA particles in the range of 80-150 nm enhanced the flexural strength (30.97 ± 5.9 versus 11.65 ± 5.63) and shear bond strength (0.97 ± 0.41 versus 0.39 ± 0.16) of a conventional glass ionomer luting agent significantly compared to the non-reinforced ones when manipulated at a liquid to powder ratio of 3:1 (P < 0.001). While conventional glass ionomer, HA-reinforced glass ionomer and resin-modified glass ionomer specimens showed exclusively mixed type of failures, adhesive resin cement showed cohesive failures within the resin cement. Increased mechanical and adhesion potential of the experimental glass ionomer luting agent after incorporation of HA particles could expand the scope of application of this cement.

Aim: This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss. Setting and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool. Statistical Analysis Used: Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software. Results: Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69). Conclusion: In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.

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