Carcinoma ex pleomorphic adenoma: a case report and review of literature.

BACKGROUND: Carcinoma ex pleomorphic adenoma (CA-ex-PA) is extremely unusual in minor salivary glands of oral cavity. CAex-PA is a carcinomatous change as a primary or as a recurrence of pleomorphic adenoma. OBJECTIVE: Due to resemblance of clinical symptoms of Ca ex PA and benign pleomorphic adenoma, it is mandatory for surgeons to keep high degree of clinical alertness, considering the peculiarity of this tumor. CASE REPORT: 54-year-old male presented with swelling on left side in the pre-auricular region from the middle of zygomatic arch to mastoid process and from tragus of the ear up to angle of mandible. Fine needle aspiration cytology revealed a mixture of benign and malignant components. Total left parotidectomy with left radical neck dissection followed by reconstruction with cervicodeltopectoral flap was performed. Combination of chemotherapy and radiotherapy were given to patient. Histologic examination and pre-operative fine needle aspiration cytology confirmed the diagnosis of Carcinoma ex pleomorphic adenoma (CA-ex-PA). Two-year follow-up of patient showed no recurrence of the lesion. CONCLUSION: Due to the similarity in the clinical symptoms of CA-ex-PA and benign pleomorphic adenoma, it is vital that clinicians maintain a high degree of clinical vigilance, considering the oddity of this malignancy.

A Comparative Evaluation of the Influence of Command Set Methods on Microleakage of Glass Ionomer Cement: An In Vitro Study.

INTRODUCTION: A major challenge when using glass ionomer cement in clinical situation particularly in paediatric dentistry is to overcome the problem of microleakage. Fast or command setting of Type IX glass ionomer cement using external energy source enhances the setting reaction and results in improved initial physical and mechanical properties. AIM: To compare and evaluate the influence of ultrasonic activation, halogen light irradiation and combined effect of both on microleakage of enamel adjacent to Type IX glass ionomer restorations. MATERIALS AND METHODS: For forty premolar teeth, standard Class V cavities prepared were restored with GC Gold Label Type IX glass ionomer cement in vitro. The specimens were randomly divided into four groups: 1) Control group; 2) halogen group; 3) ultrasonic group; 4) ultrasonic with halogen group. The teeth were kept in distilled water for 24 hours. Teeth were exposed to 1500 thermocycles at temperature of 12°C ±2 and 60°C ±2 with alternate immersion in hot and cold water for one minute. First teeth were immersed in dye solution for four hours and then in developing solution for four hours. The samples were sectioned buccolingually through centre of the restorations and degree of dye penetration was assessed under stereomicroscope and scored. One-Way ANOVA model was constructed followed by post-hoc Tukey's test for multiple pair wise comparison of mean values. RESULTS: Statistically significant differences were found in microleakage among the four groups (p<0.001) with respect to dye penetration. Halogen group showed least microleakage followed by control but differences between them were statistically not significant (p>0.05). Similarly the differences between Ultrasonic plus halogen group and ultrasonic group were not significant (p>0.05). The differences between ultrasonic and halogen group were statistically significant (p<0.05). CONCLUSION: Halogen light decreases the microleakage of enamel adjacent to GC Type IX glass ionomer restorations, when used to accelerate the setting reaction of glass ionomers and can be used as command set method in paediatric dentistry.

A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic Emission Spectrometry Analysis.

INTRODUCTION: The tug of war to maintain tooth integrity is dependent on a ratio between demineralization and remineralization. Hence, demineralization should be retarded and remineralization should be enhanced to maintain a natural equilibrium in the oral cavity. AIM: To compare in-vitro acid resistance of human enamel when using Casein Phosphopeptides Amorphous Calcium Phosphate (CPP-ACP) [GC Tooth mousse] cream, Casein Phosphopeptide Amorphous Calcium Fluoride Phosphate (CPP-ACFP) [GC Tooth mousse plus] cream, Er:YAG laser alone, combination of CPP-ACP with Er:YAG laser, CPP-ACFP with Er:YAG laser. MATERIALS AND METHODS: An in-vitro study was done on 100 specimens which were prepared from 50 human premolars to investigate the caries inhibitory effect of remineralizing agents and laser on enamel using an atomic emission spectrometry analysis. The enamel specimens were randomly allocated into 6 groups: Untreated (control); CPP-ACP (GC Tooth mousse); CPP-ACFP (GC Tooth mousse plus); Er:YAG laser treatment alone; CPP-ACP with Er:YAG laser; CPP-ACFP with Er: YAG laser. Then specimens were immersed individually in 5ml of acetate buffer solution (0.1mol/L, pH 4.5) and incubated at 37°C for 24 hours, to determine the acid resistance by analyzing the calcium release using atomic emission spectrometry. An ANOVA model was constructed (p-value 0.05), followed by post-hoc Tukey's test for multiple pair wise comparisons of mean values. RESULTS: There was a significant difference among the various groups with respect to amount of calcium released (p<0.001). The lowest mean score of calcium release was observed for CPP-ACFP with Er:YAG laser followed by CPP-ACFP but the differences between these groups were statistically not significant (p>0.05). Similarly the differences between CPP-ACP with Er:YAG laser and CPP-ACP also were not significant (p>0.05). The highest mean score of calcium release was for Er:YAG laser and no significant statistical difference was noticed in comparison with control group (p>0.05). CONCLUSION: Combination of CPP-ACFP with Er:YAG laser is more effective in decreasing enamel demineralization when compared with other groups.