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Oral and maxillofacial (OMF) surgery is a unique speciality. In many countries, OMFS is a dental speciality but the scope of its practice significantly overlaps with other specialities, including otolaryngology, head and neck surgery, plastic surgery, and orthopaedics. Thus, OMF surgery represents a true amalgamation of medical and dental specialities. There are different requirements of OMF residency training, which include a dental undergraduate training, medical training, or both. The training pathways for this speciality have evolved much in the last three decades and there is still no consensus over a single uniform path of becoming an OMF surgeon. An OMF surgeon deals with trauma, cysts, tumours and other pathologies of the maxilla, mandible, and zygomatic complex that need surgical correction. In addition to being a diverse speciality, the academic and research domains of residency have also changed. In Pakistan, residency training in OMF surgery started in 1994 and since then a lot of growth has taken place. This paper summarises the evolution and scope of OMF surgery and the contribution of this speciality in the overall academia and research in Pakistan's national dental scenario.

Objective: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resinbasedsealant (RBS).Methods: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi,Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs.RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logisticregression model was employed. Study was registered at www.clinicaltrials.gov # NCT NCT03130725.Results: There were 137 teeth (23 subjects) in the BAS and 128 teeth (15 subjects) in the RBS group that wereevaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants werecompletely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age >15 years and male genderwere found to be significantly associated with the dislodgement of sealants.Conclusions: At 12 months follow-up, the retention of bonded amalgam sealant (BAS) was significantly lower thanthat of the resin-based sealant (RBS).Keywords: Bonded amalgam sealants, Resin-based sealants, Retention, Caries.RCT Registration: www.clinicaltrials.gov with # NCT NCT03130725.

To identify top 30 studies related to dental implant failures based on bibliometric analysis.The bibliometric study was conducted at Aga Khan University, Karachi from April 2021 to June 2021 and comprised database search on Google Scholar used key words "dental implant failures" for studies published between 1990 and 2020. The selected studies were reviewed based on citation count for which the cut-off date was June 1, 2021.The top 30 papers on dental implant failures had median citation count of 153 (range: 41-1583. Most of the studies were retrospective 11(36.7%), followed by literature reviews 6(20%). The top three contributing journals were the 'International Journal of Oral Maxillofacial Implants' 6(20%), the 'Clinical Oral Implants Research' 5(16.7%) and 'Clinical Implant Dentistry and Related Research' 3(10%). Goteborg University, Sweden, contributed the maximum number of most cited papers 8(26.7%).Most of the papers in the top-cited on dental implant failures were retrospective studies, and there was only one clinical trial.

To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars.The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed using SPSS 23.0.Of the 114 files, 38(33.3%) each were ProTaper Next X1, ProTaper Next X2 and HyFlex Electrical Discharge Machining. The number of files showing defects under microscopic evaluation were 17(14.9%). Deformation of the cutting edge was the most frequently seen defect type, found in 9(7.9%) files. The frequency of fractured files was 4(3.5%). The odds of microscopic defects in HyFlex Electrical Discharge Machining files was 2.64 times that of ProTaper Next files.Even after single clinical use, HyFlex Electrical Discharge Machining files were more likely to get microscopic defects on their surface compared to ProTaper files.

To analyse characteristics of literature related to dental research and education published in a single medical journal, The Journal of Pakistan Medical Association.The bibliometric study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University from March till May 2020, and comprised electronic and hand search of scientific literature relevant to dentistry published in the Journal of Pakistan Medical Association from the first issue published in 1953 till March 2020. The selected articles were analysed for year of publication, field of study, type of article, institute and country of first author, number of authors and citation count. Keyword mapping was also carried out. Data was analysed using SPSS 19.Of the 159 articles identified, 117(73.6%) were contributed from Pakistan. The most common specialties were Oral and Maxillofacial Surgery and Epidemiology with 20(12.6%) articles each, followed by Operative Dentistry and Endodontics 19(11.9%). Majority of articles were Original / Research 87(54.7%). The highest number of articles were published in 2019 26(16.35%). The Aga Khan University, contributed the most publications 30(18.9%), followed by Dow University of Health Sciences, 11(6.9%). Majority of the articles were contributed by three authors 48(38.4%). The top cited article was found to have 113 citations, followed by articles with 103 and 91 citations.The contribution of scientific papers related to dentistry and dental education in the Journal of Pakistan Medical Association was significant. With growth of dentistry as a discipline along with a parallel increase in the publication of dental research papers, it is imperative that a dedicated indexed journal for dental research be commenced.

Dental extraction of abscessed or infected teeth before cardiac operation is frequently advocated to lower the risk of infections, especially infective endocarditis. The scientific evidence that supports dental procedures before cardio-valvular surgery is, however, limited. The aim of the present paper was to explore whether there are any protocols for patients needing dental treatment before cardiac surgery. Moreover, we have discussed the real life challenges encountered in the management of such patients.

Maxillofacial Prosthodontics (MFP) is a super-specialty of prosthodontics that involves around rehabilitation of patients presenting with congenital maxillofacial defects or craniofacial disabilities acquired due to disease such as cancer or trauma. (1) There are several types of prostheses that can be designed and fabricated by a maxillofacial prosthesis to improve the quality of life of patients. A simple classification is shown in figure 1. Continuous...

Objective To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects. Methods The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper's plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23. Results Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad. Conclusions Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide.

There is a need of a new model of education and training to be implemented in the Bachelors of Dental Surgery curriculum in the relevant Pakistani institutions. The current review article was planned to suggest such a model in the light of literature aimed at building the capacity of dental graduates in a competency-driven approach with the objective of offering safe, efficient and comprehensive care to dental patients. The outcome of the reforms suggested shall prepare dental graduates suitably geared towards providing community-oriented family dental care right from their formative years. Moreover, the suggested internship model can also help to address the issue of inefficiency related to patient-care.

To determine the spectrum of maxillofacial prosthetics services in Pakistan, to explore the need of a relevant fellowship training programme in the country, and to determine whether they contribute to tumour board of head and neck oncology.The cross-sectional online survey was conducted from March to June 2020 and comprised all prosthodontists registered on the portal of the Pakistan Prosthodontics Association. Using Google Forms, the survey questionnaire was sent via email. The survey form was self-generated. Data was analysed using SPSS 23.Of the 84 prosthodontists approached, 44(52.4%) responded. The overall median age was 39 years (range: 30-60 years), and 34(77.3%) subjects were males. Overall, 19(43.2%) subjects were from Punjab, 14(31.8%) Sindh, 6(13.6%) Khyber Pakhtunkhwa, and 5(11.4%) Islamabad. None of the participants had received any formal accredited training in maxillofacial prosthetics. Although 37(84.1%) respondents reported providing maxillofacial prosthetics services to their patients as they had learnt it during their prosthodontics residency. Only 3(6.8%) respondents were contributing to head and neck tumour board. An overwhelming majority 42(95.5%) stressed the need of structured training programmes in maxillofacial prosthetics.There is no accredited maxillofacial prosthetics training centre and an obvious lack of prosthodontists with formal training in the professional area. The participation of prosthodontists in the head and neck tumour board was negligible.

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

To evaluate the root canal morphology of permanent mandibular first molars using Cone Beam Computed Tomography.The retrospective study was done at Aga Khan University Hospital, Karachi, and comprised medical records of patients who visited the dental clinics from December 2016 to March 2017. Mandibular first permanent molars were evaluated on Cone Beam Computed Tomography images. Frequency distribution of Vertucci's classification was determined, and so was the association between Vertucci's classifications and gender. SPSS 20 was used for data analysis.A total of 142 mandibular first permanent molars were evaluated on 78 Cone Beam Computed Tomography images. The most common Vertucci's classification was Type IV for mesial root 86(60.56%) and Type I for distal root 63(44%). There was no difference in the two genders for root canal morphology (p0.05).Type IV Vertucci's were prevalent in the mesial root and Type I were common in the distal root of permanent mandibular first molars.

To determine the effectiveness of different pre-cleaning methods by determining frequency and site of contamination on the sterilised dental burs using Phloxine B dye.The in-vitro experimental study was conducted from June to August 2017 at dental clinics of Aga Khan University Hospital Karachi. Diamond dental burs were selected and divided into two control and four test groups. The two control groups were classified as Negative (new burs) and Positive (used contaminated). The four test groups were classified as Manual (Group-1), Ultrasonic (Group-2), Manual + Enzyme (Group-3) and Manual + Ultrasonic (Group-4). Phloxine B dye was used to determine the contamination. The images of the burs were taken and enlarged at 15X before subjected to visual assessment. Association between contamination and pre-cleaning methods were determined. Data was analysed using SPSS version 22.A total of 210 burs were selected for the study which were divided in 6 groups of 35(16.66%) each. One (2.8%) bur in negative control group and all burs in positive control group showed contamination. In test groups, 27(77.1%), 29(82.8%), 27(77.1%) and 24(68.5%) burs showed contamination in groups 1, 2, 3 and 4, respectively. There was no association between type of pre-cleaning method with the frequency of contamination (p =0.57). The head of bur was the most frequently contaminated site (p0.003).None of the pre-cleaning method was found to be effective. Head of bur was the most frequently contaminated site.

Studies have shown that the presence of advanced periodontal disease lowers the success of dental implants. The recommended approach for such cases is the delayed placement and delayed loading of implants. The present paper reports a case of a subject who presented with severe periodontally compromised dentition. Placement and early loading of 12 implants was done using a staged approach. Three different sets of fixed-type dental prostheses were employed in the interim period. The final prostheses were cement retained metallo-ceramic fixed bridge. Use of staged extraction and using three sets of interim prostheses helped the patient to maintain his aesthetics and function during the entire treatment period. This approach can be a predictable management option in cases of advanced periodontitis. The key is proper planning and execution of the implant surgery and prosthetics.

To assess the knowledge of practising dentists regarding immediate management of dental avulsion.The cross-sectional analytical study was conducted in various dental colleges and teaching hospitals of Karachi, Pakistan, in October-November 2016, and comprised dentists working in academic institutions / departments or as general dental practitioners for at least 1 year. The subjects were asked to fill out a self-administered questionnaire. Questions related to knowledge and practice regarding immediate management of dental avulsion was asked and then responses were categorised as good knowledge, moderate and poor knowledge. SPSS 22 was used for data analysis..Of the 282 subjects, 179 (63.5%) were females and 103(36.5%) were males. The overall mean age was 28. 33±4.7 years, and 194 (68.8%) had clinical experience of less than 5 years. Of the total, 30(11%) dentists had good knowledge while 130(46%) had moderate and 122(43%) had poor knowledge. Statistically significant association of knowledge regarding tooth avulsion was observed with the specialty (p= 0.006) and qualification (p=0.001).The knowledge of dentists regarding immediate management of avulsion injuries was inadequate. Knowledge was significantly associated with specialty and qualification of the dentist.

To evaluate the root canal morphology of maxillary premolars.his retrospective study was conducted from November 2016 to January 2017 at Aga Khan University Hospital, Karachi, and reviewed Cone Beam Computed Tomography images of maxillary first and second premolars done from November 2014 to October 2016. Frequency distribution of Vertucci's classification was determined. Chi square test was applied to determine any association between Vertucci's type and gender. SPSS 19 was used for data analysis.Of the 114 first premolars, 74(68.6%) were bi-rooted and 36(31.5%) were single-rooted. The mean lengths of buccal and palatal roots were 20.6 ±1.7mm and 19.5±2.0 mm, respectively. The most common canal morphology reported for maxillary first premolars was type I 127(68%) followed by type II 24(12.9%). Of the 115 maxillary second premolars, 97(84%) were single-rooted. The mean lengths of buccal and palatal root were 20.7±1.6mm and 19.0±1.45mm, respectively. The most common canal morphology reported for second premolars was type I 71(53.4%) followed by type II 18(13.5%).Vertucci's type I was the most common canal configuration for maxillary first and second premolars and there was no gender-based difference for root canal morphology of maxillary premolars.

To determine the association between environmental tobacco smoke and dental caries.This cross-sectional study was conducted in peri-urban and urban areas of Karachi, from February to August 2014, and comprised children aged 5-14 years. A pre-coded questionnaire for environmental tobacco smoke and food frequency questionnaire for dietary habits were used. Dental examination of children was done to detect caries. Cox-proportional hazard algorithm was used to measure the association of environmental tobacco smoke with dental caries at multivariable level. STATA version 12.0 was used for statistical analysis.Of the 500 children, 250(50%) each were from peri-urban and urban localities. The prevalence of dental caries was 336(67.2%).Family members of 154(30.8%) participants reported smoking. After adjusting for junk food intake, in-between meals, age, plaque index, dental visits and socio-economic status, the association between environmental tobacco smoke and dental caries remained statistically significant (p0.05). Compared to non-exposed children, the adjusted prevalence ratio was 1.25 (95% confidence interval: 1.08-1.46) and 1.36 (95% confidence interval: 1.09-1.70) for children with30 minutes and30 minutes of environmental tobacco smoke exposure, respectively.Environmental tobacco smoke was found to be associated with dental caries.

To compare the remaining dentine thickness of root canals prepared with K-3 and ProTaper files..This in-vitro experimental study was conducted from 1st April-30th September 2015 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised human teeth. Extracted human premolars and molars were included in the study using non-probability consecutive sampling. Canals were randomly allocated into two groups i.e. K-3 and ProTaper. Changes in inner and outer walls of canals were measured using Vixwin software at 1mm, 4mm, 7mm and 10mm from the apex. SPSS 20 was used for data analysis.Of the 214 canals, 107(50%) were assigned to each group. No statistically significant difference was found in the remaining dentine thickness at 1mm, 4mm, 7mm and 10mm from the apex of the teeth prepared with in K-3 versus ProTapers system (p0.05).The remaining dentine thickness of the root canals prepared with K-3 files was similar to that of canals prepared with ProTaper files.

This experimental study was done on extracted human teeth to compare the fracture and deformation of the two rotary endodontic files system namely K-3 and Protapers. It was conducted at the dental clinics of the Aga Khan University Hospital, Karachi, A log of file deformation or fracture during root canal preparation was kept. The location of fracture was noted along with the identity of the canal in which fracture took place. The fracture in the two rotary systems was compared. SPSS 20 was used for data analysis. Of the 172(80.4%) teeth possessing more than 15 degrees of curvature, fracture occurred in 7(4.1%) cases and deformation in 10(5.8%). Of the 42(19.6%) teeth possessing less than 15 degrees of curvature, fracture occurred in none of them while deformation was seen in 1(2.4%). There was no difference in K-3 and Protaper files with respect to file deformation and fracture. Most of the fractures occurred in mesiobuccal canals of maxillary molars, n=3(21.4%). The likelihood of file fracture increased 5.65-fold when the same file was used more than 3 times. Irrespective of the rotary system, apical third of the root canal space was the most common site for file fracture.

The retrospective study was conducted to assess the dental implants that experienced failure. It was conducted at the dental clinic of the Aga Khan University Hospital, Karachi, and comprised record of dental implants from July 2010 to June 2015. Variables such as patient age, gender and systemic status, length and diameter of implants, bone grafting, type of definitive prosthesis (crown or bridge or overdenture), nature of retention (cement versus screw retained), loading strategy (immediate versus delayed loading), etc. were analysed. Of the 220 implants placed, 6(2.7%) failed to integrate (as revealed by torque test) at the beginning of prosthetic phase. Besides, 1(0.5%) implant failed after six months of function. The 7(3.2%) failed cases had common variables like deficient bone volume in maxilla (or placement of bone graft), non-submerged placement protocol, early loading with prosthesis and the presence of diabetes.

Work-related musculoskeletal pain is common among healthcare professionals, including dentists. This cross-sectional study was conducted to determine the prevalence of work-related musculoskeletal disorders (MSDs) among dentists. This study was carried out from January to April 2016 at various teaching hospitals of Karachi, and comprised 230 dentists. A self-administered questionnaire, adapted from a validated Nordic questionnaire, was distributed among the participants. Descriptive statistics were computed and associations of interest were analysed using chi-square test. Of the 230 forms, 182(79.11%) were included after leaving out the incomplete ones. The overall prevalence of MSDs was 138(75.8%). The most frequent reasons for MSDs were lack of rest 21(15.2%) and having static postures for more than half-an-hour per procedure 38(27.5%).

The aim of the retrospective study was to assess the clinical and radiographic outcome of the dental implant surgery and prosthetics. It was conducted at the Aga Khan University Hospital, Karachi, and comprised of medical charts and radiographic records of patients visiting between 2010 and 2015. Variables such as implant dimensions, final prosthesis, method of retention, loading protocol and patient factors were analysed. A total of 223 implants (143(64.1%) in maxilla and 80(35.9%) in mandible) were placed in 92 subjects (50(54.3%) males and 42(45.7%) females). All implants were Zimmer tapered screw-vent. Length of 108(48.4%) implants was 11.5mm and diameter of 84(37.7%) implants was 4.7mm. Besides, 6(2.7%) implants failed to osseointegrate, whereas 1(0.4%) implant failed at 12 months of loading. Among the 216(96.9%) successful implants, 140(64.8%) served as bridge abutments, 72(33.3%) were single crown abutments and 4(1.9%) were overdenture abutments. Also, 37(17.1%) implants were immediately loaded. The six-year survival rate of implants was 96.9%.

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analysed on Orthopantomogram. TCI was calculated for unrestored mandibular premolars and molars. Pearson\\\'s correlation was applied to assess correlation between chronological age and TCI. Besides, 30(37.5%) subjects were male and 50(62.5%) female, and 140(44.4%) teeth were of male subjects and 175(55.6%) were of females. The mean correlation coefficient between chronological age and TCI was -0.27. The highest negative correlation was observed for tooth No.47 in males (r=-0.72) whereas among females the highest negative correlation was noted for tooth No.36 (r=-0.61).There was very weak correlation between age and TCI of a tooth. Therefore, TCI index could not be predictably used for age estimation in the studied population.