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Background: The provision of dental care in Pakistan is limited, with less than 5% of the population having access to qualified dental practitioners. The lack of contextually relevant local dental guidelines further adds to the problem. We developed clinical practice guidelines (CPGs) and referral pathways to improve primary care for common oral diseases. Methods: Using the GRADE-ADOLOPMENT approach, recommendations from source guidelines (developed in Europe and the United States) were adopted (retained as is or with minor changes), adapted (modified according to the local context), or excluded (omitted due to lack of local relevance). The guidelines included diseases such as periodontitis, dental pain, intraoral swelling, and oral cavity malignancies. The end result was a set of locally relevant CPGs, which were then used to formulate referral pathways, with the incorporated suggestions being based on a thorough evidence review process. Results: We included four recommendations, three of which were adopted with minor modifications to the referral pathway. These changes focused on assessing potentially malignant oral conditions and counseling for risk factors. No content changes were needed for the CPGs of the other two disorders. We developed referral pathways for three specific oral conditions, detailing primary care physicians’ roles in diagnosis, initial treatment, and timely referral. Conclusion: Contextually relevant dental CPGs and referral pathways can improve patient outcomes in Pakistan. Our study produced four additional recommendations focused on risk factor counselling and mitigation, which could potentially reduce the burden of oral malignancies in our local population.

Abstract Objective This study underscores the transformative role of Artificial Intelligence (AI) in healthcare, particularly the promising applications of Large Language Models (LLMs) in the delivery of post-operative dental care. The aim is to evaluate the performance of an embedded GPT model and its comparison with ChatGPT-3.5 turbo. The assessment focuses on aspects like response accuracy, clarity, relevance, and up-to-date knowledge in addressing patient concerns and facilitating informed decision-making. Material and methods An embedded GPT model, employing GPT-3.5-16k, was crafted via GPT-trainer to answer postoperative questions in four dental specialties including Operative Dentistry & Endodontics, Periodontics, Oral & Maxillofacial Surgery, and Prosthodontics. The generated responses were validated by thirty-six dental experts, nine from each specialty, employing a Likert scale, providing comprehensive insights into the embedded GPT model’s performance and its comparison with GPT3.5 turbo. For content validation, a quantitative Content Validity Index (CVI) was used. The CVI was calculated both at the item level (I-CVI) and scale level (S-CVI/Ave). To adjust I-CVI for chance agreement, a modified kappa statistic (K*) was computed. Results The overall content validity of responses generated via embedded GPT model and ChatGPT was 65.62% and 61.87% respectively. Moreover, the embedded GPT model revealed a superior performance surpassing ChatGPT with an accuracy of 62.5% and clarity of 72.5%. In contrast, the responses generated via ChatGPT achieved slightly lower scores, with an accuracy of 52.5% and clarity of 67.5%. However, both models performed equally well in terms of relevance and up-to-date knowledge. Conclusion In conclusion, embedded GPT model showed better results as compared to ChatGPT in providing post-operative dental care emphasizing the benefits of embedding and prompt engineering, paving the way for future advancements in healthcare applications.

Abstract Periodontal instrument fractures are rare events in dentistry, with limited literature available on their occurrence and management. This case report highlights an incident involving the fracture of a periodontal sickle scaler blade during manual instrumentation for the removal of calculus. The fracture occurred during instrumentation on the mesial surface of the maxillary right second molar, and the separated blade was subsequently pushed into the sulcus. A radiographic assessment was performed to verify the precise location of the fractured segment. Following confirmation, the broken blade was subsequently retrieved using curved artery forceps. The case report highlights factors contributing to instrument fractures, emphasizing the importance of instrument maintenance, sterilization cycles, and operator technique. Ethical considerations regarding patient disclosure, informed consent, and instrument retrieval methods are well discussed. This case underscores the importance of truthful communication, the proper use of instruments, equipment maintenance in dentistry, and the significance of ongoing professional development to enhance treatment safety, proficiency, and ethical standards in dental care.

Abstract Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2–3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value

Abstract The prevalence of edentulism is pandemic and people resort to complete dentures for the restoration of missing teeth and esthetics. However, the determination of the correct occlusal vertical dimensions (OVD) constitutes to play an important role in overall patient satisfaction. The objective of this study was to apply anthropometric methods to correlate the length of index finger (2D) to measure the OVD from base of the nose to the base of the chin (Sn–Me) and to assess satisfaction by comparing both the methods. A total of 80 edentulous patients were randomized and controlled for this trial into experimental and control groups. A correlation was found between Sn–Me and finger measurements, dentures’ satisfaction was assessed after a 1-week follow-up and marked according to the Visual Analog Scale. Our findings established that finger measurements are greater among males, and in both genders, positive, and statistically significant correlations exist between the facial and finger length measurements. Moreover, 97.0% patients from experimental group were satisfied with the use of complete dentures through the new anthropometric method. Hence measuring the length of index finger can be an adjunct method for the restoration of OVD and is a relatively time-effective and simple method with a satisfactory follow-up. Trial registration: ID: NCT05153213 ( https://clinicaltrials.gov/ct2/show/NCT05153213 ).

Objective: To determine the frequency and extent of artefacts in magnetic resonance imaging and/or computed tomography scans of head caused by fixed dental prosthesis. Method: The retrospective study was conducted at Aga Khan University Hospital from July to December 2021, and comprised magnetic resonance imaging and/or computed tomography scans from January 2015 to December 2020 of the head of individuals with existing fixed dental prosthetic work at the time of exposure. They were analysed for the presence of artefacts. The association between artefacts and the presence of fixed dental prosthesis was explored. Data was analysed using SPSS 23. Results: Of the 297 images evaluated, 173 (58%) were magnetic resonance imaging scans, and 124(42%) were computed tomography scans. The most common artefacts was grade I 148(49.8%), followed by grade II 140(47.1%) and grade III 9(3%). There was no significant association between fixed dental prosthesis and the artefacts (p>0.05). Conclusion: There should be no reservations in placing fixed metal prosthesis in individuals on account of future brain scans. Key Words: Fixed dental prosthesis, Imaging, CT scan, MRI, OPG, Artefacts.

dental implants: a bibliometric analysis of 20 top cited articles. J Pak Med Assoc. PMID: 37427629.”1was published in June 2023. We believe that the reader has mixed up this paper with an earlier paper of ours, titled “A bibliometric analysis of the studies on dental implant failure. J Pak Med Assoc. PMID: 35202375.2 Dental implants have two types of failures: surgical (related to implant fixture, its placement techniques and bone biology etc.) and prosthetic (related to implant prosthesis, crown, abutment, other components, or technical issues arising from laboratory made implant prosthesis). The former paper was about identifying the top-cited publications on the surgical failures of implants whereas the latter bibliometrics related to the implant prosthetic complications. Regarding methodology of bibliometrics, the search terms we adopted for the first paper was “dental implant failure” whereas for the second paper, we employed “Prosthetic complication in dental implant” without using any Boolean operator. These key terms were searched in the abstracts using Web of Science, Google Scholar, and other electronic sources published in English language upto June 2021. We employed the option of “cited reference search” for ascertaining the number of citations. To review and synthesise the data, multiple parameters were explored. These included authors, journal, citation count, citation density, keywords and study design, and geographic and institutional affiliation of the first or corresponding authors. The country of literature emergence was determined by the address of the corresponding author. The details of methodology are already shared in the above-mentioned papers. Another important observation made by the reader was that the table 2 and table 3 displayed the same information that has already been shared in table 1. So why was it done? And that too in both the papers. The answer to this question is that although table 1 in both the papers displayed the primary bibliometric data but to stratify the data, based on author, institution, and the journal, table 2 was composed and to emphasize the study designs table 3 was made. That helped us to identify that there is just one clinical trial among top 30 cited papers on dental implant failures and more alarmingly, no randomized controlled trials in the list of top 20 cited papers on the implant prosthetic failures. Thus, table 2 and table 3 represented the subset of the data.

Objectives: To compare the number of aerosol-generating procedures performed and the number of coronavirus disease-2019-positive workers in dental practice. Method: The audit study was conducted in May 2021 at the Aga Khan University Hospital, Karachi, and comprised data from April 1, 2020, to March 31, 2021, which was retrieved from dental clinics at the main hospital and its Clifton branch as well as in three secondary care hospitals in Garden, Kharadar, Karimabad areas of Karachi, and one in Hyderabad, Pakistan. Data of individuals who followed mandatory pre-procedural polymerase chain reaction testing in addition to using personal protective equipment in the main hospital and Clifton branch was placed in group A, and of those using personal protective equipment only at the 4 satellite clinics with no testing was placed in group B. Dental charts of patients who underwent dental aerosol-generating procedures were analysed. Number of dental clinics affected by coronavirus disease-2019 and number of dental patients who were reported positive on pre-procedural polymerase chain reaction testing were evaluated. Data was analysed using SPSS 23. Results: Of the 63 dental healthcare workers, 44(69.8%) were in group A and 19(30.2%) were in group B. In group A, 19(43.2%) were affected by coronavirus disease-2019 compared to 2(11%) in group B (p=0.01). Among 782(67.8%) patients who underwent polymerase chain reaction testing, 26(3.3%) turned out positive for coronavirus disease-2019. Due to the mandatory testing imposed on patients, 371/1153(32.2%) refused to get the desired dental treatment. Conclusion: The benefit of pre-procedural testing in dentistry remained uncertain.

The purpose of this review was to explore the 20 most cited articles on prosthetic complications with dental implants. Identification of such articles could be helpful in prosthodontics residency programmes in devising the curriculum of essential reading material in implantology. The Institute for Scientific Information, Web of Science Database, and Google Scholar were used to identify the 20 top-cited articles published in journals from 1980 till June 2021. These articles were then evaluated according to the number of citations, authors, study design, publication year, and publishing journal. Descriptive statistics were computed for bibliometrics. It was observed that the citation count ranged from 6,391 to 315 (in descending order). The Toronto study is the most cited study on dental implant prosthetic complications. Prospective studies and systematic and narrative reviews were the predominant study designs used in the articles; however, alarmingly no randomised controlled trials were included in the list.

Objective: To identify top 30 studies related to dental implant failures based on bibliometric analysis. Methods: 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. Results: 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%). Continuous...

Abstract Objectives 1- To compare the effectiveness of 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline and a novel solution Neem extract (Azardirachta indica) in reducing intra-oral viral load in COVID-19 positive patients. 2- To determine the salivary cytokine profiles of IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL- 17 among COVID-19 patients subjected to 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline or Neem extract (Azardirachta indica) based gargles. Trial design This will be a parallel group, quadruple blind-randomised controlled pilot trial with an add on laboratory based study. Participants A non-probability, purposive sampling technique will be followed to identify participants for this study. The clinical trial will be carried out at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. The viral PCR tests will be done at main AKUH clinical laboratories whereas the immunological tests (cytokine analysis) will be done at the Juma research laboratory of AKUH. The inclusion criteria are laboratory-confirmed COVID-19 positive patients, male or female, in the age range of 18-65 years, with mild to moderate disease, already admitted to the AKUH. Subjects with low Glasgow coma score, with a history of radiotherapy or chemotherapy, who are more than 7 days past the onset of COVID- 19 symptoms, or intubated or edentulous patients will be excluded. Patients who are being treated with any form of oral or parenteral antiviral therapy will be excluded, as well as patients with known pre-existing chronic mucosal lesions such as lichen planus. Intervention and comparator Group A (n=10) patients on 10 ml gargle and nasal lavage using 0.2% Povidone-Iodine (Betadiene® by Aviro Health Inc./ Pyodine® by Brooks Pharma Inc.) for 20-30 seconds, thrice daily for 6 days. Group B (n=10) patients will be subjected to 10 ml gargle and nasal lavage using 1% Hydrogen peroxide (HP® by Karachi Chemicals Products Inc./ ActiveOxy® by Boumatic Inc.) for 20-30 seconds, thrice daily for 6 days. Group C will comprised of (n=10) subjects on 10ml gargle and nasal lavage using Neem extract solution (Azardirachta indica) formulated by Karachi University (chemistry department laboratories) for 20-30 seconds, thrice daily for 6 days. Group D (n=10) patients will use 2% hypertonic saline (Plabottle® by Otsuka Inc.) gargle and nasal lavage for a similar time period. Group E (n=10) will serve as positive controls. These will be given simple distilled water gargles and nasal lavage for 20-30 seconds, thrice daily for six days. For nasal lavage, a special douche syringe will be provided to each participant. Its use will be thoroughly explained by the data collection officer. After each use, the patient is asked not to eat, drink, or rinse their mouth for the next 30 minutes. Main outcomes The primary outcome is the reduction in the intra-oral viral load confirmed with real time quantitative PCR. Randomisation The assignment to the study group/ allocation will be done using the sealed envelope method under the supervision of Clinical Trial Unit (CTU) of Aga Khan University, Karachi, Pakistan. The patients will be randomised to their respective study group (1:1:1:1:1 allocation ratio) immediately after the eligibility assessment and consent administration is done. Blinding (masking) The study will be quadruple-blinded. Patients, intervention provider, outcome assessor and the data collection officer will be blinded. The groups will be labelled as A, B, C, D or E. The codes of the intervention will be kept in lock & key at the CTU and will only be revealed at the end of study or if the study is terminated prematurely. Numbers to be randomised (sample size) As there is no prior work on this research question, so no assumptions for the sample size calculation could be made. The present study will serve as a pilot trial. We intend to study 50 patients in five study groups with 10 patients in each study group. For details, please refer to Fig. 1 for details. Trial Status Protocol version is 7.0, approved by the department and institutional ethics committees and clinical trial unit of the university hospital. Recruitment is planned to start as soon as the funding is sanctioned. The total duration of the study is expected to be 6 months i.e. August 2020-January 2021. Trial registration This study protocol was registered at www.clinicaltrials.gov on 10 April 2020 NCT04341688 . Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2). Fig. 1 Flow diagram of study-participants’ timeline

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...

Abstract Objectives: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line among dentate subjects. To evaluate anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects Methodology: Front and profile photographs of 109 students of Fatima Jinnah Dental College with age ranging from 20 to 28 years were taken while holding the camper’s plane against the maxillary occlusal plane. The study was completed in six months. Photographs were imported in software AutoCAD(2017). An interpupillary line was drawn and angle with Camper’s plane was measured. On both profile pictures, line were drawn from base of the ala to the three different points on tragus (superior, middle and inferior). 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 analyzed using SPSS Version 23. Student’s paired sample t test and Pearson’s correlation coefficient were applied. Results: Horizontal parallelism of occlusal plane with inter-pupillary line was observed (mean angle 1.17 ±1.27). The angle between the occlusal plane and the inferior ala-tragus line was 4.25 and 4.50 degrees on right and left side, respectively. Intraorally, mandibular occlusal plane coincided with inferior (44%) and middle third (44%) of the retromolar pad. Conclusions: Inter-pupillary line and retromolar pad area (middle & inferior third) should be used as a guide in determination of plane of occlusion. Continuous...

Objective: To assess the knowledge, attitude and practice of fresh dental graduates of Karachi regarding pursuing research. Study type, settings & duration: A cross sectional study conducted at six randomly selected dental colleges from 10 dental Colleges (4 Government and 6 Private) in the city during three months. Methodology: After taking informed written consent 150 participants were enrolled. A predesigned questionnaire was filled. Questionnaire comprised of three parts; first part composed of demographic details, second part comprised of questions to assess the knowledge about research while the third part comprised of questions to evaluate the practices of dental students regarding research. Results: Out of 150 study participants 112 (74.7%) expressed a desire to conduct research in future, 22 (14.7%) were not interested, whereas, 16 (10.7%) were uncertain about carrying out research work in future. Females were found more motivated to conduct research in their future as compared to male study participants. One hundred and three (68.7%) participants did not know how to write a research proposal, whereas, 47 (31.3%) claimed to know about writing a research proposal. A large majority i.e. 69 (46%) participants reported both institutional and personal obstacles preventing them from pursuing research, 43 (28.7%) respondents reported institutional barriers, whereas, 38 (25.3%) participants reported personal reasons to be the major obstacles in conducting research. Conclusion: Although, a high percentage of the participants expressed their desire for carrying out research but due to inadequate knowledge regarding research methodology and lack of supervision, desired results could not be achieved. Significant efforts need to be made to improve the research culture in the institutions so as to facilitate students and fresh graduates in conducting research.

This article is aimed at modifying conventional window’s impression technique for making impression of edentulous flabby maxillary ridges. Vinyl Polysiloxane (VPS) impression material was preferred over conventionally used metallic oxide, due to ease of use and dimensional accuracy. The authors used VPS putty consistency on the periphery and regular body for the whole impression. This combination of material consistency gives selective pressure impression. More over the window over the flabby area give the very mucostatic impression of the displaceable area. The authors found the proposed technique superior over Watson’s technique in regards of convenience, time consumption, comfort of the operator and patient.