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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 academia in Pakistan has recently achieved an important milestone. The name of Operative Dentistry speciality has been changed to Operative Dentistry & Endodontics (ODE). It was a much-needed change that was first felt about two decades ago. However, with the correction of name, there are certain challenges that this speciality has to manage now. These include improving the curriculum, setting up standards, and lastly, setting up its boundaries and scope of practice as some of its scope overlaps with a sister speciality called Prosthodontics. This overlapping of the boundaries of dental disciplines is a problem that is unique to Pakistan, India, and some East Asian countries where Operative Dentistry or Conservative Dentistry is combined with Endodontics. This paper aims to discuss the objective delineation of dental procedures and suggest a model of peaceful co-existence of sister dental specialities. Keywords: Scope-of-practice regulation, Appointment, Credentialing, Group practice.

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 disease-free survival rates in oral squamous cell carcinoma patients initially attended to and referred by dentists versus other physicians. Methods: The systematic review was conducted after registration with the International prospective register of systematic reviews at the University of York, the United Kingdom, and comprised search on Medline, PubMed, Cochrane and CINAHAL Plus databases for studies published up to December 2021. The Population-Intervention-Comparison-Outcomes-Study criteria was used to search for studies involving patients diagnosed with oral squamous cell carcinoma receiving referrals by dentist or by other healthcare providers. Disease-free survival of patients was taken as the main outcome. Customized data collection proforma was used to record data in line with the Preferred Reporting Items in Systematic Reviews and Meta-Analysis guidelines. Data was subjected to systematic, qualitative review. Results: Of the 344 studies found, 8(2.3%) were analysed in detail. Patients referred by dentists ranged from 22.6% to 54%. Males comprised 53% to 70.3% of the sample. The highest number of referrals was made by primary physicians, ranging from 27.4% to 71.6%. Upto 67.6% cases were diagnosed with stage 1 and 2 oral cancer. The highest 5-year survival rate was 75% in a study where 59% patients were diagnosed at an early stage of disease. Conclusion: The relative scarcity of studies makes it impossible to draw an association between oral cancer survival rate and type of referral. Key Words: Oral squamous cell carcinoma, Cancer-free survival, Early detection, Referrals.

The study evaluated the position of gingival margins in anterior teeth using clinical and 3-dimensional (3D) optical scanning method among patients subjected to non-surgical periodontal treatment (NSPT). A single arm, longitudinal study was undertaken at the Archway Dental Center, University of Manchester, UK. History and clinical examination were done. Gingival recession, attachment loss (AL), and periodontal probing depth (PD) were recorded at baseline and 12-weeks follow-up. NSPT was done using hand and ultrasonic instruments. Impressions were made, the resultant gypsum models were scanned to generate 3D images. The change in the gingival level and thickness of facial gingiva were assessed. Out of eight patients recruited, three were lost to follow up. The 3D scan showed a poor correlation with the clinical assessment of gingival recession in anterior teeth following NSPT (r=-0.0089). Recession did not improve after NSPT (p 0.20). Keywords: Gingival recession; biotype; probing depth; attachment loss; non-surgical periodontal treatment.

This case report demonstrates the full mouth prosthetic rehabilitation of a patient with generalised compensated tooth wear and oral sub-mucous fibrosis (OSMF). A 50-year-old female with advanced tooth wear and concomitant OSMF presented to the clinic. She was managed in a sequential manner using an occlusal splint, extractions of hopeless teeth, root canal treatment of strategically important teeth, surgical crown lengthening of abutment teeth, and dental implants to replace missing dentition, followed by crown and bridgework to rehabilitate the dentition. All procedures were done on the principles of re-organised occlusal intervention. The outcome was a functional dentition with an aesthetic smile and a satisfied patient. The regaining of mouth opening among OSMF subjects is a challenge. ---Continue

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.

Dental implants offer a predictable solution for the replacement of missing dentition. This report describes the case of a patient who underwent dental implant surgery several years ago but due to negligence on the part of previous dentist, her implant pushed into the maxillary sinus. The patient presented with vague pain and swelling in the right maxillary region. Orthopantomogram (OPG) showed that the implant was lying in the right maxillary sinus which the patient had no clue of. It was decided to retrieve the implant and later restore the missing teeth for definitive function and aesthetics. However, at the time of surgery, the implant in question was missing from the anticipated position as it had migrated to the most posterior-superior compartment of the antrum making its retrieval difficult in the first attempt. Later, a maxillofacial surgeon carried out the retrieval. ---Continue

Objective: To evaluate the position of the root apices of posterior teeth of mandible with inferior alveolar nerve canal and the cortical bone on cone beam computed tomography. Method: The retrospective study was conducted from September to October 2021 at the Aga Khan University Hospital, and comprised cone beam computed tomography scans between November 2017 and October 2021 scans of healthy individuals of either gender aged 18-71 years with healthy, untreated, mandibular posterior teeth bilaterally. Shortest distance from apices of the mandibular posterior teeth to the border of inferior alveolar nerve canal, and to the mandibular buccal cortex were measured on the scans. Data was analysed using SPSS 23. Result: Of the 106 scans, 55(52%) were males and 51(48%) were females. Of the 746 33teeth in the scans, 385(51.6%) were present in the scans of males and 361(48.4%) in those of the females. For all mandibular posterior teeth, the distances in females were shorter than males, but for the distance from root apices to the IAN canal, the difference between genders was significant for the roots of second premolar and second molar only on the left side (p0.05). Regarding the distance from the root apices to the buccal cortex, no significant difference was found between the genders, for each type of tooth, (p>0.05). Correlations between the distance from apex to inferior alveolar nerve (r

Objective: To determine the difference in the marginal accuracy at buccal, lingual, mesial and distal margins of temporary crowns fabricated with bisacryl-based temporary crown material. Method: The in-vitro, experimental, laboratory-based study was conducted at the Aga Khan University, Karachi, from September to December 2019, and comprised two bisacryl-based temporary crown material, Integrity and Protemp 4, which were used to fabricate a sample of 24 temporary crowns. A pre-operative polyvinyl siloxane impression served as a template for temporary crown fabrication. A right mandibular molar tooth on a typodont was prepared to receive a crown. The provisional crown material was syringed onto the template and was allowed to cure. All four surfaces of the crown were observed under a stereomicroscope equipped with digital single-lens reflex camera at 25.6x magnification. An image of each surface was captured and a photographic record was maintained. An image processing software was used for the measurement of marginal discrepancy. Marginal accuracy among the four surfaces was assessed. Data was analysed using SPSS 23. Results: Mean marginal discrepancy for provisional crowns fabricated with Protemp 4 and Integrity was 410±222um and 319±176um, respectively. The marginal discrepancy between the two groups was statistically significant (p=0.027), with buccal margin exhibiting the most discrepancy (p

We aimed to explore the predictors of hospital length of stay for patients admitted and with maxillofacial injuries. Patients presenting with maxillofacial trauma were included. Poly-trauma involving neurosurgery and/ or needing orthopedics intervention were excluded. Logistic regression was applied to explore the predictors associated with the hospital stay of > 4 days. There were 241 patients with mean age 29.35 ± 12.5 years (age range 12-80 years). Mandibular fracture was the commonest observation 121(50.2%), followed by maxillary 48(19.9%), and zygomatic bone fracture 9 (3.7%). Road traffic accident 196 (81.3%) appears to be the most common etiology of maxillofacial injuries in the studied sample. The mean length of hospital stay among bone plating patients was 5.96 ±6.8 days compared to 4.15±6.2 days for ones treated without bone plating; p-value 0.05. It was concluded that longer length of stay is required in patients with more complex management including bone plates. Keywords: Maxillofacial injury; road traffic accident; bone plating; length of stay.

Abstract Radicular cyst is the most common type of odontogenic cyst associated with the apex of non-vital teeth. The lining of the radicular cyst usually arises from the epithelial rests of Malassez. These cyst usually persists even after the elimination of microbial load from the root canals. Surgical removal is deemed necessary for the management. For larger lesions extending to the facial or palatal cortical plates, additional regenerative procedures such as bone grafting along with collagen membrane are warranted. This case report describes the surgical and prosthetic management of a giant radicular cyst that was perforating the cortical plates in the anterior maxilla. Key words: cysts, radicular cyst; bone grafting, esthetic management, regeneration.

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...

Objective: To radiographically evaluate the proximal marginal fit of the clinically acceptable metal-ceramic crowns. Method: The prospective study was conducted at the dental clinics of Aga Khan University, Karachi, from July to December 2018, and comprised metal-ceramic crowns that were evaluated prior to the cementation. Clinical examinations were conducted by seating the crown on the tooth preparation and visual assessment was done using sharp explorer along the margins. Clinically acceptable crowns were then evaluated on the bite-wing radiograph. Any horizontal or vertical inaccuracy of >0.5mm at the proximal margins was recorded as 'discrepancy'. Data was analysed using SPSS 22. Results: Of the 230 interproximal margins of 115 crowns evaluated, 113(49.1%) sites had marginal discrepancies; 44(19.1%) horizontal discrepancies, 58(25.2%) vertical discrepancies, and 11(4.8%) having both horizontal and vertical discrepancies. Horizontal crown margin discrepancies were most associated with the mesial site of the maxillary crowns, while vertical discrepancies were commonly associated with the distal aspect of all crowns (p

Objective: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resinbased sealant (RBS). Methods: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December 2019 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 logistic regression 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 were evaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants were completely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and 10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age >15 years and male gender were 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 than that of the resin-based sealant (RBS). Keywords: Bonded amalgam sealants, Resin-based sealants, Retention, Caries. RCT Registration: www.clinicaltrials.gov with # NCT NCT03130725.

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 analyse characteristics of literature related to dental research and education published in a single medical journal. Method: 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. Results: 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%) 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, Karachi, contributed the most publications 30(18.9%), followed by Dow University of Health Sciences, Karachi, 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 1(0.6%) each with 103 and 91 citations. Conclusions: 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, Continuous...

Abstract 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 operations. Moreover, we have discussed the real life challenges encountered in the management of such patients. 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...

Abstract Objective: To compare the effect of OneShape and ProTaper Next file on the change in canal width and angle of curvature in simulated curved canal in resin blocks. Methods: The quasi-experimental study was conducted at the Aga Khan University, Karachi, from January to March 2018, and comprised endodontic resin blocks that had inbuilt curved canals. These were randomly divided into 2 equal groups and were subsequently prepared using OneShape in group A, and ProTaper Next rotary instrument in group B followed by staining with red and blue ink for comparison of pre- and post-operative images of canals. Standardised photographs were taken along with reference measuring scale. SPSS 22 was used for data analysis. Results: Of the 60 blocks, 30(50%) were in each of the two groups. The mean pre-instrumentation angle of curvature was 32.3±2.13 and 31.0+3.28 degrees for groups A and B. The mean degree of canal straightening post-intervention was 1.5+0.5 and 3.6+1.38 degrees in groups A and B (p

Abstract This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. Continuous...

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, ---Continue

Objective: To compare the surface defects created on the ProTaper Next files versus Hyflex EDM files after single clinical use in molars. Methods: One hundred and fourteen Nickel-Titanium files belonging to two contemporary systems, HyFlex EDM and ProTaper Next, were used to perform complete root canal treatment of a molar tooth. The files were first visually examined and then analyzed under 25.6x magnification using a stereomicroscope for evaluation of surface defects. A photographic record was maintained and studied. Descriptive statistics were calculated for frequency of defects. Chi-square test was used to check the association between file and defect type. Odd’s ratio was calculated to check the strength of association between file type and microscopic presence of defects. Results: Frequency of files showing defects was 14.9%. Deformation of the cutting edge was the most frequently seen defect type, found in 7.9% files. The frequency of fractured files was 3.5%. The odds of microscopic defects in HyFlex EDM is 2.64 times that of ProTaper Next. Conclusion: Even after single clinical use, HyFlex EDM files are more likely to get microscopic defects on their surface compared to ProTaper files. Continuous...