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Abstract Background Parameningeal rhabdomyosarcoma (PM-RMS) is a rare and aggressive soft tissue malignancy that primarily occurs in the head and neck region. The standard treatment approach for RMS involves a multimodal therapy regimen, which includes surgery, chemotherapy, and radiotherapy. However, the routine use of radiotherapy and chemotherapy in young patients with RMS in the head and neck region can lead to adverse effects on dental development and thereby, pose a challenge in planning dental intervention. Case presentation This case report outlines the dental and facial developmental consequences in a 13-year-old child, who received chemo-radiotherapeutic intervention at the age of 7 years for the management of PM-RMS. Following treatment, the child exhibited significant dental complications, including arrested root growth and restricted mouth opening. Conclusions This case highlights the necessity for interdisciplinary collaboration between oncologists, dentists, and other healthcare professionals to mitigate the adverse effects on dental health and overall quality of life in patients undergoing chemo-radiotherapy for rhabdomyosarcoma.

Abstract Objective Disturbances in the oral mucosa is a major concern among patients undergoing chemotherapy. One of the most significant barriers in the implementation of oral care is the lack of knowledge. The aim of the study was to assess gingival and periodontal health status of chemotherapy patients before and after the provision of oral hygiene instructions. Methods A single group, pre-post test was conducted to assess oral health status of patients at the daycare chemotherapy, Aga Khan University Hospital, Karachi, Pakistan. Oral hygiene instructions were given with study models and leaflets. Patients were followed for 6-weeks. Oral health was assessed by using Simplified-Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Differences in indices were analyzed in STATA version-15.0 using Generalized Estimating Equation (GEE) and Wilcoxon Signed-rank test. Results Out of 74, 53 (72%) patients completed study follow-up. Improvement in the OHI-S was found in 14 (26%) patients (p-value

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 After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N – 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46–28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p

BackgroundOral mucositis is an inflammatory condition of oral cavity which is a common and serious side effect of cancer treatment. Severe oral mucositis compromises basic functions like eating and swallowing causing malnutrition also affecting overall patient's oral health related quality of life. The aim of the study was to find the frequency of oral mucositis in patients with breast cancer during their chemotherapy, the factors associated with oral mucositis & the overall patient's oral health related quality of life.MethodsA cross-sectional study was conducted and a total of 160 women diagnosed with breast cancer, receiving chemotherapy and who had undergone at least one cycle of chemotherapy were recruited from two hospital settings. In-person interviews were done, patients were asked questions about their sociodemographic history, personal habits, oral history and oral findings, breast cancer stage, chemotherapy history and Oral Health Related Quality of Life. Their oral examination was done at the end of the interview to assess presence or absence of oral mucositis, using World Health Organization oral mucositis tool. Oral Health Related Quality of Life was assessed using Oral Health Impact Profile-14 questionnaire.ResultsOur results showed that out of 160 patients 88 (55%) of the breast cancer cases developed oral mucositis during chemotherapy. The mean Oral Health Impact Profile -14 scores in patients with oral mucositis was high 18.36±0.96 showing poor Oral Health Related Quality of Life. Occasional frequency of brushing was significantly associated with oral mucositis (Prevalence ratio:2.26, 95%_CI 1.06-4.84) compared to those patients who brushed once and twice daily. Low level of education showed negative association with oral mucositis (Prevalence ratio:0.52, 95%_CI 0.31-0.88).ConclusionOur study showed significant positive association of occasional brushing with OM and protective association of low level of education with the development of OM. Emphasis should be given to oral hygiene instructions and dental education to cancer patients in oncology clinics with the prescription of mouth washes, gels and toothpaste to patients to decrease OM during chemotherapy.

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.

Background. The relationship of the root of the maxillary third molars and the maxillary sinus (MS) is an important predictor of the anticipated difficulty in extraction. The aim of this study was to assess the location of maxillary third molars to the inferior wall of the MS in a sample of Pakistani population evaluated using cone-beam computed tomography (CBCT) imaging and to assess if age or gender has any influence on third molar to MS distance. Methods. The CBCT scans of adult patients, carried out keeping image volume at 8 cm×8 cm, and the voxel size 0.2 and 0.1 mm. Images retrieved from the hospital database were included in the study. The relationship of root apices of maxillary third molar with the MS was assessed according to the vertical, horizontal and Winter’s classification. Descriptive statistics, t test and chi-square test of association were applied. Results. CBCT scans of 93 patients, 56 males and 37 females were evaluated. The mean age was 41.12±17.13 years. The mean distance of third molar roots to the MS wall was 2.38±1.54 mm for males and 1.86±1.04 mm for females, on the left and 2.67±1.81 mm for males and 2.58±1.54 mm in females, on the right side. Independent sample t test showed that there was no significant difference for third molar to sinus wall distance in the two genders. No significant difference was found between the two sides. Conclusion. In a sub-population of Pakistani adults, the mean distance between the roots of the upper third molar and MS wall is around 2 mm. Only 5% males and 8% females had their upper third molars roots protruding into the MS.

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

Community dentistry or dental public health residency program are non-existent in Pakistan. Due to this, the dental institutions find it extremely difficult to hire and retain teachers in this discipline. There are other subjects such as Special Care Dentistry and Oral Medicine which too are lacking in our country. However, these disciplines are locally overseen by faculty of Oral Maxillofacial Surgery. Interestingly, other emerging disciplines such as Dental Anesthesiology, Oral Radiology and Oral Pathology are standalone specialties recognized by the American Dental Association but in Pakistan, these subjects fall in the domain of medical specialties of anesthesiology, radiology, and pathology, respectively. The two dental disciplines that warrant immediate attention of the dental academia and should be established as subject specialties are: Dental Public Health (DPH) and Pediatric Dentistry. This short communication discusses the significance and methodology of initiating a residency (fellowship training) program in Dental Public Health.

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

Context: Literature has no consensus over the utility of enameloplasty before fissure sealant placement. Aim: The objective of the study was to explore the effect of enameloplasty using a scanned electron microscope on the adaptability of resin-modified glass ionomer versus flowable resin-based sealants. Settings and Design: An in vitro, experimental study was done from July to November 2017 at the NED University and Dow University of Health Sciences, Karachi, Pakistan. Materials and Methods: An in vitro experimental study was done, for which twenty extracted human molars and premolars were selected. They were divided into two groups on the basis of sealant type (resin-modified glass ionomer versus flowable resin-based sealant). The groups were further subdivided on the basis whether these were subjected to enameloplasty or not. All specimens were thermocycled, sectioned, dried, and gold sputtered before inspection under a scanning electron microscope (×50). Statistical Analysis Used: The adaptability of the sealant material in the tooth fissures was assessed on an ordinal scale. SPSS version 23.0 was used for data analysis. Mann–Whitney U-test and ordinal regression were applied at 0.05 level of significance. Results: There were no statistically significant differences between adaptability scores achieved with resin-modified glass ionomer-based sealant and flowable resin-based sealant (P = 0.96). Moreover, enameloplasty resulted in inferior adaptability of the two sealant materials (P = 0.02). Conclusions: Enameloplasty has shown to exert a negative influence over adaptation of the sealant material into the tooth fissure irrespective of the sealant chemistry.

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.

Background: Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss. Objective: The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries. Materials and Methods: It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made. Results: Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004). Conclusions: The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.

Introduction: Achieving profound pulpal anesthesia is considered as a keystone in endodontic practice as it benefits both the patient and the dentist for smooth delivery of care. A tooth that has irreversible pulpitis causes severe pain and poses an additional challenge. The aim of the present systematic review is to compare the standard inferior alveolar nerve block with other local anesthesia techniques for effectively anesthetizing the mandibular posterior teeth that present with irreversible pulpitis. Materials and Methods: A systematic review protocol was registered at Prospero. The following databases were searched: PubMed, CINAHL, Cochrane, EBSCO Oral and Dentistry Database, and Trip Database using strict inclusion and exclusion criteria. All randomized control trials on the topic published in the English language only were included. Results: The first search yielded 1213 articles, and after going through extensive screening and eligibility process, only 8 articles were finally selected for the review. There were six articaine infiltration technique groups; two were based on intraosseous technique and one each on Gow-Gates and Vazirani–Akinosi methods. The standard inferior alveolar nerve block was compared with other mandibular anesthesia techniques pooled together. A meta-analysis was carried out to compare inferior alveolar nerve block with the articaine infiltration. The difference among two sets of techniques was found to be nonsignificant (P = 0.07). However, the overall results of the meta-analysis favor articaine infiltration. The study is first of its kind comparing multiple anesthetic techniques in mandibular posterior teeth with irreversible pulpitis. Studies with the highest level of evidence, i.e., randomized controlled trials, were included only. No conclusive inference regarding Gow-Gates block and Vazirani–Akinosi techniques could be drawn on account of limited data. Conclusions: Infiltration and intraosseous appeared to be viable alternative to standard inferior alveolar nerve block in the posterior teeth with irreversible pulpitis.

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.

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...

The present report is comprised of five patients of panfacial fractures in which initially oral intubation was done that was later moved to retromolar area. This modification is an improvised approach that appears beneficial in surgeries requiring maxillo-mandibular fixation. Owing to low morbidity, the retromolar intubation should be considered as a preferred method to avoid tracheostomy.

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...

Aim or Purpose: To compare the mean microleakage (in millimeters) around two temporary restorative materials (zinc-oxide based versus light-cure resin based) at tooth-temporary restoration and temporary-permanent restoration interfaces, within the complex endodontic access cavities in the extracted human teeth. Materials and Methods: Thirty teeth randomly allocated into 2 experimental groups in this in-vitro experimental study. Teeth in each group had conventional class II cavities prepared and restored with the composite filling. After 14 days of aging in saline, complex endodontic access cavities were prepared in these teeth. This was followed by placement of either of the temporary restorative materials to seal the access cavities. After immersion in 1% methylene blue dye, teeth were sectioned and observed under stereomicroscope (magnification X25.6) Measurement was made at two interfaces ‘a’ and ‘b’ (temporary restoration-tooth and temporary restoration-pre-existing restoration), respectively. Depth of dye penetration in millimeters was recorded as the microleakage. Independent sample t-test was applied to compare the mean difference in dye penetration measurements in the two study groups at interfaces ‘a’ and ‘b's. A p-value of < 0.05 was taken as statistically significant. Results: Light-cure resin-based material showed microleakage of 0.14 ±0.26 mm at interface ‘a’ and 0.07 ±0.17 mm at ‘b’, respectively. Whereas zinc-oxide based temporary restorative material showed microleakage of 0.54 ±0.42 mm at ‘a’ and 0.88 ±0.51 mm at ‘b’ interface. Conclusions: In complex endodontic access cavity, compared to zinc-oxide based material, light-cure resin-based material showed significantly less microleakage at the tooth-temporary restoration and pre-existing permanent filling-temporary restoration interfaces.

Background and Aim: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. Materials and Methods: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. Results: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). Conclusions: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.

Objectives: The aim of this study is to compare the depth of cure of two composite materials (SDR and Filtek bulk-fill) cured at variable increment depths (2, 4, and 6 mm) and voltages (180 and 220 volts). Materials and Methods: Each sample of the composite material was packed in a mold of 2 mm, 4 mm, and 6 mm and curing light (quartz tungsten halogen) of optimal intensity was exposed for 20 s at 2 different voltages on each specimen. After curing, the specimens were removed and the composite on the nonexposed end was scraped with a plastic instrument. The remaining composite thickness was measured using a digital Vernier caliper. The reading was divided by half to follow the ISO 4049 method. Independent sample t-test, one-way ANOVA, and linear regression analysis were applied. Level of significance was kept at 0.01. Results: The mean DOC of SDR and Filtek were 1.93 ± 0.82 and 1.77 ± 0.65 mm. Lowering the voltage from 220 to 180 volts reduced the depth of Filtek from 1.87 ± 0.74 to 1.67 ± 0.54 mm, whereas the DOC of SDR remained unchanged at 1.93 mm at the two voltages. The adjusted R2 for the depth of cure was 0.93 when the increment thickness, voltage, and restorative material were taken together in the regression model. Conclusions: There was no statistically significant difference between SDR and Filtek for the depth of cure at 2 and 4 mm increments. However, at 6 mm increment, the SDR cured significantly deeper than the Filtek. Around 91% variation in the depth of cure of these composites materials is explained by increment thickness alone.

Background: Tooth extraction is a common oral surgery procedure carried out mainly on outpatient basis. It is important to evaluate the risk factors which can lead to various complications after extraction of teeth. Normal healing of an extraction socket may be impaired by the presence of one or more factors. The objective of this study was to find out the effect of the medical conditions such diabetes, hypertension and smoking habit on the process of normal healing following dental extractions. Methodology: Patients reported for dental extraction in oral and maxillofacial surgery department at Baqai Dental College were divided into two groups. A control group and a disease group with systemic conditions like diabetes mellitus, hypertension and habit of smoking. All the extractions were performed under local anesthesia by the dental officers. SPSS version 17 was used to perform statistical analysis to identify the risk factors and possible relationships with the healing in extraction sockets. Results: In this study 88 females, 152 males participated. In healthy group there were 93 patients enrolled. In the healthy subjects (n = 93) 39.7% reported complications whereas in the diseased group (n = 147) the reported complications were 61.2% (Table 1). The percentages and number of patients are charted below according to complications. Table 2 is showing different complications and their percentages. Table 3 is showing disease patterns in both the groups and odds ratio which is greater than 4 in our study. Conclusions: The odds of complications among subjects with co-morbidities are four times that of same in the healthy subjects.

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...

Background: In contemporary health care, monitor displays are important devices that help clinicians in reading and understanding diagnostic images including radiographs. Image quality and observer performance could be compromised if the performance of monitor is below the known standards. Objectives: To estimate the parameters of diagnostic quality of digital display monitors (using AAPM TG-18 criteria) installed at the dental clinics of a university hospital. Materials and methods: A survey was carried out on a convenience sample of forty-four diagnostic monitor displays currently being used for radiographic interpretation at dental clinics of a university hospital. A calibrated photometer (BARCO V950-180, USA) comprising of different test patterns and reference standards developed by the AAPM TG18 and DICOM part 14 GSDF were used on the monitors to assess their diagnostic image quality. It is a scale which consists of five parameters that labels monitors into two categories: primary grade or secondary grade. Data was reported as frequencies of the five parameters of imaging. Results: Of the 44 monitors assessed, none fulfilled the primary grade criteria. All monitors fulfilled the parameters for secondary grade display except the luminance response for which only 16/44 monitors passed the criteria. There was an excellent agreement between the assessors for the image quality parameters; kappa: 0.92. Conclusions: Within the limitations of this study, it is concluded that all monitors at dental clinics were of secondary grade and the only parameter in which majority of the monitors failed, was the luminance response. Keywords: Diagnostic imaging, Digital imaging, Luminance, Image quality

Objective: The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis. Materials and Methods: A systematic review protocol was registered at PROSPERO registry, University of York, UK (CRD42016041919). Following databases were explored: PubMed, CINAHL, Cochrane, and Web of knowledge. The PICO model included participants who received occlusal splint or complete denture or full arch fixed dental prosthesis at the centric relation position. The intervention was the use of facebow transfer. Comparators were prosthesis made without using a facebow. Outcomes were the patient satisfaction of the prosthesis and the need for laboratory adjustments. Only randomized clinical trials were included in the present review. A customized data extraction pro forma was used to extract the data and assess its quality. Results: A total of 505 articles were retrieved. On excluding duplicates, protocols, case reports, case series, narrative reviews, etc., only eight studies were selected for review. Six clinical trials on 249 complete dentures and two clinical trials on 65 occlusal splints were reviewed. No study on full arch crown and bridge work satisfied the inclusion criteria. Conclusions: The use of facebow did not yield a superior fit or comfort of the complete dentures or occlusal splints. Therefore, there is no evidence of the utility facebow transfer for these prostheses. However, no inference could be drawn for its utility in full arch fixed dental prosthesis as there were no studies to draw an inference.

Invasive cervical resorption is a condition that affects the root surface area below the epithelial attachment. Multiple treatment modalities are advocated, involving exposure of the invasive defect, removal of the granulation tissue and sealing with various restorative materials. This report demonstrates conservative treatment of a patient presenting with peri-apical periodontitis in upper right central and lateral incisors, along with Class II invasive resorption defect cervically on the mesial aspect of the central incisor, as a result of trauma. As the patient was not willing for any surgical intervention, only ortho-grade root canal treatment was carried out in both teeth, with Calcium hydroxide as intra-canal medicament. At three year follow-up, the patient remains asymptomatic demonstrating radiographic evidence of infilling of defect with bone-like tissue. Within the limitations of this report, it was seen that this conservative method for halting the progression of invasive cervical resorption could be under taken in patients who are un-willing for surgical intervention or in whom surgery is contra-indicated.