JOURNAL OF KHYBER COLLEGE OF DENTISTRY

2025-12-31

MOLECULAR MECHANISMS OF ORAL MICROBIOME–HOST INTERACTIONS IN THE PATHOGENESIS OF PERIODONTAL DISEASE

Nighat Shafiq — 2025-12-31

Periodontal disease remains one of the most prevalent chronic inflammatory conditions worldwide, affecting the supporting structures of teeth and compromising oral health. Its pathogenesis is driven by a complex and imbalanced interaction between the periodontal microbiota and the host inflammatory response. Beyond its local consequences, Periodontal disease is not just a problem for the gums—it has also been linked to serious health issues like diabetes, heart disease, and bowel disorders, making it an important global health concern. The World Health Organization has recognized severe periodontal disease as a major public health issue due to its high prevalence (20%-50 %) and its impact on quality of life.

Periodontal health depends on both internal and external factors. Internal factors include the strength of tissue barriers, differences in how cells drive immune responses, the effects of ageing, and how the body’s immune system (both innate and adaptive) reacts to microbes and environmental challenges. Underlying systemic diseases can increase the body’s vulnerability to periodontal breakdown. External factors involve the oral microbiome—its balance and diversity—as well as lifestyle habits such as diet and smoking. These factors determine how well the body can protect itself against periodontal disease. Clinically, periodontitis is graded from slow to rapid bone loss (Grades A–C), reflecting how microbial deposits interact with risk factors such as diabetes and smoking.

Understanding the molecular mechanisms of oral microbiome–host interactions is therefore essential not only for advancing periodontal therapy but also for addressing its systemic implications. As research continues to uncover these pathways, integrating microbiological, immunological, and clinical perspectives, it will provide a pivotal role in developing preventive and therapeutic strategies that protect both oral and overall health.

COMPARISON OF POSTOPERATIVE PAIN FOLLOWING ENDODONTIC TREATMENT OF SYMPTOMATIC APICAL PERIODONTITIS WITH AND WITHOUT THE BUCCAL INFILTRATION OF METHYLPREDNISOLONE

Iftikhar Akbar — 2025-12-31

Objectives: To compare postoperative pain levels following endodontic treatment of symptomatic apical periodontitis, with and without the buccal infiltration of methylprednisolone.

Materials and Methods: This quasi-experimental clinical trial was conducted at the Department of Operative Dentistry and Endodontics of Peshawar Dental College. A total of 100 patients (51 males and 49 females) experiencing moderate to severe pain due to symptomatic apical periodontitis were included. The treated teeth included maxillary and mandibular premolars and molars diagnosed with symptomatic apical periodontitis.
Patients were randomly divided into two groups: Group A (n = 50): did not receive methylprednisolone administration and Group B (n = 50): received a buccal infiltration of methylprednisolone (40 mg/mL) In Group B, methylprednisolone was administered slowly into the buccal vestibule near the root apex of the affected tooth after achieving profound soft tissue anesthesia. Once anesthesia was confirmed, standard root canal preparation was performed. Pain intensity was assessed using a Visual Analog Scale ranging from 0 (no pain) to 10 (worst possible pain) at baseline (before treatment) and 24 hours postoperatively.

Results: The mean age of participants was 38.29 ± 11.34 years. Postoperative pain was reported in 50% of patients in the methylprednisolone group and 62% in the control group. However, the difference was not statistically significant (Chi-square test, p = 0.44). Mean VAS scores also showed no significant difference at baseline or after 24 hours.

Conclusion: Buccal infiltration of methylprednisolone did not result in a statistically significant reduction in postoperative pain following cleaning and shaping of teeth with symptomatic apical periodontitis.

ASSESSMENT OF ORTHODONTIC TREATMENT NEED IN ADOLESCENT POPULATION USING INDEX OF ORTHODONTIC TREATMENT NEED (IOTN): A MULTI CENTRE CROSS-SECTIONAL STUDY

Shahzonia Tariq — 2025-12-31

Objectives: To assess orthodontic treatment need in adolescent population using index of orthodontic treatment need (IOTN).
Materials and Methods: This multicentre cross-sectional study comprised 60 adolescents in total. Eligible participants were individuals aged 12 to 18 years with no previous orthodontic treatment and showed willingness to participate. Adolescents with craniofacial anomalies, syndromes, or medical conditions affecting facial development were excluded from the study. Both the dental health component (DHC) and the aesthetic component (AC) of IOTN were used to evaluate the necessity for orthodontic treatment. The frequency of adolescents that need orthodontic treatment was assessed in relation to both IOTN components. Chi-square test was used to assess association between orthodontic treatment need and other variables (gender and age). A p-value of <0.05 was considered statistically significant.
Results: 46.7% of adolescent population need orthodontic treatment according to DHC while 23% need orthodontic treatment according to AC of IOTN. The result of chi-square test indicated that there was no statistically significant association of gender and age with IOTN grades.
Conclusion: A significant proportion of adolescent population required orthodontic treatment. Therefore, the routine dental checkups should include early orthodontic examinations and interventions to improve dental function and psychosocial well-being by promptly addressing malocclusions.

AWARENESS, ATTITUDES, NEED AND DEMAND FOR MISSING TEETH REPLACEMENT AMONG PARTIALLY DENTATE PATIENTS

Syeda Sameen Zehra — 2025-12-31

Objectives: This study was conducted to determine the awareness, attitude, need, and demand for missing teeth replacement among partially dentate patients in tertiary care settings.

Materials and Methods: This cross-sectional study was carried out at HITEC- institute of dentistry Taxila and included partially dentate patients aged 18–60 years from December 2022 to September 2023. All participants completed a pre-tested and validated questionnaire. Demographic information (age, gender, and educational status) was recorded. The second section of the questionnaire assessed awareness, attitude, need, and demand for the replacement of missing teeth. Clinical evaluation was performed to determine treatment needs and to identify suitable prosthetic options for each arch based on Kennedy’s Classification. Data were analysed using the chi-square test in SPSS version 26, with p < 0.05 considered statistically significant.
Results: A total of 99% of the patients were aware of their missing teeth; however, only 73.5% expressed willingness to replace them. Among the 26.5% with a negative attitude toward replacement, the most common reason was the perception of no need for treatment. Regarding treatment options, 96% were aware of tooth-supported fixed prostheses, while 94% and 52% were aware of removable and implant-supported prostheses, respectively. Nearly all participants agreed that replacing both anterior and posterior teeth is equally important. Patients with Kennedy’s Class I, II, III, and IV showed greater interest in fixed prostheses compared to removable options.
Conclusion: Most partially dentate patients desire replacement of missing teeth to improve mastication and exhibit good awareness of available removable and implant-supported prosthetic options. Patients with Kennedy’s Class I and II show particularly high demand for prosthetic replacement.

USE OF PREOPERATIVE SUBMUCOSAL DEXAMETHASONE IN THIRD MOLAR SURGERY: A STEP TOWARDS IMPROVEMENT IN QUALITY OF LIFE

Sarmad Suleman — 2025-12-31

Objectives: To determine the efficacy of pre-operative submucosal administration of dexamethasone in surgery of impacted third molar (M3) teeth.
Materials and Methods: Prospective, randomized controlled trial was conducted at Armed Forces Institute of Dentistry, CMH Rawalpindi, from April 2023 to October 2023. A total 130 patients were enrolled in study and divided into two groups by simple randomization method. Group A was control group injected placebo and group B was case group injected 4mg dexamethasone immediately after induction of anesthesia through submucosal route. Efficacy was measured in terms of reduction in trismus, pain and inflammation in post-operative time. SPSS version 24 was used for data entry and analysis of variables.
Results: The mean pain score in Group A was 31.29 ± 6.04, while in Group B it was 25.32 ± 3.49, with Group B showing significantly lower pain levels than Group A (p < 0.001). The mean swelling measured 4.63 ± 1.22 mm in Group A and 3.16 ± 0.72 mm in Group B, indicating signifi cantly less swelling in Group B (p < 0.001). Similarly, the mean trismus was 26.17 ± 3.63 mm in Group A compared to 21.15 ± 2.44 mm in Group B.
Conclusion: Administering 4mg of dexamethasone through the submucosal route prior to mandibular third molar surgery can effectively reduce post-operative pain, swelling, and trismus.

DETERMINING THE CORRELATION BETWEEN INTERCANINE DISTANCE, INTERCOMMISSURAL DISTANCE AND INTERPUPILLARY DISTANCE IN POPULATION OF TWIN CITIES

Sajjad Hussain — 2025-12-31

Objectives: Finding a relationship between the maxillary intercanine width and facial landmarks such interpupillary distance and intercommissural width, as well as calculating the ratio between the variables that were evaluated, were the goals of this study; this information may be helpful in clinical settings.

Materials and Methods: This was a cross sectional study that required use of a precise digital vernier caliper [Mitutoyo (UK) Ltd.] with a 0.01 mm precision and the ability to measure distances ranging from 0 to 150 mm was used for all of these measurements. The Intercanine width measurements were taken directly on the participant with the help of a dental fl oss. Each dimension was recorded thrice and a mean was calculated.

Results: Inter commissural width was also significantly higher in males as compare to the females (49.0±5.8 vs 46.63±4.2 respectively, p<0.001). Whereas, no significant association was found between mean width of maxillary anteriors among males and female participants.

Conclusion: When building a prosthesis for an edentulous patient, the physician should consider these facial landmarks to help them determine the best canine positioning.

COMPARISON OF THE MECHANICAL PROPERTIES OF DENTAL COMPOSITE AND ITS MODIFIED COUNTERPART WITH HYDROXYAPATITE

Wajiha Ahmad — 2025-12-31

Objectives: This study compared mechanical properties of pure dental composite made with that of copper dope hydroxyapatite integrated in dental resin composite.

Materials and Methods: Dental resin composite with 2%, 5% and 8% Nano hydroxyapatite crystals doped in Copper was mechanically tested in comparison to dental resin composite manufactured manually having 70% Bis-GMA and 30% TEGDMA, Camphor quinine as a initiator and dimethyl aminoethyl methacrylate in a form of co-initiator. Flexural strength, Vickers hardness and values of compressive strength were evaluated.

Results: The mechanical tests revealed that as compared to dental composite manufactured in laboratory, the hydroxyapatite doped with copper dental composite had signifi cantly better mechanical properties.

Conclusion: The Vickers’s hardness, flexural strength and compressive strength of experimental dental composite increased with increasing percentage of hydroxyapatite nanoparticles added as a fi ller in a proportion of 3%, 5% and 8% with salinized silica in dental composite.

ANALYSIS OF MEAN ANTERIOR ALVEOLAR BONE THICKNESS AMONG THE PATIENTS PRESENTING WITH MALALIGNED TEETH AT TERTIARY CARE HOSPITAL

Marina Memon — 2025-12-31

Objectives: To analyze the mean anterior alveolar bone thickness among patients presenting with malaligned teeth.

Materials and Methods: This cross-sectional study was conducted in the “Department of Orthodontics, Altamash Institute of Dental Medicine”, Karachi, Pakistan from 1st Dec 2024 to 31st May 2025. A total of 100 patients with malaligned teeth, full permanent dentition, and clear lateral cephalograms were included. Malocclusion was classified using Angle’s criteria, and lateral cephalograms were hand-traced by a single examiner. Alveolar bone thickness was measured. Continuous variables were reported as mean ± SD, categorical variables as frequency and percentage. Chi-square or Fisher’s exact test, one-way ANOVA, and independent t-test were applied, with p < 0.05 considered statistically significant.
Results: The mean age was 19.78 ± 6.20 years, with 53% females. Maxillary alveolar bone thickness averaged 10.02 ± 1.55 mm with no significant differences among malocclusion groups (p = 0.121). Mandibular thickness varied significantly (p = 0.003), highest in Class III (12.00 ± 3.32 mm). Maxillary labial bone was thinner in Class II (4.62 ± 1.41 mm) than Class I (5.58 ± 1.57 mm; p = 0.008), and mandibular lingual bone was thicker in Class III (5.75 ± 1.19 mm; p = 0.0005). No significant gender differences were observe.
Conclusion: Alveolar bone thickness varies with malocclusion type. Thinner maxillary labial bone in Class II and thicker mandibular bone in Class III emphasize the importance of individualized orthodontic planning to safeguard periodontal health.

IMPACT OF TARGETED TRAINING ON INTRAORAL RADIOGRAPHIC QUALITY: A PROSPECTIVE COMPARATIVE STUDY OF DENTAL STUDENTS AND ASSISTANTS

Abdul Manan — 2025-12-31

Objectives: This study was conducted to evaluate the impact of training intervention on the intraoral radiographic quality acquired by dental students and qualified assistants.

Materials and Methods: This prospective, interventional study was carried out to evaluate the Impact of Targeted Training on Intraoral Radiographic Quality (Bitewing and Periapicals). A cohort of 25 dental students and 25 dental assistants was recruited. Each participant took 50 periapical (PA) and 50 bitewing (BW) radiographs during baseline session. All images were evaluated for diagnostic quality by two calibrated dentists using FGDP, UK guidelines. Following baseline assessment, a structured training and feedback session was provided to participants. One month post-training, a second session was conducted where participants took another set of 50 PA and 50 BW radiographs for evaluation. Data were analyzed using SPSS version 28.

Results: At baseline, the proportion of acceptable radiographs was low for both groups, with students demonstrating significantly lower PA acceptance rates than assistants (38% vs. 78%, p=0.001). Following training, students showed a significant improvement in PA radiographs (72% vs. 38%, p<0.001). Bitewing improvements for both groups and PA improvements for assistants were modest and not statistically significant.

Conclusion: Targeted training and feedback significantly improved the quality of periapical radiographs produced by dental students, closing the initial performance gap with experienced assistants. This study underscores the value of structured education in achieving quality radiographic results.

COMPARISON OF COMPLICATIONS AND FUNCTIONAL OUTCOMES OF SUBMENTAL ISLAND FLAP VS RADIAL FOREARM FLAP FOR RECONSTRUCTION OF TONGUE DEFECTS IN SQUAMOUS CELL CARCINOMA

Mushtaq Ahmed — 2025-12-31

Objectives: To compare postoperative complications and functional outcomes of submental island flap versus radial forearm used in reconstruction of tongue defects in squamous cell carcinoma patients.

Materials and Methods: After receiving approval from the Ethical Review Committee, this study was carried out in a tertiary care center's Department of Oral and Maxillofacial Surgery (Ref. No: 10130425MAOM). It comprised 60 patients in a non- randomized control trial, 30 in each group, between the ages of 18 and 70, who were undergoing surgical reconstruction and resection for squamous cell carcinoma of the tongue. Depending on the size of the defect, patients were randomized to either the radial forearm free flap group or the submental island fl ap group. Poor nutrition (BMI <18.5 or >35), substance abuse, active oral infections, severe comorbidities, previous head and neck radiation, recurrent disease, and prior reconstruction were all excluded. Adults aged 18–70 years undergoing tongue reconstruction were included. Functional outcomes (speech, swallowing, mobility) and complications (infection, wound dehiscence, necrosis, donor-site morbidity) were assessed at 1-week and 15-day follow-up. Data were analyzed with SPSS 22 using chi-square/Fisher’s exact tests, with eff ect sizes and 95% confi dence intervals reported. Qualitative variables were presented as percentages and frequencies, while quantitative variables were summarized as mean ± SD or IQR. A p-value of less than 0.05 was deemed statistically significant.

Results: Among the 159 participants, the mean age was 33.08 ± 8.83years, with a higher proportion of males (n=95, 59.7%). While most respondents recognized the benefits of laser technology in endodontics, practical application was limited, with only 4.4% reporting its use. Significant differences were observed between respondents with 1-4 years and 5-8 years of experience in their familiarity with laser technology and beliefs about its application and outcomes. Barriers to adoption included cost concerns and perceived training accessibility.

Conclusion: For tongue reconstruction, RFFF and SMIF both demonstrated comparable healing and functional results, demonstrating their efficacy and dependability. However, SMIF provides a less invasive alternative that is perfect for moderate defects because it requires less time during surgery and has less donor-site morbidity.

CORRELATION BETWEEN FACIAL REFERENCES AND MESIODISTAL WIDTH OF MAXILLARY ANTERIOR TEETH

Gohar Ali — 2025-12-31

Objectives: To find the relationship between facial measurements Inter Arch Width (IAW), Inter Canthal Distance (ICD), Inter Pupillary Distance (IPD) and the mesiodistal width of maxillary anterior teeth.

Materials and Methods: The study employed non-probability purposive sampling on 100 patients, including both genders Measurements for ICD, IAW, IPD were taken using a digital vernier caliper and a wooden spatula. Pearson correlation coefficients assessed correlations between maxillary anterior teeth width and the measured parameters.

Results: The study involved 100 participants with a mean age of 29.95 years (SD ± 6.83), comprising 40% females and 60% males. Key facial and dental measurements included a mean inter-canthal width of 35.62 mm (SD ± 2.22), inter-pupillary distance of 61.44 mm (SD ± 4.35), inter-alar width of 40.62 ± 5.35 mm, and combined maxillary teeth width of 47.02 mm (SD ± 3.30). Signifi cant correlations were found between combined width of maxillary teeth (CWMT) and the facial measurements: ICD (r = 0.48), IPD (r = 0.42), and IAW (r = 0.61), all with p < 0.001. Strong correlations were found Between Combined Width Of Maxillary Teeth (CWMT) and ICD in females (r = 0.59) and moderate in males (r = 0.46), all statistically significant.

Conclusion: The findings showed significant correlations between CWMT and facial dimensions (ICD, IPD, IAW) across all genders with the strongest correlation between CWMT and IAW, indicating their potential as biometric landmarks for selecting upper anterior teeth .

ASSESSMENT OF PATIENTS' ATTITUDES REGARDING THE USE OF RUBBER DAMS IN ENDODONTIC THERAPY

Fayyaz Alam — 2025-12-31

Objectives: To determine patients' attitudes towards the use of rubber dams in endodontic therapy at Saidu College of Dentistry, Swat.

Materials and Methods: The cross-sectional survey was conducted at Saidu College of Dentistry, District Swat, on 150 participants using a non-probability consecutive sampling technique. Participants aged 12–50 years who were healthy and willing were included, while those refusing consent or with psychiatric disorders, diabetes, cardiovascular, respiratory, or infectious diseases were excluded. Data were collected using a validated, pre-tested questionnaire covering demographics, awareness, experience, comfort, and perceptions of rubber dam use. The Chi-square or Fisher’s exact test was applied to compare awareness, perception, and efficacy of rubber dam across gender and education.

Results: Among 150 participants (54.7% female), most had higher education (59.3%). Overall, 33.7% were aware of rubber dam use, 11.3% had undergone a procedure, and 23.7% believed in its essential use. Regarding experience, 17.7% felt comfortable, 23.3% reported less discomfort, and 43.7% felt secure about cleanliness. For efficacy, 62.3% believed it increased effectiveness, 73.3% reduced infection risk, and 63.3% facilitated a quicker procedure. Females more often reported reduced infection risk (79.3% vs 66.2%; p = 0.04), and higher education was associated with greater awareness and positive perceptions (p < 0.05).

Conclusion: The study shows a large gap in awareness and comfort with rubber dams, despite their known benefits in improving procedure efficiency and reducing infection risk. The findings shows the importance of the need for increased education and patient acceptance to enhance the clinical effectiveness of rubber dams.