Pakistan Orthodontic Journal

Orthodontic Management of Impacted Mandibular Second Molars: A Narrative Overview

2025-11-29T11:04:18+05:00

Introduction: Mandibular second molar impaction incidence has been clinically observed as increasing over the past period of two decades with different diagnosis and management approaches, stressing. High level literature evidence published regarding prevalence, etiology and treatment strategies for impacted mandibular second molars was assessed.

Methodology: Literature was searched through computerized databases, manual assessment and validated texts on the theme of impacted mandibular second molars for narrative overview.

Results: Through a narrative overview impacted mandibular second molars has been presented from prevalence, etiology, diagnosis and management perspective. Decision making, clinical relevance and treatment strategies have been outlined as a guidance for young clinicians to ensure maximum success.

Conclusions: Presented information in this narrative overview can facilitate / assist young clinicians in resolving impaction related concerns with possibly greater precision.

Editor’s Message

2026-01-27T21:10:47+05:00

The Pakistan Orthodontic Journal (POJ) continues to strengthen its academic rigor, global relevance, and professional impact. Over the past year, we have witnessed significant enhancements in the journal’s quality, driven by strategic initiatives including the incorporation of more international reviewers, the inclusion of dental education articles, the appointment of medical educationists as peer reviewers, and a more robust peer-review process. These efforts reflect our commitment to ensuring that the POJ remains a leading platform for orthodontic scholarship, both nationally and internationally.

A highlight of 2025 in the orthodontic community was the 11th International Orthodontic Conference, organized by the Pakistan Association of Orthodontists (PAO) in Islamabad. This landmark event, held under the patronage of Prof. Ambreen Afzal (Vice President CPSP), the leadership of Prof. Saad Asad (President PAO & Principal, College of Dentistry, RIHS), and the guidance of Prof. Amra Minhas Abid (General Secretary PAO), demonstrated the growing stature of Pakistan in regional and global orthodontics. The conference featured pre- and post-conference workshops, e-poster presentations, and lectures by distinguished national and international speakers, attracting orthodontists, postgraduate trainees, and dental professionals from across Pakistan.

Commentary PAO’s 11th International Orthodontic Conference 2025: Advancing Knowledge, Shaping the Future

2026-01-27T21:13:38+05:00

The 11th International Orthodontic Conference of the Pakistan Association of Orthodontists (PAO), held in 2025 at Islamabad, marked a significant milestone in the academic and professional journey of orthodontics in Pakistan. The two-day scientific event brought together a vibrant community of national and international orthodontists, educators, postgraduate trainees, and researchers, reaffirming PAO’s role as a leading platform for scholarly exchange, clinical innovation, and professional development.

Organized under the patronage of Prof. Dr. Ambreen Ehsan Afzal, Vice President CPSP, the conference reflected a strong commitment to academic excellence and postgraduate training. The formal inauguration was under taken by the Chief Guest, Prof. Dr. Shoaib Shafi (CPSP), In his address, he emphasized PAO’s consistent efforts in fostering a culture of research, collaboration, and global engagement within the specialty.

Commentary PAO’s 11th International Orthodontic Conference 2025: Smile 2.0 – Unleashing the future of orthodontics

2026-01-27T21:15:57+05:00

The 11th International orthodontic conference was held in Islamabad on the 30th and 31st of October 2025. Educational opportunities such as workshops and lectures were led by eminent professionals to give participants the opportunity to enrich their skill set. More than just a collection of paper presentations, these sessions zoomed into specific clinical application.

In the two-day hectic program, a total of 27 international and national speakers participated with a mix of physical presence and online presentations. The conference offered collaborative and interactive professional development for orthodontists, boasting a program of interdisciplinary lectures delivered by renowned clinicians and researchers committed to fostering personal and professional growth within our community.

Influence of low-level laser therapy on the rate of orthodontic tooth movement

2025-08-19T14:56:19+05:00

Introduction: Methods to accelerate orthodontic tooth movement have been the topic of research to minimize the side effects related to increased treatment time. This study has been conducted to investigate the influence of low-level laser therapy with wavelength 980 nm on orthodontic canine retraction rate.

Methodology: This was a single center split-mouth randomized control trial. 45 patients planned for bilateral first premolars extraction with indirect anchorage, reporting to Orthodontics Department requiring bilateral maxillary first premolar extractions with critical anchorage were included in the study. One side of the maxillary arch was being irradiated by diode laser (aluminum-gallium-arsenide) of 980nm on three points both buccally and palatally and the opposite side of the arch was acted as placebo (control). Laser irradiation was done at initial appointment of premolars extraction (T0), followed by doses and measurements at three weeks interval (T1, T2 and T3).

Results: 53 patients were included in the study. There were eight drop outs leaving 45 patients for analysis. The speed of canine retraction was significantly faster on the experimental side (1.86 ± 0.48mm) compared with the control side (1.24 ± 0.03mm) (P-value < 0.001).

Conclusions: LLLT has a significant effect on OTM by reducing the duration of orthodontic treatment at 3 weekly intervals keeping the energy dose minimal.

Facial Soft Tissue Profile Differences in Various Vertical Facial Patterns: A Cephalometric Analysis

2025-08-08T13:34:28+05:00

Introduction: The orthodontic treatment is aimed at achieving a proper functional occlusion, as well as balanced and aesthetic face. The purpose of this study was to identify how facial soft tissue parameters correlate with the vertical facial pattern that might impact diagnosis and treatment plan construction.

Methodology: A cross-sectional quantitative study involving 265 orthodontic patients was conducted in Islamic International Dental Hospital, Islamabad. Pretreatment lateral cephalograms records were assessed and soft tissue parameters were measured. Statistical comparisons were performed on SPSS v23 using the One-way ANOVA and Post Hoc Scheffe tests.

Results: Dolichofacial individuals had significantly longer upper and lower lips compared with mesofacial and brachyfacial faces, while brachyfacial faces showed the greatest upper lip thickness (p ? 0.05). No significant differences were observed for lower lip thickness, soft tissue chin thickness, nasolabial angle, or nasal height across facial types (p > 0.05). These results indicate that vertical facial pattern mainly influences lip dimensions, whereas other soft tissue parameters remain relatively stable, providing guidance for orthodontic diagnosis and esthetic treatment planning.

Conclusions: While correlating facial soft tissue parameters with the vertical facial patterns it was found out that upper and lower lip lengths and upper lip thickness varied significantly between various facial types. However, Lower lip thickness, Soft Tissue Chin, Nasolabial Angle and Nasal Height didn’t show significant difference among the three facial patterns.

Effect of change in Mesiodistal Angulation of the Maxillary Central Incisors on mean attractiveness score of the Smile in Frontal view in local Population

2025-02-07T11:35:49+05:00

Introduction: This study explored how changing the mesio-distal inclination of the maxillary central incisors influence the perceived smile attractiveness, as assessed by orthodontic residents and laypersons .

Methodology: Four Smile simulations based upon mesio-distal inclination were created at (?4º), (+4º and +8º) and control image (0º). 102 orthodontists/orthodontic residents and 102 laypersons assessed these images by rating them from 0–100 attractiveness scale (0 = very unattractive; 100 = very attractive). Photographs were printed and distributed with questionnaires for evaluation.

Results: Attractiveness scores declined progressively with greater mesiodistal inclination. No statistically significant differences were found between orthodontists, trainees, and laypersons. Lay participants were less likely to detect subtle changes, while orthodontic trainees demonstrated higher accuracy, particularly with lower facial third views compared to full-face views.

Conclusions: Alterations in mesiodistal angulation of maxillary central incisors did not significantly influence smile attractiveness perception across genders or between professional and non-professional evaluators (p > 0.05).

Nasofacial anthropometric evaluation of a sample of Pakistani children: A community-based study

2025-08-08T13:33:50+05:00

Introduction: Harmony in facial morphology is created by a delicate balance between nose-chin and lip spatial relationship. Nasal proportions and dimensions have always be pivotal in creating / affecting facial aesthetics and nasal index assessment pre-post extraction, expansion, distraction and orthognathic surgery has re-enforced its significance in orthodontics. . Aim of this study is to evaluate the nasal and facial indices in Pakistani children that will help to identify the variation in type of nose and face among them.

Methodology: This cross-sectional study was conducted at various schools of Lahore, Pakistan with age range 3-14 years. Data was collected by taking nasal and facial measurements with digital vernier caliper and geometric divider to the nearest 1mm. Data was entered and analyzed for description using SPSS version-25. One- sample t-test was applied to test the significance of the variables. Post-stratification Pearson correlation test was used between facial and nasal index.

Results: The means of nasal height, nasal width, nasal index, face height, face width, facial index of total sample (N) were found to be 53.08±5.56 mm, 28.84±3.67 mm, 54.41±6.34 mm,106.25±9.02 mm, 118.07±9.28 mm and 89.95±6.91 respectively. Frequent nose type found was hyperleptorrhine and face type was hyperleptoprosopic in both genders.

Conclusions: Statistically significant negative correlation was found between nasal and facial index in both genders (r= -0.102 females and r= -0.237 in males).

Accuracy of in-built tip and effective tip expression capacity of different bracket sets with 19x25 stainless steel arch wire.? A Cross-Sectional Evaluation

2025-05-06T13:32:32+05:00

Introduction: Variability and lack of precision in the bracket’s manufacturing process can reduce the efficacy of the appliance and can therefore, force the clinicians to compensate for any dimensional inaccuracy through wire bending. This in-vivo exploratory investigation aimed to compare the tip values of the brackets from different companies with (MBT prescription) and amount of play (tip) produced by 19x25 stainless steel wire in 0.22 slot metal brackets.

Methodology: 18 pre-adjusted maxillary anterior bracket (3-3) from 3 different companies (A, B and C) were selected through purposive sampling technique and were mounted on modelling wax. Pictures were taken with DSLR (Canon D-600 with 100mm macro lens) camera. Bracket tip and play angles were measured with the help of IC Measure 3.1 software. Student's t-test, compared the tip values of all the maxillary anterior brackets of different manufacturers with the ideal tip values (MBT prescription). One-way ANOVA test and Post Hoc Tuckey test were used to identify and analyze any significant differences between tip and play values of different company bracket sets.

Results: : A statistically significant difference was observed between the ideal values and mean tip values of Company A (bracket# 21, 22, 13) and Company B (bracket # 11, 22) but the mean difference was clinically insignificant. However, Company C shows no significant difference. The (tip) play angles between the wire and bracket from difference companies show a significant difference (P<0.05). However, the difference was clinically insignificant. Also, there was a weak negative co-relation between brackets width and play angles (P=0.191).

Conclusions: This study's findings provide valuable information to the orthodontists, aiding them in making decisions regarding bracket selection for optimal treatment outcomes and also incorporate wire bending wherever necessary to compensate any differences between the claimed and measured tip values of the bracket sets available in market by various manufacturers.

Comparison of Success Rates between Cemented Molar Bands and Bondable Molar Tubes in Adult Patients Undergoing Fixed Appliances Treatment

2025-07-27T16:52:51+05:00

Introduction: One of the factor that affects drastically the the treatment outcome is stability of orthodontic attachments. One area of concern over the period of years has been molar banding vs molar bonding. Traditional molar bands provided superior stability and resistance to debonding while they are questioned for oral hygiene concerns and for their use in high risk patients. Molar bonding on the other hand has an additional limitation of difficulty at bonding especially in patients with limited mouth opening or excessive salivation. Aim of this study is to compare the success rates of cemented molar bands and bondable molar tubes in adult orthodontic patients keeping the operator experience and malocclusion type in consideration.

Methodology: This cross-sectional study was carried out at Saidu College of Dentistry on a sample of 280 orthodontic patients (age: 15-30 years) selected through convenience sampling between 2024 September and 2025 February.Participants were treated with fixed edgewise appliances. Molar bands were cemented using glass ionomer cement, while molar tubes were bonded using light-cured adhesive. Attachment failures were evaluated at immediate loading, 1 month, 3 months, and 6 months. Data were analyzed using SPSS version 24; chi-square tests assessed associations with failure timing, malocclusion, and education level of the clinician.

Results: Attachment stability was observed in 75% of cases. Molar tubes had slightly higher early failures, while molar bands showed more late failures. Differences between the two were not statistically significant (p > 0.05). Malocclusion type and clinician education level also showed no significant association with attachment failure.

Conclusions: Both molar bands and tubes are effective attachment methods. Case selection should consider patient comfort, hygiene, and treatment complexity.

Practice of Pecha Kucha as a Teaching Strategy in the Learning of Undergraduate Dental Students: Perceptions of Undergraduate Students - A Qualitative Study

2026-01-27T22:08:07+05:00

Introduction: Dental education relies on traditional lecture-based methods and many other techniques are also applied. Some of these methods may not always stimulate active learning and engagement. Undergraduate dental education is undergoing rapid and a period of significant transformation, driven by advancements in technology, evolving patient needs, and a growing emphasis on evidence-based practice. The objective of this study was to assess how Pecha Kucha is practiced as a teaching strategy in the learning of undergraduate dental students.

Methodology: A qualitative study was designed and conducted at Rawal General and Dental Hospital, RIHS, Islamabad. The study proposal was approved by ethical review board before initiation of study. A written consent was taken from all students before start of the Focused Group Discussion (FGD). A total of 4 FGDs were conducted. In each FGD there were 8-12 undergraduate dental student participants. The data collected were transcribed and then managed using NVIVO software and manual entries. The thematic analysis was conducted based on codes generated from the discussion, themes and sub themes.

Results: This study found a mix of responses from students. Though majority of the respondents accepted the Pecha Kucha teaching strategy and were satisfied with it, however, a few had opinions, otherwise. They mentioned that this method enhanced their engagement. Some of the students liked the time management and teaching skills while few others could not cope with presentation speed and thus, could not understand. They suggested that the time gap of a slide should be 30 seconds at least in place of 20 seconds. The key responses in favor of the Pecha Kucha pedagogy were that “it is good revision tool”. Moreover, they suggested that preparation before the session should be more systematic. Few stated that the pictorial material used for presentation should be more detailed, easy and engaging.

Conclusions: The format is excellent for summarizing and clarifying big concepts but loses its luster when applied to more complex or theoretical topics that require much more debate and analysis.

Is Biostatistics Relevant to Dentists? Understanding Pakistani Dental Professionals Knowledge, Attitude and Perceptions towards Biostatistics for Research and Professional Excellence

2025-03-19T12:12:28+05:00

Introduction: The objective of this study was to assess the knowledge, attitudes, and perceptions of dental faculty in a teaching dental hospital regarding bio-statistics as it relates to evidence-based dentistry.

Methodology: A cross-sectional survey was conducted on 231 licensed and registered dental practitioners from two teaching dental hospitals. A stratified sampling was applied by dividing the sample into three homogeneous groups. A closed-ended questionnaire containing questions pertaining to knowledge, attitude, and general perception was used, with responses recorded on a Likert scale. IBM SPSS Version 23 was used to perform descriptive and univariate data analyses (T- test). A p-value of <0.05 was considered statistically significant when comparing knowledge, attitudes, and perceptions.

Results: A response rate of 84.3% was achieved. 66.6% of the respondents found bio-statistics a difficult subject. 73.0% agreed that their training in bio-statistics is not adequate, while 62.7% respondents were unable to design and analyse their own research projects confidently. Although 70.1% claimed that knowledge of bio-statistics is an important part of evidence-based dentistry practice only 25.9% felt that learning bio-statistics would benefit their career.

Conclusion: Hospital-based dentists were found to have inadequate knowledge and training in the bio-statistics. Training programs must be re-evaluated and tailored for inclusion and integration of bio-statistics instruction as applied to dentistry to enable prospective dental professionals understand and solve dental problems/ challenges quantitatively.