Journal of Rehman College of Dentistry

Immunohistochemical Expression of Programmed Death Ligand 1 in Squamous Cell Carcinoma of Head and Neck

Maria Khan — 2026-01-09

Background: Head and neck squamous cell carcinoma (HNSCC) represents one of the most prevalent malignancies originating from the squamous cells of the nasal cavity, lip, paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands.

Objectives: To assess the immunohistochemical expression and clinicopathological features of Programmed Death Ligand 1 in head and neck squamous cell carcinoma (HNSCC).

Materials and Methods: This cross-sectional study was conducted at the Department of Histopathology, Rehman Medical Institute, Peshawar, from September 2023 to December 2024. Patients of either gender with histologically confirmed head and neck squamous cell carcinoma were included in the study. Formalin fixed tissue blocks were subjected to immunohistochemical staining with PD-L1 antibody, followed by analysis. The demographic characteristics and histopathological parameters were recorded.

Result: Among 92 participants, we observed a male predominance, with a male to female ratio of 3.8:1, and a median (IQR) age of 59.62 (56.85-62) years. PD-L1 positivity was observed in 84 patients (91.3%). The most common site of the tumor was the oral cavity in 56 (60.9%) patients followed by the larynx in 28 (30.4%) and hypopharynx in 8 patients (8.7%). We observed that lymphovascular and perineural invasion was not significantly associated with PD-L1 positivity. The T-stage of the tumors revealed that most tumors had T1 stage followed by T2 stage, while N-staging revealed most specimens 39 (46.4%) had N1 stage, followed by N0, N3, and N2 stages with a significant correlation to PD-L1 positivity. Tumors with extranodal extension and moderate tumor-infiltrating lymphocytes histologically revealed PD-L1 expression in 30 (35.7%) and 59 (70.2%) with p-1.000 and p-0.255respectively.

Conclusions: We conclude that there is a predominance of PD-L1 positivity in HNSCC with a significant correlation between PD-L1 positivity and nodal metastasis. The findings suggest that PD-L1 may have a crucial role in the biology and progression of disease. Consequently, these findings may lead to the development of immunotherapeutic strategies and aid in identification of patients who may benefit from PD-L1 targeted therapies.

Keywords: Immunohistochemistry; PD-L1; Squamous Cell Carcinoma of Head and Neck; Immunotherapy

Efficacy of Serratiopeptidase after Surgical Removal of Mesioangular Mandibular Third Molar- Randomized Controlled Trial

Muhammad Sheheryar Khan — 2026-01-09

Background: Surgical extraction of mesioangular lower third molars commonly results in restricted mouth open-ing after surgery, which can significantly affect recovery. Objectives: To determine the effectiveness of serratiopeptidasein minimizing postoperative trismus after surgical extraction of mesioangular mandibular third molar.

Materials and Methods: A randomized controlled trial was carried out in our Department of Oral and Maxillofa-cial Surgery, Sharif Medical City Hospital, Lahore from 6 June 2025 to 2 September 2025. A combined total of 110 patients (aged 18–50 years) were allocated randomly to two treatment groups using a single-blind lottery-based assignment: Group A received serratiopeptidase 10 mg twice daily for five days along with standard therapy, which consisted of oral paracetamol (500 mg every 8 hours) and Enziclor mouthwash (chlorhexidine). Group B received only the standard therapy. Exclusion criteria included concurrent oral surgical procedures, impactions close to the inferior alveolar nerve, anticoagulant use, smoking, pregnancy or lactation, peptic ulcer disease, or recent NSAID use within the past week. Measurement of mouth opening was recorded preoperatively and on post-operative days 1, 3, and 5 using the maximum interincisal distance in millimeters.

Results: At baseline, both groups had comparable mouth opening (42.8 ± 4.3 mm vs. 43.1 ± 4.1 mm, p = 0.71). On 1stpostoperative day, Group A had significantly higher mouth opening than Group B (28.6 ± 5.2 mm vs. 24.9 ± 4.8 mm, p < 0.001). This difference remained significant on day 3 (32.9 ± 5.0 mm vs. 28.7 ± 4.9 mm, p < 0.001) and day 5 (37.1 ± 5.6 mm vs. 30.5 ± 5.3 mm, p < 0.001). More patients in the serratiopeptidase group achieved clinically acceptable mouth opening (>35 mm) by day 5 as compared to controls (69.1% vs. 25.5%, p < 0.001).

Conclusion: The use of serratiopeptidase significantly reduces postoperative trismus and accelerates recovery fol-lowing the surgical removal of mesioangular mandibular third molars. The consistent effectiveness and good safe-ty record of the drug support its value as an adjunctive therapy in postoperative management. Further multicenter trials are recommended to confirm these findings

Frequency of Temporomandibular Joint Dysfuction in Patients Wearing Conventional Complete Dentures

Sania Liaqat — 2026-01-09

Background: A group of musculoskeletal and neuromuscular conditions known as temporomandibular disorders (TMDs) primarily affects the temporomandibular joint (TMJ), masticatory muscles, and associated structures.

Objectives: To assess the frequency of Temporomandibular joint dysfunction (TMD) at three specific intervals of one month, three months, six months following the use of conventional complete dentures.

Materials and Methods: The study is Descriptive case series and was conducted at the Department of Prosthodontics, Fatima Memorial Hospital, Lahore over a period of six months, from 22 June 2024 to 22 December 2024. Fifty complete denture wearers were evaluated using a modified Helkimo's dysfunction index (DI) at one, three, and six months. The DI assessed mandibular opening, deviation, pain, and joint sounds. TMD was considered present if the DI score was ≥1. The data were analyzed descriptively, and inferential tests (e.g., chi-square) were not performed since TMD was not observed in any participants.

Result: The mean age of participants was 64.34 ± 4.134 years. Among them, 27 (54%) were male and 23 (46%) were female. No patient demonstrated clinically significant signs of TMD during the six-month follow-up, irrespective of age, gender, education, socioeconomic status, BMI, and duration of edentulism.

Conclusion: During the six-month follow-up, no patients wearing conventional complete dentures showed signs meeting the criteria for temporomandibular joint dysfunction. These observations are based on a limited sample size and follow-up period.

Keywords: Conventional complete dentures, Temporomandibular joint dysfunction

Titanium Dioxide Nanocomposite Gel for Safe and Effective Tooth Whitening: An In Vitro Investigation

Mobeen Ali — 2026-01-09

Background: Tooth whitening has gained widespread attention as a noninvasive and aesthetic enhancement pro-cedures to restore the natural or desired tooth color.

Objectives: This study aims to evaluate the tooth-whitening efficacy and surface characteristics of choline citrate (CC) gel with varying concentrations of titanium dioxide nanoparticles (1%, 3%, and 5%), as compared to the stained control group, using tea-stained bovine enamel samples in an in vitro setting.

Materials and Methods: This experimental, in vitro study was conducted at the Department of Dental Materials, Khyber Medical University, over a period of six months, from 1-09-2023 to 1-03-2024.Choline citrate gel was pre-pared and titanium dioxide nanoparticle-based CC gel in 1%, 3% and 5% concentration were prepared and FTIR spectra were obtained for these gels. Enamel samples were prepared and stained with black tea. Samples were dis-tributed into experimental and control groups. Tooth color assessment via Vitapan shade matching and Surface characteristics were assessed via Micro-Hardness, Optical profilometry, Scanning Electron Microscopy.

Results: The FTIR spectra for choline citrate gel showed the peaks of both choline hydroxide and citric acid. No significant difference amongst the groups for shade matching was reported. Moreover, Microhardness analysis of all samples revealed no significant difference (p>0.05). Scanning Electron Microscopy analysis for stained tooth show rough surface while the surfaces of TiO2 gel treated samples became smooth with increase concentration of TiO2. The profilometry images for stained, 1%, 3%, 5% TiO2 treated showed an average roughness of 16.334, 9.855, 5.926 and 3.103 μm respectively.

Conclusion: Titanium Dioxide nanoparticles addition with CC gel created as a tooth whitening gel improved the color of stained enamel samples and can be further evaluated for non-invasive aesthetic tooth whitening.

Diving into the Burnout Spectrum: A Study of Burnout Among Healthcare Students of Punjab, Pakistan.

Abdullah Sikander — 2026-01-09

Background: Healthcare students experience multiple stressors, including heavy workloads, early exposure to illness and death, and financial pressures. These stressors can contribute to negative outcomes such as substance misuse, reduced empathy, suicidal ideation, and burnout.

Methods: The study was quantitative , cross sectional in nature, using a modified Maslach Burnout Inventory (MBI). The study was done from September to October 2024, with participants from 66 institutes across Punjab. The sampling technique was convenience sampling. The questionnaire was circulated online and in-person by the authors and then the data were analysed using SPSS version 26.0 (IBM Corp., Armonk, NY) and chi-square test was applied.

Results: The study included a total of 422 valid responses from healthcare students .The results show that gender, sector of institute, and residence have insignificant correlation with burnout (p>0.05), whereas, age groups, programs students are enrolled in, and years of study have significant correlation (p<0.05).

Conclusion: This study provides insight into the prevalence of burnout among Pakistani healthcare students and highlights how factors such as age, program, and year of study influence stress levels, offering a basis for targeted interventions and informing future research to develop strategies for prevention and support.

Anthropometric Correlation Between Vertical Dimension of Occlusion and Length of Right Ear of Dentate Patients Visiting A Tertiary Care Hospital of Khyber Pakhtunkhwaha

Yasir Hussain — 2026-01-09

Background: Vertical dimension of occlusion (VDO) is defined as the distance between two selected anatomic or marked points (usually one on the tip of the nose and the other on the chin) when (teeth are) maximum intercuspation.

Objectives: The aim of this study is to determine the reliability of the right ear length for determination of the VDO during the provision of complete denture using same dimensions recorded from dentulous subjects.

Materials and Methods: It was cross-sectional study conducted in the dental department of a tertiary care hospital of KPK. A total of 194 patients (both male and female ranging from 18-30 years of age were studied where after informed consent, they were instructed to seat on dental unit with their head in upright position. Using a precise vernier caliper, the VDO and right ear length were measured. Collected data was evaluated by using SPSS software. Correlation test was applied for analysis.

Result: Correlation of VDO and ear length in 18–25-year age group was r = 0.0745 and p value was 0.450063. In the age group 26-30 years r=0.0316 and p value 0.768779. In male group, the values were, r=0.0372 and p value = 0.69962. In the female group values were, r=0.0.0353 and p value 0.749892.

Conclusions: We concluded that the ear length is significantly correlated to VDO.

Keywords: Prosthodontics, Complete Denture, Vertical Dimension of Occlusion, Ear Length, Correlation.

Comparison of Ward’s and Comma-shaped Incisions in Mandibular Third Molar Surgery: Impact on Postoperative Mouth Opening

Misbah Razzaq — 2026-01-09

Background: An impacted tooth is defined as one that fails to erupt within the expected time frame of normal dental development. Evidence synthesized from a recent systematic review and meta-analysis indicates that tooth impaction is highly prevalent globally, with overall rates nearing 90% in the general population, and nearly one- third of individuals exhibiting at least one impacted third molar.

Objectives: This study aimed to compare the effect of Ward’s incision and the comma-shaped incision on postop- erative limitation of mouth opening (trismus) following surgical removal of impacted mandibular third molars.

Materials and Methods: A comparative interventional study was conducted at the Department of Oral and Maxil- lofacial Surgery, PIMS, Islamabad, over one year. A total of 114 patients aged 17–45 years requiring mandibular third molar extraction were randomly allocated into two groups: Group A (Ward’s incision, n=57) and Group B (comma-shaped incision, n=57). Standardized surgical protocols were followed, and patients were assessed for mouth opening (inter-incisal distance) on postoperative days 1, 3, and 7. Trismus was defined as <35 mm. Data were analyzed using SPSS version 25, and Chi-square tests determined statistical significance.

Result: The mean age of participants was 30.4 ± 6.8 years; females constituted 62.28% of the sample. On day 1, restricted mouth opening was more frequent in the Ward’s group, with 22.81% measuring 25–29 mm compared to only 5.26% in the comma group (p=0.001). By day 3, 54.39% of comma group patients achieved 40–44 mm versus 43.86% in Ward’s group (p=0.047). On day 7, significantly more patients in the comma group (29.82%) reached 55–50 mm compared to 7.02% in Ward’s group (p=0.00078). Overall, trismus was consistently less severe in the comma-shaped incision group.

Conclusions: The comma-shaped incision demonstrated superior outcomes, with reduced postoperative trismus and faster recovery of mouth opening compared to Ward’s incision. Careful flap selection, favoring the comma- shaped design, can significantly enhance patient recovery and minimize functional disability after third molar surgery.

Keywords: Impaction, Third Molar, Trismus, Postoperative Complications

Evaluation of the use of Clinical Practice Guidelines for Managing External Apical Root Resorption by Orthodontists in Pakistan

Samia Rahman — 2026-01-09

Background: External apical root resorption (EARR) is a common side effect of fixed orthodontic treatment, resulting from complex biological and mechanical processes involving the periodontal ligament and alveolar bone.

Objectives: To assess the current practices of orthodontists in Pakistan regarding diagnosis, risk communication, management, and follow-up of external apical root resorption using a questionnaire derived from the Dutch Clinical Practice Guideline.

Materials and Methods: A cross-sectional survey was conducted among orthodontists registered with the Pakistan Medical and Dental Council. The total study duration was three months (May–July 2025). A 13-item questionnaire based on the Dutch Clinical Practice Guideline was distributed online to orthodontists in Pakistan. Sample size estimation using G*Power (α = 0.05, power = 0.80, effect size = 0.3) indicated that a minimum of 89 participants was required but, total of 101 orthodontists responded. Data were analyzed using SPSS. Descriptive statistics were computed, and Mann-Whitney U tests compared consultants and residents.

Result: Among 101 respondents, 64 were male and 37 were female, with most having less than five years of experience. Diagnostic awareness was 67.70%, and periapical radiographs were the preferred imaging method. Risk communication was 67.5%, as the majority informed patients about general and extraction-related risks. Management response reached 72.5%, with 40.6% very often stopping forces on affected teeth and 30.7% allowing a three-month rest period. Follow-up practices were 65.8%, including 43.0% retention reviews and 33.0% coordination with general dentists showing that both consultants and residents are weak in this domain. Consultants scored higher than residents in diagnosis and treatment management domains, reflecting adherence to clinical recommendations based on expertise.

Conclusions: Orthodontists in Pakistan follow an evidence-based and a conservative approach toward the management of external apical root resorption, showing good diagnostic awareness and patient communication; however, improvement is needed in coordination with general dentists among both consultants and residents. Consultants demonstrate stronger adherence to clinical guidelines than residents, highlighting the need to strengthen postgraduate training and interdisciplinary coordination with general dentists.

Keywords: External apical root resorption, Orthodontic treatment, Clinical practice guideline, Risk communication, Periapical radiograph, Cone beam CT(CBCT)

Comparing The Post-Operative Sensitivity of Bulk-Fill Versus Incremental-Fill Placement Techniques Using Nano-Hybrid Composite Resins in Class II Restorations: A Randomized Clinical Trial

Khizer Asif — 2026-01-09

Objectives: The aim of this study was to compare the post-operative sensitivity of bulk-fill versus incremental-fill placement techniques using nano-hybrid composite resin in class II restorations.

Methodology: A randomized controlled trial was done at the Department of Operative dentistry and Endodontics, Rehman College of Dentistry, Peshawar from February 2022 to August 2022. A total of 326 participants with both genders of age 20-50 years, diagnosed with carious first mandibular molars were selected from the outpatient department using purposive sampling. The patients were divided into two groups (Group A for bulk-fill technique and Group B for incremental-fill) by random allocation using single blinded technique. After restoring the tooth, patients were recalled after one week. On the recall visit, patients were asked about possible presence or absence of sensitivity in the restored tooth. Intensity of sensitivity was measured by using Visual Analogue Scale.

Result: Chi square was used to compare the post-operative sensitivity of placement techniques among bulk-fill and incremental-fill technique. Overall post-operative sensitivity was found 29 (8.86%). The frequency of post-operative sensitivity was higher in incremental-fill technique (11.66%) than bulk-fill (6.13%), but with no statistically significant difference (p=0.228). However, the intensity of post-operative sensitivity between the two groups was statistically significant (p=0.009). Severe sensitivity was observed more in incremental group (6.13%) than bulk group (0.61%).

Conclusion: There is no significant difference in post-operative sensitivity between bulk-fill versus incremental-fill placement techniques using nano-hybrid composite resin in class II restorations.

Keywords: Post-operative sensitivity, nano-hybrid composite, bulk-fill, incremental-fill

Relationship between Degenerative Cervical Myelopathy and Trigeminal Neuralgia

Nadia Mansoor — 2026-01-09

Background: The involvement of the spinal trigeminal tract affcets the cervical spinal cord People with Trigeminal Neuralgia (TN) are more likely to experience concurrent degenerative cervical myelopathy (DCM) compared to a matched control group without TN.

Objectives: The main goal of this study was to determine the existence and strength of a relationship between Trigeminal Neuralgia (TN) and Degenerative Cervical Myelopathy (DCM).
Materials and Methods: This cross-sectional study was conducted at Bacha Khan College of Dentistry from January 2023 to January 2025, at the Department of Oral Medicine, included 100 patients with neurological disorders. TN and degenerative Myelopathy were assessed using clinical evaluations. In the first step, the study’s findings were statistically analyzed to determine whether DCM and TN had any relational significance. The p-value was calculated. The research was conducted in accordance with established ethical standards, and the participants were informed and witnessed all procedures. SPSS 22.0 was used to analyze all the data.

Result: Most patients were men mean age 52.22 ± 8.22 years. There were 41 patients with rural residency and 59 patients with urban residency. The majority of the patients , (78%) were married. The assessment of the gathered information indicated that DCM was significantly related to TN, with a calculated p-value of 0.001. While evaluating the results obtained from the sample of 100 patients, it was apparent that a remarkable proportion suffered
from both DCM and TN simultaneously. We found that, 65% of cases had DCM and 35% had TN.. The frequency of both DM and TN was found in 45% of cases. We found a strong correlation between DM and TN (p= 0.001).

Conclusions: This study shows a strong correlation between Trigeminal neuralgia (TN) and degenerative cervical myelopathy (DCM), emphasizing the necessity of multidisciplinary cooperation and additional investigations. When DCM and TN coexist, early identification and specialized therapy strategies are essential for improving patient outcomes.

Navigating the Challenges of Dentistry in Pakistan

Ghulam Rasool — 2026-01-09