Pakistan Orthodontic Journal

Editor’s Message

Saad Asad — 2026-06-30

The Pakistan Orthodontic Journal (POJ) continues to elevate its academic standing through strategic quality enhancements, including an expanded network of international reviewers, dedicated orthodontics and allied literature, and specialized medical educationists in our peerreview framework. Crucially, we are currently in the process of acquiring Digital Object Identifiers (DOIs) for all published articles to secure permanent digital indexing and improve citation tracking, with our next vital milestone being registration across leading international search engines. These structural advancements ensure that the journal remains a premier, highly rigorous platform for cutting-edge orthodontic scholarship, both within Pakistan and on the international stage, as we continue to address emerging clinical and academic frontiers.

Beyond Wellness Centres: Re-engineering the Medical Education System for Students & Residents

Muhammad Azeem — 2026-06-30

The rising frequency of suicides among medical students in Pakistan has cast a dark shadow over our prestigious medical institutions, signaling a crisis that cannot be ignored.1 While universities have responded by establishing wellness centres and counseling services, these measures often address only the symptoms of distress rather than the root causes of the disease.1 This editorial proposes that the current crisis is a result of a rigid, high-pressure system that requires fundamental systemic reform rather than just psychological support; we must move beyond wellness centres to fix the underlying educational structures that facilitate this despair.

To understand the depth of this crisis, we must look at the logical progression of the current educational environment through a deductive lens. A medical education system that prioritizes unrealistic attendance benchmarks, excessive exam burdens, and financial rigidity creates a state of chronic, high-level physiological and mental distress for students. Furthermore, it is a logical reality that chronic, unmanaged distress without systemic relief—regardless of the presence of wellness centres—is a primary driver of psychological burnout and suicidal ideation. Therefore, suicides in medical universities will continue to occur unless the educational and administrative systems themselves are restructured to be more human-centric and flexible.

Motivation trends among Orthodontic patients in the Capital Territory of Islamabad

Fatima Humayune — 2026-06-30

Introduction: Motivation serves as the driving force behind all human action so it is important to correlate this aspect of human psychology with orthodontic treatment. Not only will this give dentists insights as to how to increase patient compliance, but it will also serve as an effective tool for improved treatment planning.

Methodology: A pre-validated structured questionnaire was used for this study, conducted across a period of 5 months, dated April to August 2025, at the government hospital, School of Dentistry, SZABMU, Islamabad to determine intrinsic or extrinsic motivation tendency. Participants were classified according to the predominant motivation type, determined by the higher subscale score. Group differences were analyzed using the Wilcoxon signed-rank test.

Results: Our study concluded that among the sample size of 1500 participants the majority (912) inclined towards intrinsic motivational patterns as indicated by Wilcoxon Signed Rank Test. Furthermore, demographic factors such as increasing age and female gender were more likely to be associated with intrinsic motivation whereas factors such as unemployment and lower academic level were closely associated with extrinsic motivational trends.

Conclusions: The findings revealed a significant relationship between motivational patterns and demographic factors. Orthodontists are advised to consider these factors to enhance the effectiveness and success of their treatments.

Cephalo-photographic Evaluation of Lower Facial 3 rd in Orthodontic Patients

Muhammad Azeem — 2026-06-30

Introduction: To evaluate the lower third of face in orthodontic subjects with normal profile on lateral cephalograms and photographs

Methodology: This Cross-sectional study was conducted at Orthodontic center of Fatima Jinnah Institute of Dental Sciences (FJIDS), Lahore, from 20.01.2026 to 19.04.2026, involving 60 Class I orthodontic subjects, 30 males and 30 females (18-24 years). Standardized lateral cephalograms and lateral profile photographs were obtained and analyzed using 8 linear and 2 angular measurements. Following this data collection was done and for each measurement, mean and standard deviation were calculated, for each standardized lateral cephalogram and photograph. t- test was applied for comparison.

Results: No statistically significant difference was found between cephalometric and photographic aesthetic evaluation of lower third of face in orthodontic subjects with normal profile.

Conclusions: It was concluded that there is no difference in aesthetic evaluation of lower third of face in orthodontic subjects with normal profile by using cephalometric radiographs or photographs.

Pediatrician`s KAP Profile regarding Dento-Facial Malocclusion among Southern Punjab, Pakistani Residents

Aamir Waheed — 2026-06-30

Introduction: Children who have poor dental habits and crooked teeth may experience problems with their oral and extra oral features and self-esteem. Pediatricians are in a position to detect these problems early and help manage them because they are the primary care doctors for children. The aim of this study was to evaluate the KAP Profile of pediatricians regarding dento-facial malocclusion among southern Punjab, Pakistani residents.

Methodology: A cross-sectional survey was conducted between July 2025 to January 2026 for 210 Pediatricians, Family Physicians and Post-graduate Trainees. Participants completed a prevalidated, structured 30-question electronic survey designed to evaluate their knowledge and practices related to these issues. The response were analyzed using SPSS software to identify trends and patterns.

Results: The majority of respondants were aware of the etiology of pediatric oral condition, especially thumb sucking (95.2%) and extended pacifier use (85.7%). The majority of respondents (93.3%) reported referring children with malocclusion to dental professionals, and a sizable majority (95.2%) thought paediatricians had a significant role in preventing dental issues. Only 33.3% of participants, however, had attended workshops specifically addressing these dental problems. The results also showed that pediatricians' handling of these disorders was strongly correlated with their years of clinical experience and workplace environment.
Conclusions: The majority of participants knew that pediatricians play a crucial role in preventing orthodontic anomalies and parafunctional oral habits, but they lacked the necessary training and experience to conduct a thorough and methodical examination for malocclusion and parafunctional oral habits.

Cognizance of Orthodontic Management among School enrolled Children in Raiwind, Lahore

Faiza Rana — 2026-06-30

Introduction: Awareness is the state of having knowledge or be cognizant of something. Children between the age of 12 and 16 years would benefit with the knowledge of orthodontic treatment need, because early orthodontic treatment is more favorable and could be beneficial in preventing further malocclusion complications. The aim of this study was to determine orthodontic treatment cognizance among school enrolled children of Raiwind, Lahore.

Methodology: This cross-sectional survey included students of age group 12-16 years in the duration of 02 month at various schools of Raiwind District Lahore. A pre-validated questionnaire was used to assess the cognizance of school children towards Orthodontic management. Data was analyzed through SPSS version 25. Chi-square test (p-value <0.05) was used to assess gender and age based difference in the cognizance. P-value <0.05 was considered to be statistically significant.

Results: Out of 522 school children, only 104 (44% males and 56% females) have information about an orthodontist role and only 92(38%) females knew that orthodontist align teeth. Stratification of data was done for gender and the difference was statistically significant for 7 questions out of 12. Stratification of data was done for age and the difference was statistically significant for 6 questions out of 12.

Conclusions: There is low awareness of the term “Orthodontist” and that they align teeth, among school children of Raiwind. However, bulk of respondents was aware that speech and chewing can be affected by irregular teeth and that the treatment time is long and costly.

Revisiting Smile Esthetics: Role of Facial Type and Buccal Corridor Area in Perceived Attractiveness

Ramisha Imtiaz — 2026-06-30

Introduction: Smile esthetics plays a pivotal role in orthodontic treatment planning, with the buccal corridor being a key determinant of smile harmony. This study aimed to evaluate esthetic perceptions of the buccal corridor area ratio (BCAR) across different facial types among orthodontists, orthodontic patients, and laypersons and to determine the influence of BCAR variations on smile attractiveness.

Methodology: This “cross-sectional analytical study utilizing a digital stimulus perception design” included 279 participants, equally divided into orthodontists, orthodontic patients, and laypersons. Standardized frontal smiling images were digitally modified to represent three facial types (mesofacial, brachyfacial, dolichofacial) and five BCAR levels (1%, 5%, 10%, 15%, 20%). Perception scores were recorded using VAS scale. Data were analyzed using SPSS version 26. Mean perception scores were compared using ANOVA with post-stratification to control for effect modifiers such as age and gender. A p-value ? 0.05 was considered statistically significant.

Results: A significant association was found between facial type, BCAR levels, and perception scores. At lower BCARs (1% and 5%), dolichofacial faces received higher scores from patients, while brachyfacial faces were rated more favorably by laypersons and orthodontists. Orthodontists preferred mesofacial types overall, but rated brachyfacial smiles more positively as BCAR increased. Laypersons were more sensitive to BCAR changes in female models than male models. Patients consistently rated dolichofacial types with larger BCARs more favorably. Stratification by age showed higher perception scores in participants over 40 years across most groups.

Conclusions: Orthodontists are more sensitive to variations in buccal corridor size compared to patients and laypersons. BCARs below 15% are generally perceived as esthetically acceptable by all groups. Elimination or reduction of buccal corridors should be considered when BCAR exceeds this threshold, supporting the integration of patient esthetic expectations into clinical decision-making.