Bahria University

The goal of this clinical trial is to check the effects of lip bumper appliance contribution to driftodontics after designated tooth extractions that are already part of orthodontic treatment plan. The main questions it aims to answer are:
* Is there a significant difference in rate of incisor alignment in lip bumper group?
* Does the lip bumper have any adverse effects on oral hygiene? Researchers will compare the effects of appliance vs no appliance.
Participants will have:
* Appliance cemented in mouth after extractions in interventional group and no appliance in control group
* Three monthly follow up for checkup and impressions

A cross-sectional study of 323 cardiac patients aged 40 to 60 will be carried out at PNS Shifa and the National Institute of Cardiovascular Diseases. Data will be gathered using surveys and evaluated with SPSS software. The results are likely to show considerable differences in barrier frequency across demographic groups, offering insights into targeted treatments.
Understanding these limitations is critical for establishing successful physical activity regimens, improving heart health, and, eventually, lowering rehospitalization rates. The findings will help to develop specific approaches to overcome these challenges and encourage regular physical exercise among cardiac patients.
Objectives:
1. To identify and categorize the specific barriers to physical activity faced by cardiac patients.
2. To analyze how these barriers differ among various demographic groups (e.g., age, gender).
3. To examine how barriers to physical activity vary according to clinical characteristics.
Methodology:
Using a cross sectional study design, data data was collected from NICVD hospital and PNS shifa hospital by providing questionnaires to patient having cardiac disease. The questionnaires comprises of close ended questions.

This open label, randomized controlled clinical trial study will be conducted after obtaining ERC approval of Bahria University Health Sciences. Written informed consent will be taken from all study participants. Patients suffering from moderate to severe chronic periodontitis and diagnosed as per criteria Community Periodontal Index for Treatment Needs (CPITN) (Heiko Z et al, 2015) will be selected from the Oral Diagnostic & Periodontology department of Islamabad Medical & Dental College hospital . Patients will be randomized into 3 groups by using computer driven list. Sample size will be calculated by using software G power version3.1.9.2 . Patients will be randomly divided into 3 groups.
(I) Baseline investigations/parameters (at day zero): FBS values will be monitored using digital glucometer Clinical parameters (PI, CAL, PDD, mSBI) will be assessed at baseline, 3 , 6 , 9 & 12 months by calibrated periodontal probe. Radiological parameters (VBL & IBDA) will be carried out using OPG at baseline, 6 & 12 months. ELISA for Transforming growth factor (TGFβ) and osteocalcin biomarkers will be done at baseline and 3 months. RT-PCR for the detection of RUNX2 gene will be done at baseline and 3 months Patient will be called at 14th day for suture removal and clinical assessment . Follow up will be done at 3, 6, 9 and 12 months to assess clinically. Radiographic parameters will be assessed at 6 &12 months. Pharmacogenetic parameters will be assessed at 6months. All patients will be advised regular check-ups post surgically at per appointment . Individual study period will be 12 months. Total duration of study will be 15 months.
Primary outcomes:
Reduction in intra-bony defect angle and vertical bone loss. Periodontal and alveolar bone regeneration by detecting the levels of biomarkers namely, transforming growth factor β, osteocalcin
Secondary Outcomes:
Osteogenic proliferation : Evaluation of RUNX2 expression in response to Metformin & Alendronate 1% gel administration will be assessed per subject per genetic analysis.
RUNX2 expression will be observed through RT- PCR.