Clinical trials

The goal of this randomized controlled trial is to evaluate whether the timing of premolar extraction affects the rate of orthodontic space closure during en-masse anterior retraction. The study will also assess gingival cleft formation, mesial movement of the upper first molars, ease and duration of premolar extraction, and patient-reported pain and anxiety. The main question it aims to answer is: Does early versus late premolar extraction affect the rate of orthodontic space closure? Researchers will compare two groups of patients. In the early extraction group the maxillary first premolars will be extracted before or within one week of start of fixed orthodontic treatment. In the late extraction group, the premolars will be extracted after alignment and immediately before the start of space closure. Participants will: * Receive fixed orthodontic treatment and bilateral extraction of the maxillary first premolars. * Be randomly assigned to either the early-extraction or late-extraction group. * Undergo orthodontic alignment followed by en-masse anterior retraction. * Have dental impressions/digital models obtained at the start of retraction and at 3 and 6 months to measure orthodontic tooth movement and space closure. * Be assessed for gingival clefts and mesial movement of the upper first molars. * Have the ease and duration of their premolar extraction recorded and report their pain and anxiety associated with the extraction procedure.

The goal of this cluster-randomized trial is to learn if the SEHAT program works to improve oral health among school adolescents in Pakistan. It will also assess how the program affects oral health behaviors and knowledge. The main questions it aims to answer are: 1. Does the SEHAT program improve toothbrushing behavior and oral hygiene? 2. Does the SEHAT program reduce plaque and gingival scores among adolescents? 3. Does the program improve oral health knowledge and awareness? Researchers will compare the SEHAT virtual intervention with conventional oral health education and a control group to see which approach is most effective. Participants will: 1. Take part in either the virtual SEHAT session or conventional in-person oral health education, or receive no intervention (control) 2. Watch structured 30-minute sessions delivered via Zoom (virtual group) or classroom instruction (conventional group) 3. Participate in follow-up assessments to measure plaque, gingival indices, and oral health knowledge and behaviors.