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Vol. 32 No. 01 Jan-Mar 2023 Archives - Page 2 of 2 - JPDA

CBCT Based Assessment of First Molar Inclination in Adult Subjects

Muhammad Ashfaq1                  BDS, FCPS
Mubassar Fida2                          BDS, MCPS & FCPS (Orthodontics), MCPS (Periodontology),
MCPS (Community Dentistry), PGD HIMS

Farheen Fatima3                        BDS, FCPS

OBJECTIVE: The ideal buccolingual (BL) inclination of posterior dentition allows maximum intercuspation and avoids
occlusal interferences at rest and during jaw movements. Therefore the objective of present study was to evaluate the BL
inclination of upper and lower first molars in adult patients.
METHODOLOGY: A cross-sectional study was conducted on 52 subjects visited dental clinics. The evaluation of BL inclination
of maxillary and mandibular first molars was done using CBCT images on Galaxis/Galileos implant viewer software. After
sagittal orientation, the angle was measured on the tranverse plane from long axis of tooth to the vertical line drawn perpendicular
to horizontal reference plane.
RESULTS: Mandibular first molars were found to be lingually inclined with mean value of 14.07°±4.49°. Similarly, mean
buccalinclination of maxillary first molars was found to be 9.42°±6.70°.
CONCLUSIONS: It can be concluded from this study that maxillary molars are buccally incline over the basal bone whereas,
mandibular molars are lingually inclined.
KEYWORDS: Molar, maxilla, mandible, torque
HOW TO CITE: Ashfaq M, Fida M, Fatima F. CBCT based assessment of first molar inclination in adult subjects. J Pak Dent
Assoc 2023;32(1):4-7.
DOI: https://doi.org/10.25301/JPDA.321.4
Received: 02 August 2022, Accepted: 01 April 2023 

Download PDF

CBCT Based Assessment of First Molar Inclination in Adult Subjects

Muhammad Ashfaq1                     BDS, FCPS
Mubassar Fida2                           BDS, MCPS & FCPS (Orthodontics), MCPS (Periodontology) MCPS (Community Dentistry), PGD HIMS
Farheen Fatima3                           BDS, FCPS

 

OBJECTIVE: The ideal buccolingual (BL) inclination of posterior dentition allows maximum intercuspation and avoids
occlusal interferences at rest and during jaw movements. Therefore the objective of present study was to evaluate the BL
inclination of upper and lower first molars in adult patients.
METHODOLOGY: A cross-sectional study was conducted on 52 subjects visited dental clinics. The evaluation of BL inclination
of maxillary and mandibular first molars was done using CBCT images on Galaxis/Galileos implant viewer software. After
sagittal orientation, the angle was measured on the tranverse plane from long axis of tooth to the vertical line drawn perpendicular
to horizontal reference plane.
RESULTS: Mandibular first molars were found to be lingually inclined with mean value of 14.07°±4.49°. Similarly, mean
buccalinclination of maxillary first molars was found to be 9.42°±6.70°.
CONCLUSIONS: It can be concluded from this study that maxillary molars are buccally incline over the basal bone whereas,
mandibular molars are lingually inclined.
KEYWORDS: Molar, maxilla, mandible, torque
HOW TO CITE: Ashfaq M, Fida M, Fatima F. CBCT based assessment of first molar inclination in adult subjects. J Pak Dent
Assoc 2023;32(1):4-7.
DOI: https://doi.org/10.25301/JPDA.321.4
Received: 02 August 2022, Accepted: 01 April 2023

INTRODUCTION

The knowledge of occlusion is important to an orthodontist for proper finishing of cases to benefit the patients.1 The occlusal plane follows the teeth’s natural curvature forming an imaginary line from incisal
edges of the anterior and occlusal surface of the posterior teeth. Several studies2,3 have described number of occlusal schemes based on scientifically proven evidence and clinical applicability. It is especially true regarding the frontal view of buccolingual posterior cusp as the occlusal surfaces of the molars follow multiple planes.
The height of functional cusp affects the anterior face height. Longer functional palatal cusps and increased buccal inclinations have found to be associated with long lower anterior face height and conversely increased palatal inclination and longer buccal cusps were found in subjects having short lower anterior facial height.4 Andrews5 analyzed a sample of 120 subjects with normal occlusion and derivedsix
keys of occlusion which were used in designing the Straight Wire Appliance. The fourth key of occlusiondescribed Curve of Wilson as a concave curve formed by the angulation of the upper posterior teeth, with molars having lingual crown torque. This curve is considered as a key factor in governing stability aftermaxillary expansion.6 Any alteration in inclination of posterior teeth was considered asone of the most important causative factor in temporomandibular disorders.7
American Board of Orthodontics (ABO) suggested evaluation of differences in buccal and lingual cusps height of the posterior teeth for clinical evaluation of buccolingual inclination. Ideal inclination allows maximum intercuspation and avoids balancing interferences.8 Ross et al9 investigated correlation between inclination of tooth buccolingually and pattern of skeletal growth vertically however insignificant differences were found. Tsunori et al10 (1998) evaluated mandibular first molar inclinations and its relationship to the facial type using CT scans. It was reported by authors that -7° of mean mandibular inclination was found in sample of 21 subjects with dental class I8. Introduction of CBCT to the dental armamentarium has several advantages among
which one of the major advantages is slice by slice mode of imaging. This mode allows tooth to be viewed in different planes11 (Palomo et al, 2006).
Buccolingual inclination of a tooth is important when torque is expressed in a straight wire appliance and successful treatment outcomes and stability are not guaranteed until ideal buccolingual inclinations are expressed for individual patients. In past long axis inclinations of tooth were determined on the basis of crown position however, uneven cuspal wear or tooth morphology may result in uncertainty.
Therefore, using CBCT provides an advantage of visualization of both crown and root. According to pertinent literature survey, no local study has yet reported the buccolingual angulations of mandibular and maxillary first molars in our population. This could help us develop buccolingual prescription for our population.
Therefore, objective of the study was to determine the buccolingual inclinations of mandibular and maxillary first molars in adults using CBCT.

METHODOLOGY
A cross-sectional analytical study was conducted after the exemption taken from the ethical review board (5223-Sur-ERC-18). CBCT images of the patients who have visited dental clinics at AKUH were included in the study. The CBCT was done for routine diagnosis and treatment planning. The sample size was calculated using WHO 7.1 calculator using the findings reported by Alkhatiba12 who reported mean buccolingual inclination of 12.59° and standard deviation of 5.47°. A total of 52 subjects were required to achieve power of 80%, keeping margin of error as 0.05. The non-probability purposive sampling technique was used to obtain data. The subjects in age range of 18 to 65 years with no previous orthodontic therapy, minimum tooth wear, arch length discrepancy of less than 5 mm per arch with no hypodontia other than third molars, were included in the study. Subjects with posterior crossbite, prosthetic crowns or significant fillings on any of the first molars, retained primary teeth and craniofacial deformities were excluded. Using Galaxis/Galileos implant viewer, CBCT images were oriented and standardized. A reference line connecting lower border of mandible was drawn parallel to the floor. In sagittalview, a line was drawn passing through the midpoint of the crown mesiodistally and the mid of both the mid points of each of the mesial and distal roots at one-third the distance from the apex as described by Masumoto et al13 (2001) (Figure 1). Long axis of maxillary molars by connecting a line between furcation and central groove of the molar After achieving sagittal orientation, the angle was

measured from long axis of both maxillary and mandibular molars drawn from transverse view to the true vertical reference line perpendicular to horizontal reference line (Figure 2). Data were collected by the principal investigator (A.Y). The analyses were done using SPSS software for Windows (version 20.0, SPSS). Mean and standard deviations for maxillary and mandibular first molar inclinations were calculated. Frequency and percentages were calculated for  the gender. The comparison of maxillary and mandibular first molars buccolingual inclinations between genders was done using independent sample T test.

RESULTS
There were 52 patients who were included in this study including 30 males and 22 females. The mean age of the sample was 32.2±13.8 years.The mandibular first molars were found to be lingually inclined with mean value of 14.14°±6.33°and 14.00°±5.20° for right and left side, respectively (Table 1).Statistically insignificant differences were found between both the sides. Maxillary first molars were found to be bucally inclined with mean buccolingual inclination of 10.06°±7.31° and 8.79°±8.10° for right and left side, respectively with insignificant differences
(Table 2). Insignificant differences were found in maxillary and mandibular molar inclinations among the genders
(Table 3).
The radiographs were reassessed by the examiner (A.Y) after 3 weeks and intraexaminer reliability was tested using intraclass correlation coefficient and excellent correlation was found between two sets of reading

DISCUSSION
Buccolingual inclination of posterior teeth plays important role in static and functional occlusion. Evaluation can be done clinically by assessing clinical crown and radiographically using CBCT. CBCT images have the advantage of visualizing complete tooth structure i.e. both crown and root. This complete visualization of tooth can help avoiding errors of inclination measurement as on dental cast due to dental wear and morphological uncertainties14,15 although unnecessary radiation exposure requires clinical justification.
Maxillary molar inclinations on CBCT can be difficult to measure due to root divergence. Authors have reported different methods of assessment. Mitra16 measured maxillary molars inclinations by buccal roots only using CT images. Study conducted by Alkhatiba12 measured long axis of maxillary molars by connecting a line between furcation and central groove of the molar,similar method was used in this study.Mandibular molar roots bifurcate anteroposteriorly, therefore long axis can be drawn from central groove to root apex.17
The mandibular first molar in our study showed a mean lingual 14.07° while study by Alkhatiba12 showed a lingual inclination of 12.6°. Ross et al9 reported mean mandibular molars inclination of 7.18° in untreated normal occlusion patients, however the study was performed on dental casts and growing patients were also involved. Tsunori et al10 in their studydetermined mandibular molar angulation of 14.2° ± 3.4and 9.8° ± 4.6in patients with average and short facial heights respectively.
In our study majority of maxillary molars showed buccal inclinations with mean inclination of 9.42° however, Alkhatiba12 reported mean inclination of 4.85°. A study conducted byBarrera et al14 reported4.058° of crown angulation, however this study was conducted on small sample consisting of 10 subjects only. In another study conducted by Ross et al9 found a mean buccal angulation in maxillary molars of 8.08° ± 4.08 in a group of patients aged 9.5 to 41.5 years while using dental casts. Janson et al18compared vertical growth pattern in their study, he found mean buccal inclination for maxillary molars of 5.13° ±4.46 and 7.74° ±4.41 for horizontal and vertical growth patterns respectively. Andrews19 reported maxillary inclination of 11.53° and mandibular inclination,-30°.
Mesiodistal width of posterior teeth has also an important clinical implication when there is discrepancy between tooth size and arch length. Mild to moderate discrepancy can be treated with interproximal stripping or expanding the arch.20,21 In cases with mild to moderate crowding and constricted arch,expansion can be done however, torque control is important to achieve normal buccaolingual inclinations of posterior teeth22 (Adkins, 1972).
Stable occlusion is important for jaw function; additionally it also has an impact on TMJ health and function. Instability in occlusion has short and long term effects on TMJ that may result in asymptomatic click and crepitus to temporomandibular dysfunction disorders. Altered buccolingual inclination results in occlusal interference therefore norms should be established to avoid detrimental effects.

CONCLUSIONS
It can be concluded from this study that maxillary molars are more upright over the basal bone than the mandibular molars. Mean buccal inclination of maxillary molars was found to be 9.42° while mandibular molars had a mean lingual inclination of 14.07°.

CONFLICT OF INTEREST
None to declare

FUNDING DISCLOSURE
None to declare

REFERENCES
1. Mohlin BO, Derweduwen K, Pilley R, Kingdon A, Shaw WC, Kenealy P. Malocclusion and Temporomandibular Disorder: A Comparison of Adolescents with Moderate to Severe Dysfunction with those without Signs and Symptoms of Temporomandibular Disorder and Their Further Development to 30 Years of Age. Angle Orthod. 2004;74:319-27

2. Schuyler C. Correction of occlusion; disharmony of the natural dentition. N Y State Dent J. 1947;13:445-62

3. Beyron H. Optimal occlusion. Dent Clin North Am. 1969;13:537-54.
https://doi.org/10.1016/S0011-8532(22)03363-8

4. SchudyF.Cant of occlusal plane and axial inclinations of teeth. Angle Orthod 1963;33:69-82.

5. Andrews FL. The six Keys to normal Occlusion. Am J Orthod. 1972;62: 296-309.
https://doi.org/10.1016/S0002-9416(72)90268-0

6. Marshall S, Dawson D, Southard KA, Lee AN, Casko JS, Southard TE.Transverse molar movements during growth. Am J Orthod Dentofacial Orthop. 2003;124:615-24.
https://doi.org/10.1016/S0889-5406(03)00630-9

7. Ito H, Okimoto K, Mizumori T, Terada Y, Maruyama T. A clini¬cal study of the Relationship Between Occlusal Curvature and Craniomandibular Disorders. Int J Prosthodont. 1997;10:78-82

8. Casko JS, Vaden JL, Kokich VG, Damone J, James RD, Cangialosi TJ et al. Objective grading system for dental casts and panoramic radiographs. American Board of Orthodontics. Am J Orthod Dentofacial Orthop 1998;114:589-99.
https://doi.org/10.1016/S0889-5406(98)70179-9

9. Ross VA, Issaacson RJ, Germane N, Rubenstein LK. Influence of vertical growth pattern on faciolingualinclinationsand treatment mechanics. Am J Orthod Dentofacial Orthop 1990;98:422-9.
https://doi.org/10.1016/S0889-5406(05)81651-8

10. Tsunori M, Mashita M, Kasai K. Relationship between facial types and tooth and bone characteristics of the mandible obtained by CT scanning. Angle Orthod 1998;68:557-62.

11. Palomo JM, Kau CH, Bahl-Palomo L, Hans MG. Three dimensional cone beam computerized tomography in dentistry. Dent Today 2006;25:130-5.

12. Alkhatiba R, Chungb CH, Buccolingual inclination of first molars in untreated adults:A CBCT study. Angle Orthod. 2017;87:598-602
https://doi.org/10.2319/110116-786.1

13. Masumoto T, Hayashi I, Kawamura A, Tanaka K, Kasai K. Relationships among facial type, buccolingual molar inclination, and cortical bone thickness of the mandible. Eur J Orthod. 2001;23:15-23
https://doi.org/10.1093/ejo/23.1.15

14. Barrera JM, Llamas JM, Espinar E, Sa’enzRam’irez C, Paredes V, P’erez-Varela JC. Wilson maxillary curve analyzed by CBCT. A study on normocclusion and malocclusion individuals. Med Oral Patol Oral
Cir Bucal. 2013;18:547-552.
https://doi.org/10.4317/medoral.18291

15. Shewinvanakitkul W, Hans MG, Narendran S, Martin Palomo J. Measuring buccolingual inclination of mandibular canines and first molars using CBCT. Orthod Craniofac Res. 2011;14:168-74. https://doi.org/10.1111/j.1601-6343.2011.01518.x

16. Mitra S, Ravi MS. Evaluation of buccolingual inclination of posterior teeth in different facial patterns using computed tomography. Ind J Dent Res. 2011;22:376-380.
https://doi.org/10.4103/0970-9290.87056

17. Kasai K, Kawamura A. Correlation between buccolingual inclination and wear of mandibular teeth in ancient and modern Japanese. Arch Oral Biol. 2001;46:269-73
https://doi.org/10.1016/S0003-9969(00)00106-0

18. Janson G, Bombonatti R, Cruz KS, Hassunuma CY, Santro MD. Buccolingual inclinations of posterior teeth in subjects with different facial patterns. Am J Orthod Dentofacial Orthop 125:316-22.
https://doi.org/10.1016/j.ajodo.2003.03.010

19. Andrews LF. Straight Wire: The Concept and the Appliance. San Diego: L.A. Wells; 1989.

20. Sheridan J, Hasting J. Air-rotor stripping and lower incisor extraction treatment. J ClinOrthod 1992;36:18-22.

21. Peck S, Peck H. Crown dimension and mandibular incisor crowding. Angle Orthod 1972;42:148-53

22. Adkins M, Nanda R, Currier G. Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofacial Orthop 1990;97: 194-9.
https://doi.org/10.1016/S0889-5406(05)80051-4

Sci-Hub Project, its Legality, and its Impact on Access to Scientific Journals in Pakistan

Syed Jaffar Abbas Zaidi                                MD, MSc, MFDS RCPSG, MFD RCSI, FAIMER

Sci-Hub is a project that uses stolen log-in credentials to access pay-walled scientific articles and journals, and then makes them
available for free on its website. It has had a significant impact on medical journals. The HEC Digital Library does not cover
all research areas. The Higher Education Commission (HEC) has acknowledged that Sci-Hub could fill a gap in the availability
of research materials for Pakistani researchers but cautioned that the use of Sci-Hub is illegal and could have negative
consequences for the scientific community. Sci-Hub has faced legal challenges in some countries but has generally been able
to operate without interference. The legality of Sci-Hub is complex, with legal challenges varying by country. There are legal
ways to access scientific manuscripts. The Sci-Hub project has significantly impacted research in Pakistan, but the HEC does
not condone the use of Sci-Hub, and it could have negative consequences for the scientific community.
KEYWORDS: Sci-hub; Software Piracy; Legal issues; Higher Education.
HOW TO CITE: Zaidi SJA. Sci-Hub project, its legality, and its impact on access to scientific journals in Pakistan. J Pak Dent
Assoc 2023;32(1):1-3.
DOI: https://doi.org/10.25301/JPDA.321.1
Received: 06 January 2023, Accepted: 24 March 2023

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Sci-Hub Project, its Legality, and its Impact on Access to Scientific Journals in Pakistan

Syed Jaffar Abbas Zaidi                     MD, MSc, MFDS RCPSG, MFD RCSI, FAIMER

 

 

 

Sci-Hub is a project that uses stolen log-in credentials to access pay-walled scientific articles and journals, and then makes them available for free on its website. It has had a significant impact on medical journals. The HEC Digital Library does not cover
all research areas. The Higher Education Commission (HEC) has acknowledged that Sci-Hub could fill a gap in the availability of research materials for Pakistani researchers but cautioned that the use of Sci-Hub is illegal and could have negative
consequences for the scientific community. Sci-Hub has faced legal challenges in some countries but has generally been able to operate without interference. The legality of Sci-Hub is complex, with legal challenges varying by country. There are legal
ways to access scientific manuscripts. The Sci-Hub project has significantly impacted research in Pakistan, but the HEC does
not condone the use of Sci-Hub, and it could have negative consequences for the scientific community.
KEYWORDS: Sci-hub; Software Piracy; Legal issues; Higher Education.
HOW TO CITE: Zaidi SJA. Sci-Hub project, its legality, and its impact on access to scientific journals in Pakistan. J Pak Dent
Assoc 2023;32(1):1-3.
DOI: https://doi.org/10.25301/JPDA.321.1
Received: 06 January 2023, Accepted: 24 March 2023

INTRODUCTION

Sci-Hub is a project that provides free access to scientific articles and journals, particularly those published behind paywalls. The project was created in 2011 by Kazakhstani graduate student Alexandra Elbakyan,
who was frustrated by the excessive cost of accessing scientific articles. Sci-Hub uses stolen log-in credentials to access pay-walled articles, which it then makes available for free on its website.
The impact of Sci-Hub on medical journals has been significant, as it has provided millions of users with free access to articles that would otherwise be unavailable to them. According to a study published in the Journal of the American Medical Association, Sci-Hub had the highest number of downloads for five of the six most accessed journals in the field of medicine, including The New England Journal of Medicine and The Lancet.1
The Higher Education Commission (HEC) of Pakistan is a government agency responsible for promoting research and higher education in Pakistan. One of the ways that the HEC promotes research is by providing access to scientific articles and journals through its online research portal, the HEC Digital Library. The HEC Digital Library provides access to more than 8,000 scientific journals and more than 400,000 articles and is a valuable resource for researchers in Pakistan. However, the HEC Digital Library (http://www.digitallibrary.edu.pk/) is not without limitations, as it only provides access to a limited number of journals and does not cover all research areas. In this context, the Sci-Hub project has emerged as a popular alternative for researchers in Pakistan who are seeking access to scientific articles and journals that are not available through
the HEC Digital Library. Sci-Hub is a project that provides free access to scientific articles and journals, particularly those published behind paywalls. It uses stolen log-in credentials to access paywalled articles, which it then makes available for free on its website.
Although the HEC does not condone the use of Sci-Hub, it has acknowledged that the project has the potential to fill a gap in the availability of research materials for Pakistani researchers. In a statement, the HEC stated that it “appreciates the efforts of Sci-Hub to provide free access to scientific research materials” but cautioned that “the use of Sci-Hub is illegal and could have negative consequences for the scientific community” (Higher Education Commission, 2017).
Most universities in Pakistan rely on HEC for access to scientific journals, and only a few subscribe to limited journals. Most medical and dental journals are beyond the budgets of researchers and academicians, making it difficult or them to access them.
Although some argue that Sci-Hub provides a valuable service by making scientific research more accessible, others argue that it undermines the business model of scientific publishing and could harm the financial viability of medical journals. Many journals rely on subscription fees and payper-view charges to fund their operations. The widespread use of Sci-Hub could reduce its revenue and impact their ability to publish high-quality research.
Some medical journals have responded to the threat of Sci-Hub by increasing their efforts to promote open-access publishing, which allows articles to be freely accessed by anyone with an Internet connection. However, this model has challenges, requiring authors to pay publication fees, and may not be sustainable for all journals. The legality of Sci-Hub, a project that provides free access to scientific articles and journals, has been the subject
of much debate and legal action. Sci-Hub uses stolen login credentials to access paywalled articles, which it then makes available for free on its website.2
In 2015, the American Chemical Society (ACS) filed a lawsuit against Sci-Hub and its founder, Alexandra Elbakyan, alleging copyright infringement and violation of the Computer Fraud and Abuse Act (CFAA) (American Chemical Society v. Sci-Hub, 2017). The ACS argued that Sci-Hub’s actions constituted unauthorized access to its copyrighted material and sought damages of $4.8 million.3
In 2017, a US District Court ruled in favor of ACS and granted an injunction against Sci-Hub, ordering it to stop distributing ACS articles and to give its domain name to the ACS (American Chemical Society v. Sci-Hub, 2017). However, Sci-Hub continues to operate and has remained
active, using a series of new domain names and mirror sites to evade legal action.
The legality of Sci-Hub has also been the subject of debate in other countries. In Russia, where Sci-Hub was founded, the project has faced legal challenges, but has generally been able to operate without interference. In other countries, such as the United Kingdom and Germany, courts have issued injunctions against Sci-Hub and ordered Internet Service Providers (ISPs) to block access to the site. In March 2021, a warning was issued by the City of London Police’s Intellectual Property Crime Unit (PIPCU) to students and universities cautioning them not to use Sci-Hub as it hosts stolen intellectual property. PIPCU warns users of “malicious methods” of obtaining papers, including phishing emails that trick users into providing their university login details.
In this way, Sci-Hub is alleged to have hacked 42 universities. PIPCU has not mentioned the names of these 42 universities, and none of the universities in the UK have ever reported any hacking by Sci-Hub.
The authorities of most countries warn users to stay away from Sci-Hub to protect both their cybersecurity and their institution’s cybersecurity. They also remind users that accessing the site is illegal as the content is stolen intellectual property. Some claim that by downloading articles from
Sci-Hub, malicious software and malware will automatically be downloaded, although most antivirus and antimalware software deem these sites safe for browsing. Some authorities warn that the manuscripts downloaded from Sci-Hub could be truncated and incomplete. Sci-Hub was first sued in 2015 by Elsevier in one of the most important copyright cases of the century. Sci-Hub was found to have infringed Elsevier’s copyright in that case and was fined $15 million. The Sci-Hub domains were blocked by ISPs in Sweden, the United Kingdom, Russia, Belgium, and France following lawsuits in Europe. Libgen and Sci-Hub are also on the European Commission’s piracy watch list. Sci-Hub and Libgen constantly change their URLs to avoid ISP blocking challenges by utilizing ever-shifting domains and untraceable VPN servers. Furthermore,
academicians from developed countries constantly assist Sci-Hub by uploading the latest research publications to strengthen their databases. Libgen and Sci-Hub have now become the Robinhood of Science, stealing manuscripts from wealthy journals, and storing them on public servers for the needy and poor.
Overall, the legality of Sci-Hub is a complex and ongoing issue, with legal challenges and decisions varying by country. While some argue that Sci-Hub provides a valuable service by making scientific research more accessible, others argue that it violates copyright laws and threatens the financial viability of scientific publishers. There are legal ways to access scientific manuscripts, such as using free browser extensions such as CORE discovery, Unpaywall, and Open Access button. The Facebook group “Paper Request” is run by academicians to help researchers gain access to scientific manuscripts. Google Scholar has started compiling all free versions available to any manuscript available to readers through the “All versions” option. Furthermore, there are research platforms like ResearchGate where articles can be downloaded or requested directly from the author. Though they might not be as fast as a Sci-Hub search, these solutions are legal. Researchers are debating whether they should only be able to access scientific information for a fee or whether they should be able to access it free to citizens who pay for it through their taxes.
Publicly funded research is often published in journals that cost thousands of dollars a year to read. This barrier to access excludes poorer institutions, independent researchers, and the general public from the scientific insights “protected” by this very profitable system. Sci-Hub and Libgen provide readers with free access to these resources without commercial interest. Some authors claim that journals charge exorbitantly, although the researcher generates the knowledge, and the reviewers are not paid for the peer-review process. So, it is a case of academic exploitation and restricting research in paywall servers for only the wealthy. The publish-or-perish model of academia sustains large publishing monopolies and their “authority of knowledge.” The pay-for-knowledge model has fueled inequalities
in science and technology. The government needs to address this by negotiating with these academic journals to establish affordable subscriptions throughout the country. Meanwhile, Sci-Hub seems to be the only solution for needy researchers and Libgen for those students who cannot afford books. In general, the Sci-Hub project has significantly impacted research in Pakistan, as it has provided researchers with access to articles and journals that are not available through the HEC Digital Library. While the HEC does not condone the use of Sci-Hub, it has recognized the project’s role in promoting research in the country. Although it can potentially increase the accessibility of scientific research, it also threatens the financial viability of medical journals and could have negative consequences for the scientific community

CONFLICT OF INTEREST
None declared

REFERENCES
1. Bohannon J. Who’s downloading pirated papers? Everyone. American Association for the Advancement of Science; 2016.
https://doi.org/10.1126/science.352.6285.508

2. Nazarovets S. Black open access in Ukraine: analysis of downloading sci-hub publications by Ukrainian internet users. arXiv preprint arXiv:180408479. 2018.
https://doi.org/10.15407/scine14.02.019

3. American Chemical Society wins preliminary finding against SciHub [press release].
https://cen.acs>web>2017/10/American-Chemical-Society-winspreliminary.html