Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Dentistry
Full Version
Rehabilitation of a Hemimaxillectomy Patient with Innovative Interim Obturator Prosthesis – A Clinical Report
Correspondence Address :
Dr. Vijay Prakash (MDS)Department of Prosthodontics,I.T.S. Centre for Dental Studies & Research Delhi-Meerut Road, Muradnagar, Ghaziabad, UttarPradesh (India)e-mail:drvjprakash22@yahoo.co.in,drruchigupta@rediffmail.com,Fax: 0091 -0123225380, 0123225381,Tel: 009899932210, 009810167164
Rehabilitation of hemimaxillectomy patients can be challenging. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. Obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defect, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. This clinical report describes a modified labial flange as a means of indirect retention, to minimize the rotation of the obturator prosthesis. This approach adequately increases the retention and stability of the prosthesis.
obturator, hemi-maxillectomy, modified labial flange
Introduction
The intraoral defects in the maxilla are due to trauma, disease, pathological changes, radiation burns or surgical intervention. The defect may be small or it may include any portion of the hard and soft palate, the alveolar ridges and the floor of the nasal cavity. Post surgical defects in the maxilla result in hypernasal speech, fluid leakage into the nasal cavity and impaired masticatory function. The primary objectives in rehabilitating the maxillectomy patient are to restore the function of mastication, deglutition and speech and to achieve normal oro-facial appearance (1). The most common prosthodontic treatment problems with maxillectomy patients are lack of retention, stability and support. The size of the defect, the number of remaining teeth, the amount of the remaining bony structure and patient ability to adapt to the prosthesis are few factors which affect the prognosis of the treatment (2),(3). The complex anatomy of the midface and its endless potential for surgical or traumatic defect size, shape and location also presents with numerous possible configurations of treatment considerations.
Prosthetic rehabilitation is planned (4) depending upon the type of surgical defect and the relationship of the defect area to the remaining abutment teeth (5). Obturator prosthesis is commonly used as an effective means of rehabilitating partial or total maxillectomy patients. This type of prosthesis helps in separating the oral and nasal cavities to allow for adequate deglutition, speech, possible support of the soft tissue to restore the midfacial contours and acceptable aesthetic results (6),(7).
The movement of the obturator prosthesis is common and the degree of movement depends on the number and position of the teeth available for retention, size and configuration of the defect, the size, contour, and lining mucosa of the defect, height of the residual alveolar ridge and the availability of the undercuts. This movement of the prosthesis should be minimized in order to provide adequate retention, stability and support (7),(8). Retainers are one of the most important components contributing to the success of the obturator prosthesis. Selection of the type of retainer is based on the size, location of the defect and the number, position and periodontal status of the remaining teeth. Indirect retention components should be strategically positioned in order to minimize the movement of the prosthesis (9),(10).
In this clinical report, a hollow bulb interim obturator with a modified labial flange was used to restore speech, deglutition and normal orofacial contour for a patient with partial maxillectomy. There is no case in literature where this type of labial shield has been used as a means of achieving retention.
Clinical Report
A moderately built 35 years old male patient reported to the Department of Prosthodontics, complaining of difficulty in speech and leakage of food and liquid from the oral cavity into the nasophaynx. The medical records of the patient revealed that he had cemento-ossifying fibroma of the right maxilla involving the maxillary antrum. He underwent right side extended maxillectomy one month ago. On examination, the right side of his face was found to be depressed inwards and gave an unaesthetic appearance. The patient had a large defect extending from right incisor region to the soft palate. He had Class 1 defect according to the Armany classification (Table/Fig 1). An obvious nasal twang was observed in the speech of the patient. The lower arch was completely dentulous. Considering the large palatal defect on the right side, a closed type hollow bulb interim obturator was planned. To enhance the retention, a labial flange on the left side was modified and was joined with the prosthesis by means of clasps.
The preliminary impression was made with irreversible hydrocolloid (Zelgan 2002, Dentsply India, Gurgaon, India) and a stone cast was poured from the impression. An acrylic resin base was fabricated and green stick compound (DPI Tracing sticks, Dental products of India, Mumbai, India) was used to properly record the tissue on the defect side, so as to achieve a proper peripheral seal. The final impression was made of silicone putty impression material (Aquasil, Dentsply/ Caulk, Milford, DE). The impression was boxed and the master cast was poured in type IV dental stone ( Ultrarock, Kalabhai Karson Ltd, Mumbai, India). The denture base was fabricated with self cure resin and occusal rims were made to record the jaw relation. After selecting the teeth (Cosmo HXL, Dentsply Ltd, Surrey, U.K.), denture try-in was performed in the conventional manner, as in the complete denture construction. On the unresected side, a ‘W’ shaped clasp was placed in the canine – premolar region. After verification of the jaw relation, the trial denture was sent to the lab for interim prosthesis fabrication. A closed type hollow bulb obturator was fabricated as a two step procedure. First, the open bulb was fabricated with the heat cure resin (Trevalon Hi, Dentsply India, Gurgaon, India), with a conventional method. Later, in the second step, the lid is sealed to the body of the bulb with an autopolymerising resin. A modified labial flange was fabricated in the canine premolar region (Table/Fig 2). The final prosthesis was inserted into the patient’s mouth and it was checked for proper palatal contour and peripheral seal (Table/Fig 3) . The patient was educated about the maintenance of the prosthesis and was recalled for regular post-insertion visits. Adequate retention, stability and support were observed on subsequent recalls. The patient’s normal swallowing ability was restored by the prosthesis and he was pleased with the dramatic improvement of speech and retention of the prosthesis.
Acquired defects in the maxillae due to surgical resection result in a communication between the oral and nasal cavities, that causes difficulty in deglutition, speech and an unaesthetic appearance. Apart from this, it also results in psychological trauma to the patient. Small defects are usually closed by surgical means, but larger defects are often prosthodontically rehabilitated by obturators (11). Class 1 defect is a unilateral defect which is most commonly seen in maxillofacial rehabilitative practice. It represents the classic maxillary defect where the hard palate, alveolar ridge, and the dentition are removed to the midline (5).
This clinical report illustrates a class 1 defect which was rehabilitated by a closed hollow bulb obturator. The main objective was to decrease the weight and minimize the rotation of the prosthesis. Hollow bulb obturators help to reduce the weight of the obturator, to decrease pressure to the surrounding tissues and to aid in deglutition and to encourage regeneration of the tissues. The lightness of the obturator also does not cause excessive atrophy and physiological changes in muscle balance (1),(8).
The patterns of forces affecting the obturator prosthesis are complex because of their concurrent occurrence and mostly destabilize the prosthesis. These destabilizing forces need to be controlled by effectively and strategically positioning the indirect retainers. In the class 1 situation, the functional fulcrum line lies along the bony contours, next to the resected area and to provide maximum retention, the indirect retainer should lie in the premolar region. In this case, a modified labial flange was placed over the canine and premolars and was connected to the obturator by means of wire clasps. This provision in the prosthesis helped in minimizing the rotation of the prosthesis around the functional fulcrum line and also, it is easy to fabricate and greatly enhances the retention of the obturator.
The most challenging part in rehabilitating the patient with hemimaxillectomy, is to obtain adequate retention and stability. The modified labial flange on the unresected side not only improves retention, but also provides adequate stability to the prosthesis. This type of retention aid provides an easy option to achieve the primary objective of restoring the functions of mastication, speech and aesthetics.
In cases of large maxillary defects, the rotation of the interim obturator around the functional fulcrum line can be minimized by providing modified labial flange in the canine- premolar region.
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com