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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
Case report
Full Version
Non-Surgical Treatment of Class II Division 1 Malocclusion in an Adult Patient with a Missing Lower Lateral Incisor Tooth: A Case Report
Correspondence Address :
Mohsin Aslam Wani,
101, HMT, Mustafa Abad, Srinagar-190012, Jammu and Kashmir (U.T.), India.
E-mail: mohsynaslam@gmail.com
Class II Division 1 malocclusion is clinically more widespread than any other form of malocclusion and can be managed in a variety of ways, taking into account variables such as patient compliance, age, and anteroposterior disparity. Orthodontic camouflage treatment, aimed at masking the underlying skeletal discrepancy, is an acceptable option for most patients. This typically involves the extraction of two maxillary premolars in cases without mandibular arch crowding, or the extraction of two maxillary and two mandibular premolar teeth when crowding is present. The present case report aimed to discuss the successful treatment of a unique case involving a 19-year-old adult female patient with Class II Division 1 malocclusion, a missing mandibular left lateral incisor, and an overjet of 7 mm. Since the patient declined surgical and prosthetic treatment, an alternative, novel, and unorthodox method of camouflage treatment was employed, which involved the extraction of maxillary first premolars combined with symmetrical incisor space closure. The achieved treatment outcomes included a functionally and aesthetically acceptable occlusion, reduced overjet, and an improved soft tissue profile.
Boltons ratio, Mushroom loop, Orthodontic camouflage treatment
A 19-year-old female patient presented to the postgraduate Clinic of the Orthodontic Department with the chief complaint of upper front teeth protrusion and a gap in the lower left front region. The patient had no significant medical or dental history, except for the loss of the mandibular lateral incisor in the left quadrant due to trauma two years ago.
During extraoral examination, a convex facial profile was observed, with an average clinical Frankfort Mandibular Angle (FMA) of 27°, an acute nasolabial angle of 89°, potentially competent lips, a 4 mm inter-labial gap, and increased display of the incisors. Functional and Temporomandibular Joint (TMJ) examination revealed no abnormalities or abnormal symptoms. Intraoral examination revealed a Class II (End-on) molar and canine relationship, as well as proclined and protruded maxillary anterior teeth. There was approximately 5 mm of space in the lower arch due to the absence of a mandibular left lateral incisor, and an overjet of 7 mm was also noted (Table/Fig 1).
Panoramic examination showed no remaining tooth structure and adequate alveolar bone in the area where the mandibular tooth was missing. Cephalometric interpretation indicated a Class II skeletal diagnosis, with the maxilla positioned forward in relation to a normally positioned mandibular skeletal base. The dental parameters revealed proclination of both the upper and lower anterior teeth (Table/Fig 2).
The arch length-tooth material discrepancy in the maxilla was recorded as 8.3 mm. In the mandible, considering the available space due to the absence of the lateral incisor, a discrepancy of 7.8 mm and an anterior mandibular excess of 1.7 mm were observed. This indicated a need for tooth material reduction (extraction) in both the upper and lower arches if a full set of teeth were present.
The ideal treatment plan suggested surgical reduction of the maxilla to compensate for its protrusion and fixed/removable prosthetic rehabilitation of the mandibular space. However, the patient declined this option due to the invasiveness of the procedure and financial requirements. Therefore, an alternative treatment strategy was proposed, which involved the extraction of two maxillary first premolars and symmetrical space closure and retraction of the incisor teeth in the lower arch. The patient accepted this alternative treatment plan promptly.
Treatment objectives
• Correcting the proclination of the maxillary and mandibular anterior teeth.
• Achieve lip competence and improve the nasolabial angle.
• Attain a functionally stable and aesthetically acceptable occlusion.
• Achieve symmetrical positioning of the lower three incisors across the midline.
• Reduce the overjet and establish an adequate overbite.
• Achieve occlusal inter-digitation with Class II molar and Class I canine relation.
• Attain a pleasant soft tissue profile at the conclusion of the treatment.
Treatment progress: A pre-adjusted edgewise passive self-ligating fixed orthodontic appliance (0.018 inches) was bonded in both the upper and lower dentition. Second molars were also bonded to provide the necessary anchorage. Levelling and alignment of both arches were achieved using sequential NiTi wires (0.012, 0.014, 0.016, and 0.018) over a period of four months. Subsequently, a 17x25-inch stainless steel archwire was placed in the lower arch and a steel ligature wire was used in a figure-of-8 pattern to consolidate the lower incisor teeth into a single unit. To achieve bilaterally equal space, an open coil spring was placed in the lower right quadrant between the canine and lateral incisor tooth (Table/Fig 3). Simultaneously, maxillary first premolars were extracted, and a 17×25-inch Titanium-Molybdenum Alloy (TMA) Continuous Mushroom Loop (M-Loop) archwire was placed to initiate en-masse retraction in the upper arch. A greater beta-moment was incorporated into the distal extension of the archwire to counteract anchorage burnout.
After three months, an equivalent space of approximately 2.5 mm was achieved on both the lower right and left sides, mesial to the canines. Simultaneously, about 2 mm of retraction of the upper anterior teeth was also accomplished (Table/Fig 4). Similar to the upper arch, a 17×25-inch TMA Continuous M-Loop archwire was introduced in the lower dentition to achieve symmetrical space closure on the contralateral sides and establish a centered position of the three lower incisor teeth in relation to the mandibular arch (Table/Fig 5). In the maxilla, the M-Loop was activated by approximately 4 mm (3 mm of pre-activation and 1 mm of additional activation) and was reactivated only after 3 mm of space closure was achieved. Conversely, in the mandible, a single phase of 3 mm activation (2 mm of pre-activation and 1 mm of additional activation) was sufficient for complete bilateral space closure.
Upon completion of space closure, full thickness 18×25-inch stainless steel archwires were placed in both arches to level the arches and make any necessary third-order corrections. Final detailing was achieved using settling elastics and 0.014-inch stainless steel archwires. Subsequently, both arches were debonded, and fixed lingual retainers were provided. The patient was instructed to follow a 6-monthly follow-up schedule (Table/Fig 6),(Table/Fig 7). Notable skeletal, dental, and soft tissue changes resulting from the orthodontic treatment included a reduction in maxillary prominence, desirable improvement in the skeletal Class II profile, decreased vertical angle, improved angulation and position of the upper and lower anterior teeth in relation to the basal bone, attainment of a Class I canine relationship, and an overall refinement in the arrangement of the upper and lower lips (Table/Fig 8),(Table/Fig 9).
Patients with Class II malocclusion typically experience physical and psychological challenges due to their condition, making them common candidates for orthodontic treatment. Traditionally, there are two approaches to correcting this malocclusion in post-pubertal individuals: orthognathic surgery or orthodontic camouflage (1),(2). Camouflage therapy for Class II patients requires careful diagnosis and planning, taking into account aesthetic, occlusal, and functional factors (3). Studies have shown that orthodontic camouflage can lead to fewer functional and temporomandibular joint issues, and patients’ satisfaction and perception of outcomes are comparable to those achieved with orthognathic surgery (4).
Different authors have advocated for different extraction sequences for orthodontic camouflage of Class II cases, which may involve extraction of the upper first premolars, lower first or second premolars, or both upper and lower premolars (5),(6).
In certain malocclusions, extraction of mandibular incisor teeth can be a viable treatment option if it results in a healthier dentition that is functionally and aesthetically balanced with the surrounding structures (7). Mandibular incisor extraction is considered when the Bolton tooth size analysis shows a lower anterior excess of 1.1 mm (8). Class II malocclusion with one or two missing mandibular incisors is rarely reported in the literature (9),(10). This case report presents a similar uncommon clinical situation, complicated by the absence of a mandibular incisor tooth. Considering the presence of a full set of dentition in the patient, the mandibular anterior tooth material showed an excess of 1.7 mm, justifying the reduction of anterior tooth substance. Therefore, our treatment plan involved utilising the available anterior space in the mandible, while fulfilling the space requirements in the maxilla by extracting the maxillary first premolars (11).
Though this orthodontic treatment option has its limitations, such as the potential loss of midline, increased overjet and overbite, and the possibility of affecting anterior guidance and group function (12). However, the absence of a mandibular dental midline does not appear to have an impact on occlusion, aesthetics, periodontal health, Temporomandibular Joint (TMJ) function, or stability, which are the primary objectives of orthodontic therapy. This is provided that thorough examination of various aspects, including diagnostic criteria, the patient’s profile, and skeletal growth trends, is conducted before opting for such a treatment approach (13). One advantage of space closure in cases of agenesis is the maintenance of permanent biological compatibility of the teeth, along with the preservation of interdental gingival papilla and gingival margins around natural teeth, eliminating the need for prosthetic replacement (14). Furthermore, patients with missing or extracted mandibular incisor teeth have been reported to exhibit greater stability in the anterior segment compared to premolar extraction cases (15),(16). Additionally, similar degrees of post-treatment relapse and irregularity over time have been observed in both extraction (premolar or incisor) and non-extraction cases (17).
The use of passive self-ligating brackets has improved the overall patient experience and reduced chairside time (18). The application of the TMA M-Loop archwire allowed for an ideal moment-to-force ratio for bodily retraction of the upper and lower anterior teeth (19). The mushroom shape of the loop prevented interference with the vestibular or gingival tissues and minimised the chances of loop distortion, resulting in consistent force delivery (20).
The camouflage treatment of Class II Division 1 malocclusion in adults is a consistent challenge for orthodontists, requiring the development of a clinically feasible and functionally stable treatment strategy. The treatment plan discussed and implemented in this case report allowed us to address the patient’s primary concern of improving her facial profile, while also reducing the risk of anchorage loss and shortening the treatment duration. It is important to acknowledge that it is not always possible to manage all types of malocclusions symmetrically or achieve a perfect outcome. In certain clinical circumstances, therapeutic goals may need to be modified to meet the specific needs of the patient, even if this means achieving a final result that is less than ideal.
DOI: 10.7860/JCDR/2023/64234.18590
Date of Submission: Mar 24, 2023
Date of Peer Review: Aug 04, 2023
Date of Acceptance: Aug 30, 2023
Date of Publishing: Oct 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 28, 2023
• Manual Googling: Aug 08, 2023
• iThenticate Software: Aug 28, 2023 (10%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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