Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Calcutta National Medical College & Hospital , Kolkata

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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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)
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.
On April 2011

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
On Jan 2020

Important Notice

Year : 2010 | Month : August | Volume : 4 | Issue : 4 | Page : 2958 - 2962 Full Version

Preventive Prosthodontics for Head and Neck Radiotherapy

Published: August 1, 2010 | DOI:

*(Professor),**(Lecturer),Deptt.ofProsthodonticsHitkarini Dental College & Hospital,Jabalpur – 482001 (Madhya Pradesh) India

Correspondence Address :
Dr. (Mrs.) Sneha S. Mantri,
Ivory Tower, South Civil Lines, Denning Road,Jabalpur – 482001 (M.P.) India
Mobile : 9424685622
Phone : 0761-2601109
Email :


Adverse tissue reactions associated with the use of radiotherapy in the management of patients with head and neck cancer are painful and they diminish the quality of life, often discouraging the patient from taking treatment. Customized intraoral stents can help prevent the unnecessary irradiation of the surrounding normal tissues, thus reducing the severity of reactions. Since the use of these stents is individualized, close collaboration between the radiotherapist and the prosthodontist is essential. However, when properly designed and used, these stents are effective in reducing the treatment morbidit


Radiation stents, radiotherapy complications, head and neck cancer

In India, around 40% of the cancers detected are oral cancers. In addition to this, there are patients with cancer of the nose, nasopharynx, paranasal sinuses and the oropharynx, where treatment involves the oral cavity as well as the head and neck area. Radiotherapy is increasingly being used as an adjunctive form of treatment in the management of head and neck cancer .Radiation therapy is defined as “the therapeutic use of ionizing radiation in the management of neoplasms of the body without surgery, or as an adjunctive palliative treatment after surgery, either in combination with or without chemotherapy” (1).

The two main categories of ionizing radiations which are used are electromagnetic radiations (photons, x-rays, gamma rays) and particulate radiations (electrons, neutrons and protons). The modality for radiotherapy which is used is external radiation therapy which is also called as teletherapy which is used to deliver high doses of radiation to tumours that are located within 6 cms of the skin surface. The doses are 6500 rads to 7500 rads for 6-7 weeks. Interstitial Radiotherapy, also called as Brachytherapy isused to deliver high doses (upto 20000 rads) of radiation over a short distance for a short time period (10-15 hrs). Radiation therapy is given in a series of treatments or fractions called fractionation. Unfortunately, this treatment causes complications by increasing the morbidity of the surrounding tissues. These include erythema, mucositis, ulcers, fungal infections, xerostomia, caries from decreased salivary flow and pH changes, possibilities of infection in the jaws or the potential for osteoradionecrosis from infection or trauma to irradiated bone . Hypersensitivity of the teeth, taste loss, oral bacterial shift and periodontal breakdown are other problems of concern while treating the patient with radiotherapy (2),(3) Damage to the normal tissues can be reduced by using biological methods such as an appropriate method of radio therapy and by modifying the dose and fractionation regime. Various physical methods are also commonly used to reduce damage, which include shielding, proper positioning and the use of multiple fields.

As a preventive measure, radiotherapy protective devices/stents can be fabricated and used during the treatment. These devices are used to displace the position or to shield tissues or to assist in the efficient administration of radiotherapy to the affected areas, thus limiting the post therapy morbidity (4),(5),(6). The need for a radiation stent is determined by the treating radiotherapist. The prosthodontist can actively help in the rehabilitation of cancer patients by fabricating a whole array of possible prostheses that can be constructed to meet specific patient needs, thereby limiting complications following therapy (7). Radiation stents are commonly fabricated from acrylic resin and may or may not contain a shielding metal/alloy, depending upon several conditions; type of the radiation given, condition of the diseased hard and soft tissues, mouth opening ability and the needs of the treating radiotherapist. Conventional prosthetic techniques are used to fabricate these stents (8),(9) Silicone is the other material of choice. With the advancements in technology,,computer tomography is recently being used for the fabrication of brachytherapy carriers. Various types of radiation stents that can be fabricated are described here in brief.

Radiation Source Carriers
This type of prostheses is needed when radiation therapy is to be administered to confined areas by means of capsules, beads, tubes or needles of radiation emitting materials. The main purpose of these prostheses is to hold the radiation source securely in the same place during the entire period of treatment. It should be easy to load and unload. The exact location and the number of sources are determined by the radiotherapist and are marked on the dental model.They are used to carry the radiation sources close to the site of treatment (intracavitary) or directly into the tumour (interstitial) (10). They are of two types; preloaded carriers and after loaded carriers. (Table/Fig 1).

Perioral Cone Positioning Stents
This type of stent is commonly used when boosting the dose to the trauma site. It holds the cone in the repeatable and the exact position as desired by the radiotherapist, thus minimizing the chances of the movement of the cone during a particular treatment session. It is used in the treatment of superficial lesions involving the anterior floor of the mouth and the hard and soft palate. The actual cone or cylinder of the same diameter as the cones is used to form an acrylic resin ring of 5 to 6 cms long. Tin foil is wrapped around the cone as a separator from acrylic resin. In the presence of a radiotherapist, the cylinder is attached to the maxillary record base (edentulous patient) or occlusal indices (dentulous patients) and the cone is centered over the lesion. The treatment cone is inserted into the positioning stent for verification of the position.(Table/Fig 2).

Radiation Protection/ Shielding Stents
They are used to shield the vital structures which are adjacent to radiation therapy sites from excess dosage of radiation (Table/Fig 3). When electron beam therapy is used to treat lesions of the buccal mucosa, skin or the alveolar ridge, mucositis is frequently observed in areas which are adjacent to the metallic dental restoration. The therapy beam scatters electrons from the high-Z metals used in the dental alloys, resulting in a local dose enhancement, which leads to excess dose in the surrounding tissues, thus causing mucositis. Effective shields can be fabricated to protect the tongue, salivary glands and the opposite side of the mandible (11). Low melting alloys like Cerroband, Pb-Bi-Sn, and Lipowitz are used as shielding materials. Cerrobend alloy is preferred because of its low melting temperature and it effectively prevents the transmission of the electron beam. Maxillary and mandibular impressions are made, taking care to displace the tongue away on the side for which the stent is to be fitted, to create space between the tongue and the alveolar ridge. Casts are mounted in centric relation . A lingual extension of wax is made in the space created, which is hollowed out to create a cavity which is 1 cm thick. The wax pattern is acrylized, finished and polished. Cerrobend alloy is heated and poured into the hollow cavity and it is sealed with auto polymerizing resin to prevent back scatter dose enhancement (Table/Fig 4).

Position Maintaining Stents
It is used to precisely position structures which are to be treated in fixed and repeatable positions for multiple treatment sessions. They are used to position movable structures like tongue, soft palate etc. (Table/Fig 5).
Tongue Depressing Stents
It is a custom made device which positions the mandible, depresses the tongue and spares the parotid gland during radiotherapy of head and neck tumours. These stents are more accurate and provide greater patient comfort than the commonly used “Cork and tongue blades”. An interocclusal stent is prepared for the dentate patient, that extends lingually from both the alveolar ridges, with a flat plate of acrylic resin which serves to depress the tongue. A hole is made in the anterior segment in which the tip of the tongue is placed in order to establish a reproducible position. (Table/Fig 6).

Dosimeter Positioning Stents
Dosimeter is a device which is used to calculate the amount of doses required for a lesion. These stents are designed with a series of slots for holding lithium fluoride capsules. Lithium fluoride capsules used as a dosimeter are an accurate and efficient means of determining dose locally. The lithium fluoride capsule is wrapped in a 0.1 inch tinfoil which is wrapped with acrylic resin casing and is allowed to cure. A hole is placed at one end of the stent and an orthodontic wire is used to push the capsule out of the acrylic resin casing. The resin case is attached to the stent in position as directed by the radiotherapist (Table/Fig 7).
Tissue Recontouring Stents
These stents are effective when treating skin lesions which are associated with lips when the beam is adjusted for midlines. Low doses are delivered at the corners of the mouth because of the curvature of the lips. A stent can be made to flatten the lip and the corner of the mouth, thereby placing the entire lip in the same plane. These stents are fabricated by modeling plastic and are processed in acrylic resin (Table/Fig 8).

Tissue Bolus Compensators/ Balloon Bolus Supporting Stents
These prostheses help in the treatment of superficial lesions of the face with irregular contours. Due to irregularities in the lesions, some areas within the field may be untreated, while others may develop isolated hotspots. BOLUS is a tissue equivalent material which is placed directly onto or into the irregularities, that helps in converting irregular tissue contours into flat surfaces which are perpendicular to the central axis of the ionizing beam, to thereby more accurately aid in the homogenous distribution of the radiation.(12)(13) The most commonly used materials for bolus are tissue conditioners, water, saline, waxes and acrylic resin (Table/Fig 9)


Many oral complications associated with radiotherapy can be controlled with the treatment prostheses provided by the prosthodontist. At times, the head and neck surgeon and radiotherapist are not fully aware of the many primary and supportive services that the maxillofacial prosthodontist can perform through the use of the prostheses. It is recommended that such a specialist be on the team for consultation before planning any head and neck cancer surgery or before starting radiotherapy. These measures make the patient’s treatment course smoother and simplify the surgeon’s treatment plan.


Beumer J, Curtis TA. Firtell D N Radiation therapy of head and neck tumors : oral effects and dental manifestation. In maxillofacial Rehabilitation (Prosthodontic & Surgical Consideration). The CV Mosby Company, 1979. Chp.3, pg. 23.
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Kramer DC. The Radiation Therapy patient treatment planning and post treatment care. In Taylor TD, editors Clinical Maxillofacial Prosthetics. Quintessence Publishing Co. Inc. 2000. Chapter 3, pg 37.
Kaanders JH, Fleming TJ, Ang KK, Maor MH, Peters LJ. Devices valuable in head and neck radiotherapy. Into J Riadial Once Boil Phys 1992; 23 (3): 639-45.
Chambers MS, Tooth BB, Fleming TJ, Lemon JC. Oral and Dental Management of the cancer patient: prevention and treatment of complications. Support Care Cancer 1995; 3:168-75.
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Prostheses, stents and splints for the oral cancer patient. Jeri FC, Ramsey WO, Drone JB, et al. In oral care for the oral cancer patient, public health service. Pub No. 1968; 341-52.
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Wang RR, Olmsted LW. A direct methods for fabricating tongue shielding stent. J Prosthet Dent 1995; 74:171-73.
Miyamoto RH, Fleming TJ, Davis MG. Radio therapeutic management of an Orocutaneous defect with a balloon retaining stent. J. Prosthet Dent 1992; 68:115-17.
Brosky M, Lee C, Barlett T, Lo S. Fabrication of radiation bolus prosthesis for the maxillectomy patient. J Prosthet Dent 2000 ; 83:119-20.

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