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

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"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018

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

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

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Dr. Arunava Biswas
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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."
Best regards,
C.S. Ramesh Babu,
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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 : 2011 | Month : November | Volume : 5 | Issue : 7 | Page : 1483 - 1485

Aberrant Canal Configuration of The Maxillary First Molar: A Case Report

Mohanavelu Deepalakshmi, Meenakshi Sundaram Rajasekaran, Anil Kumar, Rajamani Indira, S. Ramachandran

1. Corresponding Author 2. Reader Department of Conservative Dentistry & Endodontics Ragas Dental College & Hospital 3. Professor Department of Conservative Dentistry & Endodontics Ragas Dental College & Hospital 4. Professor and Head Department of Conservative Dentistry & Endodontics Ragas Dental College & Hospital 5. Professor and Principal, Ragas Dental College & Hospital

Correspondence Address :
Mohanavelu Deepalakshmi
Senior Lecturer
Department of Conservative Dentistry & Endodontics
Chettinad Dental College & Research Institute,
Rajiv Gandhi Salai (OMR), Kelambakkam-603103
Mobile : 0091-9840195698
E Mail :


A clear understanding of the root morphology and canal anatomy is an essential prerequisite to achieve clean, disinfected and 3-dimensionally obturated root canal systems. Undetected extra roots or root canals can directly affect the outcome of endodontic therapy. The purpose of this article was to present a clinical case of a maxillary first molar with two palatal canals in a single palatal root. This report serves in reminding clinicians that such anatomical variations should be taken into account during the endodontic treatment of the maxillary molars.


Maxillary molar, Two palatal canal, Aberrant canal.

Knowledge of both the normal and abnormal anatomies of the root canal system dictates the parameters for the execution of root canal therapy and this can directly affect the outcome of the endodontic therapy (1). Many unusual canal configurations and anomalies in the maxillary first molars have been documented in case reports and several studies (2), (3). The endodontic literature has demonstrated the maxillary first molar to be having 3 roots (the mesiobuccal, distobuccal and the palatal root) which form the “tripod” or “molar triangle”, with 3 or 4 root canals and the fourth canal commonly being MB2 (1),(4),(5),(6). Hence, the clinician needs to be familiar with both the eccentricities and the abnormalities in the root canal system (1).

In addition to these studies, the literature cites the variation in the palatal root of the maxillary molars as a single root with 2 separate orifices, 2 separate canals, and 2 separate foramina; 2 separate roots, each with 1 orifice, 1 canal, and 1 foramen; and a single root with 1 orifice, a bifurcated canal, and 2 separate foramen, with a trifurcation at the apical third in the palatal canal (7),(8),(9),(10). This case report describes the endodontic therapy of a permanent, maxillary, first molar with 2 canals in a single palatal root.

Case Report

A 23-year-old male presented with pain in the right, maxillary, first molar of 2 months duration. The clinical examination revealed a deep carious lesion in the same tooth. The preoperative radiographical evaluation of the involved tooth indicated caries, which approximated the pulp with the normal root canal anatomy and the widening of the periodontal ligament space. The clinical and radiographic findings led to a diagnosis of apical periodontitis, for which non-surgical endodontic therapy was attempted. The patient’s medical history was found to be non-contributory. The tooth was anaesthetized by using 2% lidocaine with 1:80,000 adrenaline (Lignox, Indoco Remedies Ltd, Mumbai, India). After isolation by using a rubber dam, an access cavity was established with a straight line access by using an access cavity bur (Dentsply Maillerfer, Ballaigues, Switzerland).

The clinical evaluation of the internal anatomy of the pulp chamber revealed 3 principal root canal orifices (the Mesio-Buccal the Disto-Buccal and the Palatal). The pulp chamber was frequently flushed with 5% sodium hypochlorite to remove the tissue debris. On probing with a HU-FRIEDY (Chicago,IL) DG-16 endodontic explorer, a stick was noted at the same orifice level, approximately 2 mm distally from the orifice of the main palatal canal. The access cavity was further modified. Inspection of the pulp chamber by using magnifying loupes (Seiler loupes, 2.5X magnification) revealed four distinct orifices, two buccal and two palatal (Table/Fig 1),(Table/Fig 2). The additional canal patency was checked by using a # 10 K- file (Mani ILC, Tochigi, Japan) . A working length radiograph confirmed the presence of two canals (Vertucci’s type II) in the palatal root (Table/Fig 3). All the canals were instrumented by the crown down technique by using protaper nickel- titanium rotary instruments (Maillefer Dentsply, Baillaigues, Switzerland) with 5% sodium hypochlorite solution and EDTA (Glyde, Maillefer, Dentsply). All the instrumented canals were medicated with Ca(OH)2 and the tooth was temporized with IRM cement. After one week, the canals were obturated with an AH plus resin sealer (Dentsply, DeTrey Konstanz, Germany) and they were cold laterally condensed with gutta-percha (Mailllefer, Dentsply, Tulsa, OK) and sealed with IRM cement. The post obturation radiograph revealed a Vertucci’s type II root canal morphology in the palatal root (Table/Fig 4).


This case report emphasizes the importance of investigating the possibility of additional canals. Hess reported (1921) wide variations and the complexity of the root canal system, thus establishing that a root with a tapering canal and a single foramen was the exception rather than the rule1. Based on the literature and this clinical case, it is evident that the knowledge about the anatomical variations of the maxillary molars is extremely important for the execution of a successful endodontic therapy. The incidence of an extra canal in the palatal root is not high, and it is reported to be 1-5% (7), (9), (11), (12).

The recommended clinical approach in the maxillary molars (15) • Radiographs are the “eyes” of the clinician and they are indispensable in most aspects of the endodontic practice (1). Two diagnostic radiographs with parallel and mesial or distalhorizontal angles are always necessary to assess the anatomy and the number of roots of the maxillary molars.

• Since the shape of the pulp cavity is variable, making every treatment unique, adequate access should be ensured to improve the likelihood that additional canals will be located. An access cavity should be designed to provide direct access to the apical third of the root canal system, not merely to locate the canal orifice. It is also important for the access cavity to have smooth, externally diverging walls to improve the visibility and to prevent the debris from migrating into the canal system (13).

• The pulp chamber roof should be carefully removed and the chamber should be abundantly flushed with sodium hypochlorite.

Following the dark developmental line on the pulp chamber floor with a DG16 endodontic probe, the orifices of the three main canals (MB1, DB, and palatal)should be located. The main canals should be negotiated and a working length radiograph should be taken on a distal projection, with the insertion of the #10 or #15 k-files. If the instrument appears to be off center in the root, a second canal should be suspected.

The orifice of the MB2 canal should be localized with a DG16 probe and it should be negotiated by using an adequate file.

A careful observation of the pulp chamber floor will offer clues to search for additional canal orifices. The effervescence of sodium hypochlorite on the pulp at the orifices of these extra canals may help in localizing them.

Other aids such as troughing of the grooves with ultrasonic tips, staining the chamber floor with 1% methylene blue dye, visualizing the canal bleeding points, fiber-optic transillumination, the White line test, the Redline test, the Fast break guide line, Spiral Computed Tomography, etc, can be used to locate the extra canals.

The high-power loupes and/or the operating microscope should be used with appropriate illumination in all the phases.

In the present case, the palatal root had two separate orifices with a single exit (Vertucci’s type II), where 2 palatal canal orifices were found to be well-developed and large. The access outline was wider on the palatal aspect as compared to the usual width. The traditional triangular access opening - the MB, DB, and the palatal root which represented the apex of each point of the triangle - was often too constricted to allow a straight-line access in the maxillary molars (13). Thomas and others (14) also warranted the use of a trapezoidal access cavity in the maxillary molars, right from their earlier studies. The treatment sequence and the prognosis for the molars with 2 palatal canals should be considered to be the same as those for any maxillary molar.

All the categories of teeth may have extra roots and/or canals, but the likelihood of finding aberrant canal configurations is higher in the molars (1),(5). Such variations also result from the ethnic background, age, gender, the source of the teeth, the study design, etc (1). It has been postulated that the secondary dentin apposition during tooth maturation would form dentinal vertical partitions inside the root canal cavity, thus creating root canals (16).

The risk of missing the anatomy during root canal treatments is high due to the complexity of the root canal system (3). The possibility of missing two canals in the palatal root further increases the possibility of errors during the treatment of the maxillary molars (15). Hence, the clinician should always make every effort to find and treat various possible canal morphologies and not to precisely determine the actual number of root canals which are present.


The aetiology of endodontic failure is multifaceted, but the significant percentages are related to the inability in finding and properly treating the root canals. Therefore, the clinicians ought tobe aware of the complex root canal structures, the cross sectional dimensions and the iatrogenic alterations of the canal anatomy, together with the diagnosis and treatment planning, as the basic requirements for achieving a successful treatment outcome.


Burns RC, Herbranson EJ. Tooth morphology and access cavity preparation. In: Cohen S, Burns RC, editors. Pathways of the pulp.8th ed. St. Louis, MO: Elsevier Mosby. 2002; 173-29.
Malagnino V, Gallottini L, Passariello P. Some unusual clinical cases on the root anatomy of the permanent maxillary molars. J Endod. 1997; 23(2):127–28.
Stone LH, Stroner WF. Maxillary molars demonstrating more than one palatal root canal. Oral Surg Oral Med Oral Pathol. 1981; 51(6):49– 52.
Fogel HM, Peikoff MD, Christie WH. Canal configuration in the mesiobuccal root of the maxillary first molar: a clinical study. J Endod. 1994;20(3):135–7.
Pomeranz HH, Fishelberg G. The secondary mesiobuccal canal of the maxillary molars. J. Am. Dent. Assoc.1974;88 :119-24.
Seidberg BH, Altman M, Guttuso J and Suson M. The frequency of two mesiobuccal root canals in the maxillary permanent first molar. J Am Dent. Assoc. 1973;87; 852- 56.
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Thomas RP, Moule AJ, Bryant R. Root canal morphology of the maxillary permanent first molar teeth at various ages. Int J Endod. 1993; 26(5): 257-67.
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Martinez-Berna A, Badanelli P Mandibular first molar with six root canals. J Endod. 1981; 8:348-52.

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