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
Original article / research
Full Version
ASTOL Technique: A Novel Method for Localisation of Impacted Mandibular Tooth
Correspondence Address :
Dr. Arvind Sivakumar,
No.162, PH Road, Chennai, Tamil Nadu, India.
E-mail: arvind.sivakumar@gmail.com
Introduction: Object localisation is one of the challenges encountered in diagnosis of impacted teeth, which requires sophisticated two-dimensional and three-dimensional radiographic techniques. These sophisticated radiographs are not readily available in all clinics, and also they carry the risk of increased radiation exposure and increase burden of care.
Aim: To evaluate the accuracy of ASTOL (Arvind-Seerab Transmandibular Object Localisation) technique for object localisation in the dried mandible of a cadaver.
Materials and Methods: This cross-sectional study was conducted in Chennai city, Tamil Nadu between March 2021 to April 2021. A dried mandible of a cadaver and an extracted premolar was used to simulate 10 cases scenarios of impacted teeth at different regions of the mandible. Two intraoral periapical (IOPA) radiographs were taken for each scenario, from two different projections: first a conventional IOPA of the impacted tooth was taken and second radiograph was taken with the beam projected from the base of the mandible with the sensor placed on the occlusal surface. Both the radiographs taken for each scenario were incorporated into a questionnaire survey and were circulated to 30 dental practitioners. The results were tabulated and represented graphically. Cronbach’s alpha test and Kappa statistics were done to evaluate the internal and interobserver reliability between the validators and respondents respectively.
Results: Out of the 30 dental practitioners, a total of 25 responses (14 Males and 11 Females) were received from dental practitioners across the state. The response rate was 83.33% and the mean age of the respondents were 34±5 years. The vertical position of the crown tip of the impacted tooth had a correct response rate of 85.60% (214/250). Angulation of the impacted tooth had a correct response rate of 75.20% (188/250). Mesiodistal positioning of the crown tip of the impacted tooth had a correct response rate of 78% (195/250). Buccolingual positioning of the impacted tooth had a correct response rate of 92.80% (232/250).
Conclusion: The ASTOL technique is a novel radiographic technique which can be used as an accurate, reliable and economic alternative to other sophisticated 2D and 3D imaging techniques for object localisation in the mandibular arch.
Arvind-seerab transmandibular object localisation, Dental radiography, Diagnosis, Impacted teeth
Localisation of objects and entities such as a tooth, pathology, or any foreign particle within the human body has always been an area of interest in the field of diagnosis. Visual examination is considered to be the gold standard for object localisation (1). However, it is not always feasible and practically applicable to clinically visualise an object which is embedded within the hard and soft tissue. These anatomic limitations and the need for extensive diagnostic aids makes it a challenge in visualizing these occult objects (2).
Dentistry in particular, involves the usage of radiographs for visualising structures which are clinically not seen such as the diagnosis of any impacted or supernumerary tooth (3). Canines and premolars are two of the most commonly encountered teeth to be impacted within the maxilla and mandible, besides the third molars (4). They pose several challenges to treatment planning and the outcomes as its location dictates the prognosis of disimpaction from an orthodontic perspective. Radiographs not just help with diagnosis, but also in localisation of the impacted teeth, assessing the severity and prognosis of the impacted teeth, which will help in treatment planning. Furthermore, it can also help in diagnosing any pathological transformation of the impacted tooth, if not addressed at the right time (5).
The commonly used modalities available for the purpose of localisation of oral structures are Cephalogram, Orthopantomogram (OPG) or Panoramic Radiograph, Computed Tomography (CT), and Cone Beam Computed Tomography (CBCT) (6). However, the available plethora of modalities for imaging also come with their own limitations. Radiographic devices come with the risk of ionisation and require careful monitoring and dose limitation during usage. Their usage is weighed against the risk and benefit that comes with the process (7). Extraoral radiographic devices are bulky, expensive, not easily accessible to all clinics, especially in rural areas (8),(9). Although CT and CBCT are highly accurate in visualizing the occult structures, it is bound by its own limitations such as high radiation exposure, expense and difficulty of access (10).
Over the years, several methods have been employed to localise impacted teeth and other structures of interest. One such approach has been the tube shift method or parallax method or the Same Lingual Opposite Buccal (SLOB) technique as it is popularly known. It was described by Clark C.A. in the year 1909, where two radiographs were taken: one perpendicular to the tooth surface and one by shifting the X-ray tube mesial to the first projection (11). This was further refined by Richard AG in 1952 as he introduced the Buccal Object Rule (BOR) (12). These methods are, however, technique sensitive and require sound knowledge of the technique for its application. The other accepted modality of object localisation is a vertical tube shift method, which utilises a panoramic and an occlusal radiograph as it provides a wider field of vision for localisation of impacted tooth (13). This method provides a better picture for localising an impacted tooth or other significant structures. However, the amount of radiation exposure is more in the vertical tube shift method as compared to the horizontal tube shift method, which employs intraoral periapical (IOPA) radiograph (14).
This necessitates the need for an in-house technique for localisation of a tooth or an object within the confines of a dental clinic. A new approach called the ASTOL (Arvind-Seerab Transmandibular Object Localisation) technique utilises intraoral radiographs/sensors to localise impacted teeth in the mandibular arch. Hence, the aim of this study was to evaluate the accuracy of the ASTOL technique to successfully localise hidden structures in the dried mandible of a cadaver.
This was a cross-sectional study conducted between March 2021 to April 2021 on an online platform involving dental practitioners of Chennai, Tamil Nadu, India, to determine the efficacy of using occlusal IOPA for object localisation. Ethical clearance was obtained from the Institutional Review Board prior to the commencement of this study (IHEC/SDC/ORTHO-1905/22/350).
Inclusion criteria:
• A well-preserved mandible of a cadaver with all sets of complementary teeth present.
• Dental practitioners with a work experience of at least one year.
Exclusion criteria:
• Mandible of a cadaver with any pre-existing bony pathology.
• Mandible of a cadaver with any missing teeth.
• Dental students or practitioners with a work experience of less than one year.
Sample size calculation: Sample size calculation for the survey distribution was done using GPower software (Heinrich Heine University, Dusseldorf), version 3.0.10. Study conducted by Al Querban et al., was used for the purpose of sample size calculation (15). The alpha level and power was set at 0.05 and 80% respectively for sample size calculation, which was estimated to be 30.
Procedure
A dried adult cadaver mandible used for this cross-sectional study, had all the teeth present, including the third molars and was free of any bony pathology. An extracted premolar was used as the object for localisation (Table/Fig 1). The extracted premolar was placed at different sites varying the premolar’s buccolingual position, angulations (mesioangular, distoangular, horizontal and vertical), heights (cervical third, middle third, apical third, below apex) and mesiodistal location in relation to the adjacent tooth (Table/Fig 1)A-I. A total of 15 case scenarios were simulated by positioning the extracted premolar in various regions of the cadaver mandible. The extracted premolar tooth to be localised, was secured in place to the cadaver mandible using modelling wax.
The tooth secured in specific sites were photographed, to serve as the control. Two intraoral periapical radiographs for each scenario were taken using X-Mind DC X-Ray unit (Acteon, India). All the radiographs were taken with the standardised setting of 60 kV Tube voltage, 8 mA Tube current and Exposure time of 0.5s. Radiovisiographic (RVG) images were taken using RVG 5200 sensor (Carestream) (16). The radiographs were taken using the paralleling angle technique. However, no extension cone paralleling holders (XCP holders) were used in this study.
Two radiographs were taken for each scenario. The first radiograph was taken by placing the RVG sensor facing the occlusal surface of the tooth covering the object to be localised, and the X-ray beam was projected from the base of the mandible, perpendicular to the sensor as shown in (Table/Fig 2). The second radiograph was a standard IOPA image, taken by placing the RVG sensor parallel to the long axis of the tooth covering the object to be localised, on the lingual side and the X-ray beam projecting from the buccal side of the mandible, perpendicular to the sensor as shown in (Table/Fig 3).
The RVG images were digitally processed and uniformly cropped for different orientations. The radiographic images were marked with directions and the teeth were numbered accordingly to aid in the orientation of the image (Table/Fig 4). The tooth number identification was provided to overcome any confusions arising from the orientation of the image and to overcome the difficulty in determining the type of tooth in question, since these images do not have an embossed dot for mesiodistal orientation of the image and the participants have not visualised the specimen clinically.
Questionnaire survey: A customised questionnaire was formulated using Google forms application. A set of 15 scenarios were initially framed, each of which had four sub-questions evaluating the vertical position of the crown of impacted tooth, angulation of impacted tooth, mesiodistal positioning of the crown of impacted tooth and the buccolingual positioning of the impacted tooth.
The questionnaire survey was first shared with 10 random dental practitioners to evaluate the validity, construction and feasibility of the questionnaire. Cronbach’s alpha value of 0.875 was obtained, indicating good internal reliability of responses between the validators. Based on the initial responses of the validators and keeping in mind the length of the questionnaire survey, it was shortened to 10 case scenarios out of the 15 initially intended case scenarios due to the length and time taken for the questionnaire. The link for the revised questionnaire survey was then circulated among 30 random dental practitioners through electronic media such as Email, Facebook, WhatsApp, SMS and Telegram [Annexure-1]. The dental practitioners were chosen irrespective of their designation and field of speciality. Reminded messages were sent to all 30 practitioners at a span of one week to garner maximum responses.
Statistical Analysis
The results were obtained electronically, tabulated in a spreadsheet and were subjected to descriptive statistics using Microsoft excel 2019 MSO (Version 2202; Build 16.0.14931.20118). Cronbach’s alpha test and Kappa statistics were done to evaluate the internal and interobserver reliability between the validators and respondents respectively.
Out of the 30 dental practitioners, a total of 25 responses (14 Males and 11 Females) were received from dental practitioners across the state, as a result of 5 drop outs, who did not responded to messages. The mean age of the respondents were 34±5 years, with an average work experience of 11±3 years. The overall percentage of object localisation in the four different aspects is shown in (Table/Fig 5).
The vertical position of the crown tip of the impacted tooth had a correct response rate of 85.60% (214/250). Angulation of the impacted tooth had a correct response rate of 75.20% (188/250). Mesiodistal positioning of the crown tip of the impacted tooth had a correct response rate of 78% (195/250). Buccolingual positioning of the impacted tooth had a correct response rate of 92.80% (232/250). The kappa value obtained was 0.83 which was a good agreement among the respondents (17).
The results of this study showed that a high percentage of subjects were able to accurately localise the position of the impacted tooth in all the four directions. High accuracy of localisation was seen with respect to the buccolingual positioning (92.80%) and vertical position of the impacted tooth (85.60%), whereas comparatively lesser yet good accuracy was seen in determining the mesiodistal positioning of the crown (78%) and angulation of the impacted tooth (75.20%). Both the mesiodistal and angulation assessment of impacted tooth requires orientation of the right and left sides of the image (18). The relative decrease in accuracy of localisation seen in mesiodistal and angulation assessment might have been due to the use of RVG sensor for imaging, since these images do not have an embossed dot for mesiodistal orientation of the image (19).
Previous studies have compared reliability of various two dimensional (2D) radiographs like Orthopantomogram (OPG), Occlusal radiographs, Lateral cephalograms, Posteroanterior cephalograms (PA), Anteroposterior (AP) cephalograms and three dimensional (3D) radiographs like Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT) for the purpose of localisation of impacted canines (9),(13),(20),(21),(22),(23),(24). Previous studies have shown the use of panoramic radiographs to be a reliable modality of imaging for localisation of the impacted maxillary canines only. However, they have not documented its efficacy in localisation of impacted canines in the mandibular arch (25),(26),(27). When the impacted tooth was near the apical third or above the roots of the adjacent tooth, it is difficult to palpate the impacted tooth clinically. In such situations the reliability of localisation of impacted tooth with OPG was found to be less (25),(26). Moreover, Lai CS et al., reported that panoramic radiographs were not reliable in localisation of impacted canines (28). CBCT has been considered to be the gold standard for object localisation due to its ability to provide a 3D visualisation of the impacted object. Studies comparing the effectiveness of localisation of unerupted maxillary canines have shown that CBCTs were better than 2D radiographs (29),(30). However, it has higher radiation dosage than other conventional 2D radiographs (30),(31),(32),(33),(34). Also, CBCTs are not readily available in most clinical setups and usually require external referral to Radiology centres. Moreover, they are much more expensive as compared to conventional 2D radiographs (35).
There are no prospective or retrospective studies till date, evaluating the effectiveness of periapical radiographs in object localisation or its comparison with other diagnostic modalities for object localisation. From our study we have found that IOPAs can be used reliably and accurately for object localisation in the mandibular arch. It also has the advantage of least radiation exposure as opposed to other diagnostic imaging techniques. This would make it a safe and simpler alternative to CBCT, which has 15 times higher radiation dose than a conventional 2D radiograph (36). With respect to the radiation dosage, ease of availability and cost effectiveness, IOPA is a more feasible adjunct to any other radiographic modality in current practice. It also helps the diagnostician come to a faster provisional diagnosis, without the need for any additional imaging. Accommodation of an IOPA device in a remote clinical set up is more feasible than other larger 2D and 3D imaging devices (37). By slight modification, this in-house technique can be used to localise a wide range of anomalies such as impacted teeth, any foreign object, sialoliths, cysts and odontomes in the mandibular arch or in the floor of the mouth.
Limitation(s)
One of the limitations of using this technique for object localisation would be that it cannot be used in the maxillary arch due to the superimposition of overlying structures as the X-ray source needs to be projected from over the head. Another limitation of this study would be the smaller sample size and the lack of embossed dot for orientation of the RVG image which could have resulted in reduction in accuracy of object localisation. The clinical impact of this limitation however, would be less as the operator will have a clear idea of the orientation of the RVG sensor while interpreting the image.
More than 75% of subjects were able to accurately localise the position of the impacted tooth in all the four directions. The ASTOL technique is a novel radiographic technique which can be used as an accurate, reliable and economic in-house alternative to other sophisticated 2D and 3D imaging techniques for object localisation with respect to the angular, vertical, mesiodistal and buccolingual positioning within the mandibular arch. The reliability of this innovative method can be further tested in an in-vivo set up, which would be the scope of our future research.
DOI: 10.7860/JCDR/2022/55485.16619
Date of Submission: Feb 06, 2022
Date of Peer Review: Mar 12, 2022
Date of Acceptance: Apr 25, 2022
Date of Publishing: Jul 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 09, 2022
• Manual Googling: Apr 21, 2022
• iThenticate Software: Jun 11, 2022 (6%)
ETYMOLOGY: Author Origin
- 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