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.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



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."



Dr Kalyani R
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.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
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
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" 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,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
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,
Bengaluru.
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
Consultant
(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)
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

Important Notice

Research Protocol
Year : 2023 | Month : May | Volume : 17 | Issue : 5 | Page : ZK05 - ZK08 Full Version

Development, Evaluation, and Comparison of an Indigenous ‘APDS’ AI-based Digital Application for Effective Shade Selection of Silicone Maxillofacial Prosthesis: Protocol for A Cross-sectional Study


Published: May 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/61326.17991
Priyadarshani G Pawar, Anjali Bhoyar, Seema Sathe

1. PhD Student, Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India. 2. Professor, Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India. 3. Professor and Head, Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India.

Correspondence Address :
Priyadarshani G Pawar,
PhD Student, Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India.
E-mail: priyadarshanipawar77@gmail.com

Abstract

Introduction: Reconstruction of maxillofacial defects is challenging in achieving aesthetic results. Replicating natural skin colour in maxillofacial prosthesis has been traditionally done using trial-and-error methods. However, with their respective limitations, multiple methods have been developed recently, like colourimeter and spectrophotometer.

Need of the study: The natural appearance of the prosthesis significantly impacts the emotional and psychological well-being of patients. Thus, aesthetics have become a primary concern. Consequently, the challenge of accurately matching the colour of maxillofacial prostheses is evident. To address this, there is a need to develop customised shade guides and advanced digitised shade-matching applications with the assistance of Artificial Intelligence (AI). Therefore, a concoction of a customised silicon shade guide is contemplated with Advanced Programme in Data Sciences (APDS) AI-based digital application, and its reproducibility in clinical practice will be analysed.

Aim: Phase 1- To develop and validate a customised broad spectrum silicon shade guide and APDS AI-based digital application for the Indian population.

Phase 2- Comparative evaluation of the efficacy of indigenous APDS AI-based digital application with available shade guide systems for shade selection for silicone maxillofacial prostheses.

Materials and Methods: This cross-sectional study involves fabricating the shade guide using medical-grade room temperature vulcanising silicone, based on an observational survey. The shade guide will consist of three main groups (ABC), divided into different subgroups representing lighter to darker skin shades. The accuracy of the shade guide will be evaluated using aspectrophotometer. The APDS AI-based digital application will be developed using the reference from the customised broad-spectrum maxillofacial shade guide. The efficacy of the application will be evaluated through visual assessment of colour matching by fabricating facial veneers for participants. Investigators will assess the consent of perfect colour match. The data will be statistically analysed.

Keywords

Advanced programme in data sciences, Artificial intelligence, Shade matching, Silicone shade guide

During maxillofacial reconstruction, artificial replacements for intraoral and extraoral structures such as the nose, maxilla, mandible, esophagus, cranial bones, and palate are fixed. Maxillofacial prostheses, made with acrylic resin and silicone, are personalised to the patient’s facial structure. These prostheses address visible flaws that are linked to the face, as even slight changes in facial appearance can harm a patient’s mental health. Aesthetic maxillofacial prosthesis can improve patients’ quality of life, especially for those with issues resulting from cancer, trauma, or congenital disease [1,2]. Prosthodontists face a significant challenge in colour matching human skin during prosthesis fabrication. As demand and awareness of maxillofacial prostheses increase, achieving a natural appearance with precise shade identification becomes crucial. Silicone elastomers have shown superior qualities as maxillofacial prosthetic materials, surpassing acrylic resins in recommendations.

Traditionally, a trial-and-error method has been used to replicate natural skin colour in maxillofacial prosthesis (1). This chairside procedure involves gradually adding colours to silicone elastomers. However, the precision of the final colour match is influenced by factors such as translucency, metamerism, and the subjective nature of human colour perception (2). Various methods and procedures have been applied to match skin colour, although colourimeters or handheld spectrophotometers are not commonly used in India for this purpose. Colourimeters offer consistent and repeatable colour readings. Currently, skin colour measurements for maxillofacial prosthesis patients are obtained using colourimetric technologies, such as e-skin (Spectro Match, Bath, Techno Vent, UK). These measurements are then compared to a digital library, and known formulas are used to assemble maxillofacial prostheses (3). However, these systems rely on specialised and scarce colourimeter instruments that are expensive. In today’s world, smartphones with built-in digital cameras are ubiquitous, and their technical capabilities have rapidly advanced. This allows almost everyone to own a portable, network-connected vision sensor. Various colourimeter software programs are now available for mobile phones. These programs translate the natural colour data of each pixel into colour coordinates, such as CIE L*a*b* values. However, more evidence is needed in the realm of maxillofacial prostheses (3). Compared to present skin colour evaluation methods, such an application could provide an affordable, widely available tool for developing silicone hues for face prostheses (4),(5).

Nowadays, colourimeters and spectrophotometers are commonly used but they are reliable yet less accessible, expensive, and lack certain details (6). The software converts raw colour information of each pixel into colour coordinates, such as CIE L*a*b* values. However, more research is needed in the field of maxillofacial prostheses. In contrast to current methods, the primary goal of this study is to create a more sophisticated application that can offer an economical, precise, and generally accessible tool for creating silicone colours for facial prostheses (7). Hence, the study’s primary goal is to figure out the skin shade for the maxillofacial prostheses by developing a broad spectrum of silicone shade guides and ‘APDS’ AI-based digital applications for shade identification that will be more conventional and easily accessible for the Indian population. The present study will be divided into two phases and aims to address two research questions: whether a customised, comprehensive spectrum silicone shade guide is more effective in shade selection compared to conventional methods, and whether an indigenously developed ‘APDS’ AI-based digital application is more effective in shade selection. The aim of phase 1 will be, to develop and validate a customised, comprehensive spectrum silicon shade guide and APDS AI-based digital application for the Indian population.

The aim of phase 2 will be, to compare the efficacy of the indigenous ‘APDS’ AI-based digital application with available shade guide systems for shade selection in silicone maxillofacial prostheses.

Material and Methods

The present study will be a cross-sectional study. The subjects will be selected from the general population across various regions in India, and the fabrication will be done in the Department of Prosthodontics and Crown and Bridge, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India. The Institutional Ethics Committee (DMIMS (DU)/IEC/2022/1048) has granted ethical committee permission as a part of the PhD in prosthodontics and crown and bridge and implantology scholar proposal.

Sample size calculation: An expert biostatistician calculated the estimated sample size to evaluate and compare the efficacy of the APDS application for colour matching by facial veneers (n=86) (aim 2, phase 2) and an observational study for the commonest skin shade identification in India’s general population-random sample size (n-200) (aim 1, phase 1). The sample size was calculated based on percentage agreement values for groups provided in (Table/Fig 1) of the reference article (8). Study parameters: Incidence (group 1)- 87%, incidence (group 2)- 49.3%, alpha-0.05, beta-0.2, power-0.8. Final estimated sample size-86 (group 1=43, group 2=43) (9).

Phase 1

Objective 1: Evaluation of most common skin shades using available skin shade analysis systems (observational survey): An observational study will be conducted to identify the most common skin shades in the general population of India (n=200). A shade guide will be fabricated, ranging from the lightest to the darkest skin tones. Simple random sampling will be employed. The face will be divided into three regions for color identification-forehead to glabella, glabella to nasion, and nasion to chin. Skin tone will be recorded in hue (colour type), chroma (amount of black, red, yellow, white, and blue), and value (amount of darkness and lightness) using a commercially available colorimeter. Participation will be voluntary, and written informed consent will be obtained from 6those who agree to participate. Readings will be taken and sent for data analysis. Subjects aged between 20 to 40 years, without any skin diseases, postsurgical scars, facial abnormalities, skin bleaching, or burn injuries, will be included in the present study after obtaining informed consent. Both male and female subjects will be included in equal ratios. Subjects with skin disorders such as- hypopigmentation or hyperpigmentation, skin tanning, post-radiation therapy, and those with makeup or cosmetics product application modifying the skin colour will be excluded.

Objective 2: Fabrication of custom-made silicon shade guide (4 mm thickness) using silicone material and pigments based on the survey findings: The most prevalent skin tones identified in the population through the survey study will be used. A bespoke shade guide will be created using room temperature vulcanising. Medical-grade silicone (UK) A-2000 addition to factor II (platinum) with excellent elongation properties, Shore A 20 cure hardness, and a silicone elastomer 1:1 cure system will be used, along with intrinsic pigments. Square specimens of silicone with a clear acrylic base, with a thickness of 4 mm, will be fabricated using a metal mold. Maxillofacial silicone specimens will be prepared using clear acrylic as the base and room temperature vulcanising medical-grade silicone with intrinsic pigments. The formulation formula for each shade guide, including the quantity of silicone material and each pigment incorporated, will be recorded.

Objective 3: Develop APDS AI -based digital application using a reference from a broad-spectrum customised maxillofacial shade guide: The customised shade guide with its formulation formula and recorded coordinates will be included in the APDS AI-based digital application. The application will be developed using the Android Studio by the application developer. The mainframe application will analyse images, perform object detection and tracking using Machine Learning (ML) techniques, which is a subset of AI. The distribution details of the broad-spectrum shade guide are provided in (Table/Fig 2). Additionally, a histogram image store and process mechanism will be implemented for further analysis. The ML model will identify the targeted object and segment it into three different segments. Each segment will be analysed for colour shade using the ML object detection API. This analysis will involve capturing a raw image from a mobile camera with minimum pre-set parameters. Image processing applications typically demand more power than other applications since, they process the pixel-by-pixel image with heavy mathematical computation. In addition, image processing uses more memory and is time consuming. Therefore, the authors will optimise the shade identification algorithm to address these concerns. The image processing will be implemented using Android/Linux platforms, Java, XML language, and ML SDK library.

Phase 2

Objective 1: Evaluate and validate the accuracy of the customised silicon shade guide through a spectrophotometer: All shade tabs from a lighter shade to a dark shade will be analysed under a spectrophotometer in hue (amount of colour type), croma (amount of black, red, yellow, white, and blue), and value (amount of darkness and lightness) coordinated will be recorded, and the obtained result will be verified for accurate shade duplication with the coordinates available from the survey.

Objective 2: Evaluation and comparison of the efficacy of the “APDS” AI Based digital app for colour matching by fabricating veneers for participants: Facial silicone facings will be created for participants with light, medium, and dark complexions to test the accuracy of app shade guides based on shade given by the digital application. Three observers (a maxillofacial prosthodontist, a prosthodontist, and a postgraduate student) will visually evaluate the APDS app and assess the colour match. The evaluators will be examined for any colour vision deficiency. Scoring for each will be done on the score sheet. At first sight, each evaluator shown colour match will be identified immediately. Extended time will not permit avoiding misleading due to fatigue. The scoring sheet systems will be clarified as follows: Inconsistent and unsatisfactory, almost similar and agreeable, colour match and satisfaction and colour match perfection.

Anticipated translatory component of research: “APDS” AI-based digital applications may produce better shade identification than the available shade guide system. It will be the first AI-based digital shade guide application to facilitate prosthodontists or technicians to achieve prosthesis smoothly. Users can determine a patient’s skin shade with a touch of a button by taking a photo of the chosen area and matching it with an inbuild shade system. The user will then know the essential shade directly, avoiding the need of a conventional shade guide or digital spectrophotometer because of their difficult accessibility and cost. In addition, it will reduce the need for extrinsic pigmentation.

Statistical Analysis

The data analysis will be done using Statistical Package for Social Sciences (SPSS) version 20.1. (IBM Corporation, Chicago, USA). Descriptive and analytical statistics will be provided. The Shapiro-Wilk test will be used to assess the normality of the data. The Chi-square test for independence will be used to determine whether two variables in a contingency table are connected. It examines if categorical variable distributions differ from one another in a more general way. Cohen’s kappa coefficient will be used to test inter-rater reliability for qualitative (categorical) items (and intrarater reliability). The kappa value will be calculated according to Landis and Koch’s interpretation, with values ranging from 0 to 0.20 indicating no agreement, 0.21-0.40 indicating fair, 0.41-0.60 indicating moderate, 0.61-0.80 indicating considerable, and 0.81-1 indicating nearly perfect agreement. A p-value ≤0.05 was considered as statistically significant.

Discussion

It has been established that prosthetic rehabilitation has helped patients with congenital or acquired maxillofacial abnormalities. Since, 1600 AD, the patients’ physical and emotional health has been traumatised by the functional and aesthetic deficits that result from major surgery. A multidisciplinary strategy can be useful for positive reconstruction. The patient is unsatisfied with a simple physical restoration with a carefully positioned prosthesis. It has become necessary to provide an aesthetically pleasing natural, lifelike prosthesis. Guttal SS et al., developed the shade guide for the Indian population (7). However, due to the limitations of his study in terms of sample size and a smaller number of colours, AI needs to be used to increase the arena of mapping of colour based on colour image pixel, hue, and saturation. Therefore, there is a need to generate a new method that includes high-resolution quality and a more accessible, handy, standardised modality (7). In 2013, Wee A et al., examined 119 people and the effect of race, age, gender, and anatomic areas on skin colour values in a convenience sample stratified by age, sex, and race (10). Analyses revealed five distinct skin colour clusters. They concluded that, the study revealed variances in the blue and yellow axis across gender and age groups and a substantial variance in luminance among gender groups. CE of the five skin shade tabs in the facial shade guide is slightly over human vision’s colour tolerance. On the other hand, this proposed face shade guide may improve the efficiency of attaining an excellent match to human skin for silicone facial prostheses (10).

In 2016, Anitha KV et al., aimed to create 15 circular custom made shade tabs with medical grade, room temperature vulcanising silicone. Based on the yellow, red, and blue hues, the shade guide was divided into three primary groups: I, II, and III. Five well-defined intrinsic pigments were blended precisely to divide each group of distinct values from lighter to darker colours. Four investigators visually examined colour matching to investigate the consent of perfect colour correlation to authenticate the use of the guide. Accordingly, the red and yellow based tone shade tabs harmonised well and had statistically good colour matching. As a result, an inherent silicone shade guide can fabricate maxillofacial prostheses in the Indian population. A transparent colour solution with a specific proportioning of intrinsic pigments is offered to achieve an aesthetic match to skin tone (8). The study by Ranabhatt R et al., colour matching in maxillofacial prosthesis has been studied in the literature (6). 7 of the 15 articles dealt with colouring techniques such as tinting, spraying, milling, and commercial cosmetics. Only one study looked into the role of colour in maxillofacial prostheses. Only one investigation resulted in a silicone shade guide that matched the colour of Indian skin. There needs to be more information describing the optimum way to match the colour for maxillofacial prosthesis construction flawlessly. Colour matching abilities have increased in recent technologies such as spectrophotometers and colourimeters. They concluded that, colour matching is an important phase in manufacturing maxillofacial prosthetics. There are numerous approaches for matching colour to facial skin in maxillofacial prostheses. The practice of colouring has been more exact and time effective since, the introduction of better approaches. According to this comprehensive investigation, the trial-and-error method is the most typical methodology tested in clinical practice for the colour matching facial prosthesis. Although, data on the colour matching facial prosthesis is available, there is no proof that one procedure is superior to the other (6).

After 2019 the digitalisation of shade matching in maxillofacial prostheses started, and new devices like a colourimeter and spectrophotometer got introduced. Mulcare DC et al., studied the applicability of a mobile phone colourimeter in matching natural skin tones with maxillofacial prostheses (4). 10 pigmented maxillofacial silicone elastomer samples were made to simulate a variety of human skin complexions. A test instrument (e.g., Red, Blue and Green (RGB) colourimeter) and a reference device (e-skin spectropolarimeter, a commercially available skin colour measurement device) were used to report colour measurements of these swatches (spectro match, bath, UK). The recorded findings for each parameter were checked against a white and black background at 25 mm, 30 mm, and 35 mm distance of test equipment from the mark. The colourimeter application’s accuracy concerning the colourimeter hardware is diverse based on distance from the mark and backdrop colour. A mobile phone colourimeter software was demonstrated to be a beneficial tool for actualising the data-driven colour matching of a silicone maxillofacial prosthesis. To improve the accuracy and control of variables such as background noise, illumination coherence, and predicting distance, more picture calibration research is needed (4).

In the study by Kurt M et al., a computerised colour matching method was used to test the acceptability of light and dark skin silicone reproductions on 15 light skinned individuals and 15 dark skinned participants (11). The skin colour of these 30 volunteers (all in their 20’s and 30s) was measured using a spectrophotometer and a spectropolarimeter incorporated into a computerised colour matching system. Following the creators’ instructions, silicone skin imitations were created for every participant using the colour compositions offered by the system’s online calculator. CIE L*a*b* (E ab) and CIEDE2000 (E00) colour difference formulas were used to calculate the colour difference between original skin colour measurements and skin replica colour measurements for all patients. To evaluate the instrumental and visual judgments of colour match, three observers (two maxilla-facial prosthodontists and one postgraduate student) visually assessed and graded each silicone replica on a 5-point scale. Statistical calculations from the first skin colour measurements and their silicone replica colour readings show no differences between the dark and light skin complexion groups. The dark and light skin groups, on the other hand, were distinguished (11).

References

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DOI and Others

DOI: 10.7860/JCDR/2023/61326.17991

Date of Submission: Nov 07, 2022
Date of Peer Review: Jan 17, 2023
Date of Acceptance: Mar 03, 2023
Date of Publishing: May 01, 2023

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? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 12, 2022
• Manual Googling: Feb 02, 2023
• iThenticate Software: Feb 21, 2023 (4%)

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