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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Multidisciplinary Approach in the Management of Maxillary Anterior Region Dental Trauma: A Case Report
Correspondence Address :
Dr. Rajmohan Y Shetty,
Professor, Department of Paediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Deralakatte, Mangalore-575018, Karnataka, India.
E-mail: rajmohanshetty4@gmail.com
Traumatic Dental Injuries (TDIs) to the maxillary anterior teeth occur frequently in paediatric and adolescent populations. Prompt diagnosis, correct treatment planning, and a multidisciplinary approach are pertinent aspects of successfully managing multiple TDIs in a patient. The present case report of a 13-year-old female patient describes a multidisciplinary approach necessary to successfully manage dental trauma of an avulsed maxillary central incisor and a complicated crown fracture involving the maxillary left lateral incisor in an adolescent. The complicated crown-root fracture was treated with endodontic therapy, followed by the placement of a fibre-reinforced post, core build-up, and the cementing of a porcelain-fused-to-metal crown. Bone grafting with a mandibular symphysis block autograft, followed by prosthetic rehabilitation with transitional implants, was performed to restore the aesthetics, form, and function of the avulsed maxillary central incisors. The use of osseointegrated implants has gained wide acceptance in the adult population. However, due to concerns regarding growth, their use in the paediatric population is not as common. This accounts for a scarcity of clinical cases reported in the literature. There are no established guidelines for the placement of implants in growing patients. Thus, authors believe that the present case report contributes to the literature on this subject. The treatment of this complex, multi-dental injury in the maxillary anterior region of a young female required a holistic approach with a step-wise progressive, long-term treatment plan. Traumatic injuries in adolescent patients can adversely impact their oral health-related quality of life if not treated correctly.
Avulsion, Bone grafting, Complicated crown fracture, Transitional implants
A 13-year-old female patient, accompanied by her parent, presented to the Department of Paediatric and Preventive Dentistry with a chief complaint of missing and fractured upper anterior teeth due to trauma one month ago. Further history revealed that the patient had fallen from her bicycle, resulting in trauma to the maxillary anterior region. The maxillary central incisors (11 and 21) were lost at the accident site. The medical history was unremarkable.
Clinical examination revealed the absence of the maxillary central incisors (11 and 21) and a horizontally complicated crown fracture with the maxillary left lateral incisor (22) (Table/Fig 1). No mobility, tenderness on percussion and palpation, or response to electric and cold pulp tests were observed with tooth 22. Radiographic examination showed the absence of teeth 11 and 21 and a horizontal crown fracture (involving enamel, dentin, and pulp) with significant loss of crown structure in tooth 22. A diagnosis of avulsion was made for teeth 11 and 21, with a complicated crown fracture in tooth 22.
To address the immediate aesthetic concerns, prosthetic rehabilitation of the missing teeth 11 and 21 involved fabricating a removable partial denture for the patient (Table/Fig 2). Endodontic therapy was started and completed for tooth 22 during the same visit (Table/Fig 3).
During the second visit, scheduled one week later, postspace preparation using Peeso reamer #3 was performed, followed by cementation of a fibre-reinforced post and core build-up in tooth 22. Subsequently, tooth 22 was prepared for a porcelain-fusedto-metal crown (Table/Fig 4). The crown was cemented during the subsequent visit, scheduled one week later (Table/Fig 5).
Considering the patient’s age, transitional implants were recommended as part of the treatment plan. A three-dimensional radiographic image {Cone Beam Computed Tomography (CBCT)} of the area of interest revealed a concavity on the buccal aspect of tooth 21 with insufficient buccolingual alveolar width (2.13 mm) for implant placement (Table/Fig 6).
A bone grafting procedure using a block graft from the mandibular symphysis (autograft) was planned. The procedure and expected outcomes were explained to the patient and her mother, and written consent was obtained. Local anaesthesia (2% lignocaine hydrochloride with epinephrine 1:200,000) was administered at the recipient and donor sites. At the recipient site, a horizontal incision was made from tooth 22 to tooth 12 at the mucogingival junction using a No. 11 blade. A full-thickness mucoperiosteal flap was raised, and the extent of the defect was assessed using a probe (Table/Fig 7)a.
A vestibular incision was made 1 cm beyond the mucogingival junction, reaching the distal regions of the lateral incisors. This was followed by vertical relieving incisions on either side, and a full-thickness mucoperiosteal flap was elevated toward the base of the mandible (Table/Fig 7)b. The size of the graft was determined based on the measured defect size.
A round osteotomy bur and copious saline irrigation were used to outline the graft, which measured 6 mm in width, 4 mm in height, and 2 mm in thickness. The superior border of the graft was positioned 5 mm below the apex of the mandibular incisors to avoid accidental damage to the tooth roots during the osteotomy (Table/Fig 7)c. The osteotomy marks were joined using a fissurotomy bur, with continuous saline irrigation. A periosteal elevator and flat bone chisel were employed to separate the graft from the surrounding 5bone (Table/Fig 7)d. Decortication and perforation of the recipient site were performed to enhance the revascularisation process and improve the longevity of the graft. A pilot hole was drilled through the graft placed on the recipient site to facilitate the insertion of a 1 mm diameter and 6 mm long titanium screw for stabilisation, without resistance (Table/Fig 7)e,f.
Platelet-Rich Fibrin (PRF) was prepared by drawing the patient’s blood and centrifuging it at 12,000 rpm for 10 minutes (Table/Fig 7)g (1). The PRF and bone grafting materials (Osseograft, Demineralised Bone Matrix (DMBM)-xenograft) were placed around the autogenous bone graft to fill the remaining gaps. A collagen membrane {PerioCol-Guided Tissue Regeneration (GTR)} was used to secure the graft material in position for guided bone regeneration (Table/Fig 7)f. Interrupted sutures were placed in the donor and recipient sites (Table/Fig 7)h,i. The patient was prescribed analgesics, antibiotics, a soft diet, and an antimicrobial mouth rinse (0.12% chlorhexidine) and scheduled for suture removal after one week. The suture removal was performed without complications, and the healing process was uneventful. Regular follow-up appointments were scheduled, and a CBCT scan was taken at six months to assess the changes in the alveolar bone at the grafting site. An increase in the buccolingual width (from 2.13 mm to 5.91 mm) and density of the alveolar bone indicated new bone formation (Table/Fig 8).
Transitional implants were placed using a crestal incision in the regions of teeth 11 and 21. A mucoperiosteal flap was raised, and the previously inserted titanium screw used for graft stabilisation was removed (Table/Fig 9)a. Two implant lengths of 5 mm were drilled equidistant from each other, and adjacent teeth were drilled into the alveolar bone (Table/Fig 9)b. One-piece machined implants (2.5×11 mm Provi™ Myriad implant system, Straumann) were implanted in the drilled slots, and a wrench was used to complete the final torquing of the implants [Table/Fig-9c]. Bone graft material (Osseograft, DMBM-xenograft) was placed around the implants, and interrupted sutures were used for closure (Table/Fig 9)d,e. The patient returned after one week for the cementation of acrylic crowns (Table/Fig 9)f.
The patient is currently on a three-month follow-up schedule and has completed nine months of follow-up since implant placement (Table/Fig 10).
Traumatic tooth loss can result in alveolar resorption due to bone loss during the traumatic event or resorption of the alveolar crests after intraosseous triggering of the periodontal ligament apparatus (2). It is critical to repair these defects in order to prevent further ridge loss and degeneration (3). Removable partial dentures are the treatment of choice for substituting lost anterior teeth; however, they have the disadvantage of contributing to residual alveolar resorption (4). Thus, the emphasis of treatment methods has shifted to other options such as
implants.
Bone-implant contact can occur through fibro-osseous integration or osseointegration (5). Definitive implants used in the adult population show osseointegration with the alveolar bone. However, they are contraindicated in the active growth stage as they are fixed to the bone and do not adjust with the growing bone. This can lead to occlusal discrepancies between the level of the implant crown and adjacent teeth (6).
Transitional implants, on the other hand, have fibro-osseous integration, which allows for easy removal in the future once the patient’s growth is complete. They can be replaced without major deleterious effects due to their altered bone-implant contact (7).
Literature on the use of implants in the paediatric population is scarce and mainly focuses on children with conditions such as Ectodermal Dysplasia (ED), syndromes associated with tooth agenesis, and trauma (8). Prosthetic rehabilitation using implant-supported overdentures is often required for patients with ED who have anodontia, hypodontia, or tooth agenesis (9). Placement of implants in patients with ED has shown high predictability and positive clinical results. This includes improvements in masticatory capacity, quality of life, and phonetics, leading to increased self-esteem and social acceptability (10). Transitional implants have an overall success rate of 89.8%, with the highest survival rate observed in the mandibular anterior region (11).
Transitional implants typically have a diameter of 1.8 to 2.8 mm and a length of 7 to 14 mm. They are mainly made of commercially pure titanium, which may undergo surface treatment or machining to enhance bone-to-implant contact (6). Transitional implants provide enhanced retention, stability, and support for implant-supported fixed prostheses. They are used when immediate loading is not recommended, allowing for a healing interval before definitive implants can osseointegrate (12). In addition to being cost-effective, they are simple, quick, easier to place, and provide immediate restoration of aesthetics, which can have psychological benefits. High success rates of 96.6% have been reported when extra-narrow diameter implants are placed in adolescent patients; no discrepancies were noted in the adjacent natural teeth and implant crown level (13).
The presence of sufficient bone is the primary requirement for dental implant placement. The use of reconstructive procedures to augment alveolar bone is a favoured choice for achieving the necessary alveolar density and thickness before the insertion of dental implants (definitive/transitional) (14). There are numerous grafting methods available; however, autogenous grafts are regarded as the gold standard because they have a lower chance of graft rejection and tremendous osteoconductive and osteoinductive properties (15). Intraoral donor graft sites are preferred as they reduce the morbidity in graft extraction while requiring shorter surgical and analgesic time. The mandible is an intramembranous cortical bone that provides better volume steadiness, less postoperative resorption, and increased revascularisation and healing (16). Block grafts can be extracted from anatomical regions, and the symphysis allows easy access, a greater volume of bone, and minimal discomfort (17). PRF is a dense fibrin scaffold consisting of platelets (97%) and leukocytes that release growth factors and help maintain the local availability of progenitor cells at the surgical site, thereby assisting in bone regeneration (18).
Preservation of traumatised teeth/tooth through more conservative approaches such as re-implantation, splinting, fragment reattachment, and endodontic procedures is desirable. Failure of early treatment of TDI can result in a poor prognosis necessitating extraction of the teeth. In such scenarios, prosthetic rehabilitation using mini-implants/transitional implants may be a suitable option in growing children (19). Immediate placement of transitional implants into fresh extraction sites following dental trauma in paediatric adolescent patients has also been shown to be a predictable treatment strategy with a high survival rate of 95.7% over a three-year follow-up (20).
Traumatic injuries in adolescent patients can have a significant impact on their oral health-related quality of life. Prompt diagnosis, treatment planning, and a multidisciplinary approach are essential for managing multiple traumatic dental injuries in a single patient. While there are no established guidelines for the placement of implants in growing patients, the consideration of this treatment modality should be approached with caution. Bone grafting procedures, where indicated, can be an important factor in the success of subsequent surgical phases of therapy, resulting in effective and aesthetically pleasing outcomes.
DOI: 10.7860/JCDR/2023/66271.18438
Date of Submission: Jun 27, 2023
Date of Peer Review: Aug 18, 2023
Date of Acceptance: Aug 29, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 30, 2023
• Manual Googling: Aug 19, 2023
• iThenticate Software: Aug 28, 2023 (9%)
ETYMOLOGY: Author Origin
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