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On Sep 2018

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

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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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.
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Dr. Mamta Gupta
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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.

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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.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2024 | Month : April | Volume : 18 | Issue : 4 | Page : ZC09 - ZC11 Full Version

Awareness Regarding the use of Clear Aligners as an Orthodontic Treatment Modality among the General Population of Maharashtra, India: A Cross-sectional Survey

Published: April 1, 2024 | DOI:
Renuka Pawar, Tanya Prasad, Chanamallapa R Ganiger, Sandesh Phaphe, Yusuf Ahammed, Pratap Mane, Seema Patil

1. Professor, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 2. Postgraduate Student, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 3. Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 4. Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 5. Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 6. Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India. 7. Assistant Professor, Departme

Correspondence Address :
Tanya Prasad,
Apoorva Apartments, Koyna Vyasath, Karad-415539, Maharashtra, India.


Introduction: Fixed orthodontic treatment has been the standard method to treat malocclusions for decades; however, the number of adults seeking more inconspicuous ways to enhance their smiles has significantly increased. This trend has led to the rising popularity of clear aligners among the general population, hailed as the ‘invisible treatment’ for correcting misaligned teeth.

Aim: To assess the level of awareness among residents of Maharashtra regarding clear aligners.

Materials and Methods: A cross-sectional study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (KVV) Karad, Maharashtra, India with a sample size of 423 participants. An online survey on awareness and perceptions of clear aligners among the general population of Maharashtra was carried out for one month through the dissemination of an online questionnaire. The questionnaire was administered using Google Forms and consisted of 12 closed-ended questions. The online data was collected and analysed while assessing its content validity.

Results: The mean age of the study participants was 28.4±5.88 years. According to the survey, 203 (47.99%) participants had visited an orthodontist, with 87 (43.03%) receiving clear aligner recommendations as a treatment option. Notably, 266 (62.88%) were already familiar with clear aligners, and 268 (63.36%) considered them to be an effective treatment.

Conclusion: The study findings indicated that 62.88% of participants had prior knowledge of clear aligners, while only 47.99% had visited an orthodontist.


Clear trays, Invisalign, Modern orthodontic treatment, Removable orthodontic appliances

The current world of social media has particularly highlighted the importance of aesthetics and looks across all walks of life (1). Among the general population, there has been a significant increase in the number of people seeking convenient and less noticeable methods to attain the smile they desire (2). Traditional orthodontic treatment, while considered the standard, has also been associated with patients experiencing a compromise in facial aesthetics during treatment, which often dissuades them from choosing orthodontic treatment despite their desire to achieve better teeth alignment (3). This trend has led to more patients searching for aesthetic tools and methods to enhance their smiles. Therefore, clear aligners have become increasingly popular as an orthodontic treatment modality that helps patients overcome these obstacles.

Clear aligners were launched near the end of the 1990s and have since been viewed as a comfortable alternative to traditional multibracket orthodontic therapy (4). Constructed from thin transparent plastics that snugly fit over all surfaces of the teeth, these aesthetic removable trays have undergone numerous modifications with the addition of different strategies, such as divots, attachments, auxiliary tools, and ridges, allowing aligners to address multiple malalignments (4). The rapid technological improvements in the production and design of aligners have led to an increase in the number of complexities that can be addressed through this therapeutic treatment (4),(5).

Not only are aligners popular among adults, but they are also a popular choice among teenagers looking for less conspicuous methods than fixed orthodontic brackets. Aligners are not only more aesthetic than traditional brackets, but they also help patients maintain better oral hygiene during the course of orthodontic treatment (6),(7). This reduces the chances of patients developing discolourations, white spot lesions, and tooth decay, which are often considered the disadvantages of fixed appliances. Additionally, clear aligners are reported to cause less pain while reducing the number of appointments and emergency visits (8),(9).

However, the popularity of clear aligners has been particularly noted in third-tier or metro cities. There is a lack of data regarding awareness of orthodontic treatment among the general population living in smaller towns in India. This is highlighted by the fact that despite the numerous advantages of clear aligners, several sectors of India still remain unaware of the recent advancements made in the field of dentistry (9).

The present study seeks to address a notable research gap, as previous investigations have primarily focused on awareness levels among different populations regarding various orthodontic modalities. However, none have specifically examined the awareness levels within the general population of Maharashtra regarding clear aligners as a therapeutic orthodontic treatment (9),(10).

Against this backdrop, the study aimed to assess the awareness of the general population of Maharashtra, aged 15 to 45, regarding the use of clear aligners as a modern orthodontic treatment modality. The primary objective was to gauge awareness. The present research aimed to bridge existing knowledge gaps and provide valuable insights into the evolving landscape of orthodontic care.

Material and Methods

In the present cross-sectional survey conducted at the Department of Orthodontics and Dentofacial Orthopaedics, School of Dental Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India,, data collection spanned from July 2023 to August 2023. The study was reviewed and approved by the Institutional Ethics Committee Krishna Vishwa Vidyapeeth “Deemed To Be University”, Karad, with reference number KVV/IEC/05/2023.

Sample size calculation: The following formula was used to calculate the sample size [11,12]:

Level of significance (α error)=5%, Power=80%, Type of test=two-sided.

The formula for calculating sample size is:

n=(Z1)2 {P(1-P)}/d2.

Assuming all factors, the minimum sample size came to be around 385 subjects, increasing to 423 subjects in the present study.

Inclusion criteria:

• Participants residing in Maharashtra
• Males or females with age group between 15-45 years

Exclusion criteria:

• Temporary residents
• Dental students
• Population below the age of 15 years.

Study Procedure

A questionnaire survey was prepared online using Google Docs by a panel of five qualified orthodontists and consisted of 12 close-ended questions about knowledge related to clear aligners, public perception, and reasons for opting for the selected treatment. Lawshe’s method was used for content validity using judgements from a panel of five qualified orthodontists from KVV, Karad.

The questionnaire was distributed among 453 participants through various channels such as personal emails and communications through the phone. Each contributor was requested to fill out a consent form before proceeding with answering the questionnaire survey. The Google form link provided to every participant was filled and submitted by them online. A follow-up reminder was sent via telephonic message to non repondents after one week. The questionnaire was made available to the participants over the course of one month from July 2023 to August 2023. The participants were categorised using the convenient sampling method.

Statistical Analysis

The Statistical Package for Social Sciences (SPSS) version 22.0 was used to evaluate the data descriptively and inferentially. At the end of one month, the online data was collected and analysed while assessing its content validity.


The present survey recorded a total of 423 responses collected from Maharashtra, with the mean age being 28.4±5.88 years. The findings revealed a multifaceted perspective on orthodontic treatment preferences. Notably, 203 (47.99%) of the population sought orthodontic consultation. An intriguing 77 (38.06%) were advised clear aligners. When it came to comfort, 355 (83.92%) of participants opted for the more comfortable treatment option over the fixed orthodontic approach. Moreover, prior to an orthodontic visit, a remarkable 266 (62.88%) of the population had prior knowledge of clear aligners (Table/Fig 1).

The survey findings revealed a divergence of perceptions among participants regarding the cost of clear aligner treatment, with 292 (69.03%) considering it to be on the higher side. Interestingly, only 139 (32.86%) expressed a willingness to invest more in clear aligner therapy, while 76 (17.97%) were unsure. A total of 325 (76.83%) of participants displayed a clear preference for clear aligners over traditional fixed orthodontic treatment. This preference underscores a general inclination towards clear aligners, despite the reluctance to incur higher costs. In summary, 245 (57.92%) of participants thought clear aligner therapy was a superior choice to traditional braces.


The results of the present study showed that less than 50% of the participants had made a prior visit to an orthodontist. Devishree RA and and Felicita AS reported similar results regarding awareness of orthodontists (13). An 83.92% of the participants would choose to opt for a more comfortable form of treatment over fixed orthodontic treatment. In contrast, a minority of 11% of people did not opt for it. Moreover, 62.88% of the population had heard of clear aligners before visiting an orthodontist, most of whom had learned about the therapeutic modality via advertisements and social media, compared to less than 20% being made aware of clear aligners through friends and family members. All of these results were similar to those obtained by Alharbi IS et al., where 28.5% of the population learned about aligners via social media, but in the geographical location of Saudi Arabia (14). The reason for this indicates a recent increase in media awareness regarding clear aligners through advertisements via different platforms such as social media.

The current study divulged that a majority of 63.36% of people believe that any kind of dental malalignment can be corrected using clear aligners. This result is in accordance with a study conducted by Alharbi IS et al., in the general population of Saudi Arabia, where 74.5% of people believed that clear aligners are highly effective (14).

The majority, 69.03% of people, believed that the treatment cost of aligners was higher than fixed orthodontic treatment. The current study shows a more positive response rate than previous literature, which reported a 55% willingness (15). However, only a minority of 32.86% of the population showed a willingness to pay extra for being treated with clear aligners, contradictory to the findings in the study by Varghese R et al., (16). This result could indicate that an individual’s socio-economic status is correlated with the choice of orthodontic treatment they would select.

A 76.8% of the population said they would prefer being treated with clear aligners rather than opting for traditional braces, with only 16% choosing fixed orthodontic treatment between the two treatment methods. This indicates a positive acceptance of clear aligners as a new treatment method amongst the general population. These results are supported by studies conducted in different populations over different geographical locations, such as Chennai (16).

In the present study, 54.37% of people would prefer to opt for clear aligners based on the belief that aligners provide a more aesthetic form of orthodontic treatment rather than fixed therapeutic treatment. This addresses the primary anxiety of people while going for orthodontic treatment, which stems from uneasiness during smiling due to the visibility of metallic braces. Ziuchkovsku JP et al., reported metal brackets as being considered unattractive, with a majority opting for clear aligners as the more aesthetic option (17).

Previous literature has reported pain as a significant reason for patient non compliance during orthodontic treatment. This also leads to missed appointments and is considered to be the most common drawback of fixed treatment (18). To corroborate the aforementioned statement, the study found that 38.7% of the participants would opt for aligners over fixed therapy under the impression that aligners would result in less pain when compared to traditional braces. A 57.92% of the population chose clear aligners as a better orthodontic treatment method over a fixed treatment modality.


Some specific limitations of the study included the cross-sectional design of the study, as there is no indication of a time-based link between exposure and result. Another limitation presented was geographical restrictions. Further studies could be performed with a larger sample size and different ethnicities, which could lead to more awareness and better results.


To summarise, the current study’s findings suggest that 76.83% of the population would opt for clear aligner therapy over traditional braces due to primary reasons of aesthetics and comfort. These findings indicate a notable level of awareness and acceptance of clear aligners among the general population in Maharashtra. The shift towards inconspicuous orthodontic treatments, as indicated by the familiarity and positive perceptions of clear aligners, indicates an evolving preference within this demographic. The prospectus for future studies could involve using the present survey as a template for shedding light on the awareness among the general population regarding the limitations of clear aligner therapy.


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Tables and Figures
[Table / Fig - 1]
DOI and Others

DOI: 10.7860/JCDR/2024/68024.19255

Date of Submission: Oct 12, 2023
Date of Peer Review: Dec 01, 2023
Date of Acceptance: Feb 16, 2024
Date of Publishing: Apr 01, 2024

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

• Plagiarism X-checker: Oct 10, 2023
• Manual Googling: Dec 07, 2023
• iThenticate Software: Feb 14, 2024 (7%)

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