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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
Dentistry
Full Version
Treatment of Black Triangle by using a Subepithelial Connective Tissue Graft
Correspondence Address :
Jaideep Mahendra, MDS., Ph.D., PGDHM.,
Professor, Dept. of Periodontology,
Meenakshi Ammal Dental College, Maduravoyal, Chennai,
Tamil Nadu, India
Phone: +91- 9444963973
E-mail: jaideep_m_23@yahoo.co.in
One of the most difficult and elusive goals of periodontics in the field of reconstruction, regeneration and esthetic aspect of periodontal therapy is the surgical reconstruction of the lost interdental papilla. Loss of interdental papilla could result in patient complaints such as phonetic problems, food impaction, functional problems and esthetic concern. It is clinically represented by open embrasures and is often referred to as the “black triangle”. Periodontal plastic surgery offers both surgical and non surgical approaches in the treatment of “Black triangle”. This case report demonstrates complete reconstruction of the lost interdental papilla following a semilunar coronally repositioned papilla technique with 6 months follow-up.
Black triangle, Subepithelial connective tissue graft,Inter-dental papilla, Papilla reconstruction.
Introduction
One of the major aesthetic challenges in periodontal plastic surgery is related to the ability of rebuilding the lost papilla in the maxillary anterior segment. Absence of the papilla with opening of the black spaces result in ‘Black triangles’ and they are one of the most important aspects of the decision making process of a clinician. This condition may create aesthetic impairments and food impactions (1),(2).
The common causes of the loss of the inter-dental papilla are midline diastema, diverging roots, tooth extractions, traumatic interproximal oral hygiene procedures, abnormal crown forms and periodontal diseases (1).
Several surgical and non-surgical techniques have been proposed to treat soft tissue deformities and to manage the inter-proximal space. The non-surgical approaches are orthodontic, prosthetic and restorative procedures. They modify the interproximal space, thereby inducing modifications of the soft tissues. The surgical techniques aim to recontour, preserve or reconstruct the soft tissue between the teeth and the implants (1).
This case report highlights the importance of the inter-proximal papilla and it’s clinical significance and the progress of the papilla augmentation, based on the use of a sub-epithelial connective tissue graft for the treatment of the “Black triangle”.
This case was undertaken in the Department of Periodontology at the Meenakshi Ammal Dental College and Hospital, Chennai, India. A 21 year old patient with the class I loss of the inter-dental papilla (3) in the maxillary anterior teeth, with the distance between the bone crest and the Contact point as ≤ 5mm and the height of the inter-dental papilla as < 4mm, was selected for the treatment (Table/Fig 1). The patient had normal alignment of the teeth in the maxillary arch, he was a non smoker and maintained good oral hygiene and no proximal caries or improper restoration werepresent with respect to the site.
The Presurgical Protocol
The treatment protocol was explained to the patient and an informed consent was obtained. After the phase one therapy, the clinical parameters such as the Papilla Index Score and the Height of Interdental Papilla were measured on the 0th-day of the surgery (baseline) and postoperatively on the 90th day and the 180th day.
The Papilla Index Score (Nemcovsky CE 2001) (4)
PIS 0: No papilla was present and there was no curvature of the soft tissue contour. PIS 1: Less than half the papilla height was present as compared to that in the proximal teeth; a convex curvature of the soft tissue contour was observed. PIS2: At least half the papilla height was observed, but it was not in complete harmony with the inter-dental papilla of the proximal teeth. PIS 3: The papilla filled the inter-proximal embrasure to the same level as in the proximal teeth and it was in complete harmonywith the adjacent papilla.
Height of the Inter-dental Papilla (McGuire MK et al 2007) (5)
The height of inter-dental papilla was determined according to McGuire MK et al (2007) (7). In this procedure, the inter-dental papilla was anaesthetized with 2% lignocaine hydrochloride. A William’s periodontal probe was used to measure the distance between the bone crest to the apical end of the contact point (H). Loss of the papilla was determined by measuring the distance between the tip of the inter-dental papilla to the apical end of the contact point (H1). Then, the height of the inter-dental papilla (H2) was determined by substracing H1 from H.
The Surgical Technique Preparation of the Recipient Site The surgical area was anaesthetized with 2% lignocaine hydrochloride which contained 1:2,00,000 adrenaline. A semilunar incision was made 3mm apical to the mucogingival junction facial to the inter-dental area, followed by a pouch like preparation towards the inter-dental area (Table/Fig 2). Intra-sulcular incisions were made around the necks of the adjacent teeth to free the connective tissue attachment from the root surface, to allow the coronal displacement of the gingivo-papillary unit (Table/Fig 3).
Obtaining the Graft from the Donor Site The sub-epithelial connective tissue graft was harvested from the palate (Table/Fig 4), following a “trap door” flap design (6). A No. 15 B.P. blade was used to make a partial thickness horizontal incision, about 3mm apical to the gingival margin of the first premolar, extending towards the first molar. Two vertical incisions were made mesiodistally (Table/Fig 5). A tissue forcep was used to lift the prepared palatal flap edge. It was reflected towards the centre of the palate and the underlying connective tissue was exposed. An incision which was perpendicular to the bone was made around the edge of the connective tissue, facilitating its reflection from the bone. A small periosteal elevator and an Orban’s knife were used to reflect the connective tissue which was harvested. After harvesting the graft, the wound was closed by using 4-0 black silk sutures.
Transferring and Immobilizing the Graft The donor sub-epithelial connective tissue graft which was harvested from the palate was tucked in and pushed coronally within the prepared pouch to support and provide bulk to the coronally positioned interdental papilla (Table/Fig 6). The gingivopapillary unit was then sutured (Table/Fig 7), a tin foil was placed over the surgical site and a periodontal dressing was applied. The patient was prescribed analgesics (Ibuprofen 400mg bid for 3 days) and 0.2% chlorhexidine digluconate mouthrinse twice dailyfor 2 weeks.
Follow Up Post-operatively, the patient was instructed to rinse the mouth with 0.12% chlorhexidine mouthwash for 10 days and to refrain from flossing or interdental brushing for 4 weeks. The sutures were removed after 10 days (Table/Fig 8).The surgical site was evaluated on follow up visits post-operatively on the 90th and the 180th day. Both the clinical parameters were recorded and the post-operative clinical photographs were taken. For clinical and statistical analyses, the measurements at 0-day (baseline), the 90th day and the 180th day were taken into consideration.
The papilla index score (PIS) of the patient on the day of the surgery was PIS 2. The PIS on the 90th day was 3, which remained the same on the 180th day. Hence, there was an increase of 1 PIS unit in the patient on the 180th day. The height of the interdental papilla was 3mm on the day of the surgery, which increased to 4mm on the 90th day and remained the same on the 180th day. There was an increase of 1mm in the height of the inter-dental papilla from the 0th day to the 180th day. A 100% papilla fill was obtained on the 180th day.
The success and the predictability of any surgical procedure for treating papilla loss is based on the amount of the papilla fill. This procedure is the first of its kind as it records the height of the interdental papilla, in accordance with the method of McGuire MK et al (2007) (5).
In this case, there was a complete fill of the papilla in the site due to the stability of the connective tissue graft and the maintenance of good oral hygiene.
This procedure was employed in accordance with that of Han TJ and Takie HH (1996) (7). A semilunar coronally repositioned papilla was combined with a sub-epithelial connective tissue graft and it was found to be an effective method of achieving predictable and stable results for treating papilla loss. The success of this grafting procedure was mainly due to the dual blood supply from the underlying connective tissue base and the overlying recipient flap. An excellent colour match and a donor site with a closed wound which provided less post-operative discomfort were the advantages of this technique.
The main advantage of using a tunnel or a pouch like design for this case was that it avoided a horizontal or vertical releasing incision, which helped in maximizing the papillary and the lateral blood supply to the submerged connective tissue graft. The atraumatic management of the tissues, respect for the blood supply and avoidance of tension and pressure are critical for the viability of the tissues and the success for the procedure. This flap design maximizes the soft tissue vascularity and the primary wound closure. The sub-epithelial connective tissue graft was procured by the “Trap door” technique, as described by Edel A (1974) (6). The grafted tissue receives a flow of plasma and an ingrowth of capillaries from the periosteum, the underlying connective tissue and the overlying flaps.
The use of a sub-epithelial connective tissue graft for interproximal papilla augmentation offers a reliable solution to an aesthetic problem. The papilla augmentation procedure is relatively easy and it is based on the principles of plastic surgery techniques.
Future research is indicated to examine the total volume of the embrasure space and also in the use of novel methods to measure the treatment effect in such periodontal plastic procedures.
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