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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
Original article / research
Full Version
Stability of Midline Diastema Closure by Frenectomy and Orthodontic Treatment: A Systematic Review
Correspondence Address :
Dr. Suvetha Siva,
Senior Lecturer, Department of Orthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India.
E-mail: suvethas1@srmist.edu.in
Introduction: Midline diastema is one of the most common aesthetic complaints in mixed and sometimes in permanent dentition stage. High frenal attachment is the major aetiological factor causing midline spacing. Combined frenectomy and orthodontic treatment can be done to close the midline diastema which may also increase the stability and reduce relapse.
Aim: To assess the stability of midline diastema closure by using frenectomy and orthodontic treatment.
Materials and Methods: A systematic review was conducted on clinical trials showing the stability of midline diastema closure using frenectomy and orthodontic treatment, articles were searched from 1995 to 2022. A total of 521 articles were retrieved. Among these 433 articles were screened. The risk of bias was assessed for all the studies included in this review.
Results: A total of five studies were included in the systematic review which had clinical trials showing the stability of midline diastema closure in patients having midline diastema of at least 0.5 mm. Four studies using orthodontic treatment have shown some amount of relapse and one study using orthodontic treatment and frenectomy has shown prominent closure of median diastema.
Conclusion: Closure of maxillary median diastema is more prominent when performed using combined frenectomy and orthodontic treatment than orthodontic treatment alone and the risk of relapse is minimal. However, furthermore clinical studies are required to confirm the stability of midline diastema closure by using orthodontic treatment and frenectomy.
High frenal attachment, Midline spacing, Mixed dentition, Thick frenum
Ay space or gap existing in midline of the dental arch is termed as midline diastema. It can be defined as a space greater than 0.5 mm between proximal surfaces of adjacent central incisors. It is common in primary and mixed dentitions and is considered normal during this stage (1),(2); whereas in permanent dentition, the incidence of midline diastema is not normal and is present in approximately 38% of people (3).
The midline diastema eventually disappears after eruption of permanent maxillary canines (4),(5). This may not occur in some cases due to abnormal frenal attachment resulting in persistent maxillary midline diastema (5). The common causes for midline diastema include transient malocclusion, abnormal frenal attachment, midline pathology, genetic predisposition, supernumerary teeth (mesiodens), missing teeth, odontogenic tumours or cysts, tooth material and arch length discrepancy, abnormal tooth position and habits like thumb sucking, lip or finger sucking (1),(6).
The most common aetiologic factor of midline diastema is abnormal labial frenum attachment. The maxillary labial frenum is a fold of mucous membrane which develops as post-eruptive remnant of the tectolabial band during intrauterine life and connects the tubercle of upper lip to the palatine papilla. Transient midline diastema may be seen in the ugly duckling stage. After eruption of the permanent central and lateral incisors, the erupting permanent canines displace the roots of lateral incisors mesially resulting in transmission of force to the roots of central incisors which also get displaced mesially. This results in distal divergence of crowns of central incisors causing midline spacing. This phenomenon is called as Broadbent phenomenon or the ugly duckling stage (6),(7).
Depending upon the site of attachment of fibre, frenum can be classified as mucosal, gingival, papillary and papillary penetrating (7),(8). High frenal attachment can cause midline spacing. Midline diastema can be diagnosed both clinically and radiographically. This includes taking proper history and clinical examination and checking for presence of pernicious habit. Blanch test is a test used for indicating abnormal frenal attachment. It is performed by pulling the lips upward and outward to see for presence of blanching in the soft tissue palatal to or between the central incisors. Presence of blanch indicates high frenal attachment (5). Measuring the mesiodistal width of teeth and comparing it with the arch length determines tooth material arch length discrepancies. Any discrepancy will also lead to thick frenal attachment. Radiographs like periapical, occlusal and panaromic radiograph helps in diagnosing midline pathology. The normal radiographic image of the suture is V shaped. Periapical radiographs showing notching in interdental bone is a diagnostic feature of thick and fleshy frenum (9).
Management of midline diastema due to abnormal frenal attachment can be done by removal of underlying cause, orthodontic management, and surgical management. Orthodontic management involves using fixed appliances incorporating springs or elastics and removal appliances like finger springs and labial bows. However, relapse of midline diastema occurs twice as much in abnormal frenum compared to normal frenal attachment (1),(10). Combined orthodontic and surgical management can be done for prevention of relapse.
Frenectomy used in correction of midline diastema usually involves complete removal of maxillary midline frenum (6). Various surgical techniques include V-shaped incision, Z-plasty incision and lateral pedicle gingival flap (Miller technique). Frenectomy can also be done using CO2 laser or radiofrequency ablation (4),(11),(12). The stability of midline diastema closure can be increased by performing frenectomy and orthodontic therapy simultaneously (9). Since literature is sparse on the stability of midline diastema after frenectomy and orthodontic treatment, the aim of this study is to determine the stability of midline diastema closure by frenectomy and orthodontic treatment.
This systematic review was conducted in SRM dental college, Ramapuram campus, Chennai, India, in the year 2022, with the registration number (SRMU/M&HS/SRMDC/2022/S/017). For the current review, the PICO question was formulated (mentioned below), and the keywords were deduced. The articles collected from the data base was further scrutinised and included based on the inclusion and exclusion criteria.
The PICO of the review is as follows:
Population (P) includes patients with midline diastema;
Intervention (I) being frenectomy and orthodontic treatment;
Comparison (C) between orthodontic treatment or combined orthodontic treatment and frenectomy;
Outcome (O) includes stability of closure of midline diastema.
Inclusion criteria: Publications of studies in English with full text articles, articles based on orthodontic treatment or frenectomy as one of the treatment modalities, clinical trial studies of patients with maxillary diastema greater than or equal to 0.5 mm and half crown of permanent canines erupted and publications from all years were included in the study.
Exclusion criteria: Articles published in languages other than English, articles for which only abstracts available, case reports, case series, other systematic reviews, meta-analysis which did not compare between frenectomy and orthodontic treatment were excluded from the study.
Search strategy: Published literature on stability of midline diastema closure by frenectomy during or after orthodontic treatment which includes databases such as PubMed, Scopus, Cochrane and Google Scholar, from the year 1995 to 2022 were taken to study review. A literature search to collect relevant data was performed using the main keywords (Midline Diastema AND Frenectomy AND orthodontic treatment AND Stability). (Table/Fig 1) shows the flow diagram of the reports that were identified, screened, assessed for eligibility, excluded and included in the review.
The tool used to assess risk of bias of all the studies was done according to a study by Cozza P et al., which categorised the quality of the study as high, medium, and low accordingly (13).
The search yielded 521 articles and 433 were screened and assessed independently. A total of 419 articles were excluded which were irrelevant. Out of the remaining 14 full text articles, five articles were included and studied for this systematic review (1),(2),(3),(7),(8).
(Table/Fig 2) shows data collection and quality analysis of the included studies. All the five trials were performed in individuals presenting with midline diastema of at least 0.5 mm. In all the five studies orthodontic treatment were used except one study which uses both orthodontic and frenectomy for midline diastema closure. (Table/Fig 3) shows the risk of bias in all the studies based on the outcome.
Midline diastema is a common aesthetic complaint in the mixed and sometimes in permanent dentition stage. It is normal to have a diastema in the early and late mixed dentition stages, but it eventually closes during further development. Midline diastema could be transient or it can occur due to midline pathology, genetic predisposition, supernumerary teeth (mesiodens), missing teeth, odontogenic tumours or cysts, tooth material and arch length discrepancy and oral habits. The high frenal attachment was the major aetiological factor causing midline spacing. Treatment of diastema varies and it requires correct diagnosis of its aetiology and early intervention relevant to the specific aetiology. If the diastema is due to transient malocclusion, no treatment is usually initiated as it spontaneously closes after the eruption of permanent maxillary canines (9).
Management of midline diastema due to abnormal frenal attachment involves orthodontic treatment and surgical management that is frenectomy. Orthodontic treatment alone may not provide stability if the underlying cause is due to abnormal frenum, therefore it can be combined with frenectomy to prevent relapse of midline diastema closure. This research yielded several studies which includes management of midline diastema by using either orthodontic treatment or frenectomy or both [1,2].
In this systematic review the stability of midline diastema closure by using either orthodontic treatment or frenectomy or both has been reported. Shashua D and Artun J has discussed relapse after orthodontic correction of maxillary median diastema on 96 individuals having 0.5-5.62 mm diastema with mean age of 10.9-53.5 years and concluded that about 50% orthodontic patients having median diastema larger than 0.5 mm experience relapse and that abnormal labial frenum is associated with initial width of diastema and is not a risk factor for relapse (1).
Morais JF et al., has discussed the post-retention stability after orthodontic closure of maxillary interincisor diastemas in 30 patients (17 females, 13 males) out of which 18 were Class-I and 12 were Class-II, according to Angle’s classification of malocclusion (2). He concluded that midline diastema relapse was statistically significant and occurred in 60% of the sample. Only initial diastema width and overjet relapse showed association with relapse of midline diastema.
Carruitero MJ et al., discussed the stability of maxillary interincisor diastema closure after extraction orthodontic treatment involving 24 patients (15 females, 9 males), out of which eight were Class-I and 16 were Class-II, according to Angle’s classification of malocclusion and concluded that maxillary interincisor diastema closure showed no statistically significant relapse after orthodontic treatment with premolar extractions (3). Clinically, significant stability for maxillary interincisor diastema closure was 72.22% and, specifically, for interincisor midline diastema closure, it was 91.67%.
Suter VG et al., discussed whether the maxillary midline diastema close after frenectomy in 59 patients (7). He has divided the patients into Group-A: 11 patients with diastema <2 mm, Group-B: 41 patients with diastema 2-4 mm and Group-C: 7 patients with diastema >4 mm among which 31 (52.5%) patients had underwent frenectomy and active orthodontic treatment, 27 (45.8%) patients underwent frenectomy. For one patient information consent regarding the orthodontic treatment was not available. He concluded that closure of maxillary midline diastema with prominent frenum is more predictable with frenectomy and orthodontic treatment than with frenectomy alone.
Sullivan TC et al., has discussed a post-retention study of patients presenting with a maxillary median diastema which involves 35 patients aged 9.1-15.4 years with diastema 0.9-3 mm (8). He concluded that abnormal frenum and intermaxillary clefts are not risk factor for relapse. Proclination of maxillary incisors was the only post-treatment change associated with relapse.
Limitation(s)
No Randomised Controlled Trials (RCTs) were conducted and lesser studies regarding the comparison of two procedures used in this review. However, further clinical studies with proper randomisation must be conducted to assess the midline diastema closure and its stability using different methods.
Closure of maxillary median diastema is more prominent when it is performed by using combined frenectomy and orthodontic treatment than orthodontic treatment alone. Also, abnormal frenum is not a risk factor for relapse. The stability improves when frenectomy is done as a combination with orthodontic treatment. However, furthermore clinical studies are required to confirm the stability of midline diastema closure by using orthodontic treatment and frenectomy.
DOI: 10.7860/JCDR/2023/60342.17958
Date of Submission: Sep 20, 2022
Date of Peer Review: Nov 24, 2022
Date of Acceptance: Mar 14, 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
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• iThenticate Software: Mar 13, 2023 (20%)
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