Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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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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Dr. Mamta Gupta,
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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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Aug 2018

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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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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

Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3643 - 3647 Full Version

Aesthetic Management Of Proclined Maxillary Central Incisors With All-Ceramic Crowns : A Case Report

Published: December 1, 2010 | DOI:

*Professor and h.o.d , **Professor, ***Reader,**** Senior lecturer. Department of prosthodontics Dasmesh institute of research and dental sciences Faridkot, Punjab, India.

Correspondence Address :
Dr.akshey kumar sharma ,Professor and h.o.d
Department of prosthodontics, Dasmesh institute of research and dental sciences, Faridkot-151203
Punjab, India.
Email: -
Mobileno: - +919814504334


Maxillary anterior crowns provide an exciting challenge to our artistic and technical abilities and call upon our knowledge of the smile design principles of proportion, symmetry, harmony and tooth morphology. Smile rejuvenation can positively impact a patient's self-esteem and emotional health through an improved appearance. Metal-free crowns can allow for highly aesthetic solutions such as colour correction/ matching and allow us to reshape malformed teeth, or reshape teeth which are in incorrect arch positions, to more closely approximate their correct shapes. The development of reinforced ceramics and non-metallic post systems has made possible the generation of metal-free ceramic restorations in severely compromised anterior and posterior teeth. This article will describe a case where all-ceramic crowns were utilized to restore proclined discoloured central incisors.


aesthetics , metal- free crowns , Procera ceramics, anterior crowns

Metal ceramic systems represent a high-strength treatment which is associated with long term success, but they have several disadvantages, mainly in term of aesthetics and biocompatibility. Over the past decade, a number of novel all-ceramic systems have been developed, with the capability of restoring anterior, posterior and multiple units. The search for a new method have driven, in part, by patients who have increasingly high expectations of aesthetic dentistry and who also have concerns about the intraoral biocompatibility of metals.(1) Metal-free crowns can allow for highly aesthetic solutions such as colour correction/ matching and allow us to reshape malformed teeth or reshape teeth which are in incorrect arch positions, to more closely approximate their correct shapes.
Recent developments in dental materials have led to the introduction of a large number of all-ceramic systems for full-coverage restorations. Some systems use a single layer glass-ceramic material (e.g.,Dicor, Dentsply/Chalk;IPS Empress,Ivoclar/Vivadent),whereas others have a dual layer design(In-Ceram,Vident;Porcera,Nobel Biocare).(2) Further improvements in high strength all-ceramic technology have been achieved with the advent of computer aided design and milling (CAD/CAM) systems. The Procera system which was first introduced in 1993, is one such system.(3) This type of all ceramic crowns resists fracture during function or parafunction, both in the anterior and posterior regions, even under high stress.4
The design and manufacture of this restoration involves optical scanning and digitalizing of the dies which are created from a master impression of the prepared teeth and cores, to precisely duplicate the margins of the tooth preparation. The scanned 3-dimentional images of the die are then used to design the substructure, which is prompted by the computer software (CAD). The CAD unit is linked to a robotic CAM centre, which creates a coping to the design specifications.(1)
The clinical evaluation of all-ceramic crowns have been promising and a success rate of 98.4% over a period of 2- 3.5 years has been reported.(3) Recently, a 100% satisfaction rate among patients who were treated with all-ceramic crowns has been reported.(4) The following case report describes the aesthetic repositioning and restoration of maxillary central incisors with the Procera all-ceramic crowns.

Case Report

A 38 years old woman who was in good health was referred because her maxillary central incisors were protruded labially and were discoloured. She wanted an immediate aesthetic treatment to improve her looks and smile.[Table/Figure 1] (Table/Fig 2) During the treatment planning session, the patient was given the option of orthodontic treatment, since she also had spacing between her maxillary anterior teeth or endodontic treatment followed by metal-free restorations. Since she did not have any objection about the spacing between her anteriors and wanted to maintain the natural spaces, she opted for metal-free restorations as she wanted the central incisors to be corrected only and chose to have the two central incisors restored by Procera Alumina system.

The occlusion was analyzed preoperatively, both clinically and with the aid of mounted models on a semi-adjustable articulator. A diagnostic wax-up was completed and modified at the chairside with the patient’s input and the final form of the new restorations was deemed to be aesthetically satisfactory.

After the endodontic treatment was completed with 11 and 21 glassix fibre post ( H Nordin SA, Swiss) with composite core ( Multicore HB, Ivoclar/Vivadent AG, Liechtenstein) builtup was done palatally to reinforce the crown, since the heavy labial reduction had to be done to bring the teeth into the aesthetic zone. The abutment teeth were prepared by using modified shoulder diomand burs (coarse and superfine) (Table/Fig 3).Retraction was done by placing a small unimpregnated retraction cord (Ultrapack#000,Ultradent,South Jordan,Utah), followed by a second cord(Ultrapack#00,Ultradent) which was impregnated with a haemostatic solution( Hemodent,Ultradent).The final maxillary arch impression was made with a combination of heavy and light viscosity polyvinyl siloxane(Take 1,Kerr). An impression of the opposing arch was also made with irreversible hydrocolloid (Jeltrate, Dentsply/Caulk). An interocclussal record at the maximum intercuspidation and a face bow transfer were obtained. The Shade was determined with a shade guide (Vitapan 3D Master Vita Bad Sackingen, Germany). The patient was given provisional restorations which were made from a bis-acryl material (Intergrity,Dentsply/Caulk,Konstanz, Germany) and was cemented with non-eugenol temporary cement (Tempcem, Equinox Medical Tec. B.V., Holand).

The Procera crowns were returned from the dental laboratory.(Table/Fig 4) [Table/fig 5] The crowns were examined on an uncut solid model for fit and contacts.(Table/Fig 6) In the next appointment, the temporary crowns were removed, both the abutments were cleaned of the temporary cement and the crowns were tried in both individually and together to assess the marginal fit and contacts. The patient previewed and approved the shape and the shade of the crowns. Both the Procera crowns where cemented with a reinforced glass ionomer luting cement (GC Fuji Plus,GC, Alsip,III.)(Table/Fig 7) (Table/Fig 8) (Table/Fig 9) (Table/Fig 10). Postoperative care instructions were given to the patient and recall appointments were scheduled.

(Table/Fig 1) Proclined central incisors labial view.

(Table/Fig 2) Profile view showing discoloured 11.

(Table/Fig 3) Prepared abutments 11&21

(Table/Fig 4) Pre treatment model,showing proclined 11&21

(Table/Fig 5) Post treatment cast with crowns showing degree of repositioning.

(Table/Fig 6) Crowns on cast to check for fit and contacts

(Table/Fig 7) Labial view of restored crowns

(Table/Fig 8). Intraoral view of the crowns

(Table/Fig 9) Profile view of crowns

(Table/Fig 10) Radiograph after final cementation.


All-ceramic systems offer a promising alternative for the restorations of the anterior teeth, and short term clinical evaluations have demonstrated high success rates.(5)(6) The Procera system is a CAD/CAM system which is used for the creation of anterior and posterior crowns and fixed partial dentures . The fabrication of the alumina coping requires the scanning of the die, designing of the substructure with the computer aid, milling of the 99.5% pure aluminium oxide(Al2O3) block and sintering. According to the manufacturer, the substructure has a fracture resistance of about 680MPa. It is veneered with compatible feldspathic porcelain to achieve the desired contour and aesthetics.(2) The marginal gaps of Procera crowns are within the range of clinical acceptance, from36 µm to 83 µm.(7) Because the fitted surface of the aluminous oxide coping is microscopically rough, there is little to be gained by acid etching; the surface treatment of the fitted surface is therefore usually restricted to sandblasting and the application of the silane-coupling agent. A translucent composite cement such as Panavia 21TC (J. Morita) has been suggested as the cement of choice, yielding impressive aesthetic results. This product is supplied with a priming agent, and coupling with a total etch procedure is recommended.(8) Although the sintered aluminum oxide coping is dense, it still permits some light transmission/ translucency for increased aesthetics (unlike traditional Porcelain Fused to Metal crowns). These optical properties give the clinician the ability to mask dark dentinal stains, amalgam buildups and metallic post and cores, without the need for subopaquers. Cementation can be accomplished with a variety of luting agents such as Zinc Phosphate cement, resin cements, or glass ionomer cements. (9) Glass ionomer cement has been advocated for use in cases of suboptimal moisture control. This material has been shown to transmit light somewhat more readily.(6)
Reports from in vitro studies and some clinical trials indicate that the Procera system holds great promise. It yields high-strength copings with veneering ceramics of excellent aesthetic value. Given the metal-free nature of the prosthesis, the incidence of allergic reactions among the patients is likely to be lower than in cases where metal prostheses are used.(1)(6)


Metal-free crowns can allow for highly aesthetic solutions such as colour correction/ matching and allow us to reshape malformed teeth or reshape teeth which are in incorrect arch positions, to more closely approximate their correct shapes. These types of cases can be very satisfying to our artistic natures and can psychologically and functionally benefit our patients. The results achieved in this case indicate the potential value of the Procera system in creating restorations with excellent marginal fit and aesthetics. However, further long term clinical trials will be required to support this preliminary conclusion.


Barnfather KD, Brunton PA. Restoration of upper dental arch using Lava all-ceramic crown and bridgework.Br. Dent J 2007;202(12):731-735.
Polack MA. Restoration of maxillary incissr with zirconia all-ceramic system:a case report. Quintessence Int.2006;37(5):375-380.
Zitzman NU, Galindo ML, Hangman E, Marinello CP. Clinical evaluation of Procera AllCeram crowns in anterior and posterior regions. Int J Prosthodont2007;20(3):239-241.
Haselton DR, Diaz-Arnold AM, Hilis SL. Clinical assessment of high-strength all-ceramic crowns. J Prosthet Dent 2000;83(4):396-401.
Lopes GC, Baratieri LN, Calderia de Andrada MA, Maia HP. All-ceramic post core, and crown: technique and case report. J Esthet Restor Dent 2001;13(5):285-295.
Oden A, Andersson M, Krystek-Ondracek I, Magnusson D.Five-year clinical evaluation of Procera AllCeram crowns. J Prosthet Dent 1998;80(4):450-456.
Kokubo Y, Ohkubo C, Tsumita M, Miyashita A,Vult von Steyern P, Fukushima S. Clinical marginal and internal gaps of Procera AllCeram crowns. J Oral Rehabil 2005;32(7):526-530.
Sieber C. A key to enhancing natural esthetics in anterior restorations: the light-optical behavior of Spinell luminates. J Esthet Dent 1996;8(3)101-106.
Oden A., Razzoog M. E. Masking Ability of Procera All Ceram copings of various thickness Maxillary anterior crowns provide an exciting Connection Part 1 : Biologic Variables J Esthet Dent 6(1): 3-9 1994 16.

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