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

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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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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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
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.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
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.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
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.


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

Important Notice

Dentistry
Year : 2011 | Month : February | Volume : 5 | Issue : 1 | Page : 155 - 156

The Role Of CT Scan In The Posterior Maxilla: A Boon For Dental Implant Planning

ANUJ CHHABRA*, NIDHI**, ANIL SHARMA***

*M.D.S (Prosthodontics), Assistant Professor; **B.D.S, Postgraduate Student; ***M.D.S (Prosthodontics), Professor, Department(s) and institution(s) Dept Of Prosthodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, U.P.

Correspondence Address :
Dr. Anuj Chhabra
Dept Of Prosthodontics, ITS Dental College, Hospital & Research Centre, Greater Noida, U.P.
Mob: 9811175145
E-mail: i_ac80@yahoo.co.in

Abstract

Recent developments in computed tomography (CT scan) have changed diagnostic and radiological assessments, not only in general medicine, but also in implant dentistry. The aim is not only to improve the precision and the predictability of implant placement, but also to change an invasive surgical protocol for sinus grafting and subsequent implant placement in the posterior maxillary region. In compromised situations of rear maxilla with some bone available, the best position of the implant placement is evaluated, and the need for additional surgical interventions such as sinus lift and grafting procedures can be exactly determined. This improves the predictability of the treatment goals, allows for better risk management, and provides more individual information for the patient.

Keywords

computed tomography, posterior maxilla, Dental Implantology

INTRODUCTION

The embryological pneumatisation of the maxilla is as much a curse as it is a boon for an implantologist. The demerits lie in the eventuality that the volume of the bone which is available for implantation will significantly be reduced following the loss of the posterior maxillary teeth. The advantage of natural pneumatisation is that the clinician has a potential space to augment, which is relatively free of important anatomical structures which may complicate the sinus grafting procedures.

Lack of sufficient bone height in the posterior maxilla frequently precludes the standard implant placement in this region (1). Though the implants can be placed in the maxillary tuberosity, multiple units when needed are a problem, unless the deficient posterior maxilla is augmented.

Estimating the bone volume which has to be harvested prior to surgery for maxillary sinus floor bone grafting, might help in selecting the donor site, minimizing complications, following bone harvesting and reducing hospital expenses (2).

Chanavaz M stressed that bone loss in the posterior maxilla has two contributing factors, basal bone loss due to the osteoclastic activity of the sinus membrane and alveolar bone loss due to the disappearance of the marginal bone(3). Sinus grafting and subsequent implant placement maintains the bone height in the posterior maxilla on the basal bone side by the bone graft and on the alveolar side by the functional implant, thus providing physiological stimulus to the bone.

Several types of bone-graft materials have been used (4): autogenous bone from the iliac crest or the maxillary tuberosity, frozen bone, freeze-dried bone, demineralized freeze-dried bone, and hydroxyapatite. Hydroxyapatite is a resorbable calcium phosphate material and it acts as a foundation for new bone regeneration. Some authors have found more success when this is mixed with freeze-dried bone (5).

The technique for sinus grafting, either the lateral approach or the crestal osteotome technique, can also be decided with the help of CT scans. .

Krennmair et al suggested that the intraoral sites should be given preference and that extraoral bone harvesting is necessary only in patients with contraindications for intraoral sites, with maxilla with severe bilateral atrophy, or with maxillae for which both external and internal (onlay) grafting are needed (1). Since they provided nearly as much bone as is required for most augmentations, following this predicament could lead to disasters if the volume of bone available for the intra-oral site falls short, thus necessitating the abandoning of the operation.

Material and Methods

CONVENTIONAL DENTAL PANORAMIC TOMOGRAM

The DPT (dental panoramic tomogram) remains the mainstay of the diagnostic review of the maxillary sinuses for Implantology. Whilst it is two-dimensional by nature, it is an invaluable tool and in most situations, is by itself adequate to plan sinus surgery for Implantology.

It provides the following information:
1. residual ridge resorption
2. the amount of bone between the crest of the alveolar ridge and the floor of the sinus
3. Antero-lateral view of the maxillary sinuses.
4. bony septa or compartmentalisation of the maxillary sinus.

Its drawbacks are:
1. it is two dimensional (the bucco-lingual view of the sinus cannot be visualised)
2. it is difficult to calculate the amount of graft material which is required
3. the exact position of the opening of the maxillary sinus into the lateral wall of the nose (hiatus semilunaris) cannot be determined

CT- SCAN
Computerized tomography is a useful diagnostic tool for sinus surgery, but it is not mandatory. It provides the following information:
1. the three dimensional representation of the maxillary sinus (bucco-lingual dimension of the sinus can be seen)
2. the clear visualisation of the bony septa
3. the presence of any soft or hard tissue pathology
4. the calculation of the amount of bone graft material to be used
5. the elevations and depressions of the sinus floor can be visualised in all dimensions
6. the information on the level of sinus opening into the lateral wall of the nose.
7. the thickness of the lateral wall of the maxillary sinus

The delineating significance of the CT scan as opposed to the DPT, is obviously it’s three dimensional nature.

Bony septa are frequently seen in the floor of the sinus. The CT scan can give information about the bucco-lingual extent of the septa and allow the clinician to make pre-operative notes on them. The careful elevation of the sinus lining from the floor and its preservation is a critical part of the sinus grafting procedure.

The presence of most pathologies can be verified by the CT scan as much as the DPT. The CT scan however, can map its location accurately. The most common temporary contraindication, sinusitis, is seen as a thickening of the Schnederian membrane.

One of the most significant aspects of CT scans is the ability to calculate the amount of bone graft material which is required for the sinus grafting of the maxilla. Detailed cross-sectional CT scans allow the calculation of the augmentation volume for various implant lengths and residual ridge heights (1). In most cases however, a conventional DPT provides adequate information to calculate the augmentation volume.

Uchida and associates reported that the augmentation volume which was required for a 10 mm elevation would be 1.5 ± 0.9 cmm³ (2). Further, Krennmair et al found that with an increase of an augmentation height of 5 mm, the augmentation volume increased by 100 %. This appears to be a guideline and not a rule, as the anatomy of the sinuses is variable, however, it needs to be stressed again that such calculations can be more accurately made with the use of a CT-scan and not a DPT.

The sinus lift procedure which was developed in the mid 1970s has been refined and is now frequently performed (6)-(9). Krennmair et al opined that the contours of the sinus lift will not always follow the straight lines which are drawn on CT scans. This may not always be practically significant, as sinus floor grafting is not micro-surgery and small miscalculations can be made during clinical surgery.

The anatomical position of the maxillary sinus opening into the lateral wall of the nose can be seen with the help of CT scans. It is important to restrict the level of bone grafting to below the opening of the osteum; otherwise the graft material may extrude into the nasal cavity. Further drainage of the sinus into the lateral wall of the nose will be impeded or blocked.

Lateral wall thickness can be measured on the CT scan. This gives the clinician a good feel of the surgery. Reduced thickness means a closer proximity of the sinus lining, which requires that the clinician should be extremely careful while preparing the osteotomy from the outset. Thicker lateral walls allow the clinician to make more definitive bur cuts to outline the osteotomy before approaching the infracturing of the sinus wall.

While Uchida and associates used axial CT scans without calculating the residual ridge heights, Krennmair et al showed that cross-sectional CT scans which define the width and height of the residual ridge, allow for an exact calculation of the height and volume of bone augmentation. The latter would be more appropriate, as sinus grafting is a function of both the residual ridge bone height as well as the anatomical depths of the maxillary sinus.

Conclusion

The utilization of CT scans in implant dentistry, especially in the posterior maxilla, is a safe option in treatment planning and in the better control of the prospective implant axis with respect to the prosthetic tooth position. This contributes to a higher predictability of the ultimate treatment outcome, with subsequent better patient information about the implant prosthodontic treatment.

References

1.
Krennmair G, Krainhofner M, Maier H, Weinlander M, Peihslinger E. Computerized Tomography – Assisted Calculation of Sinus Augmentation Volume. Int. J. of Oral and Maxillfac. Implants 2006; 21:907-913.
2.
Uchida Y, Goto M, Katsuki T, Soejima Y. Measurement of Maxillary Sinus Volume Using Computerized Tomographic Images. 1998; 13: 811-818.
3.
Chanavaz M. Maxillary Sinus: Anatomy, Physiology, Surgery and Bone Grafting related to Implantology – Eleven Years of Surgical Experience(1979-1990). 1990; 15: 199-209.
4.
Reiskin AB. Implant imaging: status, controversies, and new a. developments. Dent Clin North Am1998; 42:47–56.
5.
Fugazzotto PA, Vlassis J. Long-term success of sinus augmentation using various surgical approaches and grafting materials. Int J Oral Maxillofac Implants 1998;13:52–58.
6.
Wheeler SL, Holmes RE, Calhoun CJ. Six-year clinical and histologic study of sinus-lift grafts. Int J Oral Maxillofac Implants 1996;11:26–34
7.
Lazzara RJ. The sinus elevation procedure in endosseous implant a. therapy. Curr Opin Periodontol 1996;3:178–183.
8.
Raghoebar GM, Brouwer TJ, Reintsema H, Van Oort RP. Augmentation of the maxillary sinus floor with autogenous bone for the placement of endosseous implants. J Oral Maxillofac Surg 1993;51:1198–1203.
9.
Smiler DG, Johnson PW, Lozada JL, et al. Sinus lift grafts and endosseous implants: treatment of the atrophic posterior maxilla. Dent Clin North Am 1992;36:151–186

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