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

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

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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"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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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 : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 521 - 523 Full Version

Remembering the Titan: A Case Report

Published: May 1, 2012 | DOI:
Manish Kaushik, M.K. Manjunath

1. P.G. Student, Dept. of Conservative Dentistry and Endodontics 2. Professor and H.O.D., Dept. of Conservative Dentistry and Endodontics JSS Dental College & Hospital, Mysore, Karnataka

Correspondence Address :
Dr. Manish Kaushik
Dept. of Conservative Dentistry and Endodontics,
JSS Dental College & Hospital, Mysore-570015, Karnataka.
Phone: 09620636682


The pin retained amalgam is a vital adjunct to the general practitioner in the case of badly decayed or broken down teeth. Self-threading pins, however, have been shown to produce cracks or crazing in the dentin and enamel, if they are not placed properly. Just as the pins help in binding the amalgam to the tooth structure, they also help in binding the weak tooth structure to the amalgam. In selected clinical cases, these advantages can be used for extensive restorations. This case report presents an age old clinical technique that outlines the reconstruction of severely damaged, posterior teeth with a missing functional cusp.


Dental amalgam; Pin-retained amalgam; Self-threading pin

Dental amalgam is one of the most versatile restorative materials, which constitutes approximately 75% of all the restorative materials which are used by dentists. The combination of a reliable, long-term performance in load bearing situations, the low technique sensitivity, the self-sealing property and the longevity of dental amalgam is unmatched by those of other dental restorative materials (1). Since Markley’s first report on the pin retention of amalgam in 1958, much research has been done on this topic. In 1969, Moffa et al, reported on the retentive properties of three different pin designs in dentin and amalgam. They noted that, 2 mm was the optimal retentive pin-in-dentin/pin-in-amalgam length for the self-threading pins and they concluded that the self-threading pin was the most retentive one in dentin and amalgam (2), (3). Several clinical studies have demonstrated that high-copper amalgams can provide a satisfactory performance for more than 12 years (4). Plasmins et al., evaluated the long-term survival of multisurface restorations and found that the extent of amalgam restoration had no influence on the survival rate (5).

Case Report

A 38-year-old female patient visited the Dept. of Conservative Dentistry and Endodontics, J.S.S. Dental College and Hospital, Mysore, Karnataka, with the chief compliant of a dislodged restoration and food lodgement in right upper back teeth region since 1 month. She gave a past history of getting a tooth filled two years ago. No past history of pain was noted in the region of the complaint. The medical history of the patient was non-contributory. Her dental history revealed the presence of tooth coloured and amalgam restorations. On clinical examination, a distocclusal temporary restoration in the right maxillary second premolar with a fractured palatal cusp was noted. The tooth was asymptomatic and no pain could be elicited. The tooth responded positively to the thermal and electric pulp testing. Her radiographic examination revealed the presence of a temporary restoration which was close to the pulp, with the evidence of secondary caries, with no signs of apical involvement. Case Report Dentistry Section As the fracture line was supragingival and as it had not invaded the biological width, a pin retained silver amalgam restoration was planned. The patient’s informed consent and necessary ethical clearance were obtained. The procedure was started with the removal of the temporary restoration, followed by caries excavation and elimination of the weak enamel margins. A gingival seat was then created all along the reduced palatal cusp and a proximal box was prepared on the distoproximal aspect, with a definite step which separated the two. Cavity varnish and a Zinc Phosphate cement base were placed, followed by the preparation of a slot on the gingival seat of the distoproximal box and a cove on the palatal axial wall, to facilitate the placement of the pin and the condensation of the amalgam around it. Next, a pin channel was prepared at a depth of 2 mm by using a customized drill on the palatal gingival seat, 0.5 mm within the dentinoenamel junction (DEJ). Cavity varnish was applied and a threaded pin (Filpin, FILHOL Dental, UK) of 0.76 mm diameter was inserted into the pin hole by using a contra-angled handpiece at a speed of 500 rpm. The Tofflemier matrix band and the retainer were adapted around the prepared tooth. Silver amalgam was first condensed into the slot and into the cove around the pin, and it was gradually built-up, followed by pre-carve burnishing, carving, checking of the occlusion and post-carve burnishing. The finishing and polishing were done the next day.


Traditionally, amalgam has been the material of choice for the restoration of the direct cuspal-coverage of the posterior teeth. Smales et al found a 66.7% survival rate after 10 years for large, cusp-covered amalgam restorations (6). McDaniel et al carried out a survey, which revealed that the leading cause of the failure among the cuspal-coverage amalgam restorations was the tooth fracture. They assumed that the main reason for the failure was a too conservative tooth preparation; they recommended the replacement of the weak cusps with large amalgam restorations (7). Polymerization shrinkage is a major concern during the placement of the direct, posterior, Resin Based Composite (RBC) restorations. As compared to the similar amalgam restorations, the placement of a direct RBC restoration takes 2.5 times longer due to the complex sequence which is included in the incremental techniques (Roulet, 1997). Patients with para-functional habits are not the ideal candidates for similar treatments. If a conventional, continuous, fast-curing technique is adopted, the bonding interface may remain intact, but microcracks may develop just outside the cavosurface margins due to the stress of polymerization shrinkage (8). Conversely, alternative, indirect methods for restoring the severely destroyed molars and the premolars with tooth coloured and cast metal restorations are also available, but, the operative procedures for these are more complex and time consuming and they come at higher costs (9). The cardinal principles for the cavity preparation for a pin-retained amalgam restoration are, firstly, the conservation of the remaining tooth structure and secondly, the removal of all carious / weakened tooth structures. Pins do not obviate the need for the cavity preparation, but they rather complement the features of the cavity design. Pins by themselves incorporate stresses in the tooth structure. Hence, a judicious blend of minimal pins and cavity features are ideal, to have the maximum of the retention and the resistance features. For an ideal retention, the existing facial and lingual walls should be parallel rather than converging occlusally (10). The approximal areas of the tooth should contain boxes with retention grooves, whenever practical. Additional retention may be provided by placing slots and dovetails in the remaining tooth structure (11). The area that has to receive a vertical pin should be flat and perpendicular to the long axis of the tooth, and it should present a zone of dentin which is sufficiently wide for the placement of a pin. In general, any area which is designed to receive a pin should be reduced enough to allow a pin length of 2.0 mm and an amalgam covering of at least 0.5 mm around the pin and 2.0 mm occlusal to the pin. A cove is placed, to provide a sufficient bulk of amalgam all around (11). The tensile strength of dental amalgam is approximately 17% of its compressive strength. Clinically, the tensile or the transverse strength, or both, may be of greater significance than the compressive strength (Mahler 1958; Rodriguez and Dickson 1962; Mahler and Mitchem 1964). Pins which are positioned with long axes which are parallel to the tensile stresses do not result in any significant decrease in the tensile strength (Going and others, 1968) (11). A posterior tooth needs one to four pins. In the event where a proximal wall is only partly missing, a pin should still be used if the reduced cusp is centric-bearing (11). As seen in the report, the functional cusp (palatal cusp) in the maxillary premolar was replaced with a single pin. The position of a pin depends on several factors, first of which is the internal morphology of the cavity. Secondly, the external morphology of the tooth must be considered. Thirdly, the anticipated bulk of the amalgam must be considered, since the pins which are placed in areas of greater bulk are less likely to weaken the amalgam(10). Finally, the anticipated points of the occlusal load must be considered, since a vertical pin which is positioned directly below an occlusal load weakens the amalgam significantly (Cecconi and Asgar, 1971) (11). The prediction that the amalgam would not last until the end of the 20th century was wrong. Conversely, recent studies have concluded that the combined amalgam-composite cusp coverage restoration showed acceptable clinical performance over a period of time (12),(13). Yet, amalgam continues to be the best bargain in the restorative armamentarium because of its durability and technique insensitivity. Amalgam will probably disappear eventually, but its disappearance will be brought about by a better and more aesthetic material, rather than by concerns over health hazards. When it will disappear, it will have served dentistry and patients well for more than 200 years.


Amalgam restorations have served the dentistry profession well and they will continue to do so in the years to come. In terms of longevity, they are probably superior to composite resins, especially when they are used for large restorations and cusp capping. The newer high copper single composition alloys offer superior properties, but they may not offer a good seal as the older amalgams. Amalgam can be continued to be used as a material of choice if aesthetics is not a concern.


Bharti R, Wadhwani KK, Tikku AP, Chandra A. Dental amalgam: An update. J Conserv Dent 2010;13: 204-08.
Outhwaite WC, Garman TA, Pashley DH. Pin vs. slot retention in extensive amalgam restorations. J Prosthet Dent 1979; 41(4): 396-400.
Garman TA, Binon PP, Averette D.B.S., Talman RG. Self-threading pin penetration into dentin. J Prosthet Dent 1980; 43(3): 298-302.
Letzel H, van’t Hof MA, Marshall GW, Marshall SJ. The influence of the amalgam alloy on the survival of amalgam restorations: A secondary analysis of multiple controlled clinical trials. J Dent Res 1997; 76: 1787-98.
Plasmin PJ, Creugers NH, Mulder J. Long term survival of extensive amalgam restorations. J Dent Res 1998; 77: 453-60.
Smales RJ, Hawthorne WS. The long-term survival and cost effectiveness of five dental restorative materials which were used in various classes of cavity preparations. International Dental Journal 1996; 46: 126-130.
McDaniel JR, Davis RD, Murchison DF, Cohen RB. Causes of failure among the cuspal-coverage amalgam restorations: A clinical survey. J Am Dent Assoc 2000; 131: 173-77.
Deliperi S, Bardwell DN. Direct cuspal-coverage posterior resin composite restorations: a case report. Oper Dent 2006; 30(6): 143-50.
Liebenberg WH. Assuring the restorative integrity in extensive posterior resin restorations: Pushing the envelope. Quintessence Int 2000; 31: 153-64.
Mondelli J, Vieira DF. The strength of Class II amalgam restorations with and without pins. J Prosthet Dent 1972; 28: 179-88.
Mozer JE, Watson RW. The pin-retained amalgam: a useful restoration for a large cavity or as a foundation of the crown. Oper Dent 1979; 4: 149-55.
Shafiei F, Memarpour M, Doozandeh M. A three-year clinical evaluation of the cuspal coverage with combined composite-amalgam in endodontically-treated maxillary premolars. Oper Dent. 2010; 35(6): 599-604.
Kaur G, Singh M, Bal CS, Singh UP. A comparative evaluation of the combined amalgam and composite resin restorations in extensively carious vital posterior teeth: An in vivo study. J Conserv Dent 2011; 14(1): 46–51.

DOI and Others

DOI: JCDR/2012/3752:1898


Date of Submission: Nov 30, 2011
Date of Peer Review: Jan 02, 2012
Date of Acceptance: Jan 12, 2012
Date of Publishing: May 01, 2012

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