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MBBS, MD (Pathology),
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Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Consultant
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Aug 2018




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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.
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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

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : ZC07 - ZC09 Full Version

Influence of Storage Temperature on Orthodontic Elastics


Published: July 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/48913.15115
R Piradhiba, Evan A Clement, Navaneetha Nambi, S Veerasankar, S Madhumitra, S Maheshwari

1. Reader, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India. 2. Senior Lecturer, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India. 3. Reader, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India. 4. Senior Lecturer, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India. 5. Intern, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India. 6. Intern, Department of Orthodontics, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. R Piradhiba,
No. 189A, A2. Hicon Villa, Kamaraj Salai, Kottivakkam, Chennai, Tamil Nadu, India.
E-mail: piradhiba@gmail.com

Abstract

Introduction: Orthodontic elastics are a very significant tool in orthodontics, as it is the most commonly used force delivering unit. Temperature plays a key role in the amount of force that elastics are able to produce. Hence, there is a need to evaluate the influence of storage temperature on the properties of orthodontic elastics before its clinical use.

Aim: To evaluate the influence of different storage temperature of latex orthodontic elastics.

Materials and Methods: This cross-sectional study was conducted at Sathyabama Dental College and Hospital, Chennai, in November 2019. Sample of 40 latex orthodontic elastics (TP Orthodontics, medium force, standard size of 3/16??) were divided into four groups with 10 elastics each, based on their storage temperature and stored in closed plastic packages. Group 1 was kept as a Control group and Group 2, Group 3 and Group 4 were stored in three Incubators under the specified storage temperatures such as 26-28°C, 4-8°C, 37°C respectively. The elastics were stretched and their forces measured in six progressive increases of 100% of their inner diameter, starting at a level of 100% stretching, with the Universal Testing Machine, Instron. The samples were also tested for Maximum Stress (MPa), Maximum Force (N), Maximum Elongation (%) and Break Distance (mm). Data were analysed using Statistical Package for the Social Science (SPSS) software version 16.0, one-way Analysis of Variance (ANOVA) and post-hoc test.

Results: On evaluating the stress at 100%, 200%, 300%, 400%, 500%, 600% of strain, there was no statistically significant difference between the groups. Maximum Stress MPa was found to be 24.12±3.32, 25.12±3.42, 23.3±3.41, 23.97±3.50 for group1, group 2, group 3 and group 4 respectively. Maximum Elongation (%) was found to be 1369.0±25.108, 1364.0±23.190, 1359.0±35.103, 1363.0±34.657 for group 1, group 2, group 3 and group 4, respectively. Break Distance (mm) was found to be 68.48±1.267, 68.28±1.267, 67.87±1.77 and 68.19±1.727 for group1, group 2, group 3 and group 4, respectively. And none of the parameters tested showed statistical significance between the four groups.

Conclusion: Latex elastics may be stored under any of the conditions tested in the present study over a period of one month, since different storage temperatures over a period of one month did not interfere in their mechanical properties.

Keywords

Break, Elongation, Stress, Strain

The latex elastics have become integral part of orthodontics after being first discussed by Calvin Suveril Case in 1893 at the Columbia dental congress. However, the credit goes to Henry A. Baker for the use of these elastics in clinical practice to exert a class II intermaxillary forces (1),(2). The use of latex elastics in clinical practice is predicted on force extension values given by the manufactures for different sizes of elastics. Manufacturers standardise the classification of elastics by internal diameter as 1/8”, 3/16”, and 5/16”, and by force released by 180 g, 170 g, and 184.27 g, respectively (3),(4). Force corresponds to the stretching of elastics by three times their internal diameter (5). The standard force index employed by suppliers indicates that at three times the original lumen size, elastics will exert the force stated on the package (6).

There are several factors that influence the mechanical properties of elastics, such as the material of the different makes, the influence of saliva, pH, pigments, light, heat, humidity, diet of the individual user, as well as the effects of jaw movements on the structural relaxation (7),(8),(9). An elastic material may suffer a plastic deformation if either subjected to excessive forces or exposed to adverse weather conditions. Elastics are also sensitive to long-term water exposure, enzymes, and temperature variations, and lose part of the force released throughout the stretching period (10),(11),(12).

In a previous study by Gonzaga AS et al., the influence of long-term storage on orthodontic elastics was evaluated. The elastics were stretched and their forces measured in five progressive increases of 100% of their inner diameter, starting at a level of 200% stretching. It was concluded that elastics may be stored under any of the conditions tested in the present study, since there were no changes in the potential of the force exerted by the elastics in relation to their percentage stretch over a one year period (13).

Despite the knowledge concerning these orthodontic elastics, there is a lack of confirmative evidences regarding possible changes that could take place in their mechanical properties such as maximum force, maximum stress, maximum elongation, break distance when stored under different conditions for long periods of time. Moreover, intraoral latex elastics are used to help orthodontic mechanics in the delivery of force to the teeth to correct sagittal discrepancies or to improve the interdigitation. And, these elastics are given to the patients, who require replacement on a daily basis for a period of 3-4 weeks before his/her orthodontic appointment. But a concern exists with their influence of storage temperature on its mechanical properties during this period. The present study was conducted with the aim to compare the mechanical behaviour of intraoral elastics after 30 days storage at different temperatures.

Material and Methods

A cross-sectional study was conducted at Sathyabama Dental College and Hospital, Chennai in the month of November 2019, to evaluate the influence of temperature on a total sample of 40 Orthodontic elastics (TP Orthodontics, medium force, 3/16 inch). Institutional review board clearance was obtained from Institutional biosafety and ethical committee (120/IRB-IBSEC/SIST).

Sample size calculation: Using n-master Software, with power of 80% on the alpha error 5%, the sample size was obtained at nine per group.

Accordingly, the elastic samples were divided into four groups with 10 elastics each and stored in closed plastic packages.

Group 1: Control group (as received from the manufacturer)
Group 2: Room temperature (26-28°C)
Group 3: 4-8°C to simulate refrigerator temperature
Group 4: 37°C to simulate highest room temperature in Tamil Nadu.

The criteria used to divide the groups were based on the type of the material storage temperature. The samples remained for a period of 30 days. Incubator (Generic Electric Electronics) was used in this study to regulate the temperature for Group 2 (26-28°C), Group 3 (4-8°C) and Group 4 (37°C). Air sealed plastic bags were used to prevent moisture contamination during storage. The samples were subjected to mechanical testing with the universal testing machine, Instron, at Anna University, Chennai. The removal of elastics from their plastic storage packages and hooking onto the testing machine was made with tweezers without causing any pressure. The universal testing machine measured the force exerted by the elastics. An upper and a lower fixed hook were attached to the machine to hold the elastics for the force tests (Table/Fig 1). The force required for the test was obtained by means of a 50 N load cell and the machine was set at an operating speed of 100 mm/min.

The mechanical tests were carried out in an increasing order of force. Initially the elastic was stretched to 100% of its initial internal diameter, without any previous stretching, and the force needed to do this was recorded and then the forces required to stretch the elastic to 200%, 300%, 400%, 500% and 600% of its original internal diameter were immediately measured and recorded (Table/Fig 2), (Table/Fig 3).

Statistical Analysis

The descriptive statistics consisted of the average and standard deviation for the forces exerted by the elastics of each manufacturer and their groups. The one-way Analysis of Variance (ANOVA) was used for multiple comparison of means for each elongation percentage. All statistics were performed using SPSS software version 16.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL, USA). Statistical significance was considered to be at p<0.05 level.

Results

Means and standard deviations of stress released due to progressive stretching of elastics (100%, 200%, 300%, 400%, 500%, 600%) are shown in (Table/Fig 4). There was no statistically significant difference between the groups. Maximum Stress MPa was found to be 24.12±3.32, 25.12±3.42, 23.3±3.41, 23.97±3.50 for group 1, group 2, group 3 and group 4, respectively. Maximum Elongation (%) was found to be 1369.0±25.108,1364.0±23.190, 1359.0±35.103, 1363.0±34.657 for group 1, group 2, group 3 and group 4, respectively. A 130 break distance (mm) was found to be 68.48±1.267, 68.28±1.267, 67.87±1.77 and 68.19±1.727 for group1, group 2, group 3 and group 4, respectively. None of the parameters exhibited significant difference between the four groups.

Discussion

Mechanotherapy in orthodontics often involves the use of inter-arch elastics to correct sagittal discrepancies or vertical elastics to improve the inter-digitation of teeth (14),(15). As these auxiliaries are replaced on a daily basis by the patient, a concern associated with their use pertains to the mechanical properties of the materials.

There are numerous studies for evaluating the force degradation of orthodontic elastics both in-vivo and in-vitro (16),(17),(18),(19),(20). But, there is a lack of confirmative evidences regarding possible changes that could take place in their mechanical properties when stored under different temperatures for period of 30 days which is to simulate the duration the patient has to handle the elastics before his/her next orthodontic appointment. Hence in the present study, mechanical behaviour of intraoral elastics was investigated after 30 days storage at different temperatures and there was no statistically significant difference.

Clinically the recommended stretch of elastics, is three times their internal diameter, so that they can produce an immediate ideal level of force for use in inter-maxillary mechanics for Class II and III correction (21). Based on this, the present study conducted the mechanical tests in an increasing order of force so that during the movements of the mandible, the elastics would release forces related to this stretch range. This was in accordance to the study conducted by Gonzaga AS et al., (13).

There are no reported studies evaluating the Maximum force/stress, maximum elongation and break distance of the elastics after one month of storage. Maximum force/limit indicates the elastic limit that a material can endure without undergoing permanent deformation whereas maximum elongation indicates the ultimate before its rupture. Break distance refers to the distance at which elastics ruptures.

In this study, no statistically significant differences with respect to type of storage applied to the elastics was observed, and the average force exerted by the elastics when measured immediately, i.e., as received from the manufacturers, was equivalent to the average force observed after a period of one month under various storage conditions. Therefore, based on the results presented here, it can be stated that the levels of temperature at which the samples were exposed during storage, were not capable of causing any significant decrease or increase in the forces exerted by the elastics assessed within a one-month period. Latex elastics are usually made up of natural rubber materials, obtained from plants; the chemical structure of natural rubber is 1,4-polyisoprene. And over a period of time have evolved for betterment (22). The inert behaviour of the elastics submitted to the different forms of storage adopted in this study is most likely a consequence of the advances made by the orthodontic industry in the search for new characteristics to increase the efficiency of elastomeric products. This technology gives more resilience through the reduction of undesirable characteristics, such as the deterioration of their elastic properties due to environmental factors (heat, humidity and light), chemicals, artificial and natural aging.

As far the clinical implications are concerned, this study proves that the patient/doctor can store the latex orthodontic elastics at their domestic temperature wherein the properties of elastics shall remain unchanged.

Limitation(s)

Future studies with larger sample size would result in more accurate results and also only one brand material was used in the present study, comparing with different brands of elastics can be used to evaluate the influence of humidity on the mechanical properties of elastics.

Conclusion

Latex elastics may be stored under any of the conditions tested in the present study over a period of one month, since different storage temperatures over a period of one month did not interfere in their mechanical properties.

References

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Singh V, Pokharel P, Pariekh K, Roy D, Singla A, Biswas K. Elastics in orthodontics: a review. Health Renaissance. 2012;10(1):49-56. https://doi.org/10.3126/hren.v10i1.6008. [crossref]
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Seibt S, Salmoria I, Cericato GO, Paranhos LR, Rosario HD, El Haje O. Comparative analysis of force degradation of latex orthodontic elastics of 5/16'' diameter: An in vitro study. Minerva Stomatol. 2016;65(5):284-90. PMID: 27580653.
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Wang T, Zhou G, Tan X, Dong Y. Evaluation of force degradation characteristics of orthodontic latex elastics in vitro and in vivo. Angle Orthod. 2007;77(4):688-93. Doi: 10.2319/022306-76. PMID: 17605476. [crossref] [PubMed]
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DOI and Others

10.7860/JCDR/2021/48913.15115

Date of Submission: Feb 08, 2021
Date of Peer Review: Mar 10, 2021
Date of Acceptance: May 25, 2021
Date of Publishing: Jul 01, 2021

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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 08, 2021
• Manual Googling: Feb 16, 2021
• iThenticate Software: May 05, 2021 (7%)

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