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Lucknow
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On Aug 2018




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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.
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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.


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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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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.
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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)
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

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : ZC50 - ZC54 Full Version

Knowledge, Attitude and Practice of Dental Practitioners towards Computer Guided Implant Surgery in Central India: A Cross-sectional Survey


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56383.16511
Krishankumar Lahoti, Sayali Dandekar, Jaykumar Gade, Megha Agrawal, Anand Agarkar, Ravina Khairkar

1. Professor, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. 2. Postgraduate, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. 3. Professor, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. 4. Postgraduate, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. 5. Postgraduate, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. 6. Postgraduate, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India.

Correspondence Address :
Dr. Krishankumar Lahoti,
Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College, Wanadongri, Nagpur, Maharashtra, India.
E-mail: kk.lahoti@sdkdentalcollege.edu.in

Abstract

Introduction: Incorporating digital technologies has been recently gaining popularity because of the known benefits like increased accuracy, predictable outcomes and reduction in treatment time. It is very important for the clinicians to analyse the necessity of incorporating these digital approaches into routine patient care.

Aim: To assess the knowledge, attitude and practice of dental practitioners towards Computer Guided Implant Surgery (CGIS) in Central India.

Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics at the Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India, to assess the attitude towards CGIS and Non Computer Guided Implant Surgery (non CGIS) by analysing responses from a total of 100 dental practitioners. A questionnaire consisting of 30 questions was circulated through a web based program. Analysis was done using descriptive and inferential statistics using the Kruskal Wallis test and the Mann Whitney U test. Responses were collected and analysis was performed using Statistical Analysis for the Social Sciences (SPSS) 27.0 version.

Results: Around 100 participants were included in the survey. 52 participants were female and the remaining 48 were male. Among all 97 (97%) participants were interested in CGIS but only 40 (40%) participants had any previous experience with the technology. Increased accuracy (z=7.08, p=0.0001) and predictability (z=10.64,p=0.0001) were considered the significant advantages by the participants. The overall difference in attitudes of CGIS and non CGIS users towards increased accuracy of CGIS was not statistically significant. (z=0.394, p=0.694)

Conclusion: The advantages of CGIS over non CGIS were acknowledged by majority of the practitioners. The major advantages were related to the greater accuracy and predictability associated with CGIS whereas the limited accessibility and higher cost were the most common disadvantages. The specialisation and the clinical experience did not significantly affect the attitude of the practitioners.

Keywords

Accuracy, Clinician based outcome, Dental implant, Guided placement

One of the most important goals of dental implant surgery is the accurate positioning of the implant in accordance with the planning which is achieved through diagnostic imaging (1),(2). Implant treatment comprises of basically three phases including treatment planning, surgical and prosthetic phase. Accomplishment of each phase is important as it affects the consequent phases (1).

The CGIS can effectively enhance each phase of dental implant treatment since incorporation of these technologies gives the surgeons more precise information regarding the patient’s anatomy and helps achieve predetermined virtual position of the fixture. CGIS is evolving rapidly in this era of digital dentistry as a result of the anticipated advantages of increased accuracy, reduced invasiveness, less chairside time and greater patient-acceptance (3),(4). A systematic review by Hultin M et al., had stated that guided placement provides as good a survival of implants as the conventional (5). Implants placed by computer guided surgery have been known to have a survival rate of 91-100% (6),(7),(8). The incorporation of CGIS, however, has led to some disadvantages like increased cost of treatment, added need for advanced equipment like Three Dimensional (3D) printers, increased treatment planning time and additional qualifications for operating such equipment (4),(9). Thus, it is very important for the clinicians to analyse and determine the necessity and feasibility of incorporating these digital approaches into routine patient care.

As there has been no study to assess the knowledge and attitude towards computer guided implant placement among the clinicians in Central India, there is paucity in the available literature. This makes it highly essential to assess the attitude of clinicians towards such evolving trends in implant dentistry. The aim of the present study was to assess the knowledge, attitude and practice of dental practitioners towards CGIS and to compare it with the non CGIS. This study can help determine the need for continuing education regarding the subject as well as the incorporation of such technology into routine practice.

Material and Methods

This cross-sectional study was conducted in the Department of Prosthodontics at the Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India. from 1/05/2021 to 1/10/2021. The research protocol was approved by the Institutional Ethics Committee with Ethical clearance number- SDKS/Staff/STRG/Prostho/dated 21-12-2020.

Inclusion criteria: A total of 100 participants across central India, registered under the Dental Council of India, were included in the survey. This cohort represented the dental practitioners placing dental implants in central India independent of the institute, gender, graduation year and curriculum content.

Exclusion criteria: Undergraduate students were excluded from the study.

Sample size calculation: The sample size was calculated using sample size formula for qualitative data for similar type of study conducted by Ashy LM (2021) in the Department of Prosthodontics at the Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India (4).

N0 = Z2 pq / e2

Where Zα/2 the level of significance at 5% i.e 95% confidence interval= 1.96
p = response rate= 37.3%= 0.373
d = error of margin= 10 %= 0.10

n = 1.962 x 0.373x (1-0.373) / 0.102

= 89.94 = 90
By assuming non response rate of 10%, total sample size would be n= 90+9=99
n = 100 subjects needed in the study.

Questionnaire Survey

Based on the aim, a precise survey, created and managed in Google forms, was electronically circulated among general dental practitioners and the responses were recorded. This pre-validated questionnaire survey consisting of five questions and 25 statements by Ashy LM, (2021) was used after seeking permission for the same (4). The questionnaire assessed knowledge, attitude and practice of dental practitioners towards CGIS in central India. The first five were closed-ended questions were regarding gender, speciality, experience with number of implant placement, experience with using CGIS, and interest in using CGIS. For the remaining questions, practitioners had to select an option on the Likert scale from 0 (totally disagree) to 10 (totally agree). These statements were designed to assess the specific attitude towards non CGIS and CGIS approach. Scores from 6 to 10 indicated a positive response / agreement of the practitioners [Annexure-1]. Subsequently, the questionnaire was randomly distributed to be answered on an anonymous basis and the responses were collected. The results of the survey were tabulated in google sheets.

Statistical Analysis

Analysis was done using descriptive and inferential statistics using the Kruskal Wallis test and the Mann Whitney U test. SPSS 27.0 version was used and p<0.05 was considered as the level of significance.

Results

A total of 100 participants were included in the survey. 52 participants (52%) were females and remaining 48 (48 %) were males with the mean age of 34±1.75 (age range 23-50 years). Among the total 100 participants, 51 (51%) were general dentists, 13 (13%) were oral surgeons, 13 (13%) were periodontists and 23 (23%) were prosthodontists. Baseline characteristics of the 100 responses included in the survey are presented in (Table/Fig 1).

Around 97 (97%) practitioners were interested in using CGIS while only 40 (40%) practitioners had a chance to use it. Scores on the Likert scale were used to interpret the responses. The overall response score for the questions in the survey had an inclination towards CGIS as the response score were within the 6-10 range. A higher mean score (7.43±1.44) on the Likert scale for accuracy was observed for CGIS compared to the conventional non CGIS (6.05±1.30) and the difference was found to be significant (z=7.08, p=0.0001). Predictability of treatment was considered significantly better by the participants with CGIS (7.56±1.36) for flapless implant placement compared to non CGIS (5.13±1.82). It was observed that the practitioners perceived that chair side time for surgery was less for CGIS when compared to non CGIS (z=7.16, p=0.0001). Practitioners felt that clinician’s skill was significantly critical with non CGIS (z=6.31, p=0.0001) and guided placement is comparatively a less stressful procedure (z=9.74, p=0.0001). According to the practitioners in this survey, higher cost and lengthy treatment planning were the disadvantages associated with CGIS (Table/Fig 2).

As per the experience level of practitioners, the difference in the mean scores on Likert scale regarding accuracy, keeping pace with technology, clinical stress, skill, cost or treatment planning time did not show a significant difference of opinion. Practitioners who have placed 100-200 or >200 implants believed that CGIS had better predictability with flapless guided placement and reduced chair side time (Table/Fig 3).

The comparison between the responses of the users of CGIS and the non users showed no significant difference as per Mann Whitney U test (Table/Fig 4). The greatest disadvantage encountered by practitioners according to the analysis was the inaccessibility to the planning software followed by steep learning curve and inconvenient communication to production centers (Table/Fig 5). A comparison of specialty with predictability of CGIS showed no significant difference. (z=2.85, p=0.41, Kruskal Wallis test) (Table/Fig 6).

CGIS was recommended by 54 (54%) practitioners for single edentulous spaces. 51 (51%) practitioners believed that CGIS is indicated for rehabilitation of posterior edentulous gap situations. 81 (81%) practitioners recommended CGIS for extended anterior gap situations while 84 (84%) practitioners recommended CGIS in extended posterior gap situations. About 88 (88%) practitioners recommended use of CGIS for completely edentulous patients.

Discussion

In the present study, majority of the practitioners acknowledged the advantages of the CGIS. This result is similar to the findings of study by Ashy L (4). Most of the participants showed interest towards CGIS. The practitioners felt that implants could be more accurately placed with CGIS. Ease to control the depth and angulation of implant placement can be a probable reason for the positive response towards CGIS. A systematic review by Tattan M et al., (10). in 2020 based on a quantitative analysis of 10 Randomised Clinical Trials (RCTS) stated that static computer aided implant placement showed significantly lower angulation deviation values compared to a free hand implant placement. Tahmaseb A et al., stated that the accuracy of computer guided placement lies within the clinically acceptable range (11). Free hand implant placement can lead to three times greater deviation in the final implant position compared to a computer guided one (12). A higher accuracy can be obtained with a fully guided approach compared to conventional surgery (13).

The responses from the clinicians indicated that the implants can be surgically placed in less time with a computer guided approach. Arisan V et al., in 2010 stated that the duration of treatment was half for guided flapless surgery compared to the conventional way. Even though the time needed for surgical procedure is less for CGIS, more time has to be invested in the preoperative planning (10).

Clinicians in this study felt that the predictability of implants placed with CGIS, with the flapless approach, was better than the ones with non CGIS. As the flapless surgery is a blind procedure, CGIS can improve the outcome by decreasing patient discomfort and treatment time while making the procedure safer (15). Guided surgery utilizes the advanced imaging techniques, implant planning softwares and equipment utilising Computer-Aided Design-Computer-Aided Manufacturing (CAD-CAM) and moreover stereolithographic technology also as dynamic navigation systems, keeping pace with the current technology (2). Participants in this survey also perceived that guided surgery keeps pace with the technology.

Participants felt that the clinical skill required for implant placement is critical for non CGIS. A review by Hultin M et al., (5). in 2012 stated that several unexpected events can be encountered even with the computer guided placement which indicates that the clinical skill demanded for guided is not less compared to non guided placement (5). It was observed from the responses that placing implants with CGIS was associated with less surgical stress. This is in accordance with the findings of Ashy L wherein low stress during surgery was considered as a major advantage of CGIS (4).

In this study, practitioners felt that CGIS could prove more useful for completely edentulous patients, which is in accordance with Ashy L (4). Majority of the participants felt that CGIS is indicated for extended anterior and posterior edentulous gap situations. Multiple implant placement and ideal positioning of the implants in relation to one another as well as surrounding anatomical structures could be a benefit of using the CGIS approach (16),(17).

The opinions of the participants did not differ based on the utilisation of the CGIS technology. The advantages and disadvantages were equally recognized by the users and non users of the technology. The opinions of different specialities were compared for a single outcome of predictability with flapless guided surgery and no difference was observed.

Although 97% practitioners were interested in using CGIS, only 40% had actually reported using them. Accessibility to training courses and the pre operative implant planning software was considered as the most common limitation by majority of the practitioners. The limited accessibility and high cost were the major disadvantages of CGIS. The treatment planning time is longer for CGIS as there are multiple steps involved in the protocol. Learning and using the advanced equipments and planning softwares makes the learning curve steeper for practitioners who have minimum experience and no training. Also, the communication with the production centres was a disadvantage as acknowledged by the practitioners. All these factors caused a significant hindrance leading to the limited use of CGIS. Despite the interest in CGIS, these hindrances have limited the use. Educational programs to train the practitioners would improve the understanding and utilisation of the computer guided implant technology which would further optimum the treatment outcomes in patients requiring rehabilitation with dental implants.

Limitation(s)

This study included a relatively smaller sample size only from central India. The results may vary with a larger sample size or a different geographic locations of India and otherwise.

Conclusion

The advantages of CGIS were acknowledged by a majority of the practitioners over non CGIS. The major advantages with CGIS were related to the greater accuracy and predictability with flapless technique, whereas the limited accessibility and higher cost were the most significant disadvantages. The specialisation and the clinical experience did not significantly affect the attitude of the practitioners. Training through courses to educate the undergraduates, general practitioners and implantologists regarding the use computer guided technology is essential. Further research related to utilisation, accuracy and feasibility of such technologies is required in Indian population to assess the situation more accurately.

References

1.
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DOI and Others

DOI: 10.7860/JCDR/2022/56383.16511

Date of Submission: Mar 15, 2022
Date of Peer Review: Apr 20, 2022
Date of Acceptance: May 11, 2022
Date of Publishing: Jun 01, 2022

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: Mar 24, 2022
• Manual Googling: May 10, 2022
• iThenticate Software: May 30, 2022 (19%)

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