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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
Case report
Full Version
Minimally Invasive Surgical Approach for the Treatment of Miller’s Class I Recession Defects- A Report of Two Cases
Correspondence Address :
Ridhima Uppal,
House Number 77, First Floor, Raja Garden, New Delhi, India.
E-mail: dr.ridhima.ru@gmail.com
Gingival recession is defined as the apical displacement of the gingival margin leading to exposure of the root surface. Occurrence of the gingival recessions in the anterior teeth is a major concern for the patients as it leads to compromised aesthetics and achieving the aesthetics and functional requirements of the patients remains a major therapeutic challenge for the treating dental surgeon. Incorporating the principles of Minimally Invasive Surgical Technique (MIST), surgical trauma is minimised, thus causing less cell damage, eventually resulting in less inflammation and less discomfort. MIST aims to achieve aesthetically superior outcomes that are made possible due to improved visual acuity. Therefore, the intent of this case report was to emphasise the impact of implementing the minimally invasive surgical procedure in the management of marginal gingival recessions using the conventional Coronally Advanced Flap (CAF) and the Tarnow’s technique, with the use of microsurgical instruments and magnifying surgical loupes.
Coronally advanced flap, Gingival recession, Microsurgery, Periodontal plastic surgery, Root coverage
Case 1- Conventional Coronally Advanced Flap Technique
A 32-year-old male patient, reported to the Department of Periodontology with the chief complaint of unaesthetic appearance due to receding gums; localised to one tooth in the left lower front region, observed by the patient 4-5 months ago. Patient did not report any relevant past medical or dental history. Radiographic examination revealed no bone loss. All the clinical parameters of probing depth (1), plaque index (1), plaque index score (Loe-Silness) (1), clinical attachment level (2), recession depth (2), recession width (2) and gingival biotype (3) were recorded. Thus the diagnosis of Miller’s class 1 gingival recession (4) was made for the left mandibular lateral incisor (tooth number 32) (Table/Fig 1)a,b. The decision was made to perform root coverage procedure by the means of Coronally Advanced Flap (CAF) technique as described by Norberg in 1926 (5), a technique that has been advocated for the treatment of the isolated gingival recession defects (5). Informed consent was obtained from the patient.
Surgical technique: The armamentarium for the case report has been depicted in detail in (Table/Fig 2).
The patient was advised for presurgical rinse using 0.2% chlorhexidine gluconate solution {Dr. Reddy’s Clohex Anti Discolouration System (ADS) mouthwash}. Disinfection of the extraoral surfaces using 10% povidone iodine was done and local anaesthesia {Lignox (LOX) 2% adrenaline,1:200000} was administered. Implementing the Minimally Invasive Surgical Technique (MIST) principles, horizontal releasing incisions were given in the mesial and distal aspects, at a distance equal to Recession Depth (RD)+1 mm from the tip of the interdental papillae (Table/Fig 3)a,b. An intrasulcular incision was made at the labial aspect of the tooth to be treated. This was followed by two non parallel, minimally diverging incisions, starting from the ends of the two horizontal incisions and extending upto the alveolar mucosa. The trapezoidal design of the flap thus obtained was elevated with a split-full-split thickness technique directed in the coronal direction, exposing upto 3-4 mm of bone (Table/Fig 3)c.
De-epithelialization of the facial part of the anatomic interdental papillae was done, followed by root biomodification; using 10% tetracycline hydrochloride solution (Humoxy-Coax Bioremedies). Periosteal releasing incision was then given using a sharp dissection to allow adequate flap mobilisation. Passive closure of the flap was done using 5-0 vicryl sutures (Table/Fig 3)d.
Postsurgical instructions: Postsurgical instructions were given and patients were instructed to leave the surgical site undisturbed. The Non Steroidal Anti-Inflammatory Drugs (NSAIDs) (Ibuprofen 800 mg every 12 hours) were prescribed for three days to allow an uneventful healing phase and 0.2% chlorhexidine gluconate (Dr. Reddy’s Clohex ADS mouthwash) to be used twice everyday for two weeks. Patients were recalled after three weeks (Table/Fig 3)e for suture removal and were monitored regularly postoperatively for about 24 weeks (Table/Fig 3)f ensuring for the maintenance of a good oral hygiene in the surgical area.
In the follow-up visits, the distance from the Cemento-enamel Junction (CEJ) to the free gingival margin i.e the recession depth was calculated, using the millimeter markings of the University of North Carolina-15 (UNC-15) periodontal probe. The root coverage outcome percentage was calculated using the following formula (6); (Preoperative recession-Postoperative recession depth) *100=Percentage of root coverage preoperative recession depth.
Intraoral findings for the specific case have been elucidated in (Table/Fig 4).
Case 2- Semilunar Coronally Advanced Flap-Tarnow’s Technique
A 32-year-old male patient reported with the chief complaint of unaesthetic appearance due to receding gums; localised to a tooth in the right upper front region (Table/Fig 5)a,b, since 4-5 months. The patient was systemically healthy and no relevant dental history was reported by the patient. Radiographic examination revealed no bone loss. And thus the diagnosis of Miller’s Class 1 gingival recession (4) was made in the right maxillary canine (tooth number 13) (Table/Fig 5)a,b. The decision was made to perform root coverage procedure using Semilunar CAF technique as described by Tarnow DP in 1986 (7), for the treatment of the isolated recession defect simultaneously preserving the papillary anatomy (7).
Presurgical preparation was done as described earlier. A semilunar incision was designed and specified following the curvature of the free gingival margin (Table/Fig 5)b. Midfacially, the curved incision was extended far enough so that the apical curve of the incision rested on the bone after it was brought down to cover the uncovered portion of the root. The incision was extended upto the papilla on each end of the tooth, not involving the tip of the papilla so as to leave a minimum of 2 mm on either side of the flap, thus leaving the blood supply reach the flap unhampered. The initial incision line was directed coronally to connect with the intrasulcular incision made midfacially with a split thickness technique (Table/Fig 5)c. The resultant semilunar shaped flap was then positioned 1-2 mm coronal to the CEJ, upto the height of the adjacent papillae (Table/Fig 5)d. After flap approximation, suturing was done using 5-0 vicryl sutures (Table/Fig 5)e.
Postsurgical instructions: Postsurgical instructions were given as suggested earlier. Patient was recalled after three weeks (Table/Fig 5)f for suture removal and was monitored regularly postoperatively for about 24 weeks (Table/Fig 5)g ensuring for the maintenance of a good oral hygiene in the surgical area. The root coverage outcome percentage was calculated as described earlier. Intraoral findings for the specific case have been elucidated in (Table/Fig 6).
In both the cases, recession defects depicted complete coverage (100%) at 24 weeks follow-up (Table/Fig 4), (Table/Fig 6).
Gingival recession is a condition where the gingival margin shifts apically from its physiologic position; causing pathologic exposure of the root surfaces. The patients start complaining of hypersensitivity, black discolouration due to root caries and improper plaque removal in the exposed root surfaces (8). Periodontal plastic surgery is the appropriate treatment option suggested for the patients with aesthetic concerns due to the uncovered root surface (9).
In 1993, Hunter and Sackier defined the Minimally Invasive Surgical Technique (MIST) as a practice that permits precise incisions of the periodontal flap, minimal flap reflection thereby preserving the soft tissues, discussed by Harrel SK; study (10). This further helps in achieving a passive and primary wound closure. Using magnification tools makes it more predictable as it improves the work accuracy by bringing the working field closer to the eyes and enhancing the surgeon’s fine motor skills (11). These elements assure the modern day patients who envisage the most painless and minimally invasive treatment to be delivered to them (12). Norberg advocated a common and very reliable periodontal plastic surgical procedure- Coronally Advanced Flap (CAF); to achieve root coverage with an inclusive recovery of the original morphology of the marginal soft tissues (5).
It is important to emphasise on the best available evidence and select the most foreseeable surgical approach for root coverage in a given clinical situation due to increased aesthetic concerns of the patient (13). This case report contemplates the importance of the principles of periodontal microsurgery that provides enhanced visual acuity and better soft tissue management, further improving the outcome of CAF procedure and its modifications, for root coverage in a minimally invasive manner. Minimally invasive approach improves the vascularization by ascertaining the preparation of a well-defined split thickness flap along with maintaining the thickness for the entire flap preparation. It ensures maintaining primary wound closure, thus respecting the biological principles, thereby bringing about the enhancement of clinical parameters and reduced patient morbidity (14).
CAF procedure brings forth optimum results by providing good colour blending of the treated and the surrounding soft tissues and an inclusive recovery of the original morphology of the marginal soft tissues as well (5). A modification of CAF procedure was described by Tarnow DP in 1986 with the advantage that it results in no tension on the flap, no shortening of the vestibule and no interference to the existing papillae. In this technique, the sutures may not be essentially required, with the flap stabilisation being achieved with the periodontal dressing itself (6). CAF procedures however can be only utilised for Miller’s class I and class II root recession defects. Also, the residual keratinized tissue present should be same as the depth of the recession defect should be present, thus limiting this approach to shallow recession depth i.e., equal to or less than 3 mm (15).
In 2015, Kang J et al., conducted four randomised clinical trials to evaluate if microsurgical methods provide better results in root coverage when compared to conventional surgical methods and concluded that the use of magnification and finer instruments provide greater opportunities of achieving complete root coverage as compared to conventional methods. And therein, the microsurgical approach clearly contributed with a remarkable improvement of about 8% on an average (16). Rossi R in 2019 conducted a systematic review on the use of CAF procedure for the treatment of gingival recessions in the aesthetic area using the microsurgical approach and he concluded that CAF offers today the most reliable and effective solution to this problem and the association of this procedure with the use of the microscope, makes it less morbid and more delicate and accurate (17).
Similarly in the present case report, clinically significant coverage of the recession defect was achieved for both the cases which is in coherence with the results seen in the microsurgical groups in the controlled trials mentioned above.
The use of magnification reduces the surgical fatigue and the subsequent musculoskeletal problems for the clinician, simultaneously inflicting minimal tissue trauma and a comfortable healing phase. This also helps increase the patient’s acceptance towards the surgical procedure. Multiple beneficial outcomes of the minimally invasive surgical approach makes it essential to be incorporated in our daily practice decisively. Hence, Minimally invasive surgical approach inevitably leads to superior healing outcomes with more promising results.
DOI: 10.7860/JCDR/2022/53708.16314
Date of Submission: Jan 03, 2022
Date of Peer Review: Feb 05, 2022
Date of Acceptance: Mar 29, 2022
Date of Publishing: May 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
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