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On Sep 2018

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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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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
On Sep 2018

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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"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,
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
(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)
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 : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : ZE01 - ZE04 Full Version

Bonding of Fractured Fragments using Various Bonding Materials as a Treatment Modality in Cases of Vertical Root Fracture- A Systematic Review

Published: May 1, 2022 | DOI:
Pooja Chandak, Manoj Ghanshyamdasji Chandak, Kajol Relan, Madhulika Chandak, Chanchal Rathi, Payal Chaudhary

1. Postgraduate, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India. 2. Dean and Professor, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India. 3. Postgraduate, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India. 4. Postgraduate, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India. 5. Postgraduate, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India. 6. Postgraduate, Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, DMIMS (Du), Wardha, Maharashtra, India.

Correspondence Address :
Pooja Chandak,
Sharad Pawar Dental College, Wardha, Maharashtra, India.


Introduction: Vertical Root Fracture (VRF) is third most common factor leading to extraction of root canal treated tooth. It has a longitudinal orientation. This occurs due to reduction in structural integrity and dehydration of dentine. Most common treatment includes extraction of the teeth. Other modality is amputation of involved root in molars. Various materials can also be used for bonding of the fragments.

Aim: To compare and evaluate the effectiveness of dentine bonding systems in re-attatchment of fractured root.

Materials and Methods: The present systematic review included a comprehensive search of last 10 years was performed in the systematic electronic database PubMed. In-vitro laboratory studies that evaluated the microtensile bond strength and fracture resistance of multiple dentine adhesive systems and compared them in human and/or animal teeth in which VRF had occurred were included. A total of 16 non duplicated studies were retrieved in the systematic search.

Results: Out of 16 studies four studies were included in the systematic review. One study assessed the bond strength of the adhesive using table top testing machine. Two studies assessed the microtensile bond strength using stereo microscope and one study assessed recurrence of the fracture using Instron Machine. The studies demonstrated large variability among methodology used for evaluation. In one study, acid phosphate monomer showed highest microtensile bond strength (p<0.05), and in another study Refracture (RF) occurred easily in samples bonded with Glass Ionomer Cement (GIC) as compared to those bound with Perma Bond and Gluma (p<0.0003).

Conclusion: From the present study's analysis, dual cure adhesive resin cement either reinforced with polyethylene fibers or glass fibers, and glass ionomer cement may increase the fracture resistance of bonded tooth.


Adhesive systems, Longitudinal fractures, Re-attachment

Vertical Root Fracture has longitudinal orientation and originates from apex of the root and propagate to the coronal part of the tooth (1). It is third most common factor leading to extraction of root canal treated tooth (1). Changes occurring in Root Canal (RC) treated tooth are decreased stiffness and also leads to decreased fracture resistance. This occurs due to reduction in structural integrity and dehydration of dentine. In such cases endodontic crowns are better to be used instead of full crowns (2). Post and core is also the better restorative modality in cases of RC treated tooth (3).

The VRF leads to poor outcome of the tooth. Complete root or a part may be involved in the fracture (4). It may extend to only one or both sides of the root (4). Diagnosis of VRF is quite difficult. It is likely similar to the periodontal disease or the failed endodontic treatment (1). In multi-rooted teeth, fracture is commonly oriented in buccolingual direction. In anterior teeth also it is directed buccolingually (4). VRF can be classified as: initiating from the coronal tooth structure and one initiating from the apex. It can also be classified as complete and incomplete VRFs (4). VRF presents with multiple clinical features, thus making it difficult to diagnose. It presents delayed signs and symptoms. Clinical and radiographical features include deep periodontal pocket, pain, j-type radiolucency and sinus tract. Most common treatment includes extraction of the teeth (5). Other modality is amputation of involved root in molars. Bonding of the fragments can also be done (5). Sugaya T et al., developed the method which includes atraumatic intentional extraction followed by rotational replantation of the tooth (6). Adhesive resin are used to restore the tooth. Extraction of fragment helps to clear granules. Rotational replantation creates contact in the crack and healthy periodontal tissue (7). Various materials can be used for bonding of the fragments. It includes Methyl Methacrylate (MMA) based resin material, dual cure composites and GIC (7),(8),(9).

The purpose of this systematic review was to assess the success of dual cure composite with three adhesive systems [Clearfil SE Bond (SE), Tokuyama Bond Force (BF) and Clearfil DC Bond (DC)], MMA based adhesive resins, dual cure resin cement with polyethylene fibers and glass fibers, GIC, resin and Cyanoacrylate cement to bond fractured fragments. The hypothesis is none of the above bonding materials have successful results in treatment of VRF.

Material and Methods

This systematic review was conducted according to the guidelines of the PRISMA statement. The studies were selected according to the inclusion and exclusion criteria. All abstracts and full texts were reviewed. None of the manuscript author was contacted during this process. Disagreements between authors were evaluated and the studies were eliminated through discussion among researchers until a consensus was reached.

Inclusion criteria: The eligibility criteria considered in-vitro laboratory studies that evaluated the microtensile bond strength and fracture resistance of multiple dentine adhesive systems and compared them in human and/or animal teeth in which VRF has occurred. The studies in the review were included from year 1993 to 2013 and duration of systematic review was 2 months.

Exclusion criteria: Studies that considered extraction as a treatment option for VRF were excluded.

Search Strategy

A systematic search without restrictions was performed by two independent reviewers in the electronic database PubMed without restriction on year of publication. No filters or limits were applied in the searches. The selection of the descriptors was based on the most cited terms in previous publications related to this theme. The Boolean operators ‘AND’ and ‘OR’ were used to create the keywords search (Table/Fig 1). The keywords used were “VRF,” “re-attatchment of fragment”, “material for bonding”. The search details were VRF (all fields) AND re-attatchment OR bonding (all field) AND bonding material (all field).”

Selection of the Studies

Two independent authors selected the studies, examining the retrieved titles and abstracts according to the search strategy. When it was not possible to judge the studies by title and abstract, full text was obtained for the final decision. This review included in-vitro studies. For this reason, the Patient Intervention Comparison Outcome (PICO) system was adapted: population (studies conducted in human/animal extracted teeth), intervention (evaluation of success of material used for the treatment), comparison (between the materials used), and outcomes (success rate of the material). Disagreements on inclusion criteria were solved by consensus with a third author following the predefined inclusion criteria. Studies that appeared to be duplicated in the database search were considered only once.

Quality Assessment of Studies

In second step full text of the chosen articles were read out for data extraction and quality assessment was done as per Oral Health Assessment Tool (OHAT) by two independent reviewers (PC, KR) (10),(11). In cases of difference between reviewers, the third senior reviewer (MC) clarified the discrepancy. Flow chart for this systematic review is shown in (Table/Fig 2).

In the beginning, 21 articles were selected which included bonding of fractured root fragment with the dentine adhesive. Five articles were excluded due to duplication. Out of remaining 16 articles, six studies were excluded due to wrong study design, no relevant result, no proper comparison of the adhesive system, different intervention and six more articles were excluded due to unavailability of full text. Hence, only four articles were selected (Table/Fig 2). Title, abstract, a scientific context based on bonding of fractured root fragment with dentine adhesive was included. Also, rationale, objectives hypothesis, methodology showing study type was incorporated. Intrusion, statistical analysis, evaluation period were also used and main results were extracted from each experimental study.

In this study, after quality assessment for risk of bias was done by three independent reviews and by OHAT tool, it was found that all studies included low risk of bias (Table/Fig 3) (7),(8),(9),(12).

Research question: Is bonding of the fractured fragment using various bonding material is the effective treatment modality in cases of VRF?


Search findings and study characteristics: A total of 21 articles were found. After screening the titles and the abstracts of the identified studies, four studies were included in the full-text analysis. No additional relevant studies were found from hand searching. The four studies included were in-vitro studies. As the articles were heterogeneous in design/methodology and contained disparate data types, quantitative analysis was not possible and a qualitative systematic review was performed.

The initial screening of the retrieved studies was conducted using titles and abstracts. The corresponding full text was read when the results were unclear. The authors independently evaluated the studies and discussed the results until a decision was reached by consensus. The outcome of the included studies is mentioned in (Table/Fig 4). The performance of the included articles on the JBI The Joanna Briggs Institute Critical Appraisal tool (JBI) is presented in (Table/Fig 5) (13).


The studies included in this systematic review did not have common materials to compare. Hence, it is difficult to give an appropriate conclusion. Studies with common parameter for comparison are required to come to proper conclusion. As these studies conducted were in-vitro, more in vivo studies are required on the use of these materials in re-attatchment of VRF.


By reviewing the above studies, it is demonstrated that dual cure composite resin with resin adhesive system, MMA based resin (SB C and B) showed significant results for bonding in cases of VRF. Dual cure adhesive resin cement either reinforced with polyethylene fibers or glass fibre, and GIC can be used to increase the fracture resistance of bonded tooth.


Khasnis SA, Kidiyoor KH, Patil AB, Kenganal SB. Vertical root fractures and their management. Journal of Conservative Dentistry: JCD. 2014;17(2):103. [crossref] [PubMed]
Oswal N, Chandak M, Oswal R, Saoji M. Management of endodontically treated teeth with endocrown. Journal of Datta Meghe Institute of Medical Sciences University. 2018;13(1):60. [crossref]
Vyas R, Suchitra SR, Gaikwad PT, Gurumurthy V, Arora S, Shetty S. Assessment of fracture resistance capacity of different core materials with porcelain fused to metal crown: an in-vitro study. The Journal of Contemporary Dental Practice. 2018;19(4):389-92. [crossref] [PubMed]
Moule AJ, Kahler B. Diagnosis and management of teeth with vertical root fractures. Australian Dental Journal. 1999;44(2):75-87. [crossref] [PubMed]
Yildiz ED, Arslan H, Ayaz N, Gündoğdu M, Özdoğan A, Gundogdu EC. Effect of Super-Bond C&B and self-adhesive dual-cured resin cement on the fracture resistance of roots with vertical root fracture. Journal of Dental Research, Dental Clinics, Dental Prospects. 2019;13(2):153. [crossref] [PubMed]
Sugaya T, Kawanami M, Noguchi H, Kato H, Masaka N. Periodontal healing after bonding treatment of vertical root fracture. Dental Traumatology. 2001;17(4):174-79. [crossref] [PubMed]
Nurrohman H, Nikaido T, Sadr A, Takagaki T, Kitayama S, Ikeda M, et al. Long-term regional bond strength of three MMA-based adhesive resins in simulated vertical root fracture. Dental Materials Journal. 2011;2011:1109210177. [crossref] [PubMed]
Waidyasekera K, Nikaido T, Weerasinghe D, Nurrohman H, Tagami J. Bonding durability of dual-curing composite core material with different self-etching adhesive systems in a model complete vertical root fracture reconstruction. Journal of Adhesive Dentistry. 2012;14(3).
Friedman S, Moshonov J, Trope M. Resistance to vertical fracture of roots, previously fractured and bonded with glass ionomer cement, composite resin and cyanoacrylate cement. Dental Traumatology. 1993;9(3):101-05. [crossref] [PubMed]
Chalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The oral health assessment tool-validity and reliability. Australian Dental Journal. 2005;50(3):191-99. [crossref] [PubMed]
Tran L, Tam DN, Elshafay A, Dang T, Hirayama K, Huy NT. Quality assessment tools used in systematic reviews of in-vitro studies: A systematic review. BMC Medical Research Methodology. 2021;21(1):01-03. [crossref] [PubMed]
Kumar BS, Spoorti P, Reddy J, Bhandi S, Gopal SS, Ittigi J. Evaluation of fracture resistance of reattached vertical fragments bonded with fiber-reinforced composites: an in-vitro study. The Journal of Contemporary Dental Practice. 2013;14(4):573. [crossref] [PubMed]
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Quasi-Experimental Studies (non-randomized experimental studies) Assessed Date- 24th April 2021

DOI and Others

DOI: 10.7860/JCDR/2022/50150.16303

Date of Submission: Apr 29, 2021
Date of Peer Review: Jul 03, 2021
Date of Acceptance: Jan 03, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• 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 X-checker: May 03, 2021
• Manual Googling: Dec 02, 2021
• iThenticate Software: Jan 22, 2022 (20%)

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