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

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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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On Aug 2018

Dr. Arundhathi. S
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Dr. Arundhathi. S
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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.
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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

Research Protocol
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZK01 - ZK03 Full Version

Efficacy of Orange Oil, Lemon Oil and Xylene as Solvents in Removing Gutta Percha from Curved Root Canals: An In-vitro Study

Published: November 1, 2022 | DOI:
Prajakta Prashant Kothiwan, Gauri Vilas Patil, Aditya Patel, Priyanka Paul, Amit Reche

1. Intern, Sharad Pawar Dental College, DMIMS, Wardha, Maharashtra, India. 2. Intern, Sharad Pawar Dental College, DMIMS, Wardha, Maharastra , India. 3. Associate Professor, Department of Conservative and Endodontics, DMIMS, Wardha, Maharastra, India. 4. Assistant Professor, Department of Public Health Dentistry, DMIMS, Wardha, Maharastra, India. 5. Head, Department of Public Health Dentistry, DMIMS, Wardha, Maharastra, India.

Correspondence Address :
Dr. Prajakta Prashant Kothiwan,
Indira Girls Hostel, DMIMS, Sawangi, Wardha, Maharashtra, India.


Introduction: Root Canal Treatment (RCT) is the most common and effective treatment for saving natural tooth. Despite of modern technology and progress in the materials, failures in endodontic treatment still remains. Microbial infection majorly bacteria in the root canal is the prime cause of reinfection in root canal treatment. Endodontic instruments, solvents, lasers are the different techniques that can be used for removing gutta percha from the root canal.

Aim: To compare the efficacy of orange oil, lemon oil, and xylene as solvents in removing gutta percha from curved root canals.

Materials and Methods: This in-vitro study conducted in Sharad Pawar Dental College and Hospital, Sawangi Meghe, Wardha, Maharashtra, India, for three months and 24 freshly extracted teeth including incisors, premolars and molars having curved root will be taken. Then, RCT would be performed in all the extracted teeth by using cold lateral compression obturation method. Then all teeth would be divided in three groups (n=8). After one month, the Gutta Percha (GP) would removed by ProTaper Universal system. First group will use orange oil as solvent, second group will use lemon oil as solvent and the third group will use xylene as a solvent. The micro-Computed Tomography (CT) images prior to the application of solvent and after application of solvent will be taken and would be evaluated to check the percentage of filling material remaining.

Results: The expected outcome is orange oil and lemon oil to act as a better root canal solvent, as compared to xylene.

Conclusion: The determination and comparison of the efficacy of orange oil, lemon oil and xylene as GP solvents from the present planned study will help the clinicians during re-RCT treatment.


Endodontic retreatment, Micro-computed tomography, Re-infection

Root Canal Treatment (RCT) is the foremost treatment for preserving our natural tooth. In spite of new technology and advancement in the materials, failures in endodontic treatment persist (1),(2),(3). This is mainly identified radiographically, where there are changes in periapical region or there may be symptoms of pain and swelling indicating need for endodontic retreatment (4),(5). The primary reason for lack of success in RCT is the presence of microbial infection mainly bacteria in the root canal (6). Therefore, non surgical treatment is usually practiced. An endodontic retreatment removes obturating material from the canal and facilitates biomechanical preparation and obturation of the canal (7),(8). There are many obturating materials like dental amalgam, gold foil, lead, copper, oxy-chloride of zinc, paraffin, that are used but gutta percha is primarily used as it has low toxicity (9).

Many techniques can be used for taking out GP from the root canal. The use of hand instruments like Hedstrom file and Gates Glidden drill is practiced. Rotary instrument like Nickel-Titanium (NiTi) rotary instrument can also be used (10). Generally, ultrasound can only be used on hard compounds such as Glass Ionomer Cement (GIC) or as final debridement in endodontic retreatment. Laser can also be used to remove gutta percha like Nd:YAP (Neodymium-doped Yttrium Aluminum Garnet), which is more effective in dry root canals (11). Furthermore, when solvent is used, it facilitates in taking out filling material. Drawing out of filling material mechanically will only reduce the bulk but the solvent will soften the GP and remove the remnants of it. Various solvents can be used to take out the filling material like- chloroform, tetrachloroethylene, orange oil, eucalyptol, xylol, xylene, tetrahydrofuran and methylene chloride (12),(13). As per the United States Food and Drug Administration, though chloroform is considered the most effective solvent but because of its carcinogenicity, it is not commonly used. Also, though xylene is not considered a carcinogen, it harms the living tissue. Xylene can cause Central Nervous System (CNS) depression, pathologies related to heart and liver, blood disorders, decreased concentration, insomnia and tremors (14).

The present study differs from other studies as xylene is harmful to the living tissue and has various side effects on humans, so the present study aims to find a better alternative against xylene (14). Also, the present study conducted in-vitro, uses freshly extracted teeth with curved root canals. In root canals that are curved, removing filling material and further instrumentation can be challenging than straight root canals. Also, very less studies have been conducted on curved root canals (15). The gutta percha solvents used in the present study have not been compared together in any other study. The aim of the present study would be to evaluate the efficacy of orange oil, lemon oil and xylene as GP solvents in retreatment in endodontics.

Material and Methods

This in-vitro study would be conducted in Sharad Pawar Dental College and Hospital, Sawangi Meghe, Wardha, Maharashtra, India. The approximated time for the study is three months. The ethical approval was taken from Institutional Ethical Committee (DMIMS (DU)/IEC/2022/976).

Inclusion criteria: Teeth with curved root canals and freshly extracted teeth were included in the study.

Exclusion criteria: Fractured teeth, resorbed root, teeth with straight root canals and teeth with pulp stone were excluded from the study.

Sample size calculation: Formula used:

n=2 (Z1-a + Z1-Ăź) 2 p(1-p)/d

d=0.01, Level of significance a=0.05, Power 1-Ăź=0.80, Z alpha value=at 90% 1.645, at 99% 2.576, at 95% 1.96, at 80%,1.282 G power analysis

Input: Tail(s)=One, Effect size |.|=0.1
a err prob=0.05, Power (1-Ăź err prob)=0.95, Output: Non centrality parameter d=3.39, Critical t=1.6589
Df=31, Actual power=0.9503

Where n=total sample size, d=non centrality parameter, Z=critical value, p=sample proportion, a=type 1 error, Ăź=type 2 error

The sample size determined was 24 considering the dropouts, sample size has been estimated 8 samples in every group.

A total of 24 freshly extracted teeth with curved root canals would be taken with eight teeth in each group and presented as follows:

Group A: 8 teeth- orange oil
Group B: 8 teeth- lemon oil
Group C: 8 teeth- xylene

Study Procedure

Recently extracted 24 teeth will be included in the planned in-vitro research and access opening would be done using endo-access bur and Z bur and the opening would be enlarged by Gates Glidden drill. Teeth will be prepared using Protaper universal system. While biomechanical preparation of the canal with electrically driven instruments, the canals would be cleaned using 5.2% of Sodium Hypochlorite (NaOCl) solution, 17% Ethylenediamine Tetraacetic acid (EDTA) and the final irrigation with the help of saline would be done. Paper points will be used to dry the canal and the teeth would be obturated using cold lateral compression technique with GP. As the material sets with time, therefore after one month, gutta percha will be retrieved from the curved canal using Protaper Universal system.

Group A: ProTaper Universal system would be used to take out GP from the curved canal. For two minutes, orange oil commercially available as DPI GP solvent, will be introduced into the curved root canal to soften GP after instrumentation.
Group B: Same as group A, but instead of orange oil, lemon oil commercially available as Pyrax RC Clean GP Solvent will be used.
Group C: Same as group A, but instead of orange oil, xylene will be used.

Then the micro-CT images prior to the application of solvent and after application of solvent would be taken and will be evaluated to check the percentage of remaining filling material.

Micro-Computed Tomography (CT)

Micro-CT is a three dimensional imaging technique which can be used to visualise hard tissues of the oral cavity like alveolar bone, dentition; soft tissues can also be visualised that have infiltative growth such as in cases of carcinoma. Along with these ceramics, crowns, obturating material can also be seen in micro-CT (16). In the present study, micro-CT images prior to the application of solvent and after application of solvents was checked to evaluate the percentage of remaining GP in the curved root canal. Under voltage of 100 kV and current of 100 μA with aluminium and copper filters and at 360°, all samples would be scanned with a rotation step of 0.4°. Each tooth sample will be reconstructed three dimensionally and the data sets will be analysed. Gutta percha would be measured in mm3 following which, the mean value of every sample would be calculated.

Statistical Amalysis

The intergroup comparison will be done by one way Analysis of Variance (ANOVA) test and descriptive statistics applied for mean and standard deviation of the variables. The p-value <0.05 level was considered as level of significance. Specimens would be scanned with Skyscan 1172 (Bruker_micro-CT 1172, Kontich, Belgium).


Due to the hazardous effects of xylene, the efficacy of lemon oil and orange oil as GP solvents are expected to be better during re-RCT procedure for the clinicians.


Failure of the re-RCT occurs, due to remaining GP in the canal hence, its complete removal is an important aspect in the procedure. Number of studies reveal that the major aetiology of RCT failure is due to residual gutta percha in the canal (17),(18),(19). Widely used root canal solvents are xylene, chloroform and turpentine oil. Among these solvents, xylene is the most commonly used solvent, but it has hazardous health effects like ailments related to heart and liver, depression, skin erythema and Central Nervous System depression. Also, xylene is highly toxic to living tissues (20),(21). Thus, there arise a need to find a better root canal solvent.

In the present study, the authors would attempt to find a better solvent which is more effective and more biocompatible as compared to the solvents that are in use till date. In a study done by Pecora JD both orange oil and xylol acts in a similar manner on gutta percha, but orange oil is less hazardous to living tissue (22). In order to measure the effectiveness of root canal solvents, a variety of techniques have been used. The GP residuals have been measured using radiographs or photographs are also used to measure longitudinally split roots (23),(24),(26). A study used root transparency to check for the GP residue in the root canal (27). Recently, micro-CT analysis has become increasingly popular for assessing the efficacy of retreatment procedures (15). Using micro-CT as a diagnostic tool is advantageous because it offers quantitative three-dimensional assessment of residual gutta percha, filling materials, dentin and sealant separately (28).

Saglam BC et al., in their study used micro-computed tomography to evaluate two root canal solvents, chloroform and endosolv, used in the curved root canal to remove filling material (15). Likewise in the planned research study, micro-CT and curved canal will be used. In the study done by Saglam BC et al, (15) the retreatment procedure was conducted to remove gutta percha remnants with ProTaper Universal System and self-adjusting files were also used in the similar manner as the present study also plan to use the same armamentarium. In a study conducted, it was confirmed that orange oil is good solvent which is non toxic and has good biocompatibility (29). On the other hand, xylene removed the covalent bonds of carbon but it also induces a toxic reaction by an intermediate metabolic product, methyl benzaldehyde (14). Thus, orange oil is considered more beneficial as compared to xylene as a GP solvent.

In a study, done by Jantarat J et al., dissolving capacity of different essential oils containing different D-limonene concentrations was evaluated. Their study included grapefruit oil, tangerine oil, lime oil, and lemon oil. The results stated that, the oil that contained a greater percentage of D-limonene had a significantly higher dissolving effect on the gutta-percha. The author evaluated the dissolving ability of many essential oils that contain different D-limonene concentrations. Their study used grapefruit oil (90% D-limonene), tangerine oil (90% D-limonene), lime oil (60% D-limonene), and lemon oil (60% D-limonene). The results demonstrated that, after a five minutes of contact time, the oil that contained a higher percentage of D-limonene had a significantly higher dissolving effect on the GP (30).

Similarly in present study would use solvents containing D-limonene (orange oil, lemon oil). A clear colourless liquid with a pleasant lemon-like odor is D-limonene which is soluble in ethanol. On oxidation, it forms a film in air, and has oxidation behavior similar to that of rubber or drying oils (31). Limonene is the active ingredient in citrus fruit oil and is used as a less hazardous substitute for xylene in histopathology and microscopy. The 3-cyclohexen-1-ol, 4-methyl-1-(1-methylethyl) which is the most abundant constituent and a derivative of limonene, is responsible for antimicrobial activity (32). Limonene reagents are advocated as potential substitute as dissolvent over xylene with least biological hazards (33).


The present planned protocol would compare and determine the most effective and efficient root canal solvent amongst orange oil, lemon oil and xylene to help the clinicians in re-RCT treatments.


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DOI and Others

DOI: 10.7860/JCDR/2022/57456.17108

Date of Submission: Apr 30, 2022
Date of Peer Review: Jun 08, 2022
Date of Acceptance: Aug 13, 2022
Date of Publishing: Nov 01, 2022

• 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 X-checker: May 04, 2022
• Manual Googling: Jun 08, 2022
• iThenticate Software: Aug 10, 2022 (8%)

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