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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
Mineral Trioxide Aggregate for Management of Three Resorptive Areas in a Single Rooted Tooth
Correspondence Address :
Dr. G Swapnika,
Room No-2, Poojitha Hostel, Vishnu Dental College, Vishnupur,
West Godavari District, Bhimavaram-534202, Andhra Pradesh, India.
E-mail: swapnikag94@gmail.com
The maxillary anterior tooth is the key tooth for the esthetics of an individual. Unfortunate trauma to the maxillary anterior tooth results in compromised esthetics and self-esteem of a young patient. Multiple resorptive defects in a tooth may compromise its prognosis and may be indicated for extraction following replacement by the implant. However, “a naturally retained tooth is the ultimate implant”. A 25-year-old patient visited the Department of Conservative Dentistry and Endodontics with the complaint of purulent pus discharge and unacceptable colour in the front tooth region for two months. The yellowish-brown discolouration was observed in 11. Radiographic imaging revealed two internal resorption areas. Apical resorption was evident on the distal aspect of the root. The Cone-beam Computed Tomography (CBCT) imaging revealed two internal resorptive areas with external resorption. This case report describes the successful surgical therapy of communicating internal, external and apical resorption with complicated pulp space that was managed effectively with the help of CBCT, magnification and bioceramic materials. This case report highlights the importance of Mineral Trioxide Aggregate (MTA), Dental operating microscope and CBCT for the diagnosis and effective management of a structurally compromised tooth.
Cone beam computed tomography, Internal resorption, Surgical management
A 25-year-old patient visited the Department of Conservative Dentistry and Endodontics with the complaint of purulent pus discharge and unacceptable colour in front tooth region for two months. The patient revealed an incident of trauma eight years back and pus discharge that increased over the past one week. Soft tissue examination revealed a draining sinus tract in the midroot region of 11. Clinical examination revealed yellowish-brown discolouration in 11 with spacing between 11 and 12 (Table/Fig 1)a. On palpation of the mid root region, a hard bony structure was felt. No tenderness was elicited on vertical percussion. Mobility was within the normal physiological range. Pulp sensibility tests showed negative responses for cold test and electric pulp tester.
Radiographic examination revealed a wide radiolucency at the intersection of the coronal and midsection of the root, radiopacity in the middle-third, patent pulp space in the apical third with distal external resorption. Obscure periapical radiolucency was present with Periapical Index (PAI) Score-5 (Table/Fig 1)b (1). CBCT imaging revealed two radiolucencies within the tooth that were communicating with the Periodontal Ligament (PDL) (Table/Fig 1)c, patent root canal and resorption in the apical-third. Sagittal section revealed tear drop shaped radiolucency from cervical to middle-third of root canal. Axial section revealed, thinning of the dentinal wall, absence of labial cortical plate and periapical radiolucency (Table/Fig 2). A probable diagnosis of a case of communicating internal-external inflammatory resorption in 11 was made considering the clinical and radiographic imaging. According to Kim S and Kratchman S, this case was designated as Class F, which represents a tooth with an apical lesion and complete denudement of the buccal plate but no mobility (2). Surgical management of communicating resorptions and apical root resorption were planned under Dental Operating Microscope (DOM).
In the first appointment, after rubber dam isolation, pulp chamber was accessed in 11. The canal could not be negotiated till the full working length. The negotiated canal was cleaned and shaped till 25 K-file (Mani, Tochigi, Japan) and calcium hydroxide dressing was placed. The tooth was temporised. The tooth was asymptomatic after a week but the sinus tract did not heal. Another attempt was made to renegotiate the canal, which was unsuccessful. Surgical intervention was planned for the next visit and repeat calcium hydroxide dressing was placed.
The entire surgical procedure was performed under DOM (Labomed Dental Microscope Prima DNT, CA, USA) at 3X magnification. Infraorbital nerve block was administered with 2 mL of 1:1,00,000 epinephrine. A full-thickness mucoperiosteal rectangular flap was elevated and surprisingly only a small piece of bone was visible in the middle-third of the root. Two external resorptive sites were identified. Orthograde root canal negotiation was tried with 10 K-files, but in vain. The instrument was exiting at the external resorption sites (Table/Fig 3)a,b. Cleaning and shaping was completed till 30/0.04 using Hero gold files (Micro Mega, Becacon, France), and irrigation was done using 3% sodium hypochlorite (NaOCl). Ultrasonic irrigation activation was done with a stainless steel #20/.00 file (IrriSafe; Acteon, Merignac, France, Satelec P5 NewtronXS). Sectional obturation was done in the negotiated canal followed by thermoplasticised obturation of guttapercha (Guilin Woodpecker Medical Instrument Co., Ltd, China) (Table/Fig 3)c.
Management of external resorptions: The two external resorptive defects were sealed with Mineral Trioxide Aggregate (MTA Plus, Prevest Denpro Limited, Jammu, India) (Table/Fig 3)d.
Management of apical resorption: The 3 mm of the root tip was sectioned using #703 carbide bur along with copious saline irrigation (Table/Fig 4)a. Periapical lesion was curetted using curette (SybronEndo, Orange, California, United States of America (USA)). The root end visualisation was done at 17X magnification using a micromirror (SybronEndo, Orange, California, USA) (Table/Fig 4)b. The retrograde canal was negotiated using microexplorer (Kerr, Romulus, MI, USA). A 3 mm of root-end preparation was carried out using AS3D ultrasonic tip (Satelec/Acteon, Merignac, France) (Table/Fig 4)c. The retrograde filling was done using MTA and was compacted using micropluggers (SybronEndo, Orange, California, USA) (Table/Fig 5)a. The quality of the restoration was confirmed with radiograph (Table/Fig 5)b.
The apical lesion was filled with a Xenogenic bone graft (Osseograft®) (Table/Fig 5)c and was covered with a type I collagen resorbable membrane (Healiguide®) (Table/Fig 5)d. The flap was sutured back atraumatically using simple interrupted sutures. Postendodontic composite restoration was placed in 11. The surgical site was dressed with a periodontal pack (COE-PAK, Coe Laboratories Alsip, IL, USA). The patient was recalled after five days for evaluation and suture removal.
A follow-up examination was done after 12 months. The tooth was functional with no associated symptoms. Clinically, the sinus tract opening had healed and the soft tissues were of normal architecture (Table/Fig 6)a. Interestingly, there was a reduction in tooth discolouration. Radiographically, there was a reduction in apical radiolucency to PAI Score-2 (1). External resorption sites revealed normal PDL with lamina dura (Table/Fig 6)b. Only the chief complaint was resolved because the patient refused to undergo other treatments for diastema closure.
Tooth resorption can be a physiological or pathological activity occurring internally (pulpal origin), externally (periodontal origin), or both. According to the glossary of endodontic terms, resorption is a condition associated with either a physiologic or a pathologic process resulting in the loss of dentin, cementum, or bone (3). The treatment planning, in this case, included: eradication of intrapulpal infection and granulation tissue followed by restoration of resorptive defects. In this case scenario, the patient presented with discolouration and a draining sinus tract opening. The trauma might have resulted in pulpal haemorrhage and necrosis. The infiltration of pulpal haemorrhagic products into the dentinal tubules might have caused discolouration over time (4).
Considering the complexity of the case, CBCT imaging was indicated. The communicating external resorptions were evident on the buccal surface of 11, which was not appreciated in conventional radiographs. In the CBCT imaging of different sections, the canal patency was appreciated. However, clinically, because of the communicating internal-external resorption, the canal could not be negotiated. Hence, both orthograde and retrograde treatment of the pulp space was decided and executed.
The magnification and illumination with a green filter assisted in identification and management of external resorptions in two different sites. Precise root resection, retro preparation and restoration were possible with endosonics and microsurgical instruments. Bacteria that persist even after chemo mechanical preparation can be eradicated with calcium hydroxide because of its antibacterial property (5). In the present case, calcium hydroxide dressing was given for two weeks because of its high alkalinity and ability to inhibit clastic activity that causes 180 resorption.
The irregular resorption cavity cannot be cleaned by only mechanical instruments hence chemical means like ultrasonically activated NaOCl, are required. Using copious amounts of NaOCl during multiple visits could have resulted in a bleaching effect on the discoloured tooth. NaOCl is highly effective in removing chromogenic organic material located in the enamel, by oxidising it and allowing the smaller degraded molecules to be washed away (6). Obturation could be best achieved by thermoplasticised obturation technique to enhance the filling of the resorptive defect area (7).
Two areas of internal resorption with external resorption were identified and sealed with MTA. MTA possesses beneficial properties like biocompatibility, bioactivity, fluid tight sealing ability and sets in blood or moisture contamination (8). The apical region of the root canal was patent but could not be negotiated conventionally. Additionally, apical root resorption was evident. So, root end resection was performed and the retrograde cavity was restored with MTA. This procedure established a fluid tight seal between the radicular space and periapical tissues (9). The patient was followedup after 12 months. The tooth remained functional and the patient is expected for follow-up after five years.
The presence of multiple resorptions with complicated pulp space is quite a rare occurrence in anterior teeth. Considering the complexity of the case, CBCT imaging was performed to precisely locate the extent of the resorptive defects. The internal, external and apical resorptions were managed effectively using microsurgery and MTA. At 12 months of recall, the tooth remained functional and interestingly, there was a reduction in tooth discolouration, probably due to the bleaching effect of sodium hypochlorite. It is worth an effort to try slow down the resorption process and maintain the tooth as long as possible in the arch for esthetics, mastication and natural space maintenance and, above all psychological uplift of the patient.
DOI: 10.7860/JCDR/2022/58729.17030
Date of Submission: Jun 28, 2022
Date of Peer Review: Aug 25, 2022
Date of Acceptance: Sep 08, 2022
Date of Publishing: Oct 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:
• Plagiarism X-checker: Jun 30, 2022
• Manual Googling: Aug 31, 2022
• iThenticate Software: Sep 07, 2022 (8%)
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