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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
Original article / research
Full Version
Comparative Evaluation of Passive Tactile Sensibility Associated with Osseointegrated Implants in Various Regions of Partially Edentulous Arch- A Prospective Cohort Study
Correspondence Address :
Murugesan Krishnan,
Professor, Department of Prosthodontics, SRM Dental College, Bharathi Salai, Ramapuram, Chennai, Tamil Nadu, India.
E-mail: mgsan2k@yahoo.com
Introduction: The extremely sensitive tactile sensors periodontal mechanoreceptors play a key role in sensory innervation of teeth. The oral kinaesthetic perceptual abilities in the absence of periodontal mechanoreceptive input can be achieved by osseointegrated prosthesis.
Aim: To evaluate the passive tactile sensibility associated with osseointegrated dental implant in various regions of the maxillary and mandibular arch.
Materials and Methods: A prospective cohort study was performed in SRM Dental College, Chennai, India between August 2013 to February 2015. Fifty patients who had single tooth replacement with functioning implants loaded six months before were included. A compressive force was applied along the long axis of the implant supported prosthesis using a push type force measuring gauge until the subject felt the first sensation of pressure and subsequently, it displayed the magnitude of force that provided the tactile sensation. The force measuring gauge used was Model: FG 5000 A form Lutron electronic enterprises co., ltd. The procedure was repeated thrice. The patient was guided to record the force perception on visual analogue scale with continuous force. The visual analogue scale has values 0-4 starting from no sensation, mild, moderate, intense and pain and the average force measured. The values of the force recorded were statistically analysed using the t-test, Statistical Package for the Social Sciences (SPSS) version 17.0 was used. The p-value of 0.05 was considered statistically significant.
Results: The overall mean value of maxilla was 23.12 N and the standard deviation was ±2.88 N. The overall mean value of mandibular was 22.44 N and the standard deviation of ±2.06 N and there was no significant difference in the threshold for passive tactile perception between maxilla and mandible.
Conclusion: The results showed that mandibular anterior teeth had least threshold for force applied than any other region of the mouth and the maxillary posterior had the highest threshold. The anterior region exhibited better passive tactile threshold measure when compared to posterior region.
Oral kinesthetic perception, Osseoperception, Periodontal mechanoreceptors, Visual analogue scale
Human teeth are innervated with highly sensitive tactile periodontal mechanoreceptors. These sensors provide information about tooth loads and are located in Periodontal Ligaments (PDL). The extraction of the teeth involves the elimination of these mechanoreceptors (1),(2). Histological, neurophysiological and, psychological evidence of osseoperception reveals that a peripheral feedback pathway can be restored when the teeth are replaced with osseointegrated implants (3),(4),(5). Though the functional reinnervation around the implant is still not fully understood, the implant allows for perception of pressure and load through a process called osseoperception. The loss of PDL and the mechanoreceptors leads to functional and psychological disturbances (6). Implant-supported prostheses restore the jaw function to the physiological discriminatory ability and oral stereognosis. The peripheral feedback for implants is contributed by rich jaw bone innervation that may help to sense mechanical deformation during implant loading (7),(8). There are numerous neurophysiological and psychophysical methods to record the oral tactile sensation. Neurophysiological examinations are complex and hence, the studies are scarce. The oral tactile sensation can be efficiently recorded by the Trigeminal Somatosensory Evoked Potentials (TSEP) after stimulation of the receptors in the oral cavity (9),(10).
Owing to the complexity in the examination of the TSEP, psychophysical methods attained popularity and the studies are numerous (1),(2),(11).
In the psychophysical method of assessment, the psychological response of the patients was correlated to the physiological functions of the receptors by following well-defined methodologies to determine the threshold level of the sensory receptors. But, the psychophysical methods are influenced by the environment and the patient-related factors (1).
The psychophysical testing reveals an improved tactile and vibrotactile capacity with an osseointegrated implant. The recent consensus statement on osseoperception included the sensory-motor interaction and defined it as the sensation arising from mechanical stimulation of a bone-anchored prosthesis, transduced by mechanoreceptors that may include those located in muscles, joint, mucosal and periosteal tissues; together with a change in central neural processing in maintaining sensory-motor function (2). Such tactile sensation from the osseointegrated dental implants can be best recorded on the visual analogue scale by psychophysical method.
The visual analogue scale is the tool to record the psychophysiological response to the force applied (11). Thus, the aim of the study was to evaluate the passive tactile sensibility associated with osseointegrated dental implant in various regions of the maxillary and mandibular arch.
A prospective cohort study was performed at SRM Dental College, Chennai, India between August 2013 to February 2015. Informed consent was taken from the patients and Institutional Ethical Committee clearance was obtained before commencing the study (SRM/M&HS/SRMDC/M.D.S.-PG Student/203).
Sample size calculation: Using nMaster software with the power of 80% and level of significance alpha error 5%, the mean 2.5 and, standard deviation 1.39, we arrived at the sample size 42 and rounded it to 50 (12).
Inclusion and Exclusion criteria: Inclusion criteria prioritised functioning implants which were loaded at least six months earlier, owing to the better osseointegration over the functioning period. Irradiated patients or patients with any systemic condition such as rheumatoid arthritis, chronic kidney disease, respiratory disease, cognitive impairment, cancer or those who had mobile implants or implants with peri-implantitis were excluded.
Study Procedure
Thus, 50 subjects of both sexes of age group 20-70 years, who underwent single tooth replacements with dental implants (Two-piece, screwed abutment and restored with a cement retained porcelain fused to metal crown) either in anterior or posterior region of both arches were selected for the study. Implant mobility was checked based on surgeon’s perception. An Orthopantomagram (OPG) was taken before the study to identify any underlying pathology such as horizontal or vertical bone loss, cysts, tumours etc. The patients were seated comfortably in a relaxed posture in an upright position in the center of the OPG machine and the patient’s head was carefully secured in position.
A cheek retractor was placed in the patient’s mouth to avoid any interference from the cheek and surrounding musculature during the procedure. Test loading was accomplished with the push-end of force measuring gauge (Model FG-5000 A, Lutron Electronic Enterprise Co Ltd.,: 150 9001 quality management system certified by SGS Technical services Pvt., Ltd.,) (Table/Fig 1).
Force Measurement
The force measuring gauge (push-end) was placed on occlusal/incisal surface parallel to the long axis of the implant and compressive force was applied directly on the restoration. Force application was subjective. Any contact between the lips and any other part of the muscles or device was avoided to overcome any false reading. The force application was progressively increased. During the application of the force, the patient was asked to respond at the first sensation of the application of the pressure.
The perception of the patient was recorded on Visual Analogue Scale (VAS) as 0-no sensation; 1-mild sensation; 2-moderate sensation; 3-intense sensation; 4-pain sensation; and the corresponding force values in the gauge were recorded for all cases (13).
The recording for each tooth was done thrice in the same position and the average force measured was tabulated. The forces recorded for each tooth at 0, 1, 2, 3 of VAS was tabulated as maxillary anterior (n=15), maxillary posterior (n=15), mandibular anterior (n=10) and, mandibular posterior (n=10).
Statistical Analysis
The values of the force recorded were statistically analysed using Student’s t-test. The Student’s t-test was used to compare the tactile sensation between two regions of the oral cavity. SPSS Windows version 17.0 was used. The p-value of 0.05 was considered statistically significant.
The forces corresponding to the passive tactile sensation were recorded to compare the threshold between the maxillary anterior and maxillary posteriors (Table/Fig 2). (Table/Fig 1), (Table/Fig 2) shows that the threshold for passive tactile perception of posterior were found to be higher than anterior in the maxillary arch. Total mean of the maxillary anterior was found to be 20.81 N and standard deviation was ±0.85 N and the total mean for the maxillary posterior was 24.85 N, standard deviation was ±2.66 N. The p-value of 0.001 was considered statistically significant. The p-value was found to be significant in mild, moderate, intense, pain sensation groups (p<0.001).
The forces corresponding to the passive tactile sensation were recorded to compare the threshold between the mandibular anterior and mandibular posteriors. (Table/Fig 3) shows that there were significant differences in passive tactile sensation between mandibular anterior and posterior teeth. The overall mean force was found to be 20.67 N and 23.77 N and the standard deviation of 0.6 N and 1.75 N for mandibular anterior and posteriors, respectively.
The forces corresponding to the passive tactile sensation were recorded to compare the threshold between the mandibular anterior and the maxillary anterior. (Table/Fig 4) shows that the overall mean for mandibular anterior was 20.67 N and maxillary anterior was 20.81 N. The p-value was 0.11.
The forces corresponding to the passive tactile sensation were recorded to compare the threshold between the mandibular posterior and maxillary posterior using Student’s t-test. (Table/Fig 5) shows that the threshold for passive tactile perception for the maxillary posterior was found to be higher than mandibular posterior. The overall mean of the maxillary posterior was found to be 24.8 N and standard deviation was ±2.6 N. The overall mean for mandibular posterior was found to be 23.7 N and standard deviation was ±1.7 N. The p-value was found to be significant (p=0.03).
(Table/Fig 6) showed that the forces corresponding to the passive tactile sensation were recorded to compare the threshold between the mandibular and the maxillary arch irrespective of anterior and posterior position. (Table/Fig 6) shows that there was no significant difference in the threshold for passive tactile perception between maxilla and mandible at p<0.05. The overall mean value of maxilla was 23.12 N and the standard deviation was ±2.88. The overall mean value of mandibular was 22.44 N and the standard deviation of ±2.06 N which was statistically not significant.
The functioning of the oral apparatus is very much dependent on the input of the neural network by proprioception and perception. The loss of an individual chewing unit can lead to the non integration of the proprioception and perception which in turn handicaps the neural system (2). The sensory and motor responses go hand in hand in neuro-muscular activity of the masticatory system. When missing teeth are replaced, the successful outcome of the treatment is also dependent on the proper integration of the proprioceptive feedback and motor responses. Tooth extraction damages the sensory feedback pathway owing to the loss of PDL and its richly innervated mechanoreceptors (2). Unanchored removable prostheses cannot compensate for the normal tooth loading compared to the anchored (osseointegrated) prosthesis as the mucosal mechanoreceptor functions are less efficient than the periodontal mechanoreceptors (2). The direction, magnitude and, the rate of occlusal load is best perceived by the periodontal mechanoreceptors. With tooth extraction, all these fine proprioceptive control mechanisms are lost. Still, the oral tactile function can be restored with dental implants (14).
The tactile function with implant-supported prosthesis is extensively studied (Haraldson T et al., 1979; Lindquist LW and Carlsson GE 1986; Carr AB and Laney WR 1987) and compared with natural teeth and complete dentures (14),(15),(16). The periodontal mechanoreceptors have varied active and passive discriminative ability of forces. Passive discrimination of the receptors was assessed by the application of controlled forces to the tooth. Active discrimination involves the presence of an object between the teeth and does not solely depend on periodontal receptors. The input from the teeth, periodontium, jaw muscles, TMJ ligaments and, capsules also play a role in active discrimination (16).
Various studies by Karayiannis AI et al., Jacobs R and van Steenberghe D indicate that passive tactile sensation of an implant-supported prosthesis is higher than that of a natural tooth. In this study, the passive tactile sensibilities associated with osseo-integrated implant-supported prostheses were recorded in various regions of the oral cavity of partially edentulous patients and compared the sensibilities within the anterior and posterior region of the same arch and between the maxillary and mandibular arches (12),(17). Experiments involving electrical stimulation in cats demonstrate that some sensory innervation exists in the alveolar bone comprising of both unmyelinated and myelinated sensory fibers (17). The unmyelinated (type C) fibers have a conduction velocity of 1 to 2 m/s. The free endings also characterise the C fibers endowing the mandibular alveolar bone and might play a role in sensory impulses. The myelinated (type A) fibers have conduction velocities ranging between 3 and 11 m/s. Some of the A fibers are found to be connected to the encapsulated endings, Ruffini’s corpuscles. These sensory formations are found in osteoblasts in the tissue connecting between canine to the first premolars which act as force sensors. Studies show that these sensory innervations are not present only in the alveolar but also the spongy bone apart from the PDL. Histological findings show the presence of specialised Ruffini mechanoreceptive terminals in the immediate vicinity of the implant. They were predominately myelinated fibers. The unmyelinated fibers were also present under the implant thread. Repetition of histological studies after implant loading revealed the increase in the number of free nerve endings (18),(19). Hence, an implant-supported prosthesis osseintegrated with bone has better osseoperception than the unanchored prosthesis. The intensity of osseoperception varies with the quality and quantity of available bone (20),(21).
Limitation(s)
The study was performed based on VAS which is more a subjective measure. This could influence the results.
The anterior region exhibited better passive tactile threshold measure when compared to posterior region. There was no significant difference in sensation between maxillary and mandibular arches. The result showed that mandibular anterior teeth have least threshold for force applied than any other region of the mouth and the maxillary posterior had the highest threshold.
DOI: 10.7860/JCDR/2022/50779.15989
Date of Submission: Jun 10, 2021
Date of Peer Review: Aug 20, 2021
Date of Acceptance: Dec 03, 2021
Date of Publishing: Feb 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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