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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
Retrieval of Separated Endodontic Ni-Ti Rotary File with the Aid of Hypodermic Needle and K-File: A Case Report
Correspondence Address :
NJ Nagaraj,
Senior Lecturer, Department of Conservative Dentistry and Endodontics,
Rajas Dental College and Hospital, Kavalkinaru-627105, Tamil Nadu, India.
E-mail: dr.njendo1992@gmail.com
One of the most prevalent operational errors that can occur during endodontic therapy is instrument separation. A fractured instrument may cause a blockage in the root canal, impeding the cleaning and shaping process. There are numerous recommended ways for retrieving a separated instrument, some of which are challenging to implement in clinical practice. Some of these procedures may need removal of substantial root dentin, which may weaken the tooth structure. This case report describes an alternate method for removing a fractured endodontic instrument from the root canal using a hypodermic needle and a K-file. A 31-year-old female patient came to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the upper left front tooth region since two weeks. The clinical and radiographic examination indicated the existence of a broken Nickel-Titanium (Ni-Ti) rotary file along the coronal third of the root canal till apex. Under magnification, the fragment was initially exposed by creating a 2 mm trough around the fractured instrument using ultrasonics. In order to fix the fragment, a hypodermic needle was introduced into the root canal and the K-file was fitted in the needle lumen. Together, the fragment was removed without any complications. This technique can be used as a safe, easy, and low-cost approach of fractured instrument retrieval from the root canal.
Fractured instrument, Rotary file, Root canal, Ultrasonics
A 31-year-old female patient presented to the Department of Conservative Dentistry and Endodontics with the primary complaint of pain in the upper left front tooth region since two weeks. Patient history indicated a previously initiated endodontic treatment performed 8 months back on maxillary left canine (23). Her medical history was non contributory. On clinical examination, the concerned tooth was properly aligned in the arch. There was no pain when percussion or palpation was applied, no swelling, and no evidence of a sinus tract. Periodontal examination indicated normal probing depth, gingival tone, and no mobility. A Nickel-Titanium (Ni-Ti) instrument was evident on radiographic inspection, from the coronal one third of the tooth to the apex and confirmed the diagnosis as previously initiated root canal therapy with fractured instrument in relation to tooth number 23 (Table/Fig 1). The patient was made aware about the instrument fracture, and the treatment plan was decided as removal of the separated fragment. Informed consent was acquired from the patient before beginning the treatment.
A 2% lignocaine hydrochloride and 1:80000 adrenaline (Lignox 2%, Indoco Remedies Ltd., Mumbai) was used to deliver local anaesthesia. Access cavity was modified with a sterile Endo access bur No. 2 (Dentsply Maillefer, Switzerland) under rubber dam isolation (GDC Fine Crafted Dental Pvt., Ltd., India). A 10 mL 3% Sodium Hypochlorite (NaOCl) (Prime Dental Products Pvt. Ltd., Thane, India) was used to irrigate the pulp chamber. Initially, retrieval of the separated instrument was attempted using ultrasonics. Though the fragment became loosened, complete removal of fragment was unsuccessful using this technique. Then, the instrument was exposed by forming a 2 mm trough around the broken instrument using ultrasonics (Acteon, Satelec, France), done under the dental operating microscope (Sanma Medineers Vision Private Limited, Chennai, India). A 15 size K-file (Dentsply Maillefer, Switzerland) was used to partially bypass the instrument within the canal (Table/Fig 2).
An 18-gauge needle (1.27 mm in outer diameter, 0.84 mm in inner diameter) was converted into a microtube by straightening the bevel of the needle using carborundum disc. The prepared needle was fitted to the coronal end of the separated instrument. Following proper adaptation within the root canal and the free portion of the broken instrument, a 25 size K-file (Dentsply Maillefer, Switzerland) was introduced in a clockwise manner through the needle, to create a wedging effect between the needle and the coronal aspect of the separated fragment (Table/Fig 3). K-file, needle, and the separated instrument were ensured to be in tight contact. Together, the set was pulled out coronally, by grabbing on the handle of the K-file (Table/Fig 4).
With this movement, the fractured instrument was successfully retrieved from the canal (Table/Fig 5) and a radiograph was taken to confirm the same (Table/Fig 6). Following that, working length was determined with 25 size K-file. Chemomechanical root canal preparation was performed using crown-down technique till size F3 (6% taper) using protaper gold rotary system (Dentsply Tulsa Dental, OK, USA). Calcium hydroxide (ApexCal, Ivoclar Vivadent, Schaan, Liechtenstein) intracanal medicament was placed for a fortnight. Obturation was done using single cone technique with F3 gutta percha point (Dentsply Maillefer, Switzerland) and AH Plus resin-based sealer (Dentsply DE Trey, Konstanz, Germany) in the following appointment. Permanent coronal seal was placed using bulkfill composite restorative material (Tetric N Ceram, Ivoclar Vivadent, AG) (Table/Fig 7).
Instrument fracture within the root canal causes metallic pieces to block the intracanal space, compromising complete chemomechanical debridement and jeopardising a successful root canal therapy. When such an event is clinically confirmed, the fragment may be removed, bypassed, and sealed inside the root canal, or true blockage may be caused. Instrument fractures may also be attributed to a lack of knowledge regarding the procedure, over usage of the instrument, and the number of sterilisation cycles undergone by the instrument (1). The presence of broken fragment in the root canal indicates a negative prognosis for the case, since cleaning and shaping of the obstructed root canal may be difficult (2).
The usage of Ni-Ti file system has altered the way we shape the root canal system. Ni-Ti alloys have several advantages including super elasticity, shape memory effect, and resistance to corrosion, all of which contributed to their extensive usage in a variety of dental applications. However, as compared to stainless steel, Ni-Ti alloy has a lower ultimate tensile strength and yield strength, making it at increased risk to fracture at reduced loads (3). Despite the numerous benefits and increasing popularity of Ni-Ti instruments, the chances of procedural errors are significantly higher (1.3% and 10%, respectively) than for stainless steel instruments (0.25% and 6%, respectively) (4). The success rate for retrieving separated instruments is shown to be between 55% and 79% (5). There are several methods for removing broken instruments, including the conventional approach using manual instruments, ultrasonics, the Masserann kit, the Terauchi kit, the Canal Finder and the Instrument Removal System (IRS), etc., (6). However, no systematic approach for the removal of intracanal metallic obstacles has been developed. Many of these techniques, however, result in excessive radicular dentin removal and cause decreased resistance to tooth fracture (7).
In the present case, a Ni-Ti rotary instrument was fractured to the full length of the canal, and fully bypassing the canal was difficult. Initial retrieval attempt was made using ultrasonics, but the fragment was not able to be dislodged, since it was entrapped within the root canal wall. Stainless steel files are relatively easier to retrieve using ultrasonics because they tend to not break further during the process of removal. When ultrasonics is used to remove Ni-Ti instruments, heat build-up may cause additional breakage (8). As a result, for the removal of fractured fragment, authors employed a low-cost, conservative method using a prepared stainless steel hypodermic needle in conjunction with a 25 size K-file. Literature research had shown that similar approaches were attempted for separated instrument retrieval previously (Table/Fig 8) (2),(5),(6),(9),(10),(11),(12),(13).
Ingle JI and Bakland LK recommended a second tool inserted into the needle lumen in order to wedge the fractured fragment to aid in removal (14). The use of hypodermic needle for instrument removal was originally reported by Eleazer PD and O’Connor R (11). There are several advantages of using a hypodermic needle to loosen or remove a blockage from the root canal. A hypodermic needle removes much less dentin than a rotary trephan since it does not have the ability to cut the dentinal walls (15). The current instrument retrieval approach was previously reported by Monteiro JC et al., who used a prepared stainless steel needle in conjunction with a K-file (12). This permits the clinician to constantly consider removing the broken instrument as a clinical alternative for enhancing the patient’s prognosis.
Suter B suggested utilising a small length of stainless steel cylindrical tube, put over the visible tip of the fractured instrument and an H-file pushed through the tube in a clockwise rotating manner to entrap between the tube and the end of the instrument (10). K-file was chosen instead of H-file in this case due to its structural characteristics. According to Monteiro JC et al., there is an increased chance of additional instrument separation during the tight adaptation between the fractured segment and the H-file. Furthermore, because the active blade is at a lower angle in reference to the instrument’s long axis, K-file allows for increased penetration between the fractured fragment and the inner lumen of the needle (12). Coronal removal of fractured fragment is aided by the extended adaptation of the endodontic file between the fractured fragment and the inner lumen of the stainless steel needle, especially when the fragment is smooth (12). The fragment removal with K-file justifies a greater capture and adaptation to improve the separated instrument removal approach.
To conclude, the use of prepared hypodermic surgical needle and K-file led to the successful retrieval of the broken instrument. Adjunctive use of ultrasonics may be beneficial. This technique also provides the added benefit of minimal root dentin removal.
DOI: 10.7860/JCDR/2022/52253.16049
Date of Submission: Sep 04, 2021
Date of Peer Review: Nov 23, 2021
Date of Acceptance: Jan 12, 2022
Date of Publishing: Mar 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: Sep 06, 2021
• Manual Googling: Jan 03, 2022
• iThenticate Software: Jan 28, 2022 (12%)
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