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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 Fracture Resistance of Maxillary Premolars with Class II Cavities Restored with Glass Hybrid Restorative System and Nanohybrid Composite Resin: An In-vitro Study
Correspondence Address :
Karkala Venkappa Kishan,
Professor, Department of Conservative Dentistry and Endodontics, Room No. 8, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Waghodia, Vadodara-391760, Gujarat, India.
E-mail: drkishankv@yahoo.co.in
Introduction: Maxillary premolars are the most susceptible teeth to fracture if both marginal ridges are compromised. Composite restorations have performed remarkably in restoring the marginal ridges. However, it has certain disadvantages, thus to overcome this, modified glass ionomer based restorative materials with improved mechanical properties were introduced.
Aim: To compare and evaluate the fracture resistance of maxillary premolars with class II Mesio-Occluso-Distal (MOD) cavities which received Glass hybrid restorative system and Nanohybrid Composite resin.
Materials and Methods: The present study was an in-vitro study conducted at KM Shah Dental College and Hospital, Vadodara, Gujarat from December 2019 to June 2020, on 30 Extracted Maxillary premolars. Total samples were divided into group A (n=15) restored by glass hybrid restorative system and group B (n=15) restored by nanohybrid composite resin. Standardised class II MOD Cavity preparation was done in all the samples. The samples were subjected to a thermocycling procedure, and a universal testing machine measured the fracture resistance. Data obtained from all the samples was analysed by Independent sample t-test with a p-value set at less than 0.05.
Results: In group A, mean fracture resistance (at mean force 947.07±236.41) was found to be greater than in Group B. However, the difference among the groups was not statistically significant with a p-value of 0.555.
Conclusion: Glass Hybrid restorative system showed better fracture resistance than Nanohybrid Composite Resin in maxillary premolars with class II MOD Cavities.
EQUIA forte, Fracture resistance, Thermocycling procedure
In the past decade, posterior teeth have been extensively restored using dental restorative composites. Secondary caries and wearing of the occlusal surfaces are the most common failures in direct posterior composite fillings. However, it has been shown that fracture is also a common reason for replacement (1). One of the most important characteristic features of any dental material is its fracture resistance which means the resistance of the material to prevent crack propagation (2).
After the preparation of large MOD cavities, a significant amount of reduction in tooth structure occurs due to loss of marginal ridges, leading to an increased risk of tooth fracture, which is one of the most common problems in restorative dentistry. Therefore, to avoid such tooth fractures providing the resistance form when preparing a cavity is essential. The stiffness is reduced by 63% if the cavity preparation design incorporates both marginal ridges (3).
It is considered that because composite resins can adhere to the remaining tooth structure, they can transmit and distribute functional stress, but they have certain disadvantages. Glass Ionomer Cements (GICs) are frequently employed in many different dental specialties. When opposed to other restorative materials, one benefit of glass ionomers is that they can be inserted into cavities without the use of bonding agents, however it has less flexural strength and lack of fracture toughness (4). To overcome these disadvantages, EQUIA was introduced. EQUIA is a new glass ionomer restorative system. Chemically cured, self-adhesive, highly filled GIC and light-cured, self-adhesive, filled resin surface sealant are combined in this restorative material (5).
EQUIA Forte was set upon the exceptional clinical performance of the existing EQUIA system (6). Manufacturers claim that EQUIA Forte Fil (GC America) is a restorative material with a significant increase in flexural energy (fracture toughness). EQUIA Forte Fil is stronger because the glass fillers’ matrix is strong which is attributed to the new Hybrid glass technology. Besides the original glass particles (fluoro-alumino-silicate (FAS)), innovative ultrafine, highly reactive glass (FAS) fillers (<4 μm) are dispersed into EQUIA Forte Fil. In addition, the set cement’s physical, chemical, and acid resistance qualities are enhanced by polyacrylic acid which has a relatively higher molecular weight. It extends recommended indication to include stress-bearing class II restorations (7).
With the help of single dispersion nano-fillers, the EQUIA Forte Coat’s innovative cross-linking monomer chemistry and more effective polymerisation capabilities provide a stronger resin matrix (8). Scarce literature is available comparing fracture resistance of glass hybrid restorative system and nanohybrid composite resin. Also, the testing parameters used in those studies were mainly in non carious cervical lesions. Hence, there is a need of testing these materials in the high-stress bearing areas of marginal ridges before it can be used in the clinical scenario [6-9]. Thus, the present study aimed to evaluate and compare the fracture resistance of maxillary premolars with class II MOD Cavities restored with Glass Hybrid restorative system (Equia Forte, GC) and Nanohybrid Composite (FiltekTMZ350XT, 3M/ESPE). The null hypothesis was that there is no difference in fracture resistance in maxillary premolars restored with Glass Hybrid restorative system (Equia Forte, GC) and Nanohybrid Composite (FiltekTMZ350XT, 3M/ESPE).
The present study was an in-vitro study conducted at the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from December 2019 to June 2020. After taking approval from the Ethical Committee (SVIEC/ Dent/ON/SRP/20028).
Sample size calculation: G*Power 3.1 (Heinrich Heine University, Germany) was used to calculate the sample size, and it had a power of 80% and an alpha type error of 0.05. The calculated sample size was 15 per group.
Inclusion criteria: Adult maxillary premolars which were extracted for orthodontic purpose were included in the study.
Exclusion criteria: Carious, attrited, cracked, and teeth with hypoplastic defects or restored teeth were excluded from the study.
Study Procedure
The samples were disinfected with a 0.5% chloramine T. Then, using an ultrasonic scaler, all teeth were cleansed of periodontal tissue and calculus. The samples were kept in normal saline solution at 4 degrees.
Class II (MOD) type cavity preparation was done with a pulpal depth of 2±0.2 mm, axial height of 2±0.2 mm, 1.5±0.2 mm gingival width. Proximally, 3±0.2 mm buccolingual width and one-third of the inter-cuspal distance at occlusal isthmus. After proper measurement of the cavity, the samples were randomly (Flip coin method) divided into two experimental groups of 15 samples each, and restoration was carried out. The details of the restorative materials used are listed in (Table/Fig 1).
• For Group A (n=15), teeth were restored with EQUIA Forte,
• For Group B (n=15), teeth were restored with nanohybrid composite resin (FiltekTMZ350XT, 3M/ESPE).
In Group A, 20% Polyacrylic acid was applied for 10 seconds, rinsed and the cavity was dried using a cotton pellet. After that, EQUIA Forte (GC) Capsule was activated just before the mixing. After that, the capsule was mixed for 10 seconds using an amalgamator. It was directly then placed within 10 seconds after mixing. The self-curing restoration was finished after 2 minutes 30 seconds from the start of mixing, as per the manufacturers’ instructions (8).
In Group B all conventional protocols of composite restoration placement were followed, and finishing and polishing were performed.
After that, thermocycling of the samples of both groups was done (500 cycles) at 5°C ± 2° C to 55 °C±2°C. To replicate the periodontal ligament, polyvinyl siloxane was applied around the root surfaces after a layer of light body elastomeric impression material. Next, a block of cold-cure acrylic resin was used to mount the teeth upto 1.5 mm apical to the Cemento-Enamel Junction (CEJ). Using a universal testing machine (Instron testing machine), a compressive force at a strain rate of 1 mm/min was applied to measure fracture resistance. The force necessary to fracture each tooth was measured in Newton’s (N). As shown in (Table/Fig 2).
Statistical Analysis
Statistical significance was set at p-value <0.05 in Statistical Package for Social Sciences (SPSS) software (version 20.0.1; International Business Management (IBM) Corp, Armonk, NY). The data obtained were tabulated and subjected to Independent sample t-test, and the difference in fracture resistance will be evaluated between the two groups.
The mean force that caused the fracture of the teeth in each group and the standard deviation are presented in (Table/Fig 3). For EQUIA Forte, the mean force was 947.07 Newton with a standard deviation of 236.41, whereas for Nanohybrid Composite, it was 895.23 Newton with a standard deviation of 238.17. Statistical analysis was first made by independent sample t-test, which showed that Group A had more fracture resistance among both the groups but the difference was statistically non significant with p-value 0.555.
One of the challenges with restoring large cavities is the remaining tooth structure’s resistance to fracture under masticatory stresses. However, by employing different restorative materials, it might be possible to reinforce the tooth structure that is still present. The physical characteristics of restorative materials may have an impact on tooth reinforcement. Thus, the mechanical properties of the restorative material are a primary concern when selecting any restorative material. Restoration of teeth also depends on many parameters, like tooth type, remaining tooth structure, and position of the teeth in the arch (1).
In the oral cavity, maxillary premolars tend to fracture due to their morphology (crown root ratio and crown shape) and cuspal inclination, making them more susceptible to fracture under occlusal load. Thus, in the present study, maxillary premolars were selected to check fracture resistance (10). The removal of dental structure is directly correlated with a decrease in fracture resistance. There is a significant amount of reduction in the strength of the tooth after the preparation of Class II MOD cavities due to the loss of both marginal ridges. Thus, in the present study, Class II MOD cavities were prepared to simulate a similar condition often seen in routine clinical practice (11).
Various studies have found that nanohybrid composite has higher fracture resistance, and composite resin can reinforce and restore teeth weakened by wide class II MOD Cavity preparation [5,12]. The physical and mechanical properties of nanohybrid composites made of nanofillers have a significantly higher filler content, have improved considerably. Thus, in the present study, nanohybrid composite (Filtek Z350 XT) was selected as a control [13,14].
According to a study conducted by Mostafa S and Mohamed A (2) nanohybrid composite resin group showed an acceptable fracture resistance. The major drawback of direct resin composite restoration is high polymerisation shrinkage, resulting in microleakage. GIC has been used in restorative dentistry for a long time as it has anticariogenic properties but has poor mechanical properties such as low fracture strength and low fracture toughness (15).
To overcome the poor mechanical properties of conventional GIC, high-strength GIC restoration with improved physical properties was introduced. This led to the introduction of EQUIA, a combination of self-adhesive, chemically cured, highly filled GIC and self-adhesive light-cured filled resin surface sealants (16). It has been claimed by manufacturers that the material has increased fracture toughness, flexural strength, and flexural fatigue resistance.
The present study’s results showed no statistically significant difference in fracture resistance between Glass Hybrid restorative system (Equia Forte, GC) group and nanohybrid composite group. However, Glass Hybrid restorative system (Equia Forte, GC) group showed comparatively better results than the Nanohybrid group, in accordance with the previous study done by Kutuk ZB et al., (9), which concluded that glass hybrid restorative material exhibited sufficient mechanical properties and could be used for extensive carious lesion in posterior teeth. Similar results were found in the study done by Moshaverinia M et al., wherein the glass hybrid restorative materials showed superior flexural strength and surface hardness (17).
The differences between Glass Hybrid restorative system (Equia Forte, GC) and nanohybrid composite may be explained by the novel hybrid glass technology of EQUIA Forte in which, apart from the glass particles, a novel ultra-fine, highly reactive glass is incorporated into EQUIA Forte Fil (17). This innovative hybrid glass formulation boosts ion availability, improves matrix formation, and creates a significantly stronger matrix structure when combined with a higher molecular weight polyacrylic acid. The material’s micron-sized filler particles release more metal ions, which enhances the matrix’s cross-linking of polyacrylic acid and its general physical qualities. In addition, the coating agent (EQUIA Forte Coat) applied on the surface of the EQUIA Forte restorations contains a nano-filled resin and multifunctional monomer that may significantly increase the surface hardness and fracture resistance of the material to withstand masticatory forces (18).
Limitation(s)
One of the limitations of this in-vitro study was that some differences exist between induced fracture variables like the speed of force application and direction of forces. Thus, it does not simulate the functional environment of the oral cavity.
The fracture resistance of the Glass Hybrid restorative system was found to be insignificantly better than that of Nanohybrid Composite Resin in maxillary premolars with class II MOD Cavities. However, clinical research with long follow-up will give us a better validity of the Glass Hybrid restorative system for clinical usage.
DOI: 10.7860/JCDR/2023/58969.17591
Date of Submission: Jul 08, 2022
Date of Peer Review: Aug 31, 2022
Date of Acceptance: Oct 26, 2022
Date of Publishing: Mar 01, 2023
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? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
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