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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
Comparison of Non Surgical Periodontal Treatment Outcome and Clinician’s Comfort Levels using LM ErgoMax over Hu-Friedy Hand Instruments- A Randomised Clinical Trial
Correspondence Address :
Dr. Mohan Kumar Pasupuleti,
Reader, Department of Periodontics and Implantology, Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh, India.
E-mail: mosups@gmail.com
Introduction: Non surgical periodontal therapy by scaling is done by using different sets of hand and motor driven instruments. The best instrument for non surgical periodontal therapy has to be identified, so that, it will benefit the clinicians in point of ergonomics and for patients in terms of less discomfort caused during scaling.
Aim: To compare the effectiveness of Linear Monolithic (LM) instruments to Hu-Friedy instruments in non surgical periodontal treatment.
Materials and Methods: The split-mouth randomised clinical trial study comprised 50 patients, who were selected from those attending the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, and who were classified with gingivitis or moderate to severe periodontitis according to American Academy of Periodontology (AAP) standards from 1999 and had not undergone any periodontal therapy in the previous six months to one year. The study was conducted from September 2021 to February 2022. Periodontal treatment outcomes were evaluated by plaque index, bleeding index, probing pocket depths, gingival index and clinical attachment level. Clinicians comfort levels and handling characteristics of two sets of hand instruments (Test: LM instruments to control: Hu-Friedy instruments) were assessed by questionnaire consisting of 10 closed ended questions immediately after the non surgical therapy. The unpaired t-test was used for intergroup analysis and one-way ANOVA was used for intragroup analysis.
Results: The mean gingival index scores for test and control sites at baseline were (1.65 and 1.72), at one week were (0.89 and 0.64) and at one month were (0.46 and 0.31). The mean periodontal pocket depth for test and control sites at baseline were (3.93 and 3.79), at one week were (3.40 and 3.25) and at one month were (3.18 and 2.42). A statistically significant difference seen in gingival index (p=0.001), sulcus bleeding index (p<0.001), periodontal probing depths (p<0.001) and clinical attachment level (p<0.001) at one-month interval.
Conclusion: The findings demonstrate that LM instruments have higher handling features and cutting efficiency than Hu-Friedy instruments, although there is no significant difference in plaque index, gingival index, probing depth reduction, sulcus bleeding index, or clinical attachment level.
Linear monolithic ErgoMax, Non surgical therapy, Subgingival debridement
Dentists can produce good non surgical periodontal therapy treatment outcomes by combining manual and power instruments. Both modalities are more important and effective than ever because of the newly developed designs. Dentists may now provide patients with the best periodontal care possible in order to increase clinical effectiveness, enhance outcomes and eventually benefit individuals by delivering superior dental and general healthcare (1).
Due to the ineffective instrumentation, or due to improper selection of instruments, the infection or disease process can frequently develop in unresolved regions depending on the host's reaction to inflammation. To decrease chronic gingival inflammation after non surgical periodontal therapy, hand instrumentation must involve full biofilm and calculus removal (1).
There are many different dimensions, shapes, materials, weights and comfort options for tool handles. Hand devices with varied handle diameters can help prevent hand stress and repetitive motion injuries. Clinician comfort is a significant concern in handling selection, which is crucial in reducing repetitive strain injuries. Larger diameter handles may reduce hand fatigue and finger cramps. The optimal handle weight is 15 gms or less, and the ideal handle diameter is atleast 10 mm (2).
Tools with patterned grip surfaces or other surface coatings may help to create friction among gloved fingers and the tool, minimising pinching forces, because clinician comfort is the most crucial element (3). Tool handles made of plastic as well as alloy steels with such an etching process decorative pattern avoid slippage and provide a firm grip. Since 1908, Hu-Friedy has been extensively utilised because to its exceptional quality and is regarded as an innovative dental product in the hands of dental experts all over the world (4).
Linear Monolithic (LM) Ergomax is constructed of an extraordinarily durable unique metal alloy with a protective micro-membrane covering that improves wear resistance and reduces the time required on routine dental tool maintenance. The fundamental benefit of LM over Hu-Friedy is that LM employs a combined ideal feature of higher sharpness and tactile sensitivity, as well as increasing instrumentation comfort (5).
With an increasing understanding of the relationship between periodontal health and systemic health it is critical to provide accurate, comprehensive and pleasant periodontal diagnostic and treatment choices. Hand instrument designs and materials for dental hygiene treatment are constantly developing and improving, presenting dental hygienists with the problem of choosing the proper tool for each clinical setting (4),(5).
There is currently no research comparing ergonomics and clinical outcomes of these two instruments. Thus, the primary goal of the present study was to compare the effectiveness of LM instruments to Hu-Friedy instruments and to assess periodontal treatment outcomes by evaluating plaque index, bleeding index, probing pocket depths, gingival index and clinical attachment level. Secondary goals were to assess and compare clinician comfort levels and to assess the effect of instrument design on static friction and pinch forces required to perform root planing.
This was a split-mouth randomised clinical trial conducted to compare the non surgical periodontal treatment outcome and clinician's comfort levels using LM ErgoMax over Hu-Friedy hand instruments. All the patients were selected from those attending the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from September 2021 and completed the entire study by February 2022. The study was approved, and ethical clearance was obtained from the Institutional Ethics Committee with Ref No: (IECVDC/2021/PG01/PI/IVV/49) and also approved under Clinical Trials Registry- India (CTRI/2021/09/036951). Randomisation done by using coin toss method and only the patients were blinded regarding the type of instruments used.
Inclusion criteria:
• Age range of 19-65 years
• Minimum of 20 teeth in the mouth
• Patients who did not receive any periodontal treatment in the last six months to one year
Exclusion criteria:
• Patients with uncontrolled systemic diseases.
• Physically and mentally challenged individuals
Sample size calculation: G-power software version 3.10 was used to calculate the sample size. Sample size of 50 was obtained in the study.
• Input: Tail(s)=Two
Effect size=0.7857143 (3)
α err prob=0.05
Power (1-β err prob)=0.80
Output: Non centrality parameter δ=3.1746499
Critical t=2.2009852
Df=15
Total sample size=50
Actual power=0.8234309
Parameters Assessed
The primary goal of the present study was to compare the effectiveness of LM instruments to Hu-Friedy instruments and to assess periodontal treatment outcomes by evaluating plaque index, bleeding index, probing pocket depths, gingival index and clinical attachment level.
A trained examiner (primary investigator) performed clinical examinations for dental plaque and gingivitis under ambient light at the baseline one week and one month time points. The Löe-Silness (Loe 1963) and Turesky Modification of the Quigley-Hein (Turesky et al., 1970) were used to evaluate dental plaque and gingivitis in the whole mouth (6).
Using the UNC-15 periodontal probe, the sulcus bleeding index (Muhlemann and Son, 1971), Pocket depth measurement and clinical attachment levels were evaluated (6).
Secondary goals were to assess and compare clinician comfort levels and to assess the effect of instrument design on static friction and pinch forces required to perform root planing. Total five operators were included each of five operator performed root planning treatment in 10 patients (Table/Fig 1).
Study Procedure
Operators checked their latex gloves by pulling them while applying an usual force of 40 Newton (N) and placing a moist thumb pad along the tool's long axis. The lead investigator assessed the thumb-tool interaction during and immediately following the static friction test by noting which dental instruments had the strongest grip and which ones slipped. In the present study, authors evaluated which type of instrument design required higher force during root planing. Pinch force is the hand pressure applied to the instrument handle [7,8]. In the present study, authors asked the operators to rate the comfort levels related to the static friction and pinch forces while using LM and Hu-Friedy instruments.
A questionnaire validated by subject experts, consisting of 10 closed ended questions on comfort levels and on clinical handling characteristics of two different sets of instruments was assessed immediately after the non surgical periodontal therapy [Annexure 1]. Questionnairere is adopted from the study by Mohan Kumar P et al., where they have compared the comfort levels of clinicians and handling characteristics of instruments used for non surgical periodontal therapy (9).
Before starting of the study, standardisation and calibration exercise was performed on the postgraduate students to achieve consistency. Ten postgraduate students trained in professional root planing were included in the pilot study and asked for the best instrument while checking for hand instrument design, handling characteristics and efficiency in calculus removal (10),(11).
The responses from the postgraduate students were assessed and Cronbach’s alpha value was calculated as a measure of consistency which is 0.9. There was 90% agreement between the postgraduate students in performing the procedure by both sets of instruments. According to the minimum values of Content Validity Ratio (CVR) for different panellist’s, a minimum CVR value of 0.99 was considered the cut-off value for 10 panellists. The value obtained for the validity evaluation of the questionnaire is 99% which is well, as in the minimum values of CVR.
Statistical Analysis
The unpaired t-test was used for intergroup assessment, and one-way Analysis of Variance (ANOVA) was used for intergroup analysis by using Statistical Package for the Social Sciences (SPSS) software. The p-value less than 0.05 was considered significant.
The patients recruited into the present study were aged in between 19-60 years, in which 20 were men (40%) and 30 (60%) were women (Table/Fig 2),(Table/Fig 3).
Intergroup analysis was performed between the test and control groups for various periodontal parameters. Statistically significant Gingival Index (GI) scores (0.003) was obtained by comparing the gingival index at one week for the test group and for the control group. The sulcus bleeding index differed significantly (p-value 0.001) between the test and control groups, with mean values of 1.6403 and 1.4148 at one month intervals. At one month, there was statistically significant difference seen (0.001) in probing depths between the test and control groups, with a mean value of 3.1864 for the test group and a mean value of 2.4298 for the control group. At monthly intervals, the test group and control group had a statistically significant (p-value=0.001) difference in clinical attachment level, with mean values of 3.1866 and 2.4298, respectively (Table/Fig 4).
Intergroup analysis revealed highly statistical significance result for evaluation of periodontal probing depth (0.001) at one month interval in both test and control group (Table/Fig 5),(Table/Fig 6).
A questionnaire was used to compare the treatment outcomes, comfort (Table/Fig 7),(Table/Fig 8), handling characteristics like grip when working (Table/Fig 9),(Table/Fig 10), treatment satisfaction by the operators, and the cutting efficiency of the Hu-Friedy instruments and LM instruments (Table/Fig 11). A 60% of the clinicians felt excellent comfort with LM instruments as compared to 40% for Hu-Friedy instruments. An 80% of the clinicians felt that LM instruments provided improvement in friction while working as compared to only 20% clinicians for Hu-Friedy instruments. The coefficient of static friction was higher for a smooth surfaced LM instrument than HuFriedy instruments. Static friction and pinch forces were good for 80% of operators with HuFriedy instruments, whereas 100% of operators were satisfied with LM instruments when used for root planing procedure.
The outcome of the present study compared the LM curettes to the Hu-Friedy curettes to assess the instrument's efficiency. When utilising LM curettes, greater tactile sensitivity and complete control were seen, leading in improved ergonomics. A 60% of the clinicians felt excellent comfort with LM instruments as compared to 40% for Hu-Friedy instruments. LM curettes are composed of an extremely durable unique metal alloy, and a protective micro membrane covering improves wear resistance and cuts down on time spent sharpening instruments. These characteristics enhance the clinician's comfort and tactile sensitivity (12),(13), whereas, Hu-Friedy instruments designed with True Fit technology to maximise ergonomics and reduce pinch force and its scaler blade is 72% sharper to enable calculus removal with less pressure (14).
According to studies by Hill RW et al., and Schlageter L et al., hand instrumentation curettage generated the smoothest root surface, whereas mechanical instruments, such as the ultrasonic scaler, roughened the root surface (15),(16). In research comparing manual and ultrasonic subgingival debridement, Yan Y et al., discovered no significant change in clinical indicators such as Bleeding on Probing (BOP), Clinical Attachment Loss (CAL) and Probing Depth (PD) (17). However, in the present investigation, we found statistically significant differences between two types of hand instruments, LM and Hu-Friedy hand instruments.
Cobb CM, realised that hand curettes needed greater skill and time (18). Several studies have brought the prior technique of removing damaged cementum to render the root surface favourable for soft tissue healing into question. Hand instrumentation for subgingival debridement makes therapy less harsh and more enjoyable for both the patient and the therapist (19),(20),(21). As a result, the importance of hand root planing cannot be overstated. Hand instrumentation has been recommended as the last finishing step in the treatment of periodontitis affected roots following ultrasonic debridement (22). In the findings of the study conducted by Rempel D et al., demonstrated that dental instrument design affects dentist’s experiences of discomfort, thereby use of a lighter instrument with a larger diameter increases clinicians comfort levels (23). In the present study, LM curettes with their unique handling properties have shown to be ergonomic friendly to the clinicians.
Puglisi R et al., has compared the four different instruments (Gracey curettes-Hu-Friedy, piezoelectric ultrasonic (Satelec®) with No.1S insert, diamond burs 40 μm (Intensiv Perioset®), piezosurgery ultrasonic (Mectron®) with PP1 insert to assess clinical outcome, chair side time at various timelines i.e., one, two, four, eight weeks after treatment. Gracey curettes have shown clinically more effective than diamond burs. The present study is in line with the previous study in terms of probing depths and clinical attachment levels where the statistically significant difference was seen in both the studies. In par with ultrasonic unit, LM curettes with their unique characteristic sharpness have shown to have lessened chair side time for instrumentation (24).
Static friction and pinch forces were good for 80% of operators with Hu-Friedy instruments, whereas 100% of operators were satisfied with LM instruments. As LM curette has large diameter and light weight it requires less pinch force when compared to Hu-Friedy curette. Decreased pinch force led to least chance to hand fatigue and injury risk due to repetitive motions (7),(8). The mean coefficients of static friction by tool material and glove should range from 0.20-0.34 for effective scaling and root planing. The mean safety margin of pinch forces used during scaling and root planing will be 4.88 N±1.58 N for inexperienced and 3.35 N±0.55 N for experienced dentists (7),(8).
Root planing is now utilised to aid in the removal of subgingival plaque rather than to emphasise the purposeful removal of cementum. As a result, the goal of the present study is to compare the efficacy of LM curettes with Hu-Friedy curettes in the non surgical treatment of periodontitis using a split-mouth design after one week and one month.
Limitation(s)
The study limitations include less sample size and the number of operators included in the study is minimal.
The present study findings demonstrate that LM instruments have better handling features and cutting efficiency of Hu-Friedy instruments is better initially and reduced of its continuous usage. Although, there is no significant difference in plaque index, gingival index, probing depth reduction, sulcus bleeding index, or clinical attachment level with both set of instruments.
DOI: 10.7860/JCDR/2023/59704.17525
Date of Submission: Aug 17, 2022
Date of Peer Review: Oct 06, 2022
Date of Acceptance: Nov 15, 2022
Date of Publishing: Feb 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? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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