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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
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Aug 2018

Dr. Rajendra Kumar Ghritlaharey

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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)
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.
On April 2011

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
On Jan 2020

Important Notice

Case report
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : ZD01 - ZD04 Full Version

Full Mouth Rehabilitation of a Post COVID-19 Mucormycosis Treated Patient using Bar- Retained Prosthesis: A Case Report

Published: June 1, 2023 | DOI:
Archit Kapadia, Sattyam Wankhade, Arun Khalikar, Suryakant Deogade, Samiksha Lalsare

1. Postgraduate Student, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. 2. Associate Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. 3. Professor and Head, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. 4. Associate Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. 5. Postgraduate Student, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India.

Correspondence Address :
Archit Kapadia,
Postgraduate Student, Department of Prosthodontics, Government Dental College and Hospital, Medical Chowk, Nagpur-440009, Maharashtra, India.


During the second wave of Coronavirus Disease-2019 (COVID-19), the Indian subcontinent witnessed a steep rise in post-COVID mucormycosis cases, with an alarming rate of about 70 times higher than the rest of the world. Maxillofacial defects amounted to various post-surgical hindrances such as difficulty in mastication, impaired speech, nasal regurgitation, mental despair and socially awkward situations. Dentists worldwide faced the challenge of fabricating a well-retained and functionally comfortable prosthesis to improve the condition of physiologically debilitating and psychologically impaired patient. In this case report, the authors present the full mouth rehabilitation of a 65-year-old male patient who had been treated for post-COVID mucormycosis. A bar-retained prosthesis was delivered, which was non-invasive, highly retentive, and pocket-friendly for the patient. This case report also shows that through meticulous planning and execution of the treatment plan, one can achieve the desired results and meet the patient’s expectations.


Aesthetic correction, Andrew’s bridge, Coronavirus disease-2019, Definitive obturator, Hader bar clips, Psychological health, Speech improvement

Case Report

A 65-year-old male patient reported to the Department of Prosthodontics with a chief complaint of impaired facial appearance with difficulty in chewing food and altered speech after the surgical excision of the infected area both in the maxillary and mandibular arch. The patient gave a medical history of being COVID-19 positive ten months back for which he was under intensive care. Three months after testing positive, he underwent surgical debridement of rhinocerebral mucormycosis involving a part of maxilla and mandible following which he was given a delayed surgical obturator which he used for six months.

Extraorally, there was loss of lip support because of the surgical debridement of anterior part of maxilla (Table/Fig 1). Intraoral clinical examination revealed that there was a either well healed maxillary arch defect which was classified as Aramany’s Class-IV (1) and a completely well healed mandibular defect which was classified as Cantor and Curtis class V (Table/Fig 2) (2). Teeth present in the maxillary arch according to Fédération Dentaire Internationale (FDI) system were 26 and 28 and in the mandibular arch were 34, 35, 36, 37, 38, 48 and a bridge connecting 45 and 47. The patient was not willing to undergo an implant-retained fixed prosthesis and hence a bar-retained removable prosthesis was planned for both the arches. The retention was obtained from the bar and undercuts of the defect.

Some of the technical difficulties faced included achieving retention for the maxillary prosthesis due to only two periodontally sound teeth being present, achieving a harmonious occlusal plane, restoring the excessive vertical restorative space with a shallow vestibule in the mandibular arch, achieving an ideal path of insertion for easy insertion and removal of the prosthesis, improving aesthetics, and maintaining oral hygiene.

To begin with, primary impressions were made using irreversible hydrocolloid (Vignette chromatic; Dentsply) and primary casts were poured using Type-III dental stone (Kalstone; Kalabhai) (Table/Fig 3). Facebow record was made and mounted indirectly on a Hanau wide view semi-adjustable articulator. To check for the aesthetics and phonetics, anterior teeth arrangement was done. This was also helpful for the determination of canine position which was required for establishing a proper plane following the curve of spee (Table/Fig 4). Mandibular posteriors were ink-stained and a modified customised occlusal plane analyser was used to grind the cast occlusally till both the canine tips and the distobuccal cusps of the first molars contacted the plane analyser simultaneously. This helped to determine which tooth needed enameloplasty and which tooth required a crown (Table/Fig 5). A putty index was used to transfer the corrected occlusal plane intraorally. The occlusal interferences were removed and tooth preparation was done. A two-stage putty light body impression (Zhermack Elite HD+) was made and master cast was poured in Type-IV die stone (Ultrastone; Kalabhai). Wax pattern followed by casting of the Andrew’s bridge with Hader bar and preci- horix attachment (Ceka Preci-Horix) was done. The bar was kept 2 mm away from the ridge to maintain proper hygiene (Table/Fig 6). Metal framework was tried in the patient’s mouth to check for proper marginal fit, occlusal plane and arch form. This was followed by bisque trial along with the clip attachment incorporated in the denture (Table/Fig 7).

Before the final fabrication of lower denture was carried out, the two periodontally sound maxillary teeth were prepared and a definitive impression of teeth along with the defect was recorded using customised single tray technique (Table/Fig 8). The master cast was poured and jaw relation was recorded which was then indirectly mounted on the semi-adjustable articulator (Table/Fig 9). Maxillary teeth arrangement along with the wax pattern trial with bar and preci-horix attachment was done intraorally. The bar attachment was then casted and in the final teeth arrangement, a tooth was added over the bar attachment (Table/Fig 10). The final try-in along with the casted bar attachment was done to check for occlusion, lip support and aesthetics (Table/Fig 11).

Acrylisation of the mandibular and maxillary denture was done using compression moulding technique. Hollowing of the maxillary denture was done using the lost salt technique and an aluminium mesh was adapted over the master cast to reinforce the denture (Table/Fig 12). The final prosthesis was delivered by following a certain protocol of cementing the bar attachment followed by clipping of the polished dentures upon them [Table/Fig-13,14]. This case was followed-up for six months to check for the wear of any attachments, fracture in the prosthesis and the oral hygiene maintenance by the patient. The patient was able to insert and remove the prosthesis easily and above all was able to maintain oral hygiene. There were no issues with the attachments and the prosthesis was nicely retained in the oral cavity. There was no problem in mastication, there was a drastic change in his speech, no fluid leaking into the nasal cavity and was more than satisfied with the final aesthetics as well (Table/Fig 15).


There was a steep rise in patients infected by the opportunistic fungal infection of mucormycosis in the second wave of COVID-19 which had imposed an immense physiological and psychosocial burden on the patients affected by it (3),(4). The in-ordinate use of corticosteroids to suppress the cytokine storm had paved way for opportunistic infections like mucormycosis across India (5). The surgical resection of such extensive infection led to the formation of a multitude of acquired maxillofacial defects which posed a number of challenges for the clinicians to rehabilitate the same.

In central India, the most common extent of the defect site was Aramany’s class 1 (46%) in the maxillary arch with only 24% of the cases having Class-IV defect whereas the mandibular arch was rarely infected (6). Use of implants for support or retention of the prosthesis is one of the most promising options for rehabilitating such patients. Nonetheless, the financial burden on the patients with mucormycosis was massive in India wherein not all could afford such treatment options and not everyone had a positive mindset of undergoing a second surgery (7).

This case report describes one such case wherein a full mouth rehabilitation of a patient who was surgically treated for post-COVID mucormycosis both in the maxillary and mandibular arch was done following which he was prosthetically rehabilitated using a bar-retained prosthesis.

In patients who have undergone resective surgeries for post-COVID- 19 mucormycosis, an early and appropriate prosthetic rehabilitative effort is essential for the physical, social and psychological well-being. Hypernasal speech, fluid leakage into the nasal cavity, impaired masticatory function and varying degrees of cosmetic deformities are the post-surgical defects these patients are predisposed to (8). The prescribed prosthetic rehabilitative options usually range from heat-cure acrylic surgical obturators to implant-supported definitive obturators. The final prosthesis depends upon the extent of defect, healing phase, patient’s choice and economic conditions (9).

Use of a hader bar with preci-horix attachment improved the retention of maxillary and mandibular prosthesis. Use of a self-grinding occlusal plane template to modify the uneven mandibular occlusal plane before providing the definitive restorations was useful to achieve the harmonious occlusal plane (10). The occlusal surface was kept in metal since it was opposed by acrylic teeth and hence this reduced the wear of the acrylic teeth. The bar was kept 2 mm above the vestibule for easy cleaning and maintaining the oral hygiene. The maxillary prosthesis was reinforced with aluminium mesh to prevent fracture of the prosthesis. The defect area recorded was made hollow by using the lost salt technique which made the prosthesis light in weight (11). The normal contour of patient’s upper lip that was compromised due to maxillectomy was restored by adding adequate permissible bulk to anterior region of the maxillary prosthesis that acted as a lip plumper (12).

Novel methods to rehabilitate post-COVID mucormycosis surgically treated patients using Patient Specific Implants (PSI) also represent a valid alternative for the same (13). But not all patients are willing for a second surgery and not all patients can afford them. The patient in the current case report was not willing for a surgical re-entry and hence the described method being non-invasive, unlike in cases of implant-supported prosthesis, cost-effectiveness had a positive psychological effect on the patient’s mind. Nevertheless, the attachments need to be changed in the future due to wear as the prosthesis is inserted and removed daily.


This case report describes the rehabilitation of post COVID-19 mucormycosis affected maxillary and mandibular arches wherein the affected parts were surgically excised. The patient had been explained about all the possible prosthetic rehabilitation options from an implant-supported fixed prosthesis to a removable heat cure prosthesis retained by clasps. The patient was not ready for a surgical re-entry and hence, keeping in mind the patient’s choice of treatment of being non-invasive and at the same time being economical, the following prosthetic treatment was planned. The patient was satisfied with the aesthetics and the phonetics also improved drastically. Therefore, implant is not the only available option for rehabilitating such cases. With proper planning, a wellfitted and a physiologically comfortable prosthesis can be fabricated.


Aramany MA. Basic principles of obturator design for partially edentulous patients. Part I: classification. Journal of Prosthetic Dentistry. 1978;40(5):554-57. [crossref][PubMed]
Cantor R, Curtis TA. Prosthetic management of edentulous mandibulectomy patients. Part I. Anatomic, physiologic, and psychologic considerations. The Journal of Prosthetic Dentistry. 1971;25(4):446-57. [crossref][PubMed]
Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID 19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr. 2021;15(4):102146. [crossref][PubMed]
Kapadia A, Wate SR, Wankhade S, Khalikar A, Deogade S. Prosthetic rehabilitation of a post-COVID mucormycosis exenterated orbital defect with a two-piece hollow orbital prosthesis. J Datta Meghe Inst Med Sci Univ. 2022;17:S67-72. Doi: 10.4103/jdmimsu.jdmimsu_38_22. [crossref]
Nambiar M, Varma SR, Damdoum M. Post-Covid alliancemucormycosis, a fatal sequel to the pandemic in India. Saudi J Biol Sci. 2021;28:6461-64. Doi: 10.1016/j.sjbs.2021.07.004. [crossref][PubMed]
Kapadia A, Wankhade S, Khalikar A. Impact of oral rehabilitation on patients with post-COVID-19 mucormycosis using liverpool oral rehabilitation questionnaire in Central India: Qualitative study. World J Dent. 2022;13:460-64. https:// [crossref]
Padma Srivastava MV, Vishnu VY, Pandit AK. Mucormycosis epidemic and stroke in India during the COVID-19 pandemic. Stroke. 2021;52(10):e622-23. [crossref][PubMed]
Beumer, John III, Thomas A Curtis, David N Fritell. Maxillofacial rehabilitation prosthodontic and surgical considerations. St Louis: CV Mosby. Br J Oral Maxillofac Surg 1979:130-56. ISBN: 978-0-86715-498-6; 9780867154986.
Barman J, Chakraborty D, Nath S. Mucormycosis: An insight into its early diagnosis and prosthodontic rehabilitation. International Journal of Oral Care and Research. 2022;10:37. [crossref]
Patil PG, Nimbalkar S. A self-grinding occlusal plane template to help modify an uneven occlusal plane before providing definitive restorations. Journal of Prosthetic Dentistry. 2021;125(3):551-53. [crossref][PubMed]
Aggarwal H, Jurel SK, Singh RD, Chand P, Kumar P. Lost salt technique for severely resorbed alveolar ridges: An innovative approach. Contemporary Clinical Dentistry. 2012;3(3):352. [crossref][PubMed]
Mukohyama H, Kadota C, Ohyama T, Taniguchi H. Lip plumper prosthesis for a patient with a marginal mandibulectomy: A clinical report. The Journal of Prosthetic Dentistry. 2004;92(1):23-26. [crossref][PubMed]
Patel N, Mel A, Patel P, Fakkhruddin A, Gupta S. A novel method to rehabilitate post-mucormycosis maxillectomy defect by using patient-specific zygoma implant. Journal of Maxillofacial and Oral Surgery. 2023;22(Suppl 1):118-23.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/64110.18011

Date of Submission: Mar 17, 2023
Date of Peer Review: Apr 22, 2023
Date of Acceptance: May 02, 2023
Date of Publishing: Jun 01, 2023

• 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 X-checker: Mar 28, 2023
• Manual Googling: Apr 26, 2023
• iThenticate Software: May 01, 2023 (5%)

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