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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
Cephalometric Evaluation of Soft-tissue Profile Changes in Class-II Division 1 Patients with Varied Growth Patterns Treated with all First Premolar Extractions: A Cross-sectional Study
Correspondence Address :
Dr. Santosh Kumar,
Professor, Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram-122505, Haryana, India.
E-mail: santosh_fdsc@sgtuniversity.org
Introduction: Knowledge of the facial skeleton and its overlying soft-tissue is essential in determining facial harmony. Additionally, an individual’s growth pattern may influence post-treatment facial profiles and needs to be considered during treatment planning.
Aim: To evaluate the soft-tissue profile changes in treated Class-II malocclusion patients with varied mandibular growth patterns and to compare these changes with patients having a skeletal Class-I relationship and a balanced facial profile.
Materials and Methods: The present cross-sectional cephalometric study was conducted in the Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, from June 2021 to December 2022. The study included 210 lateral cephalograms of 120 patients. The cephalograms were divided into four groups based on the Frankfort horizontal Mandibular plane Angle (FMA): Group-1 (control, n=30): skeletal Class-I (FMA=22°-28°); Group-2 (n=30): skeletal Class-II with a horizontal growth pattern (FMA<22°); Group-3 (n=30): skeletal Class-II with an average growth pattern (FMA=22°-28°); and group-4 (n=30): skeletal Class-II with a vertical growth pattern (FMA>28°). All patients in the groups-2,3, and 4 were treated with all first premolar extractions using a 0.022? McLaughlin, Bennett and Trevisi (MBT) appliance. The student’s t-test and post-hoc test was used to analyse skeletal, dental and soft-tissue parameters using Statistical Package for the Social Sciences (SPSS) software (version 22.00 for Windows; SPSS Inc., Chicago, USA).
Results: Of the total, 120 patients, 52 were males and 68 females with an age range of 18-28 years. On intergroup analysis, significant changes (p-value<0.05) in the Sella, Nasion and A point (SNA) and Sella, Nasion and B point (SNB) angles were observed in group-3. Clinically insignificant changes were found in the A point, Nasion and B point (ANB) angle across all experimental groups. However, a significant change (p-value<0.001) in the post-treatment ANB angle was observed in group-2, followed by group-3 and 4 when compared with group-1. The soft-tissue profile angle showed a significant change in Group-2 when compared with Group-1 (p-value=0.012).
Conclusion: The post-treatment soft-tissue profiles of the experimental groups were comparable to the balanced profile of the control group patients.
Camouflage treatment, Facial divergence, Facial profile
Orthodontic therapy is frequently sought for Class-II Division 1 malocclusion, which is characterised by a convex facial profile, lip strain, lip trap and proclination of the maxillary anterior teeth (1). A major goal of orthodontic treatment is to improve facial aesthetics and maintain or enhance the labial contours of the upper and lower lips (2). It has long been acknowledged that the primary objective of orthodontic therapy is to achieve a harmonious facial appearance. For Class-II patients, maxillary premolar extraction effectively modifies the soft-tissue profile. The extraction of upper premolars is often chosen as an alternative to orthognathic surgery for non growing Class-II patients with significant overjet (3). The protocol for extraction therapy leads to cephalometric modifications such as an increased nasolabial angle, upper lip retraction, maxillary incisor uprighting and a straighter profile (4). Therefore, orthodontic therapy may indirectly result in soft-tissue alterations to the facial profile in addition to changing the dentoskeletal framework (1).
Knowledge of the facial skeleton and its overlying soft-tissue is essential for determining facial harmony (5). Few studies have focused on the impact of alterations in the mandibular development pattern on the facial profile. Blanchette ME et al., found that individuals with vertical growth had longer and thicker soft-tissue drapes than patients with short facial patterns (6). This outcome was attributed to a compensatory process that created a normal facial profile while concealing the vertical dysplasia. According to Macari AT and Hanna AE adults with hyperdivergent patterns had thinner soft-tissue at gnathion and mention than adults with normal or hypodivergent patterns (7). Therefore, it is necessary to consider any alterations in the mandibular plane during treatment planning, as they may negatively impact facial profiles following treatment.
Several studies have shown changes in the soft-tissue profile of patients with Class-II malocclusion treated with maxillary premolar extraction, with or without mandibular premolar extraction (8),(9),(10). However, the effects of divergence patterns in Class-II malocclusion patients treated with premolar extraction have not been investigated in detail. Additionally, there is limited orthodontic evidence to support the notion that individuals with Class-II malocclusion who underwent premolar extractions would have post-treatment profiles similar to those of Class-I patients.
The present study was designed to examine the changes in the soft-tissue profile between patients with a skeletal class-I relationship and a balanced facial profile, and patients with corrected Class-II malocclusion who have different mandibular growth patterns. To the best of the authors knowledge, the influence of growth pattern and first premolar extraction on the soft-tissue profile in Class-II division 1 subjects has not been studied in detail in the past. The present study is the first to investigate the soft-tissue parameters in detail.
The present cross-sectional cephalometric study was conducted in the Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, from June 2021 to December 2022. The study involved the collection of 210 lateral cephalograms from 120 patients who visited the Department of Orthodontics between June 2021 and July 2022. Ethical clearance was obtained from the Ethical Committee (FODS/EC/ORTHO/2021/04).
All adult orthodontic patients with the same ethnic background (North Indian population) had their pre and post-treatment cephalograms selected. The pre and post-treatment lateral cephalograms were divided into four groups. The pretreatment cephalograms of 30 patients with Class-I malocclusion and a balanced facial profile were used for the control group (group-1), who had visited the department for orthodontic treatment. One hundred and eighty pre and post-treatment cephalograms of patients with Class-II malocclusion were used as experimental groups (groups-2-4).
Inclusion criteria: The inclusion criteria for the control group were an ANB angle of 2°±2°, an overjet of 1-2 mm, an FMA angle of 22°-28°, and a balanced facial profile. The inclusion criteria for the experimental group were an ANB angle of 6°±1°, an overjet of 5-9 mm, a full complement of permanent dentition with or without third molars, and a convex soft-tissue profile.
Exclusion criteria: Patients with history of orthognathic surgery, missing permanent first molars and any congenital anomalies were excluded from the study.
Sample size calculation: G*Power Software (version 3.0.10) was used to calculate the sample size. With an effect size of 0.4 (11), a precision level of 5%, a confidence level of 95% and 80% power, the trial produced a total of 84 patients, with 21 in each group.
Study Procedure
The experimental groups were further subclassified into three groups based on the FMA. Group-2 (n=30) was classified as having a horizontal growth pattern (FMA<22°), group-3 (n=30) was classified as having an average growth pattern (FMA=22°-28°), and group-4 (n=30) was classified as having a vertical growth pattern (FMA>28°) (12).
All patients in the experimental groups underwent treatment involving the extraction of all first premolars with an MBT prescription (0.022 slot). Anterior retraction was carried out using loops or elastomeric chains on 0.019 × 0.025 Stainless Steel (SS) wire. All cases were finished in Class-I occlusion with a 1-2 mm overjet. After the removal of brackets, the patients were given bonded lingual retainers in the lower arch and Hawley retainers in the upper arch. The average treatment time was 20 to 24 months.
All digital radiographs were analysed using the NemoCeph software (Digital cephalometric system, version 11.0, Nemotec). The skeletal and soft-tissue parameters used in the study are given in (Table/Fig 1) and illustrated in (Table/Fig 2).
Statistical Analysis
The data were tabulated using an Excel sheet. For statistical analysis, the means and standard deviations of each group’s measurements were calculated using SPSS software version 22.00 for Windows (SPSS Inc., Chicago, USA). A t-test was utilised to determine the differences between the groups, using a significance level of p-value<0.05. An analysis of variance, along with post-hoc Dunnett t-tests, was employed to compare the groups.
The present study included 210 lateral cephalograms of 120 patients (52 males and 68 females) aged 18-28 years. All adult orthodontic patients had the same ethnic background (North Indian population), and their pre- and post-treatment cephalograms were selected.
The skeletal, dental and soft-tissue parameters were tabulated. (Table/Fig 3) shows the intragroup comparison of pre and post-treatment skeletal cephalometric parameters in all experimental groups. In all the experimental groups, there was an increase in the post-treatment Sella-nasion/Mandibular Plane (SN-MP) and FMA angles, but it was statistically significant only in groups-2 and 3 (p-value<0.05) when compared with the pretreatment values. Clinically, insignificant changes were observed in the ANB angle in all the experimental groups.
The intragroup comparison of pre and post-treatment dental cephalometric parameters in all experimental groups is shown in (Table/Fig 4). In all the experimental groups, there was a significant decrease (p-value<0.01) in post-treatment values of upper incisor to NA (both angular and linear), lower incisor to NB (both angular and linear), and IMPA compared to pretreatment values.
The comparison of pre and post-treatment soft-tissue cephalometric parameters within all experimental groups is tabulated in (Table/Fig 5). In group-2, among the soft-tissue parameters, there was a significant increase (p-value<0.01) in post-treatment upper lip thickness, nasolabial angle and inferior labial sulcus depth. Additionally, there was a significant decrease (p-value<0.01) in post-treatment upper lip strain, lower lip to H line, upper lip to E line, interlabial gap, facial convexity angle and upper lip protrusion.
In group-3, among the soft-tissue parameters, there was a significant increase (p-value<0.01) in post-treatment upper lip thickness, nasolabial angle and inferior labial sulcus depth. Furthermore, there was a significant decrease (p-value<0.01) in post-treatment upper lip strain, subnasale to H line, lower lip to H line, upper lip to E line, lower lip to E line, H angle, interlabial gap, facial convexity angle and upper lip protrusion.
In group-4, among the soft-tissue parameters, there was a significant increase (p-value<0.01) in post-treatment upper lip thickness, nasolabial angle and inferior labial sulcus depth. There was also a significant decrease (p-value<0.01) in post-treatment upper lip strain, lower lip to H line, upper lip to E line, lower lip to E line, H angle, interlabial gap, facial convexity angle and upper lip protrusion.
An intergroup comparison of the post-treatment changes in the skeletal, dental, and soft-tissue cephalometric parameters is presented in (Table/Fig 6). A significant change (p-value<0.001) in the post-treatment ANB angle was observed in group-2, followed by groups-3 and 4, when compared with group-1 (Table/Fig 7). The post-treatment SN-MP and FMA angles of groups-2 and 4 showed a significant difference (p-value<0.001) when compared with group-1. The post lower lip to H line parameter of groups-2 and 4 was significantly different (p-value<0.01) when compared with group-1. The lower lip to the E line did not show any significant difference among the groups. The soft-tissue profile angle showed a significant change in group-3 when compared with group-1 (p-value=0.012).
The present study was conducted to assess soft-tissue profile changes in Class-II Division 1 patients treated with the extraction of all first premolars, considering varied growth patterns.
In this study, all experimental groups demonstrated an increase in the post-treatment SN-MP and FMA angles; however, this increase was significant only in group-2 when compared to pretreatment values. The increase in post-treatment SN-MP and FMA angles may be attributed to the extrusive nature of orthodontic treatment and the subsequent clockwise rotation of the mandible, which leads to an opening of the bite (13). During orthodontic therapy, Creekmore TD also observed a vertical eruption of the molars, which contributed to bite opening and was beneficial for patients with deep bites (13).
Clinically insignificant changes were noted in the SNA, SNB and ANB angles across all experimental groups. In all experimental groups (groups-2, 3 and 4), there was a significant decrease in post-treatment upper incisor to NA (both angular and linear), lower incisor to NB (both angular and linear), and IMPA compared to pretreatment values. These post-treatment parameters in the experimental groups were also comparable to those in group-1. Ali US et al., Anderson BD, and Maetevorakul S and Viteporn S also found that premolar extractions in the maxillary and mandibular arches of patients with Class-II Division 1 malocclusion resulted in more upright maxillary and mandibular incisors compared to non extraction cases (14),(15),(16).
There was a significant increase in post-treatment upper lip thickness compared to pretreatment values in all experimental groups. Talass MF et al., and Issacson JR et al., reported increases in upper lip thickness due to the retraction of the maxillary incisors (17),(18). Similarly, there was a significant decrease in post-treatment upper lip strain when compared with pretreatment values in all experimental groups. The current study revealed a strong association between the quantity of upper lip fall and the relief from lip strain caused by upper incisor retraction. More relief from lip strain also resulted in less severe upper lip taper and a closer upper lip-to-upper incisor retraction relationship. Similar findings were reported in studies conducted by Johnston DJ et al., Schudy FF and Murugesan A et al., (19),(20),(21).
In all experimental groups, there was a significant decrease in post-treatment lower lip to H line and upper lip to E line measurements compared with pretreatment findings. These post-treatment soft-tissue parameters were also comparable to those in group-1. This finding suggests that maxillary incisor retraction in the experimental groups produced a lip fall, thereby decreasing the upper lip to E line values and resulting in a comparable upper lip soft-tissue profile as seen in Class-I individuals, irrespective of their growth pattern. These findings are in accordance with the studies conducted by Mishra D et al., Ekstam M et al., and Fang ML et al., (22),(23),(24).
There was a significant increase (109±2 degrees) in the post-treatment nasolabial angle in all experimental groups when compared with pretreatment values (93±2 degrees). Mishra D et al. reported a similar increase in the nasolabial angle (107±2 degrees) (22). This larger response in the nasolabial angle was probably related to the retraction of the upper lip during orthodontic treatment (22). Similarly, there was a decrease in post-treatment H angle in all experimental groups, and it was comparable to individuals with a Class-I profile. Similar results were found in a study conducted by Basciftci FA and Usumez S in which they compared extraction and non extraction groups (25).
These findings suggest that first premolar extraction in skeletal Class-II patients achieved a soft-tissue profile comparable to that of group-1, irrespective of their growth pattern. In the present study, there was a significant decrease in the post-treatment interlabial gap, as well as, upper and lower lip protrusion in all experimental groups. The decrease in these parameters might be due to the retrusion of the upper and lower lips subsequent to the retraction of the maxillary and mandibular anterior teeth, which leads to a decrease in the interlabial gap. Similar findings were noted by Janson G et al., Albertini P et al., and Kochar GD et al., (26),(27),(28). These studies observed that the extraction of premolars led to a significant reduction in the interlabial gap throughout the long-term treatment period.
Similarly, there was a significant difference in the post-treatment facial convexity angle among all experimental groups. Comparable results were observed in a study conducted by Chua AL et al., in which they compared the effects of extraction and non extraction cases on anterior facial height (29).
Limitation(s)
The present study did not investigate the gender-linked influence on the soft-tissue profile. Future longitudinal studies with large, gender-specific sample sizes are suggested to evaluate changes in the soft-tissue profile more effectively. Another limitation of the current study is that it was a two-dimensional study; therefore, the authors recommend conducting a three-dimensional study in the future.
The present study was conducted to assess changes in the soft-tissue profile of Class-II division 1 patients treated with the extraction of all first premolars, considering different growth patterns, using lateral cephalograms. Angular and linear measurements in Class-II division 1 subjects were affected by the extraction of all first premolars during orthodontic treatment. Changes in dental parameters and alterations in the soft-tissue profile of Class-II Division 1 malocclusion subjects after retraction of the incisors were comparable to those in a skeletal Class-I group, regardless of their growth pattern. It is concluded that in mild to moderate cases of skeletal Class-II, an acceptable soft-tissue profile can be achieved with the extraction of premolars, irrespective of growth pattern.
DOI: 10.7860/JCDR/2024/73644.20230
Date of Submission: Jun 18, 2024
Date of Peer Review: Aug 03, 2024
Date of Acceptance: Sep 26, 2024
Date of Publishing: Nov 01, 2024
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? No
• For any images presented appropriate consent has been obtained from the subjects. NA
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