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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
Exploring Intraoral Photography: A Cross-sectional Analysis of Commercially Available versus Newly Designed and Patented Contraster using Self-designed Criteria
Correspondence Address :
Dr. Nimisha Chinmay Shah,
Professor and Head, Department of Conservative and Endodontics, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Pipariya Waghodiya, Vadodara-391760, Gujarat, India.
E-mail: nshah7873@gmail.com
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility.
Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography.
Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant.
Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05).
Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.
Dental aesthetics, Dental photography, Documentation
One of the major reasons dentists shy away from dental photography is its perceived technical complexity; however, its advantages far outweigh any initial hesitation (1),(2). Dental photography serves not only its primary function of recording clinical information but also fulfills dentolegal needs and aids in education and communication with patients and colleagues (1),(2). It contributes to portfolio building, showcases a practice’s expertise, and plays a key role in marketing, ultimately elevating the practice’s status and improving patient care delivery (1),(2),(3),(4),(4).
Apart from the camera, lens and flash, a few accessories are needed to take high-resolution images, including photographic mirrors, contrasters and retractors [5,6]. The contrasters obscure the surrounding soft tissue structures, providing a uniform black background and enhancing the transparency of incisal edges. Two primary types of contrasters are available in the market: conventional and flexible (5). Previous studies have concluded that, due to the increasing demand for aesthetic considerations and the greater use of contrasters in today’s dentistry, the existing contrasters lack provisions for arch photography. They do not adapt well to the patient’s arch and can be cumbersome for both the patient and the operator during the photography process (2),(6).
Hence, while different modifications have been introduced to accessories like photographic mirrors and retractors, a similar level of innovation is needed for contrasters. Most research focuses on how to take good pictures and the technical problems involved, but often overlooks the patients’ perspectives (2). Newly designed contrasters have been created to address the challenges faced by operators when taking clinical intraoral pictures and to improve patient comfort. These contrasters utilise 3D printing technology with Polymethyl Methacrylate (PMMA) resin and are subjected to cold sterilisation.
Since there are no established evaluation criteria for comparing different accessories in dental photography, self-designed validated criteria (registration no. L-139246/2023) were developed to compare commercially available contrasters with newly designed ones in intraoral dental photography. Previous studies have shown that, although many designs exist for dental photographic accessories, there are no contrasters currently available that can adapt to the shape of the dental arch (2),(6). These limitations highlight the need for the development of new contrasters. Given that no study has been conducted to compare and assess the different types of contrasters available in the market, the present study was aimed to comparatively evaluate the ease and comfort of conventional and newly designed contrasters in intraoral photography.
The null hypothesis of the present study was that there will be no difference in the ease, comfort, and contrasting ability of commercially available and newly designed contrast agents in intraoral dental photography when evaluated by patients and operators using self-designed criteria. The alternate hypothesis was that there will be a difference in the ease, comfort and contrasting ability of commercially available and newly designed contrast agents in intraoral dental photography when evaluated by patients and operators using self-designed criteria.
The present single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. Study was conducted on the patients who visited study Institute for a general check-up. The operators taking the photographs were either postgraduate students or staff members from these two departments, all of whom were trained in intraoral DSLR photography. The equipment used included a Canon 1300D camera (Ota, Tokyo, Japan) with a 100 mm macro lens (Canon EF 100mm, Ota, Tokyo, Japan) and a ring flash.
Ethical clearance was obtained from the Institutional Ethical Committee (ethical approval no. SVIEC/ON/Dent/SRP/oct/23/21), and the study protocols were registered at the Clinical Trials Registry of India (CTRI no. CTRI/2024/01/061904). Only patients who consented to photography and documentation were enrolled in the study.
Inclusion criteria: The study included 50 adult male and female patients aged between 18 years and 65 years who had good oral hygiene and did not present with pain, swelling, or any discomfort in the maxillary anterior region. The operators comprised 25 postgraduate students and 25 staff members trained in intraoral DSLR photography.
Exclusion criteria: Patients who were allergic to Polymethyl Methacrylate (PMMA) resin, had limited mouth opening, temporomandibular joint problems, or developmental anomalies such as cleft lip or palate were excluded from the study.
Sample size calculation: The mean and standard deviation of the ICC (2.26±2.06) values for the colour selection method of the two examiners from the study conducted by Atri F et al., were used for sample size estimation. The total sample size was estimated to be 50 per group, with an alpha error of 5%, a power of 80%, and a confidence interval of 95%, considering p-value<0.05 as statistically significant. The formula used for calculation was:
n=(σ12+σ22 / κ) (z1-α/2+z1-β/2)2 ?² (7).
Each operator will take two photographs: one using the commercially available metal contraster and the other using the newly designed contraster.
Group A: Photographs taken with commercially available contrasters (n=50)
Group B: Photographs taken with newly designed contrasters (n=50)
Clinical procedure: Making of contrasters (Design No. 381404-001).
Study Procedure
Ten human maxillary casts of different arch forms (normal, ovoid, narrow ovoid, narrow tapered and tapered) were utilised for the study, comprising five males and five females for each arch form. A pilot study was conducted for calibration and feasibility of the contraster; however, the data from the pilot study were not included in the present study. The average length and width of the maxillary incisors were calculated to be 2.5 cm and 4 cm, respectively. To ensure uniform dimensions, these measurements were applied to create a cardboard model, which was then photographed on patients. None of the patients reported any difficulty during this process. Following a successful trial, digital scanning technology was employed to capture data from the casts. This data was integrated into AutoCADTM software for 3D printing, resulting in the creation of the final model using PMMA resin, after which a pilot study was conducted (Table/Fig 1).
Standardisation of equipment and cameras: The intraoral photography process was carried out using a DSLR Canon camera (model no. 1300 D, Ota, Tokyo, Japan), equipped with a 100 mm macro lens (Canon EF 100 mm, Ota, Tokyo, Japan). For consistent and optimal lighting, a ring flash (Canon MR14EX II, Ota, Tokyo, Japan) was used. To maintain precise control over the image capture, the camera settings were configured with an ISO of 100, a shutter speed of 1/200, and an aperture of F32. Images were shot with a magnification ratio set at 1:1 (8). To provide flexibility in post-processing, images were captured in both RAW and Joint Photographic Experts Group (JPEG) formats. The flash setting was adjusted to a power level of ¼, carefully balanced to achieve the desired outcome while maintaining natural colour representation. Fifty operators were selected, all trained in intraoral DSLR photography (including postgraduate students and staff from the Department of Conservative Dentistry and Orthodontics), and one operator was assigned to each patient. The randomisation of the contraster was conducted using the flip-coin method. Once the above settings were established, images were taken by the 50 operators on 50 different patients’ maxillary anterior teeth, using both contrasters (Table/Fig 2). A total of 100 photographs were obtained.
Self-designed criteria were created as no evaluation criteria were available in the literature. These criteria were validated by five subject specialists who have been using DSLR cameras for intraoral photography for the past five years. After creating the criteria, they were categorised as: 1) essential; 2) useful but not essential; and 3) not essential. To measure internal consistency, the authors asked the experts to rate the questionnaire form to create the evaluation criteria based on their classifications of essential, useful but not essential and not essential. Based on their responses, the internal consistency was validated. The test-retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC), which yielded a calculated value of 0.890. The photographs taken by operators were evaluated by two blinded investigators using the criteria they created. Kappa statistics were used to test interexaminer reliability.
According to Cohen, Kappa results are interpreted as follows: values ≤0 indicate no agreement; 0.01-0.20 indicate none to slight agreement; 0.21-0.40 indicate fair agreement; 0.41-0.60 indicate moderate agreement; 0.61-0.80 indicate substantial agreement; and 0.81-1.00 indicate almost perfect agreement (9). The kappa value for interobserver reliability was 0.85.
After the criteria were designed, they were given to patients to record their experiences regarding patient-related criteria, followed by operator-related criteria assessed by the operator (Table/Fig 3).
Statistical Analysis
The data was obtained and entered into Microsoft Excel version 13.0 and was subjected to statistical analysis using IBM SPSS statistics software version 21.0. To evaluate the difference in proportions, a Chi-square test was applied. For the comparison between the conventional and newly designed contraster, the Mann-Whitney U test was utilised. All statistical tests were performed with a confidence interval of 95%, and a p-value of less than 0.05 was considered statistically significant.
Among the 50 patients, 26 were males and 24 were females. A Mann-Whitney U test was conducted on the distribution of discomfort during placement, using the conventional contraster. Of the patients, 4 (8%) reported severe discomfort, 22 (44%) reported moderate discomfort, and 24 (48%) reported mild discomfort. In contrast, when using the newly designed contraster, 5 (10%) reported mild discomfort, while 45 (90%) reported no discomfort. The comparison revealed that the majority of patients (90%) in the newly designed group showed no discomfort. To evaluate the difference in proportions, a Chi-square test of proportions was applied, and the difference was found to be statistically significant. For the comparison of the two contrasters, the Mann-Whitney U test was applied (p-value<0.001) (Table/Fig 4).
The distribution of pain on the buccal/labial mucosa using the conventional contraster showed that 6 (12%) reported moderate pain, 11 (22%) reported mild pain and 33 (66%) reported no pain. In comparison, using the newly designed contraster, 1 (2%) reported moderate pain, 3 (6%) reported mild pain, and 46 (92%) reported no pain. When the comparison was made, it was observed that the maximum number of patients (92%) with the newly designed contraster reported no discomfort, and the difference in proportions was statistically significant (p-value<0.001) (Table/Fig 5).
Regarding the ease of placement and removal, 42 (84%) operators found it difficult with the conventional contraster, while only 8 (16%) found it easy. Conversely, with the newly designed contraster, 9 (18%) operators found it easy, and 41 (82%) found it effortless. The comparison indicated that the maximum number of operators (92%) in the newly designed group reported effortless placement, and the difference in proportions was statistically significant (p-value<0.001) (Table/Fig 6).
Both the conventional contraster and the newly designed contraster exhibited similar contrasting abilities, with 3 (6%) operators in each group reporting inferior contrasting ability and 47 (94%) reporting superior contrasting ability. The difference in operator contrasting ability between the two groups was not statistically significant (p-value=1.000) (Table/Fig 7).
Based on the results, the null hypothesis was rejected for the parameters of ease and comfort; however, it was accepted for contrasting ability. In contrast, the alternative hypothesis was accepted for ease and comfort, while it was rejected for contrasting ability. Previous studies have compared various photographic accessories and their modifications; therefore, there exists a gap in the literature regarding contrasters (2),(6). The present study evaluates a newly designed contraster in comparison to commercially available contrasters, focusing on aspects of patient comfort, operator ease and contrasting ability. The findings highlight significant advantages associated with the new design, indicating potential improvements in the overall experience and efficiency of intraoral photography procedures.
Dental photography is a routine procedure in contemporary dental practice (10),(11). A photographic black contraster is a tool used in dental photography that provides a black background to isolate the teeth of interest. The black colour neutralises the background, making it easier to visualise colour matches or mismatches (5). This aids in transferring information about shade, enamel staining, characterisation, and incisal edge translucency between the dentist and the dental laboratory technician (12),(13).
Commercially available contrasters have been found to be bulkier, as they do not conform to the arch. Furthermore, the frequent contact of metal with oral soft tissue can cause significant discomfort for patients, as well as difficulty for the operator during placement and removal (7),(11),(14). In contrast, the newly designed contrasters are anatomically shaped, smaller in size and better adapted to the arch. Additionally, the smaller handle size allows for easy placement, resulting in minimal contact with oral structures. This addresses a common challenge associated with conventional contrasters, potentially reducing procedure time and increasing workflow efficiency. This is especially important in modern dental practice, where time management is key to providing timely and effective patient treatment (13).
Despite the improvements in patient comfort and operator ease, the newly designed contraster maintains equally good contrasting ability compared to conventional contrasters. This ensures that the innovative design’s primary function is providing a uniform black background for clear intraoral images, which are not compromised (12),(14).
In addition to the features mentioned above, macrophotography requires photographs of maxillary anterior teeth for discolouration identification, translucency enhancement and post-treatment evaluation following aesthetic restoration. This provides significant assistance to clinicians (12),(13),(15),(16).
The present study is the first of its kind, meaning that no one has conducted similar research before. Because of this, the authors do not have previous evidence to support the present study findings. The authors believe the new contrasters are more effective because they are smaller and have a narrow handle, making it easy to place them in the narrowest parts of the human arch without causing discomfort to the patient. The authors designed these contrasters after studying 50 casts of human teeth from both men and women, ensuring that they fit well and are easy for dentists to use.
While existing studies have mainly focused on technical aspects and camera usage, they often overlook the patient perspective (2). Hence, the current study will undoubtedly open the door for new ideas and research aimed at creating better designs that improve patient comfort and facilitate easier use for dentists. Additionally, the evaluation criteria used are subjective and require further validation to ensure reliability and consistency in future research.
Limitation(s)
However, there are some limitations to these new contrasters. They can only be used for upper incisors, so if we need to take a picture of a larger area, we cannot use them. Being 3D printed, they cannot be autoclaved and can only be disinfected.
The findings of the present study suggest that the newly designed intraoral contraster offers significant advantages over conventional contrasters in terms of patient comfort and operator ease. While both designs exhibit comparable contrasting abilities, the innovative design of the newly developed contraster has the potential to enhance the overall experience and efficiency of intraoral photography procedures.
Author’s declaration: The name of the conventional contraster has not been revealed here on purpose. If anyone wishes to know the name, can directly contact the authors.
DOI: 10.7860/JCDR/2024/70254.20254
Date of Submission: Feb 23, 2024
Date of Peer Review: May 13, 2024
Date of Acceptance: Aug 22, 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? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 24, 2024
• Manual Googling: May 15, 2024
• iThenticate Software: Aug 21, 2024 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 9
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com