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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
Reviews
Full Version
Sterilisation of Dental Implant Surgical Instruments, Office Area and Implant Components: A Narrative Review
Correspondence Address :
Dr. K Seethal,
Girls Hostel, Government Dental College, Raipur, Chhattigarh-492001, India.
E-mail: seethalarun29@gmail.com
Implant surgical procedures require meticulous attention to sterilisation protocols to prevent infections and ensure successful outcomes. Various sterilisation methods, such as steam sterilisation, ethylene oxide sterilisation and hydrogen peroxide plasma sterilisation, are commonly used in healthcare facilities. Each method has its advantages and limitations and the selection of a sterilisation method depends on factors such as the type of implant material, instrument design and compatibility with the sterilisation process. Proper handling, packaging and storage of implant surgical components and instruments are essential to maintain their sterility until they are used. Healthcare facilities must follow standardised protocols and guidelines to ensure the effective sterilisation of implant surgical components and instruments, ultimately reducing the risk of infections and improving patient outcomes. Controversies exist regarding the reusability of healing abutments, with some advocating for single-use only to reduce the risk of contamination, while others argue for reusability under stringent sterilisation protocols. Further research is needed to establish clear guidelines on the reuse of healing abutments in implant surgery. The sterilisation of implant surgical components and instruments is a critical aspect of implant surgery that requires careful consideration of sterilisation methods and adherence to established protocols. Addressing the controversies surrounding the reusability of certain components, such as healing abutments, is essential to ensure patient safety and improve surgical outcomes.
Healing abutment, Healthcare, Residual contamination of implant components
Dental instruments are categorised according to their potential risk of infection, in accordance with the criteria for disinfection and sterilisation established by the US Centres for Disease Control and Prevention (CDC) (1). The CDC classifies instruments that come into contact with bone, soft tissue and blood as critical items. Instruments that do not penetrate soft tissues or bone but contact intact oral tissues are classified as semi-critical. These devices should be sterilised after each use. Non critical items are those that come into contact with intact skin (2).
Critical items should be sterilised by heat before use because they carry an increased risk of spreading infection due to their penetration of soft tissue or bone. Heat-tolerant semi-critical items are also sterilised by heat, as they come into contact with mucous membranes or non intact skin; although the risk is smaller than that associated with critical items. If semi-critical items are heat intolerant, they should be cleaned with a strong disinfectant.
With the advent of cutting-edge technology and newer materials, implant therapy has become increasingly predictable (3). Osseointegration is a biological phenomenon that can be successfully utilised for the rehabilitation of edentulous patients (4). However, biological complications arising from the lack of proper sterilisation protocols for various implant components remain a challenging issue (5).
Resterilisation of certain implant components used in implant dentistry has been controversial due to patient safety, ethical issues and cost concerns. Opponents argue that the risks outweigh the benefits, while supporters believe that manufacturers label devices for single use primarily to maintain their profit margins (2),(6).
The aim of the present review is to discuss the sterilisation of implant surgical instruments, the office area and implant components.
Classification of Instrument Based on Level of Infection
Spaulding EH, a prominent microbiologist, developed a classification system for medical devices and the level of disinfection or sterilisation required for each. This system, known as the Spaulding Classification, is widely used in healthcare settings. It categorises medical devices into three levels based on their intended use and the degree of contact with mucous membranes, non intact skin, or sterile tissues. This system has been instrumental in guiding healthcare facilities in implementing effective infection control practices (7).
The sterilisation and disinfection of the dental implant placement procedure can be divided into (3):
1. Sterilisation of the Operating Theatre (OT)/office area
2. Sterilisation of implant surgical instruments
3. Resterilisation of dental implant components such as abutments, prosthetic parts, cover screws, healing abutments, impression copings, implant analogs and scan bodies.
4. Sterilisation of the operating theatre/office area (8).
A sterile method should ideally be used throughout any surgical treatment where there may be a higher risk of bacterial injury. This is especially important for any procedure in which the bacterial count needs to be lowered (8).
The most commonly used chemicals for high-level disinfection of the theatre environment include aldehydes such as formaldehyde, fogging with 8-10% hydrogen peroxide and hydrogen peroxide at 4-6% combined with silver nitrate. These chemicals are employed to ensure thorough disinfection and cleanliness in operating theatres, which is crucial for maintaining sterile conditions and reducing the risk of infections during medical procedures (3).
Light handles, X-ray unit heads, cabinets, drawer pulls, tray tables, chair switches and countertops should either be covered with aluminum foil, plastic wrap, or absorbent paper, or disinfected regularly. This practice helps maintain cleanliness and hygiene in medical environments, minimising the risk of contamination and ensuring patient safety during procedures (9).
For site decontamination involving bloodstains or Other Potentially Infectious Materials (OPIM), sodium hypochlorite solutions are recommended. A 1:100 dilution is suitable for decontaminating non porous surfaces after a small spill of either blood or OPIM. However, if the spill involves large amounts of blood or OPIM, a stronger 1:10 dilution should be used for the initial application. These protocols ensure effective disinfection to mitigate the risk of contamination and maintain a safe environment in medical settings (1).
Sterilisation of Implant Surgical Instruments
Ensuring proper sterilisation of implant surgical instruments is crucial to prevent infections and ensure patient safety during dental procedures. This process involves meticulous cleaning, effective sterilisation using methods such as autoclaving or gas sterilisation and proper storage in sterile conditions. By following these techniques, healthcare providers can maintain the integrity and effectiveness of implant instruments, safeguarding patient health (10).
Most of the instruments used in implant surgery, such as mouth mirrors, explorers, tweezers, scalpel blades, periosteal elevators, retractors and implant surgical kits, are critical and pose a high-risk of infection. The different techniques for sterilisation of implant surgical instruments are shown in (Table/Fig 1).
General principles for sterilisation technique (8)
• Only sterile materials and instruments are to be placed within the sterile field.
• Check for chemical indicators to verify the sterility of items placed onto the sterile field, as well as for package integrity and expiration dates (if applicable).
• The areas above and below the sterile field table are considered non sterile.
• Materials that display a manufacturer’s expiration date should be considered unsafe for use after that date.
• If any sterile item (material, instrument, gown, glove) has been compromised, the contents of the package, the gown, or the sterile field itself is considered contaminated.
• Single-use materials should only be used on an individual patient for a single procedure and then discarded.
• Reusable medical devices shall be reprocessed and sterilised according to the manufacturer’s directions.
Resterilisation of Implant Components
Resterilisation is the repeated application of a terminal process designed to remove or destroy all viable forms of microbial life, including bacterial spores, to an acceptable sterility assurance level. The newly purchased implant components also come with instructions and must be sterilised by the clinician (11),(12). The reuse of these components has been supported in the literature as a means to reduce costs for both clinicians and patients (2),(6),(13). In a study conducted by Browne V et al., no statistically significant difference was found between autoclavable newly purchased components and reused components (6). Different methods have been advocated for reducing contamination, including precleaning with a microbrush, followed by immersion in either 5% sodium hypochlorite or 70% isopropyl alcohol, ultrasonic bathing and autoclaving (6),(14),(15). Steam sterilisation, along with either chemiclave or mechanical methods, has been widely accepted as providing adequate sterilisation (2),(6),(13). However, resterilised healing abutment surfaces may cause inflammation of the peri-implant mucosal cuff and compromise uneventful healing (2). Additionally, the impact of repeated sterilisation on the functional integrity of implant components for reuse has been documented and a combination of disinfection and sterilisation techniques has been proposed (Table/Fig 2) (2),(6),(12),(13),(14),(15),(16),(17). Dunn has addressed the ethical concerns related to sterilising single-use items and outlined specific sterilisation procedures (18). Furthermore, in dentistry, there are no published studies indicating that sterilising implant components negatively impacts the integrity of the implant placement or its success.
Ensuring proper sterilisation is critical for both the success of surgery and the seamless integration of the implant. It minimises the risk of infections, thereby promoting better clinical outcomes. The presence of remnant tissue or bioburden can significantly prolong the healing process. When proper protocols are meticulously followed, the resterilisation of reusable components can achieve a prognosis comparable to that of new components. Thus, it is advocated that a successful prognosis in implant surgery can be achieved by following standardised sterilisation protocols.
DOI: 10.7860/JCDR/2024/71155.20300
Date of Submission: Apr 25, 2024
Date of Peer Review: Jun 26, 2024
Date of Acceptance: Sep 07, 2024
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 26, 2024
• Manual Googling: Sep 03, 2024
• iThenticate Software: Sep 05, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
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- Indian Science Abstracts (ISA)
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