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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
Case report
Full Version
Synergistic Approach to Diastema Closure using Frenectomy and Restorative Procedures: A Case Report
Correspondence Address :
Dr. Deepak Moses Ravindran,
No. 1, Sri Ramachandra Nagar, Porur, Chennai 600116, India.
E-mail: deepak_perio@sriramachandra.edu.in
Midline diastema, the space between maxillary central incisors, is a common aesthetic concern with multifactorial aetiology. A 24-year-old female presented with a midline diastema caused by a high papillary frenum, contributing to multifactorial aesthetic disharmony. This created aesthetic concerns and anterior asymmetry. Digital diagnostics, including intraoral scanning and virtual smile design, supported accurate assessment and planning. Treatment involved a diode laser frenectomy to remove the high frenal attachment and restore gingival zenith harmony. This was followed by diastema closure using a digitally guided injectable resin composite technique. A 3D-printed mock-up and customised injection template helped achieve precise morphology, controlled resin placement, and strong aesthetic results while preserving tooth structure. Postoperative review at three months showed smooth healing, high patient satisfaction, and stable functional and aesthetic outcomes with no relapse. This case highlights the combined benefits of laser-assisted surgery and digitally guided restorative methods. The approach offers a minimally invasive, predictable, and refined solution for treating diastema linked to high frenal attachment.
Composite resins, Dental aesthetics, Laser, Three dimensional printing
A 24-year-old female patient presented to the Department of Periodontology with a chief complaint of spacing between the maxillary central incisors for the past 10 years. Clinical examination revealed a distinct midline diastema associated with a papillary frenal attachment classified by Mirko P et al., (1974) (1). Additionally, gingival assessment was performed through clinical examination, evaluating the gingival zenith position, contour, and symmetry relative to adjacent teeth. An altered gingival zenith of the maxillary left central incisor was noted, disrupting anterior dental symmetry and compromising the overall aesthetic balance (Table/Fig 1)a.
Comprehensive preoperative documentation was undertaken, including standardised intraoral photographs and digital impressions obtained via intraoral scanning (iTero™) (Table/Fig 1)b. Based on clinical examination, the case was diagnosed as maxillary midline diastema measured 2 mm associated with a papillary type labial frenal attachment (Placek classification), along with altered gingival zenith of the maxillary left central incisor contributing to anterior aesthetic disharmony.
These diagnostic records facilitated virtual treatment planning which encompassed three sequential interventions: laser-assisted frenectomy, correction of the gingival zenith, and definitive diastema closure using a minimally invasive injectable composite resin technique.
A digital smile design was executed using BlueSky Bio® software to simulate the anticipated restorative outcome (Table/Fig 1)c. The finalised virtual design was converted into a three-dimensional printed diagnostic mock-up (Table/Fig 1)d and presented to the patient for aesthetic evaluation. With the patient’s consent to the proposed contours and proportions, the treatment plan was commenced.
Under local anaesthesia, a diode laser (445 nm wavelength, 2.0 W, continuous mode; Sirona®) was utilised to excise the high frenum and concurrently recontour the gingival zenith in relation to tooth 21 (Table/Fig 2)a-d.
Laser parameters were optimised to achieve a precise incision, effective haemostasis and minimal collateral tissue injury. Postoperative instructions were given. The patient was advised to maintain a soft diet and avoid hot and spicy foods for 24-48 hours. Gentle oral hygiene was recommended, avoiding trauma to the surgical site and to avoid excessive lip movement. Chlorhexidine mouth rinse (0.12%) was prescribed twice daily for one week and analgesics were prescribed immediately after the procedure and for the subsequent two days. Clinical review after one week revealed uneventful healing characterised by healthy granulation tissue formation (Table/Fig 3)a.
A custom-fabricated splint template was prepared from the finalised 3D mock-up model. Precision access channels for composite injection were created along the incisal edges using fine chamfer diamond burs, ensuring optimal angulation for material placement. The template was trial-fitted intraorally to verify adaptation and marginal stability (Table/Fig 3)b.
Shade selection was performed under natural daylight conditions using the VITA® Classical Shade Guide, with A2 identified as the optimal match. After achieving complete isolation of the operative field, the enamel surface was etched with 37% phosphoric acid gel (D-tech XT Etch, India) for 15 seconds, followed by thorough rinsing and gentle air-drying. A universal adhesive (G-Premio Bond, GC Corporation, Tokyo, Japan) was applied, gently air-thinned, and light-cured for 20 seconds. The silicone template was then seated, and a flowable composite resin in shade A2 (G-ænial Universal Injectable, GC Corporation, Tokyo, Japan) was injected through the incisal access ports, allowing controlled material flow from the cervical to the incisal region between the tooth and the template. Once the space was completely filled, the material was light-cured with an LED curing unit for 40 seconds (Table/Fig 4)a.
After removal of the template, excess resin was carefully eliminated using a dental probe, and the procedure was sequentially repeated for next tooth. Finishing was accomplished with a fine-grit diamond bur (Mani Inc., Japan), followed by interproximal contouring with fine and extra-fine abrasive strips (Shofu Inc., Kyoto, Japan). The labial surfaces were refined using Sof-Lex Extra Thin contouring and polishing discs (3M ESPE, St.Paul, MN, USA) and final polishing was performed with rubber polishers in conjunction with a diamond paste (Prisma Gloss, Dentsply DeTrey GmbH,Germany) to optimise surface smoothness and minimise future plaque accumulation and discoloration (Table/Fig 4)b.
The patient reported a high level of satisfaction with the immediate postoperative aesthetic outcome. A secondary polishing session was undertaken 48-hours later to enhance surface luster. At the three months follow-up, the restoration demonstrated excellent shade stability, marginal integrity and harmonious integration with the adjacent dentition with no clinical signs of gingival inflammation or diastema relapse (Table/Fig 4)c.
Midline diastema, the space between maxillary central incisors, is a common aesthetic concern with multifactorial aetiology. While it may be transient during mixed dentition, persistence in adulthood is often linked to tooth-size discrepancies, abnormal habits, supernumerary teeth, periodontal disease, or high frenal attachment (2). This interference contributes to diastema formation and relapse after closure; therefore, frenectomy prior to space closure is essential for long-term stability (3). Modern aesthetic dentistry emphasises conservative approaches that preserve tooth structure. Direct anterior restorations are technique-sensitive, requiring composites that balance durability, aesthetics, and handling (4). For diastema closure, resin composites offer a conservative, cost-effective, and aesthetically versatile solution without aggressive tooth preparation. The injectable resin composite technique integrates the benefits of direct and indirect restorations. This case report presents the management of a midline diastema associated with high papillary frenum using a combined surgical (laser frenectomy) and restorative (digitally guided injectable composite) approach.
The preoperative midline diastema was reduced to 0 mm postoperatively, achieving 100% closure. At the three-month follow-up, periodontal conditions remained stable with no signs of inflammation, bleeding on probing, or recession, and the composite restoration showed no clinically detectable wear, marginal deterioration, or discoloration. The combined frenectomy and injectable composite technique proved to be a cost-effective alternative to more extensive orthodontic or prosthetic, treatments such as veneers or crowns.
In the present case a diode laser was selected for frenectomy because it offers better haemostasis, less postoperative discomfort, and minimal tissue damage compared to scalpel or electrosurgery (5). These advantages allowed early restorative intervention without compromising gingival health, and are consistent with reports of faster epithelialisation and reduced, postoperative pain (6),(7). This aligns with Sobouti F et al., (2024), who reported significantly less intraoperative bleeding, reduced postoperative pain, and faster healing with diode laser frenectomy, particularly at 445 nm, compared to scalpel techniques (5).
From a restorative standpoint, various modalities exist for diastema closure, ranging from orthodontic treatment to porcelain veneers and direct composite bonding (8),(9). Orthodontics provides tooth movement without altering tooth structure, but is time-consuming, costly, and may not address the underlying frenal pathology (9). Porcelain veneers provide excellent aesthetics but require greater tooth preparation and cost, reducing conservativeness (8). Direct resin composites offer a cost-effective, reversible, minimally invasive alternative, though freehand bonding is technique-sensitive and operator-dependent (8),(9). In contrast, the injectable composite technique used in this case allowed accurate transfer of a digital wax-up, ensured predictable morphology, greater efficiency, and reduced operator fatigue (10),(11). A transparent index enables controlled resin placement, minimising voids and shrinkage, while maintaining strength and handling for seamless integration with adjacent teeth, as seen at three-month follow-up (10),(11).
The integration of digital smile design and 3D-printed mock-ups enhanced communication, consent, and restorative precision, while digital workflows improved predictability and satisfaction in anterior aesthetic cases. The “synergistic approach” in this case refers to the combination of frenectomy and restorative treatment.
In a case report by Santi MR et al., (2020), digital smile design guided an integrated approach involving gingivoplasty and direct composite restorations, resulting in improved dental and gingival harmony and an aesthetically pleasing outcome with high patient satisfaction (12).
The main limitation of this case is the short follow-up period; although no relapse was noted at three months, long-term stability should be assessed at one year. In addition, while this protocol is reproducible, its implementation requires access to digital planning tools, 3D printing, and laser technology, which may not be available in all clinical settings.
The successful outcome supports combining laser frenectomy with digitally guided injectable composite as a predictable, minimally invasive, and highly aesthetic solution for diastema with high papillary frenum. This approach harmonises surgical correction with precise restorative execution, offering a patient-centered treatment pathway that aligns with modern principles of minimally invasive dentistry (8),(10).
Laser-assisted frenectomy combined with digitally guided injectable composite restoration proved to be a predictable, minimally invasive approach for treating midline diastema associated with a high papillary frenum. The technique relieved mechanical tension and enabled precise control of morphology, contour, shade, and contacts. Digital planning and custom injection templates streamlined the workflow and enhanced predictability. Three-month follow-up showed stable aesthetic and functional outcomes, supporting a conservative, aesthetic treatment option consistent with minimally invasive dentistry.
Authors’ contribution: VR: Conceptualised the case report, digital workflow planning, performed the clinical procedure including laser frenectomy and restorative treatment, collected patient data, and drafted the manuscript; DMR: Conceptualised the case report, assisted in digital workflow planning, provided clinical guidance during treatment, supervised manuscript preparation, critically revised the content, and approved the final version for submission; DK: Contributed to discussion and clinical interpretation , aided in postoperative assessment; LA: Contributed to discussion and clinical interpretation, aided in postoperative assessment; SKB: Offered expert guidance on case management and manuscript structure, contributed to discussion and clinical interpretation, and approved the final draft.
DOI: 10.7860/JCDR/2026/87584.24409
Date of Submission: Jan 21, 2026
Date of Peer Review: Mar 16, 2026
Date of Acceptance: May 23, 2026
Date of Publishing: Sep 01, 2026
Author declaration:
• 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 CHECKING METHODS:
• Plagiarism X-checker: Mar 07, 2026
• Manual Googling: May 19, 2026
• iThenticate Software: May 21, 2026 (2%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
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