A Systematic Review and Meta-Analysis of the Effective Contribution of Indian Periodontists to Global Periodontal Research Advancement

Developed nations put a lot of emphasis on scientific research and produce an enormous volume of avant-garde papers in impactful journals. These publications could serve as the foundation for different policies or other designs. The researchers in this study aimed to use a quantitative bibliometric strategy to analyze the development of Indian periodontists' publishing patterns in the PubMed database up to October 31, 2022. Publications that could be accessed through the PubMed database as of the end of October 2022 were included in the bibliometric study. By using certain search terms on the PubMed search engine, studies were found. Dental, periodontal, gingival, gingivitis, periodontal, periodontitis, and dental implants were among the terms used to find this article. To evaluate articles that are specifically about India, a parallel search was conducted with the following phrases together with "India." Selected parameters were examined in all papers, whether they had or lacked abstracts. Seven studies were selected which were in accordance with the inclusion and exclusion criteria of this study. According to the keyword search, India contributes an average of 5.65% of each keyword category to the PubMed database, since the total number of search results on PubMed for the seven keywords we entered was 1,037,584, and the same keywords when searched by adding the keyword "India" to the keyword generated a total of 58,624. Since the beginning of the last decade, India has recorded tremendous growth in all spheres of scientific literature publication, and the field of periodontics is no exception. Through the PubMed database, Indian periodontists have made a significant contribution to world literature, especially over the past 10 years, with the number of publications increasing nearly exponentially with each passing year.


Introduction And Background
Dental science, also known as dentistry, is a subspecialty of medicine that focuses on the diagnosis, treatment, and management of oral health issues, such as tooth misalignment and mouth deformities [1]. Indian dental researchers are putting a lot of effort into examining patients, diagnosing, and treating cavities in the mouth and related ailments in their offices and hospitals. Doctors of dental surgery and dentists who teach at dental schools collaborate on research and write articles about their findings side by side. Endodontics, orthodontics, periodontics, prosthodontics, pedodontics, oral and maxillofacial surgery, restorative dentistry, oral pathology, oral radiology, oral medicine, and many others are all important branches of dental science. In that year, the American Diary of Dental Science, which is considered to be the first dental journal, began its distribution [2]. The primary source of information used to refresh dentists' knowledge is journals. The Dentists Act of 1948 regulates dental education and practice in India through the Dental Council of India [3].
The goal of scientific communication is to disseminate research findings to the entire scientific community as well as to one's peers. One of the essential elements in evaluating the output of research in an academic environment is research articles. It transmits data to upcoming researchers with the intention of disseminating and reusing it for societal advancement. Contributing to existing knowledge or facts is what research is all about. Through indicators such as publication counts, citation counts, keyword analysis, cocitation analysis, and other metrics, scientometrics assesses the research contribution of a field. According to Subramanyam [4], the evaluation of collaboration should highlight a holistic approach. He also claimed that the complexity of human interaction makes it challenging to quantify the nature of research collaboration. The collection of techniques used for quantitatively assessing academic literature is known as bibliometrics.
The development of Indian dental science can be evaluated with the aid of high-caliber research articles. Some of the major bibliometric measures used to gauge research production include the number of publications, the h-index, citation counts, and impact factors (IFs) of journals. It may be useful to learn about leading dental institutions' and dentists' international partnerships for the advancement of dental science through research collaboration in the field. There are many different forms of research investigations in periodontics scientific publications. These studies contribute to the discovery of new therapies and the appropriate application of existing treatment modalities through the provision of evidence-based findings. Bibliometrics refers to the quantitative information obtained from these scientific findings using a core methodological approach by the authors and their collaborators. Thus, the term "bibliometric research" refers to a quantitative and statistical method that focuses on goals and observable indications of academic activity, namely, publications and citations [5]. Additionally, it examines how the editorial standards of scientific journals affect scientific communication, offering room for the research's quality to advance. This is done by counting the number of documents a nation or researcher has published, as well as the number of citations each article has received. The citations aid in understanding the article's significance and impact on the field of clinical practice today [6].
According to the PubMed database, the first study on dental/oral sciences in India was published in 1925 [7]. Then, in 1946, Shourie's essay was the first by an Indian author to be published in the PubMed database [8]. It was not until 1960 that Muller and Zander published cementum from Indian teeth with periodontal disease in the PubMed database [9]. An article by Chawla and Mehta, the first major work by an Indian periodontist in a public distribution from an Indian foundation, was added to the PubMed database in 1960 [10]. Instead, in 1965, Rao, Shourie, and Shankwalkar wrote a book that they distributed internationally and is considered the standard work for Indian periodontists [11]. The USA provided training and education for the first periodontists in India. Back in India, they established dental schools, departments of periodontology, and specialized clinics. They launched research projects and publications in addition to starting to monitor the development of periodontics in India. Several researchers have undertaken bibliometric evaluations of the output of research in various world locations and with regard to a particular topic [12][13][14]. The differing approaches employed, however, limit comparisons between research outcomes in other scientific fields [15].
The PubMed/MEDLINE database is one of the biggest libraries dedicated to medical literature. The world's population may always have access to this excellent resource. These databases, which are virtually updated daily, were developed and are maintained by the United States National Center for Biotechnological Information and the National Institutes of Health. Furthermore, the quality of individual articles and academics is often evaluated according to the IFs of the journals in which they were published. The SCImago Journal Rank (SJR) indicator, a journal metric system, calculates the SJR value, or the citation weight, of that specific journal for the given year, by averaging the citations over the previous three years [16]. Higher SJR levels indicate a high journal IF [17].
The purpose of this research was to analyze the scientometric data of a selection of papers documenting Indian periodontists and their impact on the field. It is important to evaluate India's contribution to scientometrics and to understand the status and significant advancements in periodontics relative to other nations.

Protocol Employed
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol and guidelines from the Cochrane group and the book "Orderly Reviews in Health Care: Meta Examination" were followed for conducting this systematic review [18].

Search Strategy
For the bibliometric analysis, only publications that were accessible through the PubMed database as of the end of October 2022 were included. The data search was conducted on October 31, 2022, at 11 a.m. Indian Standard Time (IST) and continued until 12 p.m. IST, utilizing the most recent version of the Google Chrome internet browser. The terms dental, periodontal, gingiva, gingival, periodontia, periodontitis, periodontology, and dental implant were used to conduct individual searches. The same search was conducted again, but for each term, the word "India" was added (e.g., "dental," "India," "oral," etc.). The keywords were entered exactly where they were supposed to be on the PubMed website homepage.

Study Selection
All of the keyword categories yielded all of the article abstracts. Then, for each category, only publications that connected to periodontology were manually looked for and chosen. Comparing between categories, overlapping articles were eliminated. Separate searches were conducted for Dental Dialogue (DD), the Journal of the Indian Dental Association (JIDA), and the Journal of the Indian Society of Periodontology (JISP). These Indian journals were looked up individually because they were not reliable in their publications and only occasionally appeared in the PubMed database (JISP was added to PubMed in January 2008 and later).

Inclusion Criterion
Speaking about the inclusion criteria used for our study, only papers that were still accessible in the PubMed database as of October 31, 2022 were chosen. Additionally, only publications by periodontists of Indian origin that came from India were taken into consideration for the purposes of our analysis. In other words, papers that appear in journals that are indexed by PubMed, of Indian origin, were taken into consideration.

Exclusion Criterion
The article did not contain an introduction, editorials, messages, letters to the editor, obituaries, or organizational communications. Only newly authored works, such as articles, reviews, or case studies/series, were included. Studies with specific flaws, such as incorrectly citing the name of the institution or department, omitting to cite the state of origin, or lacking abstracts, were not taken into consideration for our analysis. Articles that did not identify the authors, the name of the institute, the departmental affiliation, or any other information outside the topic of the article were also disqualified.

Statistical Analysis
The results of the meta-analysis, in the form of forest plots depicting all the studies taken up in this systematic review, were generated using the RevMan 5 software (Cochrane Interactive Learning, England and Wales). Data on the variables analyzed and different aspects of the investigations selected for our systematic review were entered into the software, and the forest plots representing the risk ratio, odds ratio, and risk difference were obtained as part of the meta-analysis for our review ( Figure 1).

TABLE 1: PubMed search results with the keywords with and without the keyword "India"
The science citation index (SCI) expanded (now owned by Clarivate Plc., London, United Kingdom) and JCR Science edition 2021-Impact factor (updated June 2022) were used to evaluate the IFs for the journals listed in the studies selected for this systematic review [19]. The results of the systematic review have been tabulated in Table 2 presented below, with the details of the six studies that were selected for the review presented in the Bibliometric assessment The majority of dental professionals in India feel a pressing need to increase their publications due to competition and academic benefits. Therefore, the authors wanted to use a questionnaire to find out how faculty and students felt about scientific publications.
With respect to the subject of Periodontology, 22 articles were published by post-graduate students, senior lecturers published seven studies, readers published 6 and 10 investigations were undertaken by professors, making a total of 45 articles which represented 6.19% of the total 726 studies that were observed in the study.

TABLE 2: Descriptions and outcomes of the selected studies in this systematic review and metaanalysis
Data on the variables analyzed and different aspects of the investigations selected for our systematic review were entered into the RevMan 5 software, and the forest plots representing the risk ratio, and odds ratio were obtained as part of the meta-analysis for our review. Figure 2 and Figure 3 given below show the results of the meta-analysis (using RevMan 5 software) in the form of a forest plot depicting all the studies taken up in this systematic review and evaluating them.

Discussion
The full scope of scientific production is not covered by publication analysis, which was chosen as one way to evaluate scientific advancement. In spite of this, bibliometrics has evolved into a factual aid tool that can plan and create a wide range of data and information handling and board markers, especially in logical, mechanical, and efficiency-related data and correspondence frameworks necessary for organizing, assessing, and managing a specific academic locality or country [12]. This review relied on articles found in the PubMed database; nonetheless, this selection may have underrepresented Indian periodontists' overall impact on the field. Nevertheless, comparable methods have been employed with great success in other partial evaluations of dental research output, and bibliometric studies are more for the distribution of information than for the evaluation of research quality. A piece of writing's reference count should be viewed as a measure of its standing or influence within the scientific community [27]. Due to the complexity and specialization of modern research, it is thought to be impossible for a single researcher to possess all the necessary knowledge and technical abilities. As a result of the complementary nature of the many abilities used in collaboration, new ideas and creativity are stimulated, as well as knowledge exchange. Therefore, collaborative projects not only allow for the efficient pooling and sharing of resources but also improve the quality of the study [28]. Our study had an extraordinarily high degree of author collaboration, with a value of 0.98 (maximum 1).
Comparable goals were pursued by Baghele et al., who used a bibliometric analysis of the PubMed database up to March 1, 2012, to look into the contribution of Indian periodontists to global literature [20]. They observed that the total number of results achieved with the 10 keywords selected for the study was 12,87,077, while only 20,567 hits were produced with the same 10 keywords plus India. According to our keyword research, India contributes an average of 1.45% for each keyword category to the PubMed database.
In their study, 764 articles totaling 2,432 authors, 3.2 authors on average per article were published. Only 8.38% of articles were published by lone authors, and the majority of articles had three co-authors. Also, out of 107 journal titles that they had evaluated, 29 belonged to Indian societies and were published there, two were being published there but belonged to international societies, and the remaining 77 were international. There are 181 articles altogether in 41 journals with impact factors of 1.1 or higher. The journal Diabetes had a single article, and the highest IF calculated was 8.889. This study indicates quite clearly the growth of periodontal research in India in terms of both the quantity and the quality of articles that have been presented to world literature, and that too in significantly high IF journals/publications.
While the IF is often used as a quality indicator for academic articles, it should be noted that this metric falls short of being perfect; yet it is the best available and has the added benefit of being tried and true [29]. When it comes to the overall value of diaries within a certain field of study, there are places where both impact factors and diaries shine [30]. As per these data, Indian periodontists dispersed 46.74% of their distributions in diaries with high-impact factors, which is absolutely outstanding. , and many more. Despite Arseculeratne's assertion that South Asian articles do not appear as frequently as they should in western journals considered to have high IFs, this is an impressive achievement, especially when the reason is not generally due to low quality, specific ordering, or particular alluding to build IFs [31]. This new direction in science was also disrupted by the virtual absence of logical linkages and stations for propagating research findings in pre-current south Asia. We keep trying for the stars, but there is no equitable way to tally up the money, time, knowledge, and equipment that each researcher, organization, and nation puts into a single research article and one basic test [32].
Since there is a real dearth of independent research being done in India, most of the publications included in this analysis are from academic institutions. The quantity of books and journals has grown dramatically since 2010. Possible causes for this trend include a rise in the total number of dental schools in the country, a rise in the total number of postgraduate seats, the Dental Council of India's policy of "publish and get recognition," a rise in the number of periodontists, a shift in academic policy, more opportunities, a rise in the total number of journals published in India that are indexed in PubMed, and so on.
A combination of all or some of these variables, or more financing from the public and private sectors is necessary. The maximum number of publications in 2021 was 604, and if these respectable numbers continue, there may be a major shift in the way that Indian periodontists are perceived around the world. The study's findings and analyses may be used by a variety of groups to inform important policies for the advancement of periodontology and dental implantology, including professional societies, individual scientists, academic institutions, and funding organizations.

Conclusions
Even though we used PubMed as a source of articles, it is possible that it is not representative of the full scope of scientific publishing output and research activity around the world because it is biased toward journals written in English. Still, it is reasonable to assume that the worldwide diary distributions remembered for these data sets accurately address universally acknowledged (or "standard") research, especially the great lab-based essential exploration in the innate sciences, medicine, and life sciences that is led in the profoundly industrialized progressed nations. The Indian literature, which until the 2010s could not be said to be of superior worth and on pace with their western equivalents, has benefited immensely from the contributions of the Indian periodontal community and has increased in the last 10 years in terms of both quality and quantity. Innovating, exploring uncharted territory, developing novel ideas, attending to pressing problems and disputes, and doing fundamental scientific research on the subject of periodontology are all on the rise in our nation right now. While most of the work in the past relied on reiterating the findings of western academics or doing proof-of-concept research, the huge and sustained increase in the number of publications by Indian writers in reputable journals over the past decade is cause for optimism. Given the large number of illustrious periodontists who have contributed to the development, expansion, dissemination, investigation, development, teaching, and mastery of the intricacies of the field of periodontology, it would be grossly unfair to single out a select few for special recognition. The researchers in this study sought to learn more about the research conducted by Indian periodontists by looking through the PubMed database. We did not deviate from this objective in order to assess the specific contributions of Indian periodontists to other databases or sectors, or their abilities in research, clinical practice, or teaching.
Analysis of publishing patterns may serve as a reference for people or government policymakers, administrators, and dental organizations as they formulate future policies and develop programs to enhance scientific and technical knowledge in the area of dentistry. Other nations, unlike India, rely on funding organizations to carry out research programs. Institutions must demonstrate their capabilities and accomplishments in relation to research and publishing in order to do this.

Conflicts of interest:
In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.