In Vitro Investigation of Material Combinations for Meso- and Suprastructures in a Biomimetic Approach to Restore One-Piece Zirconia Implants
Round 1
Reviewer 1 Report
Manuscript of considerable interest for the dental sector, it needs a minor revision before publication
Abstract: Well described, more emphasis on statistically significant data
Introduction: how does the oral microbiota change in the implant patient? Add the research of prof scribante et al.
Adhesive systems are often the cause of bacterial accumulation with increased dysbiosis.
Materials and Methods: Well described
Results: very confusing, highlight the significant data more
Discussion: add all the prophylaxis systems that can damage the prosthetic products, such as
already studied by Ermetici M. et al
Conclusion: add maintenance
bibliography: add required references
Congratulations for the
pictures, very beautiful
Author Response
Reviewer 1:
Manuscript of considerable interest for the dental sector, it needs a minor revision before publication
We would like to thank you for the effort regarding the review of our manuscript. We have considered your recommendations and have tracked the amendments in the manuscript.
Abstract: Well described, more emphasis on statistically significant data
Thank you for your valuable comment. Indeed the abstract in this section was unclear. We rephrased the results in the abstract as follows:
“For the measurement of fracture load, monolithic crowns made of the employed restorative mate-rials and identical in shape to the hybrid crowns served as controls (n=6 each). Fracture load values for feldspar ceramic and lithium-disilicate hybrid crowns were slightly higher than those of the respective monolithic crowns at baseline and after aging, which was statistically significant only for feldspar crowns after aging. In contrast fracture load values of zirconia monolithic crowns were higher than those of zirconia hybrid crowns, which was only statistically significant after aging. Artificial ageing reduced the fracture load of feldspar and lithium-disilicate crowns both for hybrid and monolithic crowns. The effect was only statistically significant for lithium disilicate hybrid crowns. Fracture load of hybrid and monolithic zirconia crowns was increased by artificial aging without reaching statistical significance. Retention force of lithium disilicate and zirconia hybrid crowns was not affected by artificial aging.”
Introduction: how does the oral microbiota change in the implant patient? Add the research of prof scribante et al. Adhesive systems are often the cause of bacterial accumulation with increased dysbiosis.
Thank you for your comment. In the Introduction, we describe that excess cement may lead to peri-implantitis (lines 49-53). We have added the scientific work of Prof. Scribante as Ref. No. 28: “Butera, A.; Pascadopoli, M.; Pellegrini, M.; Gallo, S.; Zampetti, P.; Scribante, A. Oral Microbiota in Patients with Peri-Implant Disease: A Narrative Review. Appl. Sci. 2022, 12, 3250.”
Materials and Methods: Well described
Thank you.
Results: very confusing, highlight the significant data more
Thank you very much for your valuable comment, indeed the presentation of the results in Chapter 3.1 was confusing and there were some recurrences. We structured Chapter 3.1 as follows and emphasized on the statistical significance:
- Results of hybrid crowns baseline
- Results of hybrid crowns after aging
- Results of monolithic crowns baseline
- Results of monolithic crowns after aging.
- Comparison of hybrid and monolithic crowns
We feel that now the presentation of the results is comprehensible
Discussion: add all the prophylaxis systems that can damage the prosthetic products, such as already studied by Ermetici M. et al
Thank you for the literature recommendation. We have added the following paragraph to the end of the discussion (new ref. no. 45):
“A limiting factor of this study is that it is an in-vitro study which simulates the clinical situation with respect to technical complications rather to biological. To prevent peri-implantitis, regular dental hygiene and maintenance is essential. The influence of different prophylaxis instruments on monolithic single-tooth crowns and veneering ceramics is known [45,46]. Especially for CT the effect of mechanical debridement on the integrity of the material has to be verified prior to any clinical study. Further studies on intraoral handling and maintenance of implant supported hybrid crowns and to optimize the system therefore are necessary.”
Conclusion: add maintenance
The study evaluated different combinations of materials regarding retention force and fracture load. No investigations were performed regarding maintenance. For that reason, statements on the wear or damage of restorative materials by cleaning instruments/maintenance in our opinion cannot be made.
bibliography: add required references
The bibliography was adjusted according to the additional literature (Ref. no. 28 and 45).
Congratulations for the pictures, very beautiful
Thanks a lot!
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Dear authors,
This is a well-conducted original study but few concerns related to the work exist and are listed in the atatched file.
Best regards,
Comments for author File: Comments.pdf
Author Response
Reviewer 2:
Comments and Suggestions for Authors
GENERAL COMMENTS
This is a well-conducted original study comprising numerous in vitro experiments. A few concerns
related to the work do exist and are listed below.
We would like to thank you for the effort regarding the review of our manuscript. We have considered your recommendations and have tracked the amendments in the manuscript.
- INTRODUCTION
The background of the study is overall well-presented and relevant papers are cited.
Thank you.
- MATERIAL AND METHODS
This section is overall well structured, however some details are missing.
Sample size calculation is not reported.
Thank you very much. The number of test specimens was based on a previous study. We inserted the following sentence at the beginning of chapter 2.8:
“A Sample size of n=6 for fracture load and retention force testing was chosen based on the outcome of a previous study using a similar test set-up [31].”
Line 123-128. It is not clear for the readers the “n” used in each sample
Thank you. By inserting the individual numbers of specimens, it should be easier to understand:
“...were used to measure fracture load (baseline n=6 and aged n=6) and retention force (baseline n=6 and aged n=6) before and after artificial aging.”
Line 139-140. The authors etched with 5% hydrofluoric acid (Vita Adiva Etch, Vita) the monolithic
restorations made of feldspar ceramic and lithium-disilicate ceramic for 60 s and 20 s, respectively.
What is the refence used?
Thanks for the comment. The etching times were applied according to the manufacturers recommendations of the feldspar ceramic (Vita) and lithium disilicate (Ivoclar). A study using the same etching times was given and added in the text as follows:
“… were acid etched for 60 s and 20 s [33], respectively with 5% hydrofluoric acid …”.
The reference used is:
Straface A, Rupp L, Gintaute A, Fischer J, Zitzmann NU, Rohr N. HF etching of CAD/CAM materials: influence of HF concentration and etching time on shear bond strength. Head Face Med. 2019 Aug 8;15(1):21. PMID: 31395069.
Line 177-178. This sentence is unclear about the number of specimens used in fracture and
retention. Rephrase.
We rephrased the sentence to make it easier to understand:
“The number of test specimens in each group was n=6.”
Line 185: “…./Z020…”
What is the manufacturer, city and country?
We added manufacturer, city and country:
… Z020, Zwick/Roell, Ulm, Germany
Line 200: “…. The restorative materials CT, VE, EC and YZ was …”
What is the material VE?
Thank you very much. This was a typographical error. VM was meant instead of VE.
Line 227: “… set to a=0,05.
Rephrase the sentence.
Thank you. We have rewritten the sentence as follows:
“The level of significance was set to 0.05”.
- RESULTS
Line 307: …. (Table 6, Table A2, Fig5).
Table A2 is not available in the text! Rewrite the sentence.
Table A2 can be found in the appendix and shows the results of the statistical evaluation. Therefore, no changes were made here.
- DISCUSSION
Line 356: Remove “4.1 Fracture Load”
We have removed the title.
Line 356: Remove “4.2 Retention force”
We have removed the title.
- CONCLUSIONS
What are the limitations of this study?
We have added the following paragraph to the end of the discussion (new ref. no. 45):
“A limiting factor of this study is that it is an in-vitro study which simulates the clinical situation with respect to technical complications rather to biological. To prevent peri-implantitis, regular dental hygiene and maintenance is essential. The influence of different prophylaxis instruments on monolithic single-tooth crowns and veneering ceramics is known [45,46]. Especially for CT the effect of mechanical debridement on the integrity of the material has to be verified prior to any clinical study. Further studies on intraoral handling and maintenance of implant supported hybrid crowns and to optimize the system therefore are necessary.”
Author Response File: Author Response.pdf
Reviewer 3 Report
The manuscript is well written, the aim is clearly stated.
The methodology is sound, production of the restorations is shown in high quality figures, cementation of the restorations is presented, resin composite cement and primer used are shown.
Statistical analysis is well done.
Artificial ageing, fracture load, retention force and flexural strength of restorative materials is shown.
The results and discussion are clearly presented.
The conclusion is sustained by the results.
Author Response
Reviewer 3:
The manuscript is well written, the aim is clearly stated.
We would like to thank you for the effort regarding the review of our manuscript. We have considered your recommendations and have tracked the amendments in the manuscript.
The methodology is sound, production of the restorations is shown in high quality figures, cementation of the restorations is presented, resin composite cement and primer used are shown.
Thanks!
Statistical analysis is well done.
We thank!
Artificial ageing, fracture load, retention force and flexural strength of restorative materials is shown.
The results and discussion are clearly presented.
Thank you.
The conclusion is sustained by the results.
Thanks.
Author Response File: Author Response.pdf
