Intraoral Ultrasonography for Periodontal Tissue Exploration: A Review

Round 1

Reviewer 1 Report

According to my viewpoint, it is an interesting paper. However, I have some concerns about the methodology. 

The systematic search was conducted on only one electronic database and was limited until 2020. Since it is the end of 2022, the investigation should be updated.

The Prisma procedures weren't really appropriately identified, as evidenced by the Prisma flowchart provided by the authors.

Furthermore, the quality of the included studies was not assessed. So, the risk of bias has not been evaluated.

Considering the aforementioned, I would advise the authors to redesign their study and critically evaluate their findings.

Author Response

Please find attached a revised version of our manuscript entitled "Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases".

We thank you for giving us an opportunity to substantially improve the content and the presentation of our manuscript. We have modified the article as requested. You will find every modification in the text by using track changes, and the pages are noted in the answer for every point below.

Q1: The systematic search was conducted on only one electronic database and was limited until 2020. Since it is the end of 2022, the investigation should be updated.

Response:

I would like to thank you to make the light about that. The research was well realized until March 2022 and we can correct this error on the manuscript.

Q2: The Prisma procedures weren't really appropriately identified, as evidenced by the Prisma flowchart provided by the authors.

Response:

Thank you. The Prisma flowchart has been completely revised and designed.

Q3: Furthermore, the quality of the included studies was not assessed. So, the risk of bias has not been evaluated.

Response:

The studies’ quality was added on table 1 and better discussed in the limitation part. The risk of bias was also better evaluated in the limitation part according to the level of the studies presented in this review with reference.

Reviewer 2 Report

The manuscript addresses the novel topic of ultrasonography for the evaluation of periodontal tissues. The study is overall well-written and data clearly presented. There are few minor issues requiring authors' attention:

- Lines 85-88: the authors should differentiate ultrasound techniques depending on the frequencies employed. Please check Can Assoc Radiol J. 2021 Aug;72(3):418-431. doi: 10.1177/0846537120940684

- Ultrasonography was also employed for the evaluation of gingival soft tissue anatomy. Please check for relevant literature.

- The authors should list among the limitations the heterogeneity in the frequencies and acquisition protocols employed, which can hinder direct comparison between the studies. 

Author Response

Please find attached a revised version of our manuscript entitled "Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases".

We thank you for giving us an opportunity to substantially improve the content and the presentation of our manuscript. We have modified the article as requested. You will find every modification in the text by using track changes, and the pages are noted in the answer for every point below.

Q1: Lines 85-88: the authors should differentiate ultrasound techniques depending on the frequencies employed. Please check Can Assoc Radiol J. 2021 Aug;72(3):418-431. doi: 10.1177/0846537120940684

Response:

I would like to thank you about that. This point has been better presented and defined in the introduction part and the reference presented added on the bibliography of the review.

Q2: Ultrasonography was also employed for the evaluation of gingival soft tissue anatomy. Please check for relevant literature.

Response:

Thank you about that, you are right about this point like previously describe by Fukukita and al. The bibliography has been updated and the introduction part revised.

Q3: The authors should list among the limitations the heterogeneity in the frequencies and acquisition protocols employed, which can hinder direct comparison between the studies. 

Response:

I would like to thank you to make the light about that. This point has been better identified and has been completed in the limitation section.

Reviewer 3 Report

This systematic review reported the current evidence on the use of the ultrasonography for exploring the periodontal anatomic structures. The topic is interesting, but there are some issues that need to be addressed before it can be considered for publication.

Abstract

Lines 18-20: Prisma is a set of issues for reporting in systematic reviews. Please revise the sentence accordingly.

Lines 21-23: Please, rephrase the sentence.

Introduction

Line 33: Please replace with” that can be successfully treated and controlled” 

Lines 45-47 The sentence is unclear. Sites with gingivitis display PD values ≤ 3 mm.

Lines 50-56 The two sentences are very similar in their content. Please revise them.

Lines 57-58: Please change “of clinical assessment….” with “ of periodontal diagnosis”

Lines 72-73: Please change “in this medium, namely: a solid, a liquid or a gas” with “in solid, liquid or gas medium”.

Lines 72-87: This part is too long.

Lines 92-96: Please revise the sentences. The concepts are repeated twice.

Material and Methods

The electronic search was conducted only on MEDLINE. Why only one electronic database?  This is a limitation for this study. Furthermore, the search was conducted up to March 2020. It is important that the authors update the electronic search and include all the most recent studies.

The authors should add more information on how the agreement between the reviewers was calculated (percentage of agreement, Kappa test) and they should report the corresponding data in the Results Section.

The authors should also add a section describing in detail the data they retrieved from the included studies (authors, year of publication, setting….) and which measures of reproducibility they considered.

Line 109: Please replace “conducted” with “reported”

Lines 112-113 Move the sentence in the Introduction or Discussion sections.

Lines 113-114: Delete this sentence.

Results

Lines 152-153: Please rephrase the sentence.

Lines 158-160: Please move to the Materials and Methods Section

Lines 161-163: Please rephrase the sentence.

Lines 167-170: Please move this comment to the Discussion Section.

Line 173: Please replace “teams” with “researchers”

Line 180-182: Please rephrase the sentence.

Line 217: Please replace “are” with “show”

Figure 4: oral musosis? Is this figure really necessary?

Discussion

Line 254: Replace “thematic” with “topic”

Lines 254-266 Please revise the text. The sentences are difficult to read.

Lines 267-269: It was not possible to perform a meta-analysis.

Line 292: Please delete “of”.

Lines 295-308: This paragraph is too long.

Limitations

I encourage the Authors to extensively revise this section (US imaging?) and to add the main limitations of the study.

Perspectives

Line 321: Imagery? Diagnostic methods?

Conclusions

This section is too long, the authors can move some sentences to the Discussion section.

Line 351: replace “retro-alveolar” with “periapical”.

Line 352: replace “all means” with “the conventional means”.

Lines 353: replace “prospects” with “opportunities”

Author Response

Please find attached a revised version of our manuscript entitled "Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases".

We thank you for giving us an opportunity to substantially improve the content and the presentation of our manuscript. We have modified the article as requested. You will find every modification in the text by using track changes, and the pages are noted in the answer for every point below.

Q1: Lines 18-20: Prisma is a set of issues for reporting in systematic reviews. Please revise the sentence accordingly.

Response:

Thank you. The sentence has been revised.

 Q2: Lines 21-23: Please, rephrase the sentence.

Response:

Thank you. The sentence has been revised.

Q3: Introduction

Line 33: Please replace with” that can be successfully treated and controlled” 

Lines 45-47 The sentence is unclear. Sites with gingivitis display PD values ≤ 3 mm.

Lines 50-56 The two sentences are very similar in their content. Please revise them.

Lines 57-58: Please change “of clinical assessment….” with “of periodontal diagnosis”

Lines 72-73: Please change “in this medium, namely: a solid, a liquid or a gas” with “in solid, liquid or gas medium”.

Lines 72-87: This part is too long.

Lines 92-96: Please revise the sentences. The concepts are repeated twice.

Response:

I would like to thank you to help me to improve the level of language on the manuscript. All points have been revised.

Q4: The electronic search was conducted only on MEDLINE. Why only one electronic database?  This is a limitation for this study.

Response:

Ultrasound is used in a medical application. That is why we searched the MEDLINE database. But we agree that this is a limitation of our study. This point has been clarified in the "limitation section".

Q5: Furthermore, the search was conducted up to March 2020. It is important that the authors update the electronic search and include all the most recent studies.

Response:

I would like to thank you to make the light about that. The research was well realized until March 2022 and we can correct this error on the manuscript.

Q6: It is important that the authors update the electronic search and include all the most recent studies.

The authors should add more information on how the agreement between the reviewers was calculated (percentage of agreement, Kappa test) and they should report the corresponding data in the Results Section.

Response:

On the basis of the selection criteria we had defined, a consensus was sought between our two experts. In case of disagreement, a third expert was sought. We have clarified this point page 4, line 162. We used a "Delphi" approach rather than a quantitative approach to assess the agreement between the evaluators.

Q7: The authors should also add a section describing in detail the data they retrieved from the included studies (authors, year of publication, setting….) and which measures of reproducibility they considered.

Response:

I would like to thank you. The studies’ quality was added on table 1 and better discussed in the limitation part and the Prisma flowchart has been completely revised and designed.

Q8: Line 109: Please replace “conducted” with “reported”

Lines 112-113 Move the sentence in the Introduction or Discussion sections.

Lines 113-114: Delete this sentence.

Response:

I would like to thank you to help me to improve the level of language on the manuscript. All points have been revised.

Q9: Lines 152-153: Please rephrase the sentence.

Lines 158-160: Please move to the Materials and Methods Section

Lines 161-163: Please rephrase the sentence.

Lines 167-170: Please move this comment to the Discussion Section.

Line 173: Please replace “teams” with “researchers”

Line 180-182: Please rephrase the sentence.

Line 217: Please replace “are” with “show”

Figure 4: oral musosis? Is this figure really necessary?

Response:

I would like to thank you to help me to improve the level of language on the manuscript. All points have been revised.

Q10: Line 254: Replace “thematic” with “topic”

Lines 254-266 Please revise the text. The sentences are difficult to read.

Lines 267-269: It was not possible to perform a meta-analysis.

Line 292: Please delete “of”.

Lines 295-308: This paragraph is too long.

Response:

I would like to thank you to help us to improve the level of language on the manuscript. All points have been revised.

 Q11: I encourage the Authors to extensively revise this section (US imaging?) and to add the main limitations of the study.

Response:

Thank you. This section has been completely revised 

Q12 : Line 321: Imagery? Diagnostic methods?

Conclusions

This section is too long, the authors can move some sentences to the Discussion section.

Line 351: replace “retro-alveolar” with “periapical”.

Line 352: replace “all means” with “the conventional means”.

Lines 353: replace “prospects” with “opportunities”

Response:

All points have been revised as requested.

Reviewer 4 Report

The authors should highlight more clearly the practical importance of the method

Author Response

Please find attached a revised version of our manuscript entitled "Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases".

We thank you for giving us an opportunity to substantially improve the content and the presentation of our manuscript. We have modified the article as requested. You will find every modification in the text by using track changes, and the pages are noted in the answer for every point below.

The authors should highlight more clearly the practical importance of the method

Response:

This point has been revised and appears more clearly in the introduction part.

Round 2

Reviewer 1 Report

It seems that the authors have modified the article as requested.

Author Response

We would like to thank you to help us to improve our work.

Best regards

Reviewer 3 Report

The Authors have improved the paper addressing most of the issues that I had raised on the previous version. The paper requires some minor revisions before publication.

Please, add the percentage of agreement between the reviewers.

The  electronic search was conducted only on Medline. Please, acknolwlege the use of one electronic database among the limitations of the study.

Lines 164-166: Please change the sentences as follows: Studies included into the analysis were in vitro or ex vivo studies or clinical comparative trials using different tools to validate the use of ultrasound devices. Most of them applied low ultrasound frequencies. 

Lines 260-261: Please change “Tattan et al. which………” with “the study by Tattan et al. involved both South Korean and American practitioners”.

Lines 266-267: Please delete “to follow-up for re-assessment of the periodontium” from the sentence.

Line 267: Please change as follows: “Patients recruitment for future studies should include patients requiring periodontal surgery….”

Line 296: Please change “worked on” with “enrolled”.

Author Response

Dear reviewer,

We thank you for giving us an opportunity to substantially improve the content and the presentation of our manuscript. We have modified the article as requested. You will find every modification in the text by using track changes, and the pages are noted in the answer for every point below.

Q 1: Please, add the percentage of agreement between the reviewers.

The electronic search was conducted only on Medline. Please, acknolwlege the use of one electronic database among the limitations of the study.

Response:

We added this element in results part:

Line 153: The percentage of agreement between the reviewers was 100%.

We added this element to improve limitation part:

Line 311: Indeed, the use of a only one electronic database is a particular limitation of this study.

Q2: Lines 164-166: Please change the sentences as follows: Studies included into the analysis were in vitro or ex vivo studies or clinical comparative trials using different tools to validate the use of ultrasound devices. Most of them applied low ultrasound frequencies. 

Lines 260-261: Please change “Tattan et al. which………” with “the study by Tattan et al. involved both South Korean and American practitioners”.

Lines 266-267: Please delete “to follow-up for re-assessment of the periodontium” from the sentence.

Line 267: Please change as follows: “Patients recruitment for future studies should include patients requiring periodontal surgery….”

Line 296: Please change “worked on” with “enrolled”.

Response:

I would like to thank you to help me to improve the level of language on the manuscript. All points have been revised as requested.