Immediate Implant Placement and Provisionalization in the Esthetic Zone Revisited: The Marginal Migration Concept (MMC)
Round 1
Reviewer 1 Report
49 - I recommend changing the title to Case 1. "Report and protocol" give as a subtitle.
59 - Figure 1 is missing
82, 102 - Define what division is, what does it belong to?
164 - "Spet 10" is missing
179 - repair "Ibuprofen"
194 - do not start the sentence with a number, merges with Figure numbering
195 - two dots at the end of the sentence
221 - different font type / size
227 - "Impression Stage" - use Bolt
262 - repair "Figure" 21-28
409 - "zone. It is" or "zone, it is"
448 - reference [8] contains 2 citations (missing reference [9])
Suggestion:
- 90´ to replace 90°
- put a space between the number and the unit (0.5 mm, 600 mg)
- if the Figure contains multiple images, label them a, b, c,.... and define them in the Figure description or in the text (e.g. fig.3, 4, 5, 6, 7, 8, 9, 10,......)
- Figure 27 and Figure 28 - distinguish Figure description, for example, add views
Author Response
Dear Sir,Madam
Thank you for your review. We will make all the changes requested.
Sincerely,
Ioannis Vergoullis
Reviewer 2 Report
This article “Immediate implant placement and provisionalization in the esthetic zone revisited. The Marginal Migration Concept (MMC).” is a research article that have some merits. It does fall within the journal’s scope and it has a proper study design. This article has reported a new protocol that can allow the maintenance and even the improvement of the hard and soft tissue topography, leading to superior esthetic results.
The figures are too many: authors should try to reduce them, or to use composite figures.
The introduction needs to be improved. It’s highly suggested to better discuss about the pathways able in controlling inflammation, and more specifically, on the role of dental plaque in gingivitis and the use of local treatments (Please, see and discuss “Cantore, S. et Al. Anti-plaque and antimicrobial efficiency of different oral rinses in a 3-day plaque accumulation model. J. Biol Regul Homeost Agents 2016, 30, 1173–1178.”).
Authors have reported “several authors have described the healing process of an extraction socket alone, or with simultaneous implant placement, or in combination with an alveolar ridge preservation technique with or without simultaneous implant placement”: authors must report the role of local stem cells in controlling inflammation and in immunomodulatory activity (in this light, discuss about: “Spagnuolo, G. et Al. Commitment of Oral-Derived Stem Cells in Dental and Maxillofacial Applications. Dent J (Basel) 2018, 6(4), 72. – AND - Ballini et al. Mesenchymal Stem Cells as Promoters, Enhancers, and Playmakers of the Translational Regenerative Medicine 2018. Stem Cells Int. 2018 Oct 30;2018:69274019” – AND - “Ballini et al. Mesenchymal stem cells as promoters, enhancers, and playmakers of the translational regenerative medicine. Stem Cells Int. 2017:3292810”).
Authors reported “As the healing process progresses and the inflammation moderates, the coronally migrated soft tissue remains supported, supra-crestally, by portions of the low turnover BRG and resorbable membrane that are purposefully located supra-crestally to provide for a scaffold at the supra-crestal zone of the healing socket”. In this context, Author must also discuss about the role of scaffolds in in bone tissue healing (please see and discuss: “Marrelli, et al. Innovative approach for the in vitro research on biomedical scaffolds designed and customized with CAD-CAM technology. (2016) International Journal of Immunopathology and Pharmacology, 29 (4), pp. 778-783”). Scaffolds have important mechanical features to be also considered: explain the more useful and interesting with specific clinical applications (please see and discuss the role of scaffolds in preclinical studies: Marrelli M, et al. Three-point bending tests of zirconia core/veneer ceramics for dental restorations. Int J Dent 2013; 2013, 831976.).
Conclusions must be improved: what is the clinical application of this study? Why endodontists should be informed of this study? Which different techniques do you suggest to add to the current state of the art?
Author Response
Dear Sir/Madam,
Thank you for your thorough review.
We have utilised a large number of images under the scope of allowing the reader of this article to fully understand the steps involved in the technique and under the prism that there was no restriction of image number in the directions for authors provided by the publisher. Thus, we would respectfully request to maintain their number.
With regards to the improvement of the introduction, we will include the suggested references and discuss the subject of plaque control and healing process under the scope of the mentioned references. We did not expand further on these topics in the original article as we were trying not to lose focus on the scope of this article, which is the introduction and clear description of a clinical protocol for every day clinical practice.
With regards to conclusions, we believe that we do make it clear that this is a technique that can be utilised for immediate implant placement in sockets Type I and II, instead of current state of the art procedures like socket grafting and delayed implant placement. The field of application of the technique is mentioned both in introduction and discussion sessions. The scope of the article is to make any dentist placing implants familiar with an alternative technique for immediate cases in the aesthetic zone; The same would apply for any endodontist that is placing dental implants in his/her practice. Ofcourse we appreciate the fact that you feel these details are not clear enough, so we will try to make them more evident and clear for the reader.
Sincerely,
Ioannis Vergoullis
Reviewer 3 Report
The article presents an innovative surgical technique based on well known concepts, that is quite well presented and explained; also the clinical pictures and the included graphs describe the procedures perfectly.
Some points that need to be revised are:
- Line 40. Even though the classification adopted is esplicatory enough, it is quite dated; the authors should integrate also with more recent references for describing the two presented cases.
- Line 136.The type of resorbable membrane and xenograft adopted should be included
- Line 148. An explanation on the importance of this particular description on the suture placement should be provided.
- Line 206. The position of the shoulder is not particularly clear; change “shorter” with a more precise term.
- Line 373. Remove the first comma.
- Line 392-393. The definition should be better explained; if a digital approach is adopted with a screw-retained solution it should be possible to use a one-piece customized abutment/crown with different materials, avoiding “the same shouder” with a cemented solution (risk/benefit ratio)
- Line 413: 2 of the 3 articles included as references are not exactly recent, as they were published almost 20 years ago; they should be updated or integrated with more recent studies on immediate implants.
- Line 419-Line424: This part should be moved to the discussion.
- Is the pouch flap moved in a coronally position? This should be better explained
- The position of the cervical margin of the provisional restoration in cases when the tooth has suffered a vestibular recession should be better explained in the surgical stage section of the article.
- Possible complications and related interventions during the surgical stage and or prosthetic phase should be explained
Author Response
Dear Sir/Madam,
Thank you for your thorough review.
We have adopted the specific classification under the prism that this a classification very clear for the reader. Most recent classifications mostly utilise sub-classifications from this original reference, which in return do not alter the indications for application of the technique. Thus, for example a Class II socket type A, B or C according to Ellian et al, classification does not affect the application of the technique. Nevertheless, we do appreciate your request and we will try to incorporate some more updated classifications in the discussion session.
We will also make all mentioned corrections/improvements requested.
Sincerely,
Ioannis Vergoullis
Round 2
Reviewer 2 Report
all comments have been addressed
Author Response
Thank you for your comments; The new citation has been added as per your request.
Sincerely,
Dr. Ioannis Vergoullis
