Comparative Assessment of Perception about Angle Inclination of Mandibular and Maxillary Incisors on the Cephalometric Analysis between Skeletal Class 3 and Orthognathic Cases

Round 1

Reviewer 1 Report

The preset paper discusses a topic of elevated interest both for maxillofacial surgeons and orthodontists. The pre-surgical planning for orthognathic patients involves a very tight collaboration between the two and also a very thorough knowledge of facial and skeletal landmarks and post treatment aims. 

Although most of the relevant aspects were presented, some modifications should be made, such as:

Introduction

Please define class I, II and III more precisely - mentioning the dental classification and insisting more on the skeletal aspects, like SNA, SNB and ANB values.

The surgical planning is made by taking into account several factors, with a higher relevance than just the skeletal aspects, such as the facial aspect and, more recently, the airway. Please mention the importance of these factors as well. 

Nowadays, most of the initial diagnosis and the pre-surgical plannings are done by dedicated software, reducing human error by a lot. This aspect must be mentioned! How are the analog measurements relevant in this case? Or are the measurements in this study made using such software? It is not very clear.

Digital planning leads to the easy implementation by the use of 3d printed splints or even patient specific implants (osteotomy guides and plates). In the situation of analog planning, how do you implement and verify the results during and after surgery?

 

Materials and Methods

"Subsequently, two lines signifying the Frankfort Horizontal Plane and the Inferior Border of the Mandibular Plane, as well as reference points (B) point, (A) point, (N) Nasion, were drawn on all 100 X-rays" - by one single person, at the beginning of the study, or by each examiner?

Results

Please reformat tab 1

Discussions

Class III patients frequently present a narrow maxilla which often requires a preliminary intervention before the orthodontic stage (SARPE). After the transversal expansion of the maxilla, dental decompensation of the upper arch is easier to obtain than by premolar extractions (L226-231).

CT diagnosis is only mentioned. It should be further discussed, since it is of such high interest. 

In the end, it is unclear how the actual findings of the present paper are relevant, especially form a practical point of view. First of all, what can be done to eliminate or at least limit the examiner bias, but also, where are these errors coming from and why is there a connection between the severity of the anomaly and the degree of error. 

The references are very dated, with none more recent than 2016, leading to omissions of highly relevant aspects in the field.  

Although this is an interesting paper, improvements must be made in order to elevate it's scientific value and relevance. 

 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors, 

I suggest authors consider the following. 

1. Extensive English editing is required, as it is not readable at various sections.
2. The title is written in an abrupt manner. Kindly rephrase as it’s grammatically confusing.
3. Abstract- Authors should write unstructured abstracts. Eliminate the headings such as “Research procedure”, “Results”
4. Avoid using the term “cephalometric X-ray” and “x-rays” “Photograph” instead use “cephalometric radiograph” and “radiograph” throughout the manuscript.
5. Don't refer figure in the abstract 
6. Mention “P value” in the abstract
7.  Introduction - The references are not cited in chronological order in the manuscript. After reference no. 5, the author has cited reference no. 16?
8. Elaborate the abbreviations such as FH, MP, NB
9. Material & Methods - Add ethical number, Add a section of statistical analysis
10. Results - Format the Table 1, its unclear. Add headings for column and rows.
11. Make compound graphs and merge the graphs into one
12. Make both scatter plot into a composite image  
13. Discussion - Authors have mostly discussed the literature, but did not discuss their results. Also they have not provided any rationale or justification of their results.
14. References - About 13 references (72%) are old, on the contrary, there should be 70-80% of references from the past 5 or a maximum of 10 years. Moreover, 18 references are fewer for an original study. Authors are advised to increase the number of references in recent years (2012-2022).

Best Wishes

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thank you for providing the required clarifications!

Author Response

thank you 
I also improved the English language in the latest version 

appreciate every detail you provided 

Reviewer 2 Report

Dear Authors, 

There are a few suggested corrections which are not addressed. Kindly look into the points carefully. 

1.    Don't refer figure in the abstract 

2.    Mention “P-value” in the abstract

3.    The authors have mentioned reference No. 7,  

4.     The references are not cited in chronological order in the manuscript. After reference no. 6, the author has cited reference no. 16; The authors have mentioned reference No. 7 in the discussion.

5.    References – Only 40% (9 references) are in past 10 Years. Authors are advised to increase the number of references in recent years (2012-2022).

6.    I don’t find any difference in the Format the Table 1 from the 1^st submission. Its unclear. Add headings for the variables in column and rows.

7.    Make compound graphs and merge the graphs into one

8.    Make both scatter plot into a composite image

9.    Unit of measurement is not mentioned throughout the manuscript. Please add “mm” or degree for angle.

10. Authors have not mentioned SD (Standard deviation) in table 1. Also, In figures, that have mentioned “(mean, SE)”- but I can see only Mean, and I guess SE is standard error. Why authors are considering standard error instead of standard deviation.

11. The values of table 1 and related figures are not matching. Kindly explain.

12. Discussion - Authors have mostly discussed the literature, but did not discuss their results. Also they have not provided any rationale or justification of their results.

13. If authors are comparing the perception of different examiners, then why Reliability tests was not done.

14. Figure 2- Point B is not visible

15. Figure 1 – Point A is not showing on Central Incisor

 

 

Best wishes 

Author Response

please see the attachment

Author Response File: Author Response.docx

Round 3

Reviewer 2 Report

Dear Authors, 

I appreciate your efforts to improvise the manuscript, however, a few concerns are still there. 

1. Title of the paper can be modified to "The comparative assessment of perception about angle inclination of mandibular and maxillary incisors on the cephalometric analysis between skeletal class 3 and orthognathic cases. 

2. I didn't find where the authors mentioned or discussed figures 1, 3 and 5 in the text. The figure and tables should be cited chronologically in the text.

3. Indicate the reference line / standard line on the scatter plot to assess the relationship of the coordinates to the reference line.  

4. Authors must choose between the "Standard deviation" and "standard error" to display the results. There has to be consistency in the results throughout the manuscript. I suggest using "Standard deviation". 

5. Authors have suggested the use of "CT" imaging in the abstract, whereas in the discussion they mentioned "CBCT".  The consistency is not maintained. 

6. Mention the software used for angle calculation (Cephninja® angle calculation application) in the abstract. 

7. Table 1 is still not presentable. Moreover, don't mention the word "Degree", instead use the symbol for it. 

8. Mention the ethics committee approval number. It is neither mentioned in the methods section nor in the declarations. 

9. Never start a sentence with a digit. For example, method section, page 2, second line. Cross-check the whole manuscript for such discrepancies. 

10. Only the first letter of a sentence is in uppercase. For example, abstract, the 19th line "prognathic patients". Cross-check the whole manuscript for such discrepancies. 

11. The reference mentioned have not adopted the standard style of writing references. For example, reference No. 21 should be mentioned as 

"Hwang HW, Moon JH, Kim MG, Donatelli RE, Lee SJ. Evaluation of automated cephalometric analysis based on the latest deep learning method. Angle Orthod. 2021;91(3):329-335. doi:10.2319/021220-100.1" 

instead, it is mentioned as "Hwang HW, Moon JH, Kim MG, Donatelli RE, Lee SJ. Evaluation of automated cephalometric analysis based on the latest deep learning method. Angle Orthod. 2021" 

Please modify the reference style. 

12. Language editing is required. 

Best Wishes

Author Response

please see the attachment 

thank you

Author Response File: Author Response.docx