Herbst Appliance Reinforced with an Hybrid Hyrax Expander and Two Miniscrews in the Lower Arch: Case Report

Round 1

Reviewer 1 Report

The manuscript aimed to show a treatment of Class II malocclusion with dental crowding using skeletal anchored Herbst appliance. Two miniscrews were applied in the lower arch to control mandibular incisors proclination and in the upper arch a Hybrid palatal expander was used.

Here my comments:

1. English language and punctuation need to be revised. Some sentences are confusing to understand, and some terms can be replaced by more commonly used terms, such as aesthetic/esthetic, lower incisors/mandibular incisors.
2. References are not formatted correctly in the text (must be inserted immediately after punctuation)

ABSTRACT

1. The abstract is not structured;
2. It does not have keywords.

INTRODUCTION

1. The introduction is adequate, concise and in a logical sequence, but should be divided into paragraphs for easier reading and understanding.

DIAGNOSIS AND ETIOLOGY

1. The text contains sentences in different verb tenses. It must be in the past, as the treatment has already been completed;
2. The captions of figures 1 and 2 do not match the images;
3. Table 1 uses the acronyms T0, T1 and T2, but these acronyms are not mentioned in the text or subtitled. What do they refer to?
4. There is no legend for most acronyms used in tables.

TREATMENT OBJECTIVES

1. Sentences were written in different verb tenses;
2. In the item "diagnosis and etiology", the authors reported that the patient had a convex profile with mandibular retrusion and upper lip protrusion with a reduced nasolabial angle. Why were maxillary molar distalization and maxillary incisor retrusion not desired?

TREATMENT PROGRESS

1. Please provide an occlusal photograph of the Hybrid appliance.
2. It would be interesting to show the progress and appliances used during the treatment.
3. The authors reported that the patient had an upper lip protrusion with a reduced nasolabial angle. Additionally, the upper canines were crowded. The conventional Hyrax appliance would perform better in this case permitting molar distalization to solve the maxillary dental crowding and decreasing the upper lip protrusion.
4. There is a typo in the caption of figure 4;
5. The caption of figure 5 is confused.

TREATMENT RESULTS

1. In the line 123 the authors used the term "lower arch" to refer to palatal TADs;
2. There is a lot of information repeated in different paragraphs, making the text confusing.
3. Figure 9 does not require duplication of images, as it is the same radiograph.

DISCUSSION

1. The first sentence is confusing;
2. Again, there are sentences in different verb tenses;
3. What are the limitations of this type of treatment?

REFERENCES

1. References are not formatted according to guideline.

Author Response

Dear reviwer 1, 

-english language and puntuaction have been revised 

-references have been corrected 

-we added keywords 

-abstract has been structured 

-we added table legend 

-verb tenses have been corrected 

-The nasolabial angle is proper. We avoided distalization to optimize mandibular advancement 

-Discussion has been corrected 

-References has been corrected 

Reviewer 2 Report

I have reviewed the manuscript “Herbst Appliance Reinforced With An Hybrid Hyrax Expander and Two Miniscrews in The Lower Arch: Case report” submitted to “Applied Sciences” for publication. In this study, authors have presented a case report for the management of Class II growing patient treated using a skeletally reinforced Herbst with miniscrew appliances. This case report is well-presented and can be useful for clinical orthodontists; however, it needs some major improvements; there are a few suggestions that authors may consider to improve it further:

The use of English language is reasonable, however, there are a number of punctuation and grammatical errors; that should be corrected and rephrased using academic English for a better flow of text for reader.

Avoid using capital letters once using words inside the sentence; such as

Classà class

Labial Linà labial lin-…. And many more similar in the manuscript.

Abstract: is providing sufficient information; however the introduction is very brief. Further information can be added regarding the background.

Authors should make sure that all the abbreviations are defined at their first appearance in the text and use abbreviations afterword.

Discussion should be expanded on the biomechanics aspects and limitations of this approach.

Ethical issue: please provide ethical approval for this case

Patient’s consent for treatment and publishing the personal data must be provided.

Author Response

Dear Reviwer 2

-English and punctuation have been corrected

-Introduction and discussion have been improved

-We added patient's consent of treatment 

Reviewer 3 Report

This case reports a skeletal anchored Herbst appliance with hybraid hyrax expander, the treatment outcomes are good. However, the treatment progress lacks detailed explanations. Here are my comments regarding this case report:

1. Figures were distorted and the original width and height ratios were changed, which needs revision. More detailed figures should be attached, such as palatal expander appliance, mini-screws, and fixed brackets appliance. Superimpositions without X rays would be clearer to show treatment changes (Figure 9). The outcomes of palatal expansion should be presented.
2. Line 70 “contention”, do you mean retention?
3. I didn’t see the mini-screws in lower arch in Figure 4, please point out and more intraoral photos are needed.
4. The biomechanics of skeletal anchorage of palatal expander and Herbst appliance should be more discussed, and a schematic diagram would be better.

Author Response

Dear Reviewer 3, 

-figures dimensions have been adjusted

-we added miniscrews photos in the lower arch and also a photo of the hybrid palatal expander 

-we corrected line 70 

-we added a schematic diagram for biomechanic description 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Many thanks for the revision.

The following comment is not responded and discussion is still not up to the merit.

"Discussion should be expanded on the biomechanics aspects and limitations of this approach."

Author Response

Dear reviewer, 

we expanded the discussion on the biomechanics aspects and limitations of this approach.

Kind regards