Retrospective Analysis of Full-Arch Zirconia Rehabilitations on Dental Implants: Clinical Outcomes and Patient Satisfaction

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Comments to authors

 

Dear authors,

Thank you for submitting the manuscript entitled "Full-arch zirconia rehabilitations on dental implants: a retrospective study" for potential publication in Applied Sciences. Please check my comments below.

 

- Abstract: Well-structured and easy to read. I suggest including more details about the three types of techniques compared.

- The introduction provides a good overview of the topic, but it would be beneficial to include a clearer justification for the choice of a retrospective design and the small sample size.

- Inclusion/Exclusion Criteria: The criteria are well-defined, but it would be interesting to discuss whether smokers represent a significant bias in the study.

- The Discussion of the findings could be more integrated. For instance, the relationship between complications could be better explored.

-Table 2: Reorganize the data into percentages to facilitate interpretation and allow for direct comparisons.

- The discussion lacks a deeper analysis of the study's limitations, such as the sample size and the follow-up period (36 months). I recommend to critically evaluate (and emphasize) these aspects.

- The conclusion aligns with the results presented, but emphasizing the need for long-term prospective studies with larger samples would strengthen the article's overall impact.

Author Response

Dear authors,

Thank you for submitting the manuscript entitled "Full-arch zirconia rehabilitations on dental implants: a retrospective study" for potential publication in Applied Sciences. Please check my comments below.

Authors: thank you for the time spent to read and review our article.

- Abstract: Well-structured and easy to read. I suggest including more details about the three types of techniques compared.

Authors: thank you for your suggestion. LINE 16-19 more details regarding the techniques added. Word limitation on abstract forces us to be concise.

- The introduction provides a good overview of the topic, but it would be beneficial to include a clearer justification for the choice of a retrospective design and the small sample size.

Authors: thank you for your suggestion. LINE 97-100: clear justification added. The retrospective nature of the study and the small population are due to the exploratory nature of the study which is necessary to understand if there might be differences in performance between the different techniques or not. A sample size calculation was also added. The results of the present study will be used as a basis for prospective and larger prospective studies.

- Inclusion/Exclusion Criteria: The criteria are well-defined, but it would be interesting to discuss whether smokers represent a significant bias in the study.

Authors: Thank you for your suggestion. Lines were added to state that smoker patients were included in the study. A line stating that most tissue-related complications were reported on a smoker patient was also added.

- The Discussion of the findings could be more integrated. For instance, the relationship between complications could be better explored.

Authors: Thank you for your suggestion. lines further discussing complications were added.

-Table 2: Reorganize the data into percentages to facilitate interpretation and allow for direct comparisons.

Authors: Thank you for your suggestion. data were reorganized in percentages

- The discussion lacks a deeper analysis of the study's limitations, such as the sample size and the follow-up period (36 months). I recommend to critically evaluate (and emphasize) these aspects.

Authors: Thank you for your suggestion. A deeper analysis of the study’s limitations was added.

 

- The conclusion aligns with the results presented, but emphasizing the need for long-term prospective studies with larger samples would strengthen the article's overall impact.

Authors: Thank you for your suggestion. We emphasized the need for long term prospective studies with a larger sample.

 

Reviewer 2 Report

Comments and Suggestions for Authors

 Full-arch zirconia rehabilitations on dental implants: a retrospective study

 

Several authors have demonstrated successful full‐arch rehabilitation of completely edentulous patients. In the past metal-ceramic materials showed some concerns but in the last two decades Zirconia emerged has a more reliable choice.

In this study the authors evaluate both the implant sucess and patients satisfaction when using three diferente types of zirconia rehabilitations: monolithic, hybrid and zirconia -on-zirconia. The authors considered implants “successful” in case of absence of a) prosthetic or b) implant related complications. Patient´s satisfaction was evaluated by inquiry.

General Comments

This work is quite attractive for clinical practice and biomaterials research. The authors have completed an interesting and well-designed study, however the results presentation could be improved to explore their full potential.

Specific comments

 

1.      Introduction

 

Line 66- The most common ISFCDPs described in literature are the following

The authors use as reference a narrative review, from themselves, to describe the 3 types of models used in the study.It is not wrong to use a self citation , but they shoud extract from it which studies used which model.

Line 90- The primary objective ……evaluate the success and survival over time of Zirconia with a minimum follow-up of 1 year after prosthetic delivery

I understood from the Title and Abstract that the main objective was to compare the “performance” of 3 types of Zirconia models, in full arch dental implants. This one was achieved analyzing prosthetic complications and peri-implant health.

From my point of view, patients satisfaction evaluation is the secondary outcome tested.

Line 91- minimum follow-up of 1 year after prosthetic ;

The follow -up time should be removed from the study objective.

2.      Materials and Methods

Line 119- Patients not following a periodontal maintenance program. I would think that smoking is here, in the exclusion criteria (?). Or should be an exclusion criteria on its own.

 

3.      Results

 

Line 175- In Table 1, it could be stratified mandibular and maxillary versus model type

Line 200- Complications at implant and prosthetic level (again this table woud be much better if the authors presented a more stratified Table: models versus (prosthethic /implant complications)

4.Discussion

 

Line 273- Zirconia-on-zirconia (zirc-on-zirc) ISFCDPs

I do not see any reference of the protocol. Is it created by the authors? If so, it shoud be stated. If not, it needs references.

 

5. Conclusions

Line 320-321 - prosthetic design allowed for optimal cleaning and maintenance by the patients.

Is this a result? Was it mentioned in any type of questionary to the patients?

 

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Author Response

Several authors have demonstrated successful full‐arch rehabilitation of completely edentulous patients. In the past metal-ceramic materials showed some concerns but in the last two decades Zirconia emerged has a more reliable choice.

In this study the authors evaluate both the implant sucess and patients satisfaction when using three diferente types of zirconia rehabilitations: monolithic, hybrid and zirconia -on-zirconia. The authors considered implants “successful” in case of absence of a) prosthetic or b) implant related complications. Patient´s satisfaction was evaluated by inquiry.

General Comments

This work is quite attractive for clinical practice and biomaterials research. The authors have completed an interesting and well-designed study, however the results presentation could be improved to explore their full potential.

 

Authors: We would like to thank you for your opinion on our manuscript. The comments you provided and the suggestions given show the attention and time spent in reviewing our manuscript. We hope that the revisions made satisfy your requests.

Specific comments

 

1. Introduction

 

Line 66- The most common ISFCDPs described in literature are the following

The authors use as reference a narrative review, from themselves, to describe the 3 types of models used in the study. It is not wrong to use a self citation , but they shoud extract from it which studies used which model.

REVIEWER 2: a citation was added to complete the references regarding different materials used for ISFCDPs. The literature regarding evaluation of different materials is scarce and dishomogenous, as demonstrated by our narrative review. The ITI consensus report document describes many, although not all, the materials that can be used for ISFCDPs.

Line 90- The primary objective ……evaluate the success and survival over time of Zirconia with a minimum follow-up of 1 year after prosthetic delivery

I understood from the Title and Abstract that the main objective was to compare the “performance” of 3 types of Zirconia models, in full arch dental implants. This one was achieved analyzing prosthetic complications and peri-implant health.

From my point of view, patients satisfaction evaluation is the secondary outcome tested.

REVIEWER 2: the primary and secondary objectives section was edited according to your suggestion.

Line 91- minimum follow-up of 1 year after prosthetic;

The follow -up time should be removed from the study objective.

REVIEWER 2: the follow up time was removed according to your suggestion.

 

2. Materials and Methods

Line 119- Patients not following a periodontal maintenance program. I would think that smoking is here, in the exclusion criteria (?). Or should be an exclusion criteria on its own.

 REVIEWER 2: Thank you for your comment. Light smoking (<10 cigarettes per day) was not considered an exclusion criteria. All patients undergoing an ISFCDP rehabilitation were recommended to stop smoking altogether. Lines were added stating that most of the tissue-related complications were present in smoking patients and that heavy smokers were not included in the study.

3. Results

Line 175- In Table 1, it could be stratified mandibular and maxillary versus model type

Authors: Thank you for your suggestion. Specific distribution of model type and whether it was a maxillary or mandibular rehabilitation was added in table 1.

Line 200- Complications at implant and prosthetic level (again this table woud be much better if the authors presented a more stratified Table: models versus (prosthethic /implant complications)

Authors: Thank you for your suggestion. An additional table with complications stratified considering prosthetic design was added.

 

4. Discussion

Line 273- Zirconia-on-zirconia (zirc-on-zirc) ISFCDPs

I do not see any reference of the protocol. Is it created by the authors? If so, it shoud be stated. If not, it needs references.

Authors: Thank you for your suggestion. A statement regarding this observation was added. The protocol was created by one of the authors.

5. Conclusions

Line 320-321 - prosthetic design allowed for optimal cleaning and maintenance by the patients.

Is this a result? Was it mentioned in any type of questionary to the patients?

Authors: Thank you for your comment. This was mentioned in the questionnaire given to the patients, in the form of a question stating whether the patient found it difficult to clean around and under the ISFCDP.

 

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript addresses a relevant topic concerning implant-supported full-arch zirconia fixed dental prostheses (ISFCDPs), providing valuable data on success rates, complications, and patient satisfaction. However, it requires enhanced methodological depth, updated references, and improved data presentation to strengthen its impact on the scientific and clinical community.

 

Title and Abstract

- Line 3, Page 1: The title could be more descriptive to attract attention. Suggested revision: "Retrospective Analysis of Full-Arch Zirconia Rehabilitations on Dental Implants: Clinical Outcomes and Patient Satisfaction."

- Line 16, Page 1: In the abstract, there is a grammatical error in "1.53% very satisfied." It should read "14.53% very satisfied," as indicated in Table 3.

 

Introduction

- Lines 33–39, Page 2: The introduction is informative but lacks recent references to support claims about zirconia's evolution. Include citations from 2020 or later.

- Lines 64–65, Page 2: The statement "ranging from 88% to 100%" needs additional specific references for credibility.

 

Materials and Methods

- Line 101, Page 3: Provide more details on the sample size calculation to justify the inclusion of only 14 patients.

- Line 108, Page 3: "The present study was approved by the local ethical committee". Include the specific approval number.

- Line 127, Page 3: Specify the instruments and brands used for clinical measurements (e.g., periodontal probe).

- Line 142, Page 4: Improve the description of peri-implantitis parameters, explaining the categorization and diagnostic criteria used.

 

Results

- Line 166, Page 4: Provide additional details on patient characteristics, such as risk factors (smoking, diabetes) that could influence outcomes.

- Table 2, Page 5: Revise the table format. Include "N (%)" to make complication proportions more accessible.

 

Discussion

- Line 214, Page 6: Expand the discussion to include limitations, such as the small sample size and retrospective design. Suggest strategies to address these limitations.

- Line 218, Page 6: Elaborate on how the results compare to other recent studies, especially regarding success rates.

 

Conclusion

- Line 319, Page 9: The conclusion is concise but could be enhanced by including practical implications for clinicians considering zirconia ISFCDPs.

 

Figures and Tables:

- Revise Figure 5, Page 9 captions to provide more detailed explanations.

Author Response

The manuscript addresses a relevant topic concerning implant-supported full-arch zirconia fixed dental prostheses (ISFCDPs), providing valuable data on success rates, complications, and patient satisfaction. However, it requires enhanced methodological depth, updated references, and improved data presentation to strengthen its impact on the scientific and clinical community.

 Authors: We would like to thank you for your opinion on our manuscript. The comments you provided and the suggestions given show the attention and time spent in reviewing our manuscript. We hope that the revisions made satisfy your requests.

Title and Abstract

- Line 3, Page 1: The title could be more descriptive to attract attention. Suggested revision: "Retrospective Analysis of Full-Arch Zirconia Rehabilitations on Dental Implants: Clinical Outcomes and Patient Satisfaction."

REVIEWER 3: We thank the reviewer for the suggestion. The title was changed to improve appeal.

 

- Line 16, Page 1: In the abstract, there is a grammatical error in "1.53% very satisfied." It should read "14.53% very satisfied," as indicated in Table 3.

Authors: Thank you for the correction. The typing error was corrected.

 

Introduction

- Lines 33–39, Page 2: The introduction is informative but lacks recent references to support claims about zirconia's evolution. Include citations from 2020 or later.

Authors: Thank you for your suggestion. The most recent article regarding zirconia evolution (2024) was added to the reference list.

- Lines 64–65, Page 2: The statement "ranging from 88% to 100%" needs additional specific references for credibility.

Authors: thank you for your suggestions. The statement has been reinforced with additional references.

 

 

Materials and Methods

- Line 101, Page 3: Provide more details on the sample size calculation to justify the inclusion of only 14 patients.

Authors: Thank you for your comment. The sample size calculation was provided with the citation to the reference study.

- Line 108, Page 3: "The present study was approved by the local ethical committee". Include the specific approval number.

Authors: Thank you for your observation. the specific approval number was added.

- Line 127, Page 3: Specify the instruments and brands used for clinical measurements (e.g., periodontal probe).

Authors: Thank you for your suggestion. the brand was added.

- Line 142, Page 4: Improve the description of peri-implantitis parameters, explaining the categorization and diagnostic criteria used.

Authors: thank you for your comment. Description of peri-implantitis parameters was improved.

 

Results

- Line 166, Page 4: Provide additional details on patient characteristics, such as risk factors (smoking, diabetes) that could influence outcomes.

Authors: Thank you for your suggestion. Lines were added regarding how many patients were light smokers and how many had systemic diseases such as diabetes or hypertension.

- Table 2, Page 5: Revise the table format. Include "N (%)" to make complication proportions more accessible.

REVIEWER 3: Thank you for your suggestion. The table was modified according to your suggestions.

 

 

Discussion

- Line 214, Page 6: Expand the discussion to include limitations, such as the small sample size and retrospective design. Suggest strategies to address these limitations.

Authors: Thank you for your suggestion. The discussion was expanded according to your suggestions.

 

- Line 218, Page 6: Elaborate on how the results compare to other recent studies, especially regarding success rates.

 Authors: Thank you for your comment. The discussion was expanded according to your suggestions.

 

Conclusion

- Line 319, Page 9: The conclusion is concise but could be enhanced by including practical implications for clinicians considering zirconia ISFCDPs.

Authors: Thank you for your suggestion. Lines regarding the implications of using zirconia ISFCDPs were added.

Figures and Tables:

- Revise Figure 5, Page 9 captions to provide more detailed explanations.

Authors: Thank you for your suggestion. More detail was added to figure 5

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for submitting the revised version of the manuscript entitled "Retrospective Analysis of Full-Arch Zirconia Rehabilitations on Dental Implants: Clinical Outcomes and Patient Satisfaction" for possible publication in Applied Sciences. The authors addressed all my comments thoroughly thereby improving their manuscript substantially. The manuscript can now be accepted for publication.