Exposure of Xenogeneic Biomaterial to the Oral Environment and Its Impact on Tissue Healing of Immediate Dental Implants: A Case–Control Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In the last decades dental implants have become a valuable option in the treatment of partially edentulous ridges. Immediate implant placement after tooth extraction shortens the treatment period and reduces the number of surgical interventions which is well accepted by patients.

The manuscript aimed to assess the effect of exposed xenogeneic biomaterial on tissue healing in cases of immediate dental implants. The topic is of high interest for specialists in the field of implantology as there are concerns that the unintentionally exposed xenogeneic material might get contaminated which may lead to implant failure.

The manuscript is scientifically sound, and the experimental design is appropriate.

The advantages of immediate implant placement are well described in the introduction as well as effects of the alveolar ridge preservation techniques. The research null hypothesis is clearly defined at the end of the introduction section. The study design, the types of materials used, and the statistical methods are provided. Results are presented in detail, although some clarifications are needed. In the discussion section the results are analyzed and compared with the ones of other researchers. The limitations of the study are also mentioned.

References are adequate and contemporary.

 I have a few recommendations:

-        The introduction may be enriched with general information about the bone loss in the posterior region after tooth extraction and the possible outcome when no preservation technique is applied

-        The manuscript can be enriched by adding photographs of the area of implant placement at different time points

-        In Table 1  - correct the number (n) at the part describing the Vertical soft tissue thickness (mm)

-        The results from the CBCT measurements concerning  the changes in horizontal bone thickness and height should be mentioned in the main text.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Review of the Manuscript “Exposure of Xenogeneic Biomaterial to the Oral Environment and Its Impact on Tissue Healing of Immediate Dental Implants: A Case-Control Study”

The manuscript addresses an interesting and relevant topic. However, before it can be recommended for publication, several important issues need to be addressed.

1.      Outcome Assessments

-The description of the outcome assessments requires improvement. Please provide a detailed reference protocol if a specific protocol was followed.

-The objectivity of the outcome assessment would be enhanced if two calibrated examiners, independent of the surgeon, performed the evaluations.

2.      Subheading 2.3: Keratinized Mucosa Measurement

-Provide comprehensive details regarding the measurement of keratinized mucosa. Specific recommendations include:

- Indicate the exact time points at which measurements were taken.

-Clearly define how the gingival emergence contour of the prosthesis was considered ready for KM evaluation.

-Describe the method used to identify the mucogingival junction.

- Explain how measurements were recorded (e.g., to the nearest 0.5 mm).

3.      Subheading 2.4: Clinical Assessment of Epithelialization

-The scoring system (1 to 5) for epithelialization lacks sufficient detail for reproducibility. Suggestions for improvement include:

-Provide a detailed explanation of the scoring criteria and what each grade represents.

- Indicate the timing of the assessments.

-Specify how stained areas were quantified or graded.

-Mention whether photographic documentation or digital tools were utilized to ensure consistent and objective evaluation.

-Include references to standardized methods for epithelialization assessment, if available. The current reference does not appear to describe a grading system.

4.      Subheading 2.6: Cone Beam Computed Tomography Measurements

-Specify the software used to import the DICOM files for comparison.

- Provide a clearer description of the landmarks and superimposition markers utilized in the analysis.

5.      Subheading 2.7: Statistical Analysis

-Indicate the software used for statistical analysis.

6.      Results Section

-The title of subheading “3.1. Patient Results” could be revised or avoided, as the data pertains to implants and sites as well, not just patients.

-In Table 1, it is noted that an implant was used to replace the third molar (site no. 48). This is an unusual procedure and should be discussed in the Discussion section.

7.      Discussion Section

- Begin by highlighting the novelty of the study.

-Provide a more in-depth comparison with similar studies in the literature.

-Significant improvements are needed to this section, with particular emphasis on addressing the study's limitations, such as:

-The reliability of the assessment being limited by the fact that measurements were performed by a single researcher.

-Despite sample size calculations, the number of patients included is small and may not be sufficient to draw robust conclusions.

-A split-mouth study design would have been preferable to enhance internal validity.

-Consider analyzing the maxilla and mandible separately, as they exhibit distinct anatomical and biomechanical characteristics.

By addressing these points, the manuscript will be significantly strengthened and better positioned for publication.

Author Response

Please see the attachment. 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors addressed all the issues raised during the manuscript revision process.