Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript presents a clinically relevant and well-structured retrospective analysis of the palatal bone reservoir as an alternative to maxillary sinus lift, supported by appropriate use of helical CT and quantitative HU analysis . The study is sound and the conclusions are supported by the data; however, minor revisions would improve clarity and impact. These include light language editing, clearer articulation of the knowledge gap in the introduction, and additional methodological details (e.g., observer reliability and justification of implant parameters). Minor improvements to figure quality, table formatting, and brief expansion of clinical implications and limitations are also recommended. Overall, the manuscript is suitable for publication after minor revision.

Author Response

First, we want to thank the reviewer for his valuable contribution to improving our work.

Comment 1: " include light language editing."

Response 1: The text was reviewed again, and minor language corrections were made, highlighted in yellow in the revised manuscript.

Comments 2: "clearer articulation of the knowledge gap in the introduction."

Response 2: We have expanded the last paragraph in the introduction (marked in green): Recent literature has suggested palatally positioned dental implants as a viable alternative to maxillary sinus lift [14,15]. However, a comprehensive morphological analysis of the specific bone volume and quality in this region remains lacking. In this study, we explored this less-invasive surgical alternative for posterior maxillary implantation in specific cases of alveolar height deficiency and provided an in-depth morphological assessment of the available bone volume.

Comment 3: "additional methodological details (e.g., observer reliability and justification of implant parameters)".

Response 3: We added the following sentence to the Materials and methods section, under Virtual implant positioning (marked in green): Each virtual implant position was evaluated and approved by the same attending surgeon.

justification of implant parameters - we added the following in the discussion (marked in green): "In the literature, the upper threshold for the classification of short implants is established at less than 10 mm[19]. In this study, virtual short dental implants were excluded from the analysis; therefore, the minimum implant length was 10 mm.  Virtual implants with a narrow platform were also excluded from the analysis, and only implants with a 3.75 mm diameter were used. "

Comment 4: clinical implications

Response 4: We added the following section in the discussion (marked in green): "Freehand dental implant insertion in a palatal angulation may be challenging, as it increases the risk of maxillary sinus perforation or compromising the available bony envelope. Hence, we strongly recommend a guided surgery protocol in such cases. "

Comment 5: brief expansion of limitations

Response 5: We expanded the following line in the discussion regarding limitations (marked in green): "Only implants with a diameter of 3.75mm were tested, and short implants were excluded from the analysis."

Reviewer 2 Report

Comments and Suggestions for Authors

Prevalence and Morphology of the Palatal Bone Reservoir in the Posterior Maxilla as an Alternative to Maxillary Sinus Lift: A Cross-Sectional Retrospective Analysis Determined by Helical CT Scan

 

This study investigated the possibility of having alternatives to sinus lift by assessing the prevalence of palatal bone thick enough to sustain implants. Due to the widespread use of sinus lift in clinical treatments, this study has significant clinical importance.

Introduction – briefly introduced the subject.

Materials – accurately and reproductively described the techniques used both as implant simulations as well as radiological and software analyses. Pictures are clear in describing the techniques used.

Results – clearly describe the statistical results, while the images showed the palatal bone considered as the implant site.

Discussion – clearly approached the results in the context of the current research flow.

Conclusion – pertinent and in line with the aim.

References are relevant

Author Response

We sincerely appreciate the reviewer for taking the time to approve our work.