Effect of Internal Structural Design on Stress Distribution in 3D-Printed Subperiosteal Implants Under Mechanical Loading

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1. Please add ISO 14801 and the access date in the reference.

2. Please rewrite the Materials and Methods section, as some parts of the information should be moved to the Introduction.

3. What is the research hypothesis?

4. Was the mechanical testing performed according to any established standards or protocols, such as ISO? If so, the corresponding reference should be included.

5. Please answer the hypothesis in the discussion section.

6. Please include the limitations of the study and suggestions for further research.

7. The conclusion should be written more concisely.

Author Response

Dear Reviewer,

On behalf of the entire author team, we would like to sincerely thank you for your constructive comments and valuable suggestions.

In the following document, we provide detailed, point-by-point responses to all of your remarks. We hope that, based on your observations and recommendations, the implemented revisions have significantly improved the quality and clarity of the manuscript.

Comments 1

Please add ISO 14801 and the access date in the reference.

Response 1

Thank you for pointing this out. We agree with this comment. Therefore, ISO 14801:2016 has been added to the reference list together with the corresponding access date.

Located: lines 528-530

 

Comments 2

Please rewrite the Materials and Methods section, as some parts of the information should be moved to the Introduction.

Response 2

After revision, a section has been relocated from Materials and Methods to the Introduction as suggested

Located: lines 90-137

 

Comments 3

What is the research hypothesis?

Response 3

Added into the M&M section.

The mandible and the reinforcing subperiosteal implant are predominantly subjected to compressive loading between the upper and lower dentition. It was hypothesized that the different structural regions of the implant do not contribute equally to load bearing and therefore require function-specific design considerations. Accordingly, optimized lightweight internal structures were expected to maintain global structural integrity while providing stress-distribution characteristics comparable to those of the fully solid config-uration over the investigated load range. The objective was to map the local mechanical stress distribution throughout the entire implant volume, identify minimally and maxi-mally loaded regions, and define structurally favorable surface and lattice configurations in the titanium framework accordingly.

Located: lines 139-148

 

Comments 4

Was the mechanical testing performed according to any established standards or protocols, such as ISO?

Response 4

There is currently no standardized testing protocol for subperiosteal implants; therefore, the experimental investigations conducted in this study are particularly important for establishing reliable mechanical evaluation approaches.

Added:

For endosteal implants, the qualification and testing requirements are defined in ISO 14801:2016. In contrast, subperiosteal implants lack a standardized qualification protocol owing to their patient-specific, custom-made nature.

.Located: lines 82-84

 

Comments 5

Please answer the hypothesis in the discussion section.

Response 5

Added into the end of Discussion:

Based on experimental observations, numerical results, and the supporting biome-chanical literature, the applied loading protocol can therefore be considered appropriate and representative for evaluating the mechanical response of the investigated implant configurations within clinically relevant limits

Located: Lines: 384-387

 

Comments 6

Please include the limitations of the study and suggestions for further research.

Response 6

Thank you for this important recommendation. A new subsection entitled “4.1 Limitations and Future Perspectives” has been added, describing the study limitations and outlining future research directions.

The present study has several limitations that should be acknowledged. First, the ap-plied loading protocol consisted of 500 physiological bite cycles followed by a single high-load event of 2000 N. Although this approach allowed the evaluation of structural integrity within clinically relevant limits, it does not represent long-term fatigue behavior under lifelong functional loading conditions. High-cycle fatigue testing over several mil-lion loading cycles was not possible with the current experimental setup.

Second, the applied loads were aligned parallel to the longitudinal axes of the con-nection cones and fixation pins. While this configuration represents a simplified, clinical-ly relevant axial loading scenario, it does not account for non-axial or inclined load com-ponents that may occur in vivo during complex mastication movement.

Third, the mechanical properties of the polymer-based mandibular model and the clamping system limited the maximum load level that could be applied. At substantially higher loads, deformation of the support structure may occur, restricting the reliability of measurements under extreme loading conditions.

To overcome these limitations, a new computer-controlled fatigue test bench is cur-rently being designed. The conceptual and engineering plans have already been complet-ed, and construction of the system is planned soon. The new setup will enable high-cycle fatigue testing (2–5 million loading cycles at controlled frequencies of approximately 5–15 Hz) on various implant configurations.

 Future investigations will include extended cyclic loading on multiple implant types, followed by microscopic and CT-based analyses to detect fatigue-related micro-damage, crack initiation, or structural degradation. Furthermore, non-axial loading condi-tions will be examined in accordance with ISO 14801:2016, in which the applied force is applied at a defined 30° inclination relative to the implant axis and combined with dy-namic fatigue loading. This approach will provide a more comprehensive mechanical evaluation under clinically relevant worst-case loading scenarios [30].

Located: lines 391-417

 

Comments 7

The conclusion should be written more concisely.

Response 7

The Conclusion section has been thoroughly revised and updated.

CT-based deformation measurements and finite element simulations consistently demonstrated that none of the implant configurations investigated exhibited perma-nent deformation under clinically relevant loading conditions up to 2000 N, regard-less of the applied internal infill strategy.

• Load-transfer analysis revealed that critical stresses concentrate primarily at the im-plant–prosthetic interface, while structural regions located farther from this zone ex-perience significantly lower stress levels and therefore do not govern global static in-tegrity.
• In high-load-transfer regions, sufficient material presence is essential; however, per-forated designs can safely replace fully solid structures, while in low-stress regions, extensive lightweighting may be applied without compromising mechanical per-formance.
• Lightweight, perforated, and lattice-based configurations maintain global mechani-cal stability while potentially improving stress distribution, reducing stress shield-ing, and enhancing osseointegration. Consequently, the titanium reinforcement mesh can be optimized primarily for biological rather than load-bearing considerations.

Located: lines 418-435

Kind regards,
Ádám Vörös
on behlaf of the Authors

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors

 

Your research idea is very interesting and unique.

However, the M&M section requires careful editing to enable other researchers to replicate your research.

Abstract:
What is the practical conclusion from your research that would be useful for implantologists?

Introduction
The description for Figure 1 and Figure 2. If this is a research item, shouldn't it be included in the M&M section?

Procurement - please see the definition of this word, or should I skip it, or simply "obtain" or "adapt"?

The ISO 14801:2016 standard always includes the year of its publication. We also include this as a reference.

Have others studied similar issues in the literature before you? If so, could you mention it and explain how your work differs from other experts in this field?

Will you propose a thesis before conducting your research?

M&M
line 104
Dent-Art Technik - please provide the city and country of this company.

Has the research model presented in Figure 3 been used before (reference), or is this your idea? If so, it might be worth highlighting.

line 117
"The introduction of such structural reliefs may offer several advantages and benefits" - does the use of all structures or only selected ones apply? If selected, which ones? If all, what is our reference point, which doesn't have as many advantages?

Please provide the manufacturer, city, and country of the Pattex Repair Universal adhesive and the Tough 2000 Resin V1 resin. Please also include a diagram of where the implant was, where the mandibular joints were, and where the adhesive was. Or a reference to one of the later drawings?

Line 150
After post-processing, the material exhibited a Young's modulus of approximately 1.2 GPa and a Poisson's ratio of 0.35, representing the compliant mechanical behavior of the mandibular bone. Could you provide a literature reference for this ifo? Did you test these parameters for this resin, or did you find it somewhere in the product description?

Titanium alloy - what purity, manufacturer's country? All of this is important if anyone in the future were to rely on your experiments and attempt to replicate them.

How were these implants made using laser sintering? CAD/CAM milling? There's no mention of this...
Was it just one implant with a specific geometry, or many more? If 1, is this statistically sufficient? Do imperfections during the execution of this implant affect the results???

line 163
"were acquired" - start with the definition of this word. It's mainly used in company acquisitions. Here, perhaps it's better to simply use "CBCT was used"?

Széchenyi István University - city, country? Who manufactured the CBCT model?

"loading cycle" - what device was used? Where was the load applied? Schematic diagram.

Without such basic information, it's hard to visualize all this, let alone repeat the tests.
Were the loadings performed consecutively or with breaks? How long did they last?

line
"Abaqus software" - manufacturer, city, country?

Line 220
Generative artificial intelligence was used exclusively to support language editing and stylistic refinement of the manuscript. - This sentence should be at the end of the manuscript in the acknowledgments section.

Results
This section may be divided by subheadings. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn. - This section with the template should have been removed????

I'm wondering about one thing: You used a hard metal implant structure, which was mounted on a softer material – resin, using an adhesive based on resins that are also softer than titanium alloy. It is therefore logical that possible deformations could occur in soft materials, not hard ones.

Discussion
What were the limitations of your research? What would you like to accomplish in the future, continuing your research?
Do the results of other authors' research align with yours, or do they differ?

Conclusion
This should contain 3-4 of the most important conclusions from your research in bullet points. A total of about 5-6 sentences at most, so that it's the crux of the matter.

Section 6: Patents; if it's not there, delete this section.

Funding is usually followed by the year and grant number.

If I could make a suggestion for the future: Write an article, submit it to the journal's template, and wait a few more days. Read it twice. This will help you catch many errors yourself.

Or have the article read by someone outside your team, so they can tell you what they understood. Because that's how a reviewer works. They're not there during the testing and writing of the article, and then they try to understand what the authors have done.

Congratulations on finding time to conduct research as a company owner!
Good luck with your future research!

Author Response

Dear Reviewer,

On behalf of all co-authors, I would like to express our sincere appreciation for your thorough evaluation and constructive feedback. Your comments have been invaluable in improving the clarity, structure, and scientific rigor of our manuscript.

We have carefully addressed each point in a detailed, point-by-point response and revised the manuscript accordingly. We trust that the modifications have strengthened the overall quality of the work.

 

Comments 1
What is the practical conclusion from your research that would be useful for implantologists?

Response 2
Thank you for this important question. The following statement has been added to the Conclusion section to clearly summarize the practical clinical relevance of our findings:

• Load-transfer analysis revealed that critical stresses concentrate primarily at the im-plant–prosthetic interface, while structural regions located farther from this zone ex-perience significantly lower stress levels and therefore do not govern global static in-tegrity.
• In high-load-transfer regions, sufficient material presence is essential; however, per-forated designs can safely replace fully solid structures, while in low-stress regions, extensive lightweighting may be applied without compromising mechanical per-formance.
• Lightweight, perforated, and lattice-based configurations maintain global mechani-cal stability while potentially improving stress distribution, reducing stress shield-ing, and enhancing osseointegration. Consequently, the titanium reinforcement mesh can be optimized primarily for biological rather than load-bearing considerations.

Located: lines 423–435

 

Comments 2
The description for Figure 1 and Figure 2. If this is a research item, shouldn't it be included in the M&M section?

Response 2
We thank the Reviewer for the comment. We reconsidered the placement of Figures 1 and 2 and concluded that they primarily serve to introduce the general concept and anatomical context of subperiosteal dental implants. Since not all readers may be familiar with this implant type, their inclusion in the Introduction improves clarity and provides necessary background before presenting the methodological details.
The specific modeling and simulation procedures remain fully described in the Materials and Methods section. We therefore consider it appropriate to retain these figures in the Introduction.

Located: -

 

Comments 3
Procurement – please see the definition of this word.

Response 3
Thank you for this helpful remark. The respective paragraph has been removed from the manuscript, as the description of procuring the connecting components does not directly belong to the scientific scope of implant design and manufacturing.

Located: -

 

Comments 4
ISO 14801:2016 standard always includes the year.

Response 4
Thank you for the remark. The manuscript has been revised accordingly, and the standard is now consistently cited as ISO 14801:2016. The full reference has also been added to the reference list.

Located: lines 83; 414

 

Comments 5
Have others studied similar issues before you?

Response 5
We are grateful for the Reviewer’s insightful observation. Several studies have investigated the mechanical behavior of dental implants under static or dynamic loading conditions. However, to the best of our knowledge, no previous study has examined the mechanical response of subperiosteal implant configurations using a custom-designed experimental test bench capable of simulating chewing-like motion with precisely controlled loading and localized force measurements.

While the general topic of implant mechanics has been addressed previously, the specific experimental configuration and combined CT–FEM methodology applied in the present study represent a methodological advancement.

Located: -

 

Comments 6
Will you propose a thesis before conducting your research?

Response 6
Thank you for the comment. The research hypothesis has been added to the Materials and Methods section.

The mandible and the reinforcing subperiosteal implant are predominantly subjected to compressive loading between the upper and lower dentition. It was hypothesized that the different structural regions of the implant do not contribute equally to load bearing and therefore require function-specific design considerations. Accordingly, optimized lightweight internal structures were expected to maintain global structural integrity while providing stress-distribution characteristics comparable to those of the fully solid config-uration over the investigated load range. The objective was to map the local mechanical stress distribution throughout the entire implant volume, identify minimally and maxi-mally loaded regions, and define structurally favorable surface and lattice configurations in the titanium framework accordingly.

Located: lines 139–148

 

Comments 7
Dent-Art Technik – provide city and country.

Response 7
The design parameters were established in consultation with dental implant designers from Dent-Art Technik, a Hungarian dental manufacturing company headquartered in Győr, to ensure clinical relevance and realistic geometry.

Located: lines 163–166

 

Comments 8
Has the research model presented in Figure 3 been used before (reference), or is this your idea? If so, it might be worth highlighting

Response 8
We thank the Reviewer for the comment. The text has been revised accordingly to emphasize that this is an idealized model developed by the authors.

A general and simplified reference model was created specifically for the present in-vestigations, in which the curved regions, the straight structural segments, and the areas surrounding the connection posts are clearly distinguishable. This configuration was in-tentionally designed to enable objective comparison of differently structured, lightweight internal configurations. The overall shape and geometric dimensions of the im-plant—including width, length, height, fillet radii, connection cones, and the spacing of vertical posts—were defined based on average mandibular anatomical dimensions. The design parameters were established in consultation with dental implant designers from Dent-Art Technik, a Hungarian dental manufacturing company headquartered in Győr, to ensure clinical relevance and realistic geometry.

Located: lines 157–166

 

Comments 9
The introduction of such structural reliefs may offer several advantages and benefits" - does the use of all structures or only selected ones apply? If selected, which ones? If all, what is our reference point, which doesn't have as many advantages?

Response 9
We thank the Reviewer for this clarification request. The statement refers specifically to the lattice-based, perforated, and top-relieved configurations investigated in the present study (see Figure 4 and Table 1).

The reported advantages are strictly understood in relation to the models designed and analyzed by the authors, which were evaluated in comparison to the fully solid reference configuration. We did not assess other structural concepts reported in the literature; therefore, no general conclusions are intended beyond the specific configurations investigated in this work.

The manuscript has been revised accordingly to clearly define the scope of validity of this statement and to explicitly identify the fully solid implant as the reference model.

Lattice-based frameworks, perforated configurations, and top-relieved structural designs (see Figure 4 and Table 1) may provide several potential advantages and beneficial effects, including:

Located: lines 90–92

 

Comments 10
Please provide the manufacturer, city, and country of the Pattex Repair Universal adhesive and the Tough 2000 Resin V1 resin. Please also include a diagram of where the implant was, where the mandibular joints were, and where the adhesive was. Or a reference to one of the later drawings?

Response 10
The manufacturer information has been added to the manuscript. Figure 5 has been modified to indicate the location of the adhesive layer.

Located: lines 119–120; 184

 

Comments 11
After post-processing, the material exhibited a Young's modulus of approximately 1.2 GPa and a Poisson's ratio of 0.35, representing the compliant mechanical behavior of the mandibular bone. Could you provide a literature reference for this ifo? Did you test these parameters for this resin, or did you find it somewhere in the product description?

Response 11
The following clarification has been added to the manuscript:

The base support components and the mandibular model were manufactured by stereolithography (SLA) using a Form 3B+ 3D printer (Formlabs Inc., Somerville, MA, USA) from Tough 2000 Resin V1 (Formlabs Inc., Somerville, MA, USA). The mandibular specimens were produced by PAB Kft. (Budapest, Hungary) based on their in-house measurements and the material property data provided in the manufacturer’s material datasheet. After post-processing, the material exhibited a Young’s modulus of approxi-mately 1.2 GPa and a Poisson’s ratio of 0.35, representing the compliant mechanical be-havior of mandibular bone.

Located: lines 124–131

 

Comments 12

Titanium alloy - what purity, manufacturer's country? All of this is important if anyone in the future were to rely on your experiments and attempt to replicate them.

Rsponse 12
Following clarification is added, thank you for your comment.

The four test specimens prepared for the experimental investigation are shown in Figure 4. The specimens were manufactured at Dent-Art-Technik Kft. by laser sintering using a TruPrint 1000 Basic Edition metal additive manufacturing system (TRUMPF SE + Co. KG, Ditzingen, Germany). The material used was POWDERRANGE® Ti64 supplied by Carpenter Additive (Carpenter Technology Corporation, Philadelphia, PA, USA).

Located: Lines: 179-183

 

Comments 13
How were these implants made using laser sintering? CAD/CAM milling? There's no mention of this

Response 13

Thank you for your valuable comment. We have clarified the manufacturing technology in the revised manuscript. The implants were produced by laser sintering (laser powder bed fusion) using a TruPrint 1000 Basic Edition system. This information has now been explicitly added to the Materials and Methods section.

We have also provided the same level of clarification regarding the manufacturing of the mandibular models, including the applied additive manufacturing technology and equipment.

Lines: 124-31 / 179-183

 

Comments 14
Was it just one implant with a specific geometry, or many more? If 1, is this statistically sufficient? Do imperfections during the execution of this implant affect the results???

Response 14
Thank you for this important comment. Due to the high material and production costs associated primarily with Ti6Al4V alloy powder and metal additive manufacturing, one specimen per design was produced. The objective of the present study was a comparative evaluation of different internal structural concepts rather than a statistical assessment of manufacturing variability. Concerning potential manufacturing imperfections, the risk of significant defects can be considered minimal. Ti6Al4V processing via laser powder bed fusion is a well-established and widely applied technology in dental manufacturing, with standardized and validated process parameters for this alloy. The equipment used operates with predefined technological settings specifically optimized for Ti6Al4V fabrication.

Furthermore, possible internal defects or inhomogeneities would have been detected during CT reconstruction analysis. If required, we are able to provide representative CT-based reconstructions demonstrating the absence of relevant inhomogeneities, as well as a comparison between the CT-reconstructed geometry and the original CAD model confirming the dimensional accuracy of the manufactured parts.

Located: -

 

Comments 15
were acquired" - start with the definition of this word. It's mainly used in company acquisitions. Here, perhaps it's better to simply use "CBCT was used

Response 15
Together with the next point.

Located: -

 

Comments 16
Széchenyi István University - city, country? Who manufactured the CBCT model?

Response 16
Thank you for your comment. We have applied the following rephrasing in the revised manuscript:

After adhesive bonding, each test specimen was mounted into a mandibular model manufactured from Tough 2000 Resin V1. Subsequently, cone-beam computed tomogra-phy (CBCT) scans were acquired for each assembled specimen to obtain reference datasets for later comparison. In addition, micro-CT measurements were performed using a Yxlon Modular CT system (YXLON International GmbH, Hamburg, Germany). A tube voltage of 225 kV and a flat-panel detector were used. The combination of the 2048 × 2048-pixel ma-trix detector, the dimensions of the implant models, and the technical parameters of the CT system yielded a spatial resolution of 19 μm. The acquired projection data were recon-structed using Volume Graphics StudioMax software (Volume Graphics GmbH, Heidel-berg, Germany).

Located: Lines: 186-195

 

 

Comments 17
loading cycle" - what device was used? Where was the load applied? Schematic diagram.

Response 17
The following sentence has been added, including a reference that describes the test setup and its operating principle in detail:

The test setup and its operational principle applied in the present study are identical to those described in our previously published experiments [21]

Located: lines 154–156

 

Comments 18
Were the loadings performed consecutively or with breaks? How long did they last?

Response 18
Thank you for your comment. The duration of the loading cycles is presented in Table 2. In the multiple-bite loading protocol, only a single opening phase was applied between two consecutive bites. This clarification has now been incorporated into the manuscript.

The main parameters of the two loading cycles are summarized in Table 2. Between two consecutive loading (biting) cycles, only a single opening phase was applied. The duration of this phase depended on the response speed of the pneumatic system and the control unit and was less than 0.5 s. No additional relaxation time was introduced be-tween the loading cycles.

Located: lines 217–221

 

Comments 19
Abaqus software" - manufacturer, city, country?

Response 19
Company name and address added:

(Dassault Systèmes SE, Vélizy-Villacoublay, France)

Located: lines 231

 

Comments 20
Generative artificial intelligence was used exclusively to support language editing and stylistic refinement of the manuscript. - This sentence should be at the end of the manuscript in the acknowledgments section.

Response 20
The statement regarding the use of generative artificial intelligence was originally placed at the end of the Materials and Methods section due to the template structure. It has now been relocated to the appropriate section. We will coordinate with the editor to confirm its final placement in accordance with the journal guidelines.

Located: 451-455

 

Comments 21
This section may be divided by subheadings. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn. - This section with the template should have been removed????

Response 21
Thank you for your comment. That section should have been deleted; this was our mistake. The sentence has now been removed from the manuscript.

Located: -

 

Comments 22
I'm wondering about one thing: You used a hard metal implant structure, which was mounted on a softer material – resin, using an adhesive based on resins that are also softer than titanium alloy. It is therefore logical that possible deformations could occur in soft materials, not hard ones.

Response 22
A We thank the Reviewer for this thoughtful observation. The comment is indeed valid: in a multi-material system consisting of titanium, resin, and adhesive, deformation is more likely to occur in the components with lower stiffness. However, it is important to emphasize that, in the clinical situation, the mechanical properties of mandibular bone are also significantly lower than those of the Ti-6Al-4V alloy used for the implant. Therefore, the applied test configuration reflects, to a certain extent, the actual biomechanical hierarchy of materials present in vivo.

The Tough 2000 Resin V1 material was selected because its mechanical properties are closer to those of mandibular bone compared to other commercially available printable resins. Based on our previous experimental experience using alternative materials, this resin provided the most reliable and reproducible fixation conditions while remaining economically feasible. In addition, the resin—similarly to bone tissue—is capable of slight elastic deformation and time-dependent relaxation, which contributes to a more realistic representation of load transfer under mechanical loading.

Although PEEK would offer an even closer approximation to bone behavior in certain aspects, the current stage of the research does not yet justify the use of significantly more expensive base materials.

Overall, the fixation concept mimics the clinical situation in the sense that, under physiological conditions, the implant is surrounded by bone, and long-term stability is ensured by osseointegration. Importantly, however, the implant must remain mechanically stable during the initial phase before complete osseointegration occurs. The applied setup therefore represents a controlled and clinically relevant approximation for evaluating the mechanical behavior of the implant itself

Located: -

 

Comments 23
What were the limitations of your research? What would you like to accomplish in the future, continuing your research?

Response 23
A new subsection (4.1 Limitations and Future Perspectives) has been added, detailing study limitations and outlining planned high-cycle fatigue investigations.

The present study has several limitations that should be acknowledged. First, the ap-plied loading protocol consisted of 500 physiological bite cycles followed by a single high-load event of 2000 N. Although this approach allowed the evaluation of structural integrity within clinically relevant limits, it does not represent long-term fatigue behavior under lifelong functional loading conditions. High-cycle fatigue testing over several mil-lion loading cycles was not possible with the current experimental setup.

Second, the applied loads were aligned parallel to the longitudinal axes of the con-nection cones and fixation pins. While this configuration represents a simplified, clinical-ly relevant axial loading scenario, it does not account for non-axial or inclined load com-ponents that may occur in vivo during complex mastication movement.

Third, the mechanical properties of the polymer-based mandibular model and the clamping system limited the maximum load level that could be applied. At substantially higher loads, deformation of the support structure may occur, restricting the reliability of measurements under extreme loading conditions.

To overcome these limitations, a new computer-controlled fatigue test bench is cur-rently being designed. The conceptual and engineering plans have already been complet-ed, and construction of the system is planned soon. The new setup will enable high-cycle fatigue testing (2–5 million loading cycles at controlled frequencies of approximately 5–15 Hz) on various implant configurations.

 Future investigations will include extended cyclic loading on multiple implant types, followed by microscopic and CT-based analyses to detect fatigue-related micro-damage, crack initiation, or structural degradation. Furthermore, non-axial loading condi-tions will be examined in accordance with ISO 14801:2016, in which the applied force is applied at a defined 30° inclination relative to the implant axis and combined with dy-namic fatigue loading. This approach will provide a more comprehensive mechanical evaluation under clinically relevant worst-case loading scenarios [30].

Located: lines 391–417

 

Comments 24
Do the results of other authors' research align with yours, or do they differ?

Response 24
We thank the Reviewer for this important question. The general mechanical trends observed in our study are consistent with previously published finite element analyses of subperiosteal implants. For example, Zieliński et al. (Materials 2023, 16(23), 7466) demonstrated that critical stress concentrations predominantly occur in connection and fixation regions, while structurally remote areas contribute less to global mechanical stability. Our findings regarding the localization of principal load-transfer zones agree with these observations.

However, the present study differs in its methodological approach. We intentionally developed and used a custom-designed, idealized subperiosteal implant model created by the authors. This simplified and clearly structured geometry allowed controlled experimental investigation and objective comparison of different internal structural configurations. The use of a standardized, author-designed reference model enhances reproducibility and enables systematic evaluation of structural modifications under well-defined conditions. Thus, while our mechanical trends align with the existing literature, the specific implant design concept and the combined experimental–CT–FEM methodology represent a distinct and reproducible contribution to the field.

Located: -

 

Comments 25

This should contain 3-4 of the most important conclusions from your research in bullet points. A total of about 5-6 sentences at most, so that it's the crux of the matter.

Response 25
The Conclusion section has been thoroughly revised and updated.

• CT-based deformation measurements and finite element simulations consistently demonstrated that none of the implant configurations investigated exhibited perma-nent deformation under clinically relevant loading conditions up to 2000 N, regard-less of the applied internal infill strategy.
• Load-transfer analysis revealed that critical stresses concentrate primarily at the im-plant–prosthetic interface, while structural regions located farther from this zone ex-perience significantly lower stress levels and therefore do not govern global static in-tegrity.
• In high-load-transfer regions, sufficient material presence is essential; however, per-forated designs can safely replace fully solid structures, while in low-stress regions, extensive lightweighting may be applied without compromising mechanical per-formance.
• Lightweight, perforated, and lattice-based configurations maintain global mechani-cal stability while potentially improving stress distribution, reducing stress shield-ing, and enhancing osseointegration. Consequently, the titanium reinforcement mesh can be optimized primarily for biological rather than load-bearing considerations.

Located: lines 419–436

 

Comments 26
Patents; if it's not there, delete this section

Response 26
The section has been deleted.

Located: -

 

Comments 27
The section has been deleted accordingly.

Response 27
Following part has been added in to the manuscript: (EKÖP-KDP-2024-08)

Located: line 445

Sincerely,
Ádám Vörös
on behalf of the Authors

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Accept in current form.

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you very much for the improvmnts in the mansuscript.

 NO mor ecomments

 

Good luck!