Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

The study “Fractal Analysis of Trabecular Bone Before and After Orthodontic and Surgical Extrusion: A Retrospective  Case-Control Study”  is clinically and methodologically valuable, addressing an important clinical issue. The use of non-Euclidean geometry in the analysis of radiological images—specifically fractal geometry—is noteworthy and deserves recognition.
Please make the following revisions:

1. Parametric t-tests were applied by the authors, but parametric tests require normally distributed data. How was the normal distribution verified?
2. Please add information in the Materials and Methods section explaining how the reproducibility and standardization of radiographic images were ensured.

 

Best regards,

Reviewer

Author Response

1. Parametric t-tests were applied by the authors, but parametric tests require normally distributed data. How was the normal distribution verified?

 

REPLY: Thank you for raising this point. We confirm that the assumptions for parametric testing were verified prior to statistical analysis.

This concept was clarified in the Matherials and Methods section. Please refer to page 7, lines 13-14.

 

1. Please add information in the Materials and Methods section explaining how the reproducibility and standardization of radiographic images were ensured.

 

REPLY: Thank you for your observation. Information regarding the reproducibility and standardization of radiographic images has now been added to the Materials and Methods section (page 6, lines 4-8 and 19-20).

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Please see the atatched file

Comments for author File: Comments.pdf

Author Response

1. The ROI selection follows the protocol by Soltani et al.; however, other studies in

dental fractal analysis use modified or alternative ROI definitions. Please provide a

stronger justification for selecting this protocol, and briefly discuss how ROI placement

variability was controlled during image processing.

REPLY: We appreciate the reviewer’s insightful comment regarding the selection of the ROI protocol. The followed protocol was described by Soltani et al.’s. More details were added to the Materials and Methods section. Please refer to  page 6, lines 1-8 and 17-20.

2. The use of a Gaussian Blur with a sigma value of 10 requires methodological jus-

tification, as this parameter substantially influences noise reduction and structural

smoothing. A few sentences explaining the rationale and referencing similar protocols

would improve reproducibility.

REPLY: We thank the reviewer for the comment. More details on Image Processing were added to the Materials and Methods section. Please refer to page 6, lines 23-24.

3. Although the manuscript states that Cohens kappa exceeded 0.8, the exact coefficient values for different measurement stages should be reported. Presenting the numerical kappa values (e.g., for ROI selection and FD calculation) would increase transparency regarding reproducibility.

 

REPLY: we agree with the reviewer’s insightful observation. The Kappa values for all measurements were added to the manuscript in the Results section. Please refer to pages 6 (lines 19-20), 8 (lines 1-3, 13-14, 21-23), 9 (lines 7-9), 10 (lines 7-9).

 

4. Table 3 shows a statistically significant difference in baseline apical FD values between OE and SE groups. While ANCOVA partially addresses this, the potential clinical reason for this baseline difference should be briefly acknowledged in the Discussion.

 

5. Since fractal dimension reflects both trabecular organization and mineral density, the distinction between these two biological phenomena remains unclear. The manuscript briefly mentions this limitation, but the Discussion would benefit from a more explicit explanation regarding the interpretational boundaries of fractal analysis in clinical bone assessment.

REPLY: We thank the reviewer for this important observation. We have expanded the Discussion to clarify the interpretational boundaries of this method. Please refer to the “Implications for future research” subdivision (number 4.5 in the Discussion section) at page 14, lines 35-51.

 

 

Minor comments

1. Several sentences throughout the manuscript are excessively long and may be split for clarity. A light language editing pass is recommended.

 

REPLY: Thank you for the valuable suggestion; some of the sentences were shortened modified accordingly.

 

2. Tables 6-9 contain complex layouts; consider harmonizing the headings to improve readability.

 

REPLY: Point taken; the abovementioned Tables were modified accordingly.

 

3. In the Materials and Methods section, please specify the exact model and software version used for the periapical radiographic equipment.

 

REPLY: Point taken, the requested information were added to the manuscript. Please refer to page 6, lines 1-7. 

 

4. Provide a brief rationale for the inclusion of both single- and multi-rooted teeth, and clarify whether subgroup analyses were considered or performed.

 

REPLY: We thank the reviewer for the current observation; this rationale has now been aknowledged in the Discussion section. Please see page 14, lines 3-10.

 

5. Figures 5 and 6 effectively illustrate changes over time; however, increasing axis labels and font size would improve clarity.

 

REPLY: Point taken, the figures have been modified accordingly.

 

6. The Conclusion section could more explicitly highlight the clinical implications for

timing of prosthetic rehabilitation after extrusion.

REPLY: we thank the reviewer for the insightful comment. This concept has now been clarified in the Conclusions section. Please refer to page 15, lines 15-19.

 

Author Response File: Author Response.docx