Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is an interesting and clinically relevant case report. The treatment approach is clearly presented and may be useful for clinicians managing fractured abutment teeth and existing removable prostheses.

Before publication, please address the following points:

-Provide the patient’s age, sex, relevant medical conditions, and reason for considering a minimally invasive approach.

-Report the clinical follow up period and the patient’s condition after treatment, including implant stability, prosthesis retention, comfort, and any complications.

-Clarify the selection of the retention insert. The text refers to a white insert with low retention, whereas Figure 6 refers to a yellow insert with medium retention.

-Moderate the conclusions regarding reduced wear and implant overload, since these benefits are anticipated but were not clinically evaluated in this case.

-Improve the explanation of the REFLEX attachment design and clearly distinguish established evidence from the authors’ interpretation.

-Review the figures, captions, terminology, and references for consistency. The placeholder DOI should also be corrected before publication.

Some inconsistencies are also present in the description of the retention insert and figures.

 

Comments on the Quality of English Language

The manuscript is generally understandable, but the English language requires revision to improve

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

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Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I reviewed the manuscript "Salvaging a telescopic-crown retained partial denture using a novel flexible attachment systems - Report of a Case". The case presentation is the weakest section. Due to the case report design of the study, a major revision is required to improve the case presentation.

Below, I report some comments and suggestions:

Title: check the correct use of singular or plural terms ("A" novel fexible attachment system"S")

Abstract: The abstract is insufficient as it fails to present the case report itself, focusing instead on an overly detailed background. It needs to be rewritten, given that the primary focus of the manuscript is the presentation of the clinical case and its management outcomes.

Introduction: This section directly introduces telescopic crown fractures without providing adequate context. As an introduction, it should first briefly present telescopic crowns, outline the potential etiology of structural fractures, and subsequently discuss their clinical management.   Case Presentation: The case presentation lacks essential clinical details. It lacks basic patient demographics (age and gender), medical history (it is merely stated that the patient presents a "medical risk profile"), and pharmacological history, as well as dental history. Additionally, key prosthodontic and anatomical specifics are missing, such as the exact location of the fracture, the teeth involved, and the specific retention mechanisms used. Similarly, the description of the surgical procedures is inadequate. The only specific details provided are the implant brand and the incision technique, the latter being restricted strictly to the second-stage surgery. Furthermore, no pre- or post-operative radiographic evaluations are described. Finally, following prosthetic delivery, no further information is provided regarding stability, maintenance, or follow-up outcomes. Consequently, the primary objective and clinical message of the manuscript remain unclear.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The revised version combines a statement regarding clinical success and the preservation of fit and retention with the information that no follow-up data is available. It also states that, since the patient reported no issues, it is presumed that the implant and attachment are functioning well. In the abstract, the authors describe a “successful conversion” with preserved fit and retention. In the case description, they note that the first follow-up appointment is scheduled for November and that no complications have been reported to date; they then presume the implant and attachment are in good condition. In the discussion, they acknowledge the lack of follow-up information. The absence of patient complaints prior to a documented follow-up assessment does not demonstrate prosthetic performance or clinical success. The lack of follow-up does not invalidate the description of the procedure, but it limits the conclusions that can be drawn regarding the outcome and durability. I believe it would be best to replace the claim of clinical success with a description of the immediate outcome—such as the adaptation and delivery of the prosthesis—provided this is documented. The presumption that the implant and attachment are functioning well should be removed, and it should be explicitly stated that the clinical course has not yet been evaluated during follow-up.

The objective of reporting the system's first clinical application is clear, but the claim of novelty should remain limited to that specific application, without suggesting proof of superior clinical performance.

The second version provides information on age, anticoagulant medication, the timeline, and certain surgical details. Other clinical aspects that were not reported—such as specific systemic diseases and the functional assessment of the prosthesis after delivery—should not be presumed; their inclusion is advisable only if they were recorded and are relevant to understanding the therapeutic decision.

The radiographs serve to illustrate the case rather than act as the subject of quantitative analysis. Standardization of image acquisition, examiner calibration, and intra- or inter-examiner agreement are not applicable as analytical requirements for this report. The diagnostic quality of the images cannot be fully assessed based solely on the provided text.

The manuscript notes that the first follow-up appointment was scheduled but does not present the results. It is advisable to clearly identify this as a lack of follow-up rather than as evidence of success.

It is recommended to avoid comparative statements claiming that misalignments and transfer inaccuracies will be “less problematic” than with rigid attachments, as this benefit was not evaluated in the present case. The discussion may present this as a theoretical or potential advantage, consistent with the cited literature.

Sample size calculations and statistical analyses are not applicable to a case report. While the case may illustrate a technical strategy, it cannot estimate efficacy, complication rates, or superiority.

Therefore, it is essential to align the abstract, case report, discussion, and conclusion, distinguishing between the delivery and immediate adaptation of the prosthesis and long-term clinical success. Furthermore, statements claiming the implant and attachment are in good condition—when this is merely inferred from the absence of complaints—should be removed; likewise, expectations regarding reduced wear or better performance in the face of misalignments should be characterized as potential outcomes rather than demonstrated results.

The case supports the description of adapting a flexible system to salvage an existing prosthesis following the loss of the abutment tooth and allows for reporting the technical feasibility of the procedure at the time of delivery. It does not, in itself, substantiate long-term clinical success, reduced wear, implant protection, or performance superior to that of rigid attachments. Such claims should be presented as hypotheses or potential benefits, not as demonstrated results.

Comments on the Quality of English Language

The manuscript is generally understandable, but the English language requires revision to improve

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for your comprehensive revision of the manuscript and for addressing the previous comments. The revised version has improved substantially, particularly regarding patient information, clinical documentation, the implant placement protocol, and clarification of the attachment mechanism. The manuscript's scientific quality has improved considerably. Most of my previous concerns have been adequately addressed.

However, a few minor issues remain.  The main limitation of this case report remains the follow-up. The statement in lines 108–110, which assumes satisfactory implant and attachment performance based on the absence of patient-reported complaints, should be removed or reformulated, as it cannot replace an objective clinical evaluation.

The Conclusions should be moderated to reflect the procedure's clinical feasibility, while acknowledging that the potential long-term biomechanical advantages of the flexible attachment remain to be clinically validated.

Overall, the manuscript has improved considerably and presents a clinically relevant approach. I believe the remaining issues can be addressed through minor textual revisions.

Recommendation: Minor Revision.

Best regards,

Reviewer

Comments on the Quality of English Language

Dear Authors,

I recommend English-language editing to improve clarity and readability.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I have carefully reviewed the revised manuscript and the authors’ responses to the previous comments.

The authors acknowledge the concern regarding the absence of post-delivery follow-up but justify this by stating that the manuscript describes the first clinical use of the HADER Reflex attachment and that they wished to report the approach and workflow without waiting for follow-up.

While the novelty of the clinical application is understandable, this does not resolve the methodological issue. A case report can certainly describe a novel clinical technique at an early stage; however, in that situation, the manuscript should be explicitly presented as a technical/clinical feasibility report and should avoid implying clinical success or durability.

At present, the manuscript still states that the prosthesis was successfully converted and that prosthetic fit and retention were preserved, while the only post-delivery information is that the patient reported no problems and that the implant and attachment are therefore “assumed” to be functioning appropriately. These statements are not supported by objective follow-up data. In particular, no information is available regarding prosthesis stability, retention, peri-implant soft tissues, implant status, patient comfort/function, maintenance requirements, or early mechanical complications.

The statement that the implant and attachment are “assumed” to be fine should in particular be removed, as it does not constitute a clinical outcome.

Statements suggesting that the flexible attachment reduces wear, deformation, or mechanical complications compared with rigid attachments should not be presented as demonstrated clinical benefits on the basis of this single case without follow-up.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf