Clinical, Radiological, and Aesthetic Outcomes after Placement of a Bioactive-Surfaced Implant with Immediate or Delayed Loading in the Anterior Maxilla: 1-Year Retrospective Follow-Up Study

Round 1

Reviewer 1 Report

Although retrospective and with very few patients enrolled, this study is editing worthwhile.

Wellconducted clinical protocol !

Author Response

Although retrospective and with very few patients enrolled, this study is editing worthwhile.

Well conducted clinical protocol!

Thank you for your consideration.

Reviewer 2 Report

The observations are presented in the attached document.

Review of „Clinical, radiological and aesthetic outcomes after place- ment of a bioactive-surfaced implant with immediate or delayed loading in the anterior maxilla. 1- Year Result of a Case Series”

The subject is interesting and topical, but the way the study is written needs to be improved.

Introduction- focuses more on osseointegration and less on physiognomic aspects of implanto -prosthetic rehabilitation.

The objective of the study appears in two almost identical paragraphs.

Material and method - the number of cases is small, the inclusion criteria are not clearly formulated, the aesthetic scores used should be described, and no data regarding medical ethics aspects are specified.

The discussions are brief and should be improved.

The conclusions must be clearly formulated and refer to the results obtained in the presented study.

Comments for author File: Comments.pdf

Author Response

Thank you for your submission. The aim of the study is good but the study design, presentation, and

leak of experiments and data do not reach the standard. Implant placement and its prognosis should

be clearly defined. A well-justified clinical and analytical data must be shown to meet the aim. It is not

acceptable at this stage. Please see the comments below to improve the manuscripts.

Thank you for your comments, in accordance with your suggestions, the manuscript has been edited. we have justified point by point the changes made following your review.

The title, aim of the study, and conclusion are not consistent.

According to  the reviewer's suggestions, the title was changed to immediately emphasize the retrospective design of the study. the aim of the study in both the abstract and main text was also changed. the purpose for which this retrospective analysis was conducted was more clarified and the concept of "biological response of tissues" was better explained.

The introduction has unnecessary explanations and some of them are out of context.

According to reviewer’s suggestions, the text was changed in order to remove all the parts where we have been verbose.

A case series must have a clear clinical data set. Individuals or series of cases should be presented

sequentially to evaluate the prognosis and ultimate success. It is not a review to discuss references to

justify clinical case series. I cannot see any clinical or operative diagnostic images, radiological

images, pre and post-operative evaluation images (not a single operative or post-operative clinical,

radiological preapical, and CT images).

According to reviewer’s suggestions, images have been added in order to better clarify the steps of the types of treatment described.

The bioactivity of implants should be shown.

The aim of the study was not to demonstrate the bioactivity itself, but its clinical relevance in a trial. Bioactivity has been demonstrated as mentioned in the reference list by other authors.

Results and discussion should have consistency. Out-of-context discussion demerits the manuscript.

According to reviewer's suggestions, the text was changed in order to improve these sections.

Unfortunately, the consistency of the results is heavily influenced by the small sample size, the main limitation of the study.

The conclusion needs to be proved, not based on exaggerated explanations. Please improve the manuscripts. I look forward to seeing revised manuscript.

Thank you.

According to reviewer's suggestions, the conclusion was changed.

Reviewer 3 Report

Dear Authors,

Thank you for your submission. The aim of the study is good but the study design, presentation, and leak of experiments and data do not reach the standard. Implant placement and its prognosis should be clearly defined. A well-justified clinical and analytical data must be shown to meet the aim. It is not acceptable at this stage. Please see the comments below to improve the manuscripts.

The title, aim of the study, and conclusion are not consistent.

The introduction has unnecessary explanations and some of them are out of context.

A case series must have a clear clinical data set. Individuals or series of cases should be presented sequentially to evaluate the prognosis and ultimate success. It is not a review to discuss references to justify clinical case series. I cannot see any clinical or operative diagnostic images, radiological images, pre and post-operative evaluation images ( not a single operative or post-operative clinical, radiological preapical, and CT images).

The bioactivity of implants should be shown.

Results and discussion should have consistency.

Out-of-context discussion demerits the manuscript.

The conclusion needs to be proved, not based on exaggerated explanations.

Please improve the manuscripts. I look forward to seeing revised manuscript.

Thank you.

Grammatical errors should be thoroughly checked.

Author Response

The subject is interesting and topical, but the way the study is written needs to be improved.

Thank you for your comments.

Introduction- focuses more on osseointegration and less on physiognomic aspects of implanto -prosthetic rehabilitation.

In accordance with the reviewer's suggestions, the introduction has been edited to remove out-of-context explanations.

The objective of the study appears in two almost identical paragraphs.

In accordance with the reviewer's suggestions, some changes have been made.

Material and method - the number of cases is small, the inclusion criteria are not clearly formulated, the

aesthetic scores used should be described, and no data regarding medical ethics aspects are specified.

According to reviewer’s suggestions, some changes have been made to the M&M section. the inclusion criteria have been clarified. the 5 parameters of WES and the 5 parameters of PES have been described.

there are no references to ethical aspects in the text as it is a retrospective analysis. Moreover the patients, treated in a private clinic,  have signed an informed consent before the surgery and the performed treatment  was in accordance with the declaration of Helsinki

The discussions are brief and should be improved.

in accordance with the reviewer's suggestions, the discussion have been revised.

The conclusions must be clearly formulated and refer to the results obtained in the presented study.

in accordance with the reviewer's suggestions, the conclusion have been reformulated.

Round 2

Reviewer 2 Report

It can be published in this form.

Author Response

Thank you for your valuable comments and efforts to improve the manuscript.

Reviewer 3 Report

Some points have been addressed well. It would be nice to respond to all comments.

Redundancy should be avoided.

Careful proofreading is required.

Author Response

Dear Reviewer,

We checked again and all the comments was addressed. If points was not answered please highlight it and we will comment.

 The manuscript sent to an endlish editing as requested