Clinical Effects of Interproximal Contact Loss between Teeth and Implant-Supported Prostheses: Systematic Review and Meta-Analysis
, PatrÃcia Manarte-Monteiro 1, Leonardo Aragão 2, LÃgia Pereira da Silva 1, Gabriel Silveira Pinto Brandão 1 and Bernardo Ferreira Lemos 1
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsReview for Prosthesis
Clinical effects of interproximal contact loss between teeth and
implant-supported prostheses. Systematic Review and Meta-analysis
General comment:
The paper is well researched and well written. The information is presented in an organized manner and the discussion/ conclusion sections are well supported. The paper is worthy of publication as it represents a good summary of the state of the literature on ICL
Section by Section
Title
Comment : Appropriate and explanatory
Abstract
Comment: well written , good summary of methods , goal and outcomes.
Specific comment:
Page 1 line 33. ICL was found to occur more frequently in the mandible, but not
significantly in the maxilla.
Comment , does this mean it was not statistically different from mandible to maxilla or do you mean to say that it did not occur as often in the maxilla, the use of the word “significantly” is a bit confusing here as it usually implies statistics.
Introduction
Comment: Generally well written, and good use of figures .
Specific Comments:
Page 2 Line 76-79:
“Food Impaction (FI) can occur, causing damage to the gingival tissue and promoting demineralization of the tooth with the deposition of decayed tissue and the appearance of changes in the gingival mucosa that can evolve and generate bone loss in the damaged area [12, 13].”
Comment: the statement can evolve to bone loss and decay is taken from two review papers, not from source articles , perhaps it is better to quote source articles on these outcomes.
Materials and Methods
Generally well written , descriptive and good use of figure 2 showing flow chart process.
Good use of tables and figures as well as descriptions of the parameters in the studies included
Specific comments
Page 3 line 124
“A total of 2.101 publications were collected which, after excluding duplicates”
Comment: small typo here , it reads as 2 point 101. Should read as 2101.
Page 8 line 199
“In 3 apical radiography images were token”
Comment: small typo here, should read as “taken”.
Discussion
Well written with good use of figures showing the distribution of outcomes in each paper for each particular parameter analyzed.
Page 12 line 299-300
Regarding the location of the implant in the dental arch, ICL occurred in the maxilla 299
from 14% [19] to 30% [8], but it was more frequently detected in the posterior region of 300
the mandible, which ranged from 15% [1] to 54% [20].
Comment: The maxilla had 14-30% ICL rate, which is noteworthy, please see comment above regarding abstract where it seems the authors report the maxilla had an “insignificant” prevalence of ICL.
Page 13 line 345
“Some publications have shown the development of carious lesions in the
natural tooth adjacent to the prosthesis over the implant [2, 6, 8, 10, 17, 19, 22, 24].”
Comment: The biologic cost of decay on adjacent teeth is very high , in many cases the decay is so rapid and large it leads to extraction and more implants. It is not so well described in the literature but it may be worth including in discussion a case series that described certain conditions that increased risk for DATFIR ( decay adjacent to fixed implant restorations) such as ( Two-Center Observational Case Series Describing Decay Adjacent to Fixed Implant Restorations Global Journal of Oral Science, 2018, Vol. 4, ) where ICL AND prior adjacent restoration AND open margin on implant restoration all increased observation of decay . - As well, in discussion please add some comment or speculation as to use of silver diamine fluoride as preventive measure in ICL cases or all non-esthetic zones adjacent implants, including this as an area of future study.
Conclusion
Generally well written and summarizes the findings in concise manner.
Specific comment:
Page 15 line 404
In the anterior region, the earliest occurrence was detected at 3 months, with an increase in incidence over time.
Comment: this seems to imply that increased ICL over time applies to the anterior sites, perhaps the 2 ideas should be reflected by separated sentences, such as. The earliest detection was at 3 mos at an anterior site. ICL increased over time… ( and add more information to support this statement )
Page 15 line 412
“The use of an occlusal splint, despite not preventing the appearance of ICL, becomes an important factor for minimize some clinical effects when the ICL occurs.”
Comment: the concept of an occlusal splint to prevent or reduce ICL is being introduced in the conclusion , this should be introduced in the discussion section and include the original papers that were used to validate whether a splint was beneficial or not. Please remove from conclusion if there is no information of this in discussion section, or elaborate more in the discussion section to warrant this in conclusion.
Comments on the Quality of English Languagethe paper is well written, it is clear and concise with good use of grammar. There are only a few minor typo errors.
Author Response
Point-by-point response to reviewers
Prosthesis Editor-in-Chief
Prof. Dr. Marco Cicciu
List of changes for the revised manuscript Submission prosthesis-3039693
Title: Clinical effects of interproximal contact loss between teeth and implant-supported prostheses. Systematic Review and Meta-analysis
Dear Editor,
please find enclosed our list of changes for the revised manuscript Submission ID 3039693 The changes in the revised manuscript are shaded in yellow. All line specifications refer to the original manuscript.
Reviewer 1:
Title Comment : Appropriate and explanatory
Abstract Comment: well written , good summary of methods , goal and outcomes.
Specific comment:
Page 1 line 33. ICL was found to occur more frequently in the mandible, but not significantly in the maxilla.
Comment , does this mean it was not statistically different from mandible to maxilla or do you mean to say that it did not occur as often in the maxilla, the use of the word “significantly” is a bit confusing here as it usually implies statistics.
Answer: Authors do agree with the reviewer 1 comment. The sentence ”but not significantly in the maxilla” was removed from the text.
Introduction Comment: Generally well written, and good use of figures .
Specific Comments: Page 2 Line 76-79:
“Food Impaction (FI) can occur, causing damage to the gingival tissue and promoting demineralization of the tooth with the deposition of decayed tissue and the appearance of changes in the gingival mucosa that can evolve and generate bone loss in the damaged area [12, 13].”
Comment: the statement can evolve to bone loss and decay is taken from two review papers, not from source articles , perhaps it is better to quote source articles on these outcomes.
Answer: As suggested by reviewer, the source article were quoted. The followed references were :
- Sfondouris T & Prestipino V (2019). Chairside management of an open proximal contact on an implant-supported ceramic crown using direct composite resin. J Prosthet Dent, 122 (1), 1-4. http://doi.org/10.1016/j.prosdent.2018.10.019 .
- Saber A, Chakar C, Mokbel N, Nohra J. Prevalence of Interproximal Contact Loss Between Implant-Supported Fixed Prostheses and Adjacent Teeth and Its impact on Marginal Bone Loss: A Retrospective Study. Int J Oral Maxillofac Implants. 2020 May/Jun;35(3):625-630. doi: 10.11607/jomi.7926. PMID: 32406662.
- Varthis S, Randi A, Tarnow DP. Prevalence of Interproximal Open Contacts Between Single-Implant Restorations and Adjacent Teeth. Int J Oral Maxillofac Implants. 2016 Sep-Oct;31(5):1089-92. doi: 10.11607/jomi.4432. PMID: 27632264.
Materials and Methods- Generally well written , descriptive and good use of figure 2 showing flow chart process.
Good use of tables and figures as well as descriptions of the parameters in the studies included.
Specific comments: Page 3 line 124 : “A total of 2.101 publications were collected which, after excluding duplicates” Comment: small typo here , it reads as 2 point 101. Should read as 2101.
Answer: Authors thanks the comment. The small typo was corrected. The sentence was re-written as “ Two thousand and twenty-one”.
Page 8 line 199: “In 3 apical radiography images were token” Comment: small typo here, should read as “taken”.
Answer: Authors thanks the comment. The small typo was corrected. The English was corrected as “ taken”.
Discussion
Well written with good use of figures showing the distribution of outcomes in each paper for each particular parameter analyzed.
Page 12 line 299-300: Regarding the location of the implant in the dental arch, ICL occurred in the maxilla 299 from 14% [19] to 30% [8], but it was more frequently detected in the posterior region of 300
the mandible, which ranged from 15% [1] to 54% [20].
Comment: The maxilla had 14-30% ICL rate, which is noteworthy, please see comment above regarding abstract where it seems the authors report the maxilla had an “insignificant” prevalence of ICL.
Answer: Authors agree with the reviewer 1 comment. The abstract section sentence ”but not significantly in the maxilla” was removed.
Page 13 line 345
“Some publications have shown the development of carious lesions in the natural tooth adjacent to the prosthesis over the implant [2, 6, 8, 10, 17, 19, 22, 24].”
Comment: The biologic cost of decay on adjacent teeth is very high , in many cases the decay is so rapid and large it leads to extraction and more implants. It is not so well described in the literature but it may be worth including in discussion a case series that described certain conditions that increased risk for DATFIR ( decay adjacent to fixed implant restorations) such as ( Two-Center Observational Case Series Describing Decay Adjacent to Fixed Implant Restorations Global Journal of Oral Science, 2018, Vol. 4, ) where ICL AND prior adjacent restoration AND open margin on implant restoration all increased observation of decay . - As well, in discussion please add some comment or speculation as to use of silver diamine fluoride as preventive measure in ICL cases or all non-esthetic zones adjacent implants, including this as an area of future study
Answer: The sentence was clarified in lines 291-295 and the followed reference added in the manuscript
“It is still well observed that AI was the main cause in the development of cavities on the distal surfaces of the teeth when they were adjacent to the implant and highlights the need for information about this fact to the patient to justify strategies to prevent the development of carious lesions, such as fluorides, adequate brushing, flossing and the use of silver diamine fluoride [ref]”
[ref] added: French D, French M-C, Linke B, Lizotte J. Two-center observational case series describing Decay Adjacent to Fixed Implant Restations (DATFIR) and evaluation of case parameters. Journal of Oral Science, 2018, 4, 32-41. https://www.researchgate.net/publication/325021520_Two-Center_Observational_Case_Series_Describing_Decay_Adjacent_to_Fixed_Implant_Restorations_DATFIR_and_Evaluation_of_Case_Parameters.
Conclusion: Generally well written and summarizes the findings in concise manner.
Specific comment: Page 15 line 404 - In the anterior region, the earliest occurrence was detected at 3 months, with an increase in incidence over time.
Comment: this seems to imply that increased ICL over time applies to the anterior sites, perhaps the 2 ideas should be reflected by separated sentences, such as. The earliest detection was at 3 mos at an anterior site. ICL increased over time… ( and add more information to support this statement )
Answer: As recommended by reviewer, the conclusion section was improved. The Sentence was re-written as:
“ In the anterior region, the earliest instances were detected at 3 months. Subsequent ICL frequency tendency increased over time.”
Page 15 line 412 : “The use of an occlusal splint, despite not preventing the appearance of ICL, becomes an important factor for minimize some clinical effects when the ICL occurs.”
Comment: the concept of an occlusal splint to prevent or reduce ICL is being introduced in the conclusion , this should be introduced in the discussion section and include the original papers that were used to validate whether a splint was beneficial or not. Please remove from conclusion if there is no information of this in discussion section, or elaborate more in the discussion section to warrant this in conclusion.
Answer: The concept of occlusal splint to prevent or reduce ICL was removed from conclusion section. The sentence was re-written and a reference was added in discussion section, lines 381-385, as followed:
“An important finding reported [REF] the impact of using an occlusal splint (2 mm thick) on the incidence of ICL. The study revealed that the group that did not utilize a containment drip had the highest incidence of ICL at 30%, whereas the group that used a containment drip saw a lower incidence of 15% during the study period. These results suggest promising avenues for future research in this area.”
[REF] added: Kandathilparambil MR, Nelluri VV, Vayadadi BC & Gajjam NK (2020). Evaluation of biological changes at the proximal contacts between single-tooth implant-supported prosthesis and the adjacent natural teeth - An in vivo study. J Indian Pros-thodont Soc, 20 (4), 378-386. https://doi.org/10.4103/jips.jips_155_20
Reviewer 2 Report
Comments and Suggestions for AuthorsI congratulate the authors on the idea of ​​conducting an analysis of the assessment of the influence of various factors on the clinical effects of interproximal contact loss between natural teeth and implant-supported prostheses. As a scientist and clinician, I read the work with great interest.
Author Response
Point-by-point response to reviewers
Prosthesis Editor-in-Chief
Prof. Dr. Marco Cicciu
List of changes for the revised manuscript Submission prosthesis-3039693
Title: Clinical effects of interproximal contact loss between teeth and implant-supported prostheses. Systematic Review and Meta-analysis
Dear Editor,
please find enclosed our list of changes for the revised manuscript Submission ID 3039693 The changes in the revised manuscript are shaded in yellow. All line specifications refer to the original manuscript.
Reviewer 2:
Authors would like to thank reviewer 2 for his kind comments on our submitted article.
Reviewer 3 Report
Comments and Suggestions for Authors
The manuscript is well written however I have few comments:
1- Lines 60-61: the authors mentioned that "The healthy peri-implant and periodontal regions are highlighted", it's unclear, and nothing is highlighted in the figure.
2- Lines 167: Why not use [TP] for Total Participants and [PN] for Prosthesis Number in place of [Pat] and [Rest], respectively?
3- Figure captions for Figures 3–7 should be more descriptive.
4- The conclusion should be re-written and be more precise and engaging for readers.
Author Response
Point-by-point response to reviewers
Prosthesis Editor-in-Chief
Prof. Dr. Marco Cicciu
List of changes for the revised manuscript Submission prosthesis-3039693
Title: Clinical effects of interproximal contact loss between teeth and implant-supported prostheses. Systematic Review and Meta-analysis
Dear Editor,
please find enclosed our list of changes for the revised manuscript Submission ID 3039693 The changes in the revised manuscript are shaded in yellow. All line specifications refer to the original manuscript.
Reviewer 3:
1-Lines 60-61: the authors mentioned that "The healthy peri-implant and periodontal regions are highlighted", it's unclear, and nothing is highlighted in the figure.
Answer: As suggested by reviewer 3, in Figure 1 was highlighted with a “circle” and Figure Legend described as mentioned.
2- Lines 167: Why not use [TP] for Total Participants and [PN] for Prosthesis Number in place of [Pat] and [Rest], respectively?
Answer: As indicated by reviewer 3, authors we-write in Table 3 and respective legend the acronym [TP] for “Total Participants” and [PN] for “Prosthesis Number”.
3- Figure captions for Figures 3–7 should be more descriptive.
Answer: As recommended by reviewer 3 Figure captions for Figures 3 to 7 were improved, as more descriptive, as followed:
“Figure 3. Forest plots: total cumulative results of events and number of prostheses installed, from 13 retrospective and 6 prospective clinical studies evaluated by meta-analysis.”
“Figure 4. Forest plots: Analysis of loss of contact point according to the number of prostheses per implant. Demonstrated by the graph in sub-division by Single/multiple (S-M) in 9 studies and Single (S) Prostheses in another 10 studies.”
“Figure 5. Forest plots: Analysis of loss of contact point according to the location of the prostheses. Demonstrated by graphs in subgroups by Antero-Posterior (AP) location in 9 studies and Posterior (P) in another 10 studies.”
“Figure 6. Forest plots: Analysis of loss of contact point according to the type of retention of the prostheses. Demonstrated by the graph in sub-groups of cement-retained prostheses (CR), observed in 13 studies; retained by screws (SR) in 3 studies; no information regarding the type of retention in 3 studies.”
“Figure 7. Forest plots: Analysis of subgroups in terms of loss of contact point and the occurrence of biological changes or no biological changes, subdividing the studies into two subgroups and demonstrating the proximity of both to the graph´s central diamond.”
4- The conclusion should be re-written and be more precise and engaging for readers.
Answer: Authors agree with the reviewer 3 recommendation. Conclusion section was improved and re-written according to the main purposes of this work, and shadowed as yellow in the manuscript, as followed:
“This review assessed the clinical effects of Interproximal Contact Loss (ICL), the impact of the type of prosthesis retention, the number of prosthetic elements, and the anterior or posterior positioning of the rehabilitation. Additionally, the primary as-sessment tools described in clinical trials for detecting ICL and measuring interproximal space/contact over time were examined.
ICL occurrence was found to be a complex phenomenon influenced by multiple factors. Changes were most frequently observed on the mesial surface of the implant prosthesis, particularly in the posterior mandibular region. In the anterior region, the earliest instances were detected at 3 months. Subsequent ICL frequency tendency in-creased over time. ICL played a role in food impaction, leading to tissue changes (mu-cositis) that could progress to peri-implantitis, making it a risk factor for gingival and periodontal conditions.
Factors such as continuous tooth movement, anterior load distribution, and occlusal contact were identified as significant contributors to ICL, particularly on the mesial surface of implant-supported prostheses. While the use of an occlusal splint may not prevent ICL, it can help mitigate some of the clinical effects when ICL occurs.
Due to the multiplicity of assessment tools and methods, new calibration and pro-tocols are required to development and standardization clinical and research evaluation of ICL, allowing reliable and early detection of interproximal space.”
Reviewer 4 Report
Comments and Suggestions for Authors
In relation to this work, the topic is novel and interesting, since only two previous systematic reviews and meta-analyses have been published on the subject and they are also very recent (2022 and 2024).
In general, the structure is adequate and the results are well presented, but I believe that a couple of simple modifications would further improve the quality of this review.
They would be as follows:
1. In relation to the PICO question, this has not been posed in a strict way, i.e., the research question has not really been mentioned, for example: “Does the interproximal contact loss influence………?”
2. Please, provide a table for the characteristics of excluded studies.
Author Response
Point-by-point response to reviewers
Prosthesis Editor-in-Chief
Prof. Dr. Marco Cicciu
List of changes for the revised manuscript Submission prosthesis-3039693
Title: Clinical effects of interproximal contact loss between teeth and implant-supported prostheses. Systematic Review and Meta-analysis
Dear Editor,
please find enclosed our list of changes for the revised manuscript Submission ID 3039693 The changes in the revised manuscript are shaded in yellow. All line specifications refer to the original manuscript.
Reviewer 4:
1-In relation to the PICO question, this has not been posed in a strict way, i.e., the research question has not really been mentioned, for example: “Does the interproximal contact loss influence………?”
Answer: Though a null hypothesis was described in lines 91-93, authors agree and that’s the reviewer 4 comment. We added the PICO research question and we-written the sentence in lines 83-85, as suggested by reviewer 4, as followed:
“This systematic study formulated the research question: “Does the interproximal contact loss influence the outcomes for periodontium and other clinical effects? “ based in PICO model:…”
2-Please, provide a table for the characteristics of excluded studies.
Answer: For quality improvement of the manuscript as suggested by reviewer 3, authors do agree with this upgrade, and included (Line 132) in the manuscript the following table, namely as Table 1. All tables were sequence re-numbered according to this inclusion.
Table 1: Exclusion Criteria, and number of studies excluded after reading manuscript and evaluation.
|
EXCLUSION CRITERIA |
NUMBER OF STUDIES EXCLUDED |
|
CLINICAL DATA < 1 YEAR FOLLOW UP |
2 |
|
CASE REPORTS WITHOUT NUMBER OF IMPLANTS |
3 |
|
EXPERIMENTAL LABORATORY STUDIES |
5 |
|
ANIMAL STUDIES |
0 |
