Load-Bearing Capacity of Lithium Silicate Derivates Applied as Ultra-Thin Occlusal Veneers on Molars
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsGiven the rising concern about dental erosion, this research provides valuable insights into minimally invasive restoration techniques.
The study fills a literature gap by comprehensively comparing different lithium silicate derivatives, however, there are some issue to be addressed to improve the paper.
Introduction
The introduction lacks a comparison on the alternative restorative approaches (composite resins or conventional crowns).
The authors should expand the introduction by discussing alternative restorative strategies, highlighting the advantages and limitations of other restoration types compared to lithium silicate ceramics.
Materials and methods
The choice of the three lithium silicate derivatives ("Nice," "Celt," "Vita") is not well justified. Were these materials selected based on clinical prevalence, mechanical properties, or manufacturer recommendations?
The authors should Include an explanation in Materials & Methods section regarding why these specific materials were chosen over others.
Results
The authors should use statistical markers (e.g. asterisks for significance) for clarity in figures, highlighting the p value selected.
Discussion
While the study provides a solid mechanical analysis, there is little information in the discussion section about real-world clinical applications.
Are these materials clinically recommended for patients with severe erosion or bruxism? How do mechanical findings translate into long-term durability in patients with high occlusal loads?
The authors should expand the discussion by connecting findings to clinical recommendations, including patient selection criteria.
The study acknowledges past research but does not critically compare its findings with other studies on lithium disilicate or alternative ceramics.
The authors should expand the Discussion to contrast findings with previous studies, explaining why differences or similarities exist.
Study limitations
While the sample size calculation is well explained, n = 20 per group may still be considered limited for detecting subtle material differences. While in-vitro studies are important, biological factors (saliva, occlusal forces, or patient habits) may influence long-term performance.
The authors should point out these limitations in a specific section after the Discussion, proposing future in-vivo studies to validate findings.
Author Response
Given the rising concern about dental erosion, this research provides valuable insights into minimally invasive restoration techniques.
The study fills a literature gap by comprehensively comparing different lithium silicate derivatives, however, there are some issue to be addressed to improve the paper.
Introduction
Question:
The introduction lacks a comparison on the alternative restorative approaches (composite resins or conventional crowns).
The authors should expand the introduction by discussing alternative restorative strategies, highlighting the advantages and limitations of other restoration types compared to lithium silicate ceramics.
Response:
Thank you for the comment. In the introduction it is now mentioned that both direct and indirect approaches can be used for this indication. As the study focuses on minimally invasive indirect approaches, the description of strategies using conventional crowns has not been further expanded. Using minimally invasive indirect treatment strategies and not conventional crowns is also in line with 2 consensus statements published in the past years: Lobbezzoo und SSRD consensus.
Materials and methods
Question:
The choice of the three lithium silicate derivatives ("Nice," "Celt," "Vita") is not well justified. Were these materials selected based on clinical prevalence, mechanical properties, or manufacturer recommendations?
The authors should Include an explanation in Materials & Methods section regarding why these specific materials were chosen over others.
Response:
To have a comprehensive overwiev on the mechanical performance of lithium disilicate derivates in this indication, all the products in the market at the time of the study were included. This was mentioned in the introduction.
Results
Question:
The authors should use statistical markers (e.g. asterisks for significance) for clarity in figures, highlighting the p value selected.
Response:
Statistical markers are added.
Discussion
Question:
While the study provides a solid mechanical analysis, there is little information in the discussion section about real-world clinical applications.
Are these materials clinically recommended for patients with severe erosion or bruxism? How do mechanical findings translate into long-term durability in patients with high occlusal loads?
The authors should expand the discussion by connecting findings to clinical recommendations, including patient selection criteria.
Response:
Discussion is expanded as requested.
Question:
The study acknowledges past research but does not critically compare its findings with other studies on lithium disilicate or alternative ceramics.
The authors should expand the Discussion to contrast findings with previous studies, explaining why differences or similarities exist.
Response:
Discussion is expanded in this regard.
Study limitations
Question:
While the sample size calculation is well explained, n = 20 per group may still be considered limited for detecting subtle material differences. While in-vitro studies are important, biological factors (saliva, occlusal forces, or patient habits) may influence long-term performance.
The authors should point out these limitations in a specific section after the Discussion, proposing future in-vivo studies to validate findings.
Response:
Limitations of the study and future perspectives are revised.
Kind regards
Reviewer 2 Report
Comments and Suggestions for Authors-How did you select the force of 49 N and the frequency of 1.67 Hz.
-Maybe it would have been good to conduct the study on groups of women and men, at least, if not on age groups.
-I don't know how well the expression “Load-bearing” is selected for this study.
-Depending on the geometry of the molar surface, the applied force is decomposed in different directions so that the test conditions are not similar.
-Define what “Cohesive fractures” means.
Author Response
Question:
How did you select the force of 49 N and the frequency of 1.67 Hz.
Response:
Force and frequency were selected based on the publication of Krejci I, Effects of thermocycling and occlusal force on adhesive composite, 1994, Journal of Dental Research
Question:
Maybe it would have been good to conduct the study on groups of women and men, at least, if not on age groups.
Response:
Thank you for the comment. For this in-vitro study all the teeth were extracted in male and female patients older than > 18 years old and then randomly selected.
Question:
I don't know how well the expression “Load-bearing” is selected for this study.
Response:
Similar studies are cited which used the same methodology.
Question:
Depending on the geometry of the molar surface, the applied force is decomposed in different directions so that the test conditions are not similar.
Response:
Thank you for the comment. This could be certainly an influencing factor on the reaction to the applied forces. However, the occlusal morphology in the tested specimens where due to the methodology and standardization processes of the fabrication of the occlusal veneers all rather flat. This is why it might play a neglIigable role in this study set up.
Question:
Define what “Cohesive fractures” means.
Response:
A cohesive failure refers to a type of material failure where the fracture occurs within the material itself. This was further specified in the M&M part.
Kind regards
