Evaluation of Complications and Marginal Bone Loss Observed in Prosthetic Restorations Applied to Different Implant Abutment Connection Types: A Retrospective Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The content is important. the length of the study (60months) is long enough to provide inforation which is of great vlaue. My comments for improvement are the following: 

Abstract:

1. add the kind of prosthetic restorations provided to the patients.
2. mention that the comparison is the screw retained abutment Vs screwless abutment connection (use uniform terminology throughout the text. somewhere you mention screwless somewhere tapered... check and refine)
3. mention the compliactions retention losses of prosthetic restorations and retainers, 104 abutment and abutment screw fractures, implant body fractures, prosthetic superstruc-105 ture and substructure fractures, and acrylic base fractures

MAterial and methods: 

line 111: why where panoramic radiographs used for marginal bone loss? there is paramorphosis  20%. how does this account for your results? what alternatived could you use? probing? Periapicals or bitewings even?

 

Results: 

The most important complication was loss if implant. you should comment on reparable and nonreparable complicaitons. the total implants lost where 6 for conical (total 53) and 2 screw retained (total 176). this is very high. and at the end there is a statement (line 456): "conical locking 455 connection implants and screw fixed implants; it was determined that the success rate of 456 the conical locking implant supported prosthetic restorations was higher than the screw 457 fixed implant supported prosthetic restorations."

table 6 center the 0.80151 for total mesial average column 12 month interval. 

line 168-180: do you mean that for the same group (mesial bone loss screw retained compare 12m Vs 24m? )or at 12m compare mesial screw retained Vs mesial conical? please elaborate more in words to explain your table 5.

 

Discussion should be more to the point to explain your results. it needs rewritting.

 

the conclusion as a separate section is missing.

 

 

Author Response

1-Comments and Suggestions for Authors

The content is important. the length of the study (60months) is long enough to provide inforation which is of great vlaue. My comments for improvement are the following: 

Abstract:

1. Add the kind of prosthetic restorations provided to the patients.
2. mention that the comparison is the screw retained abutment Vs screwless abutment connection (use uniform terminology throughout the text. somewhere you mention screwless somewhere tapered... check and refine )
3. mention the compliactions retention losses of prosthetic restorations and retainers, 104 abutment and abutment screw fractures, implant body fractures, prosthetic superstruc-105 ture and substructure fractures, and acrylic base fractures 

MAterial and methods: 

line 111: why where panoramic radiographs used for marginal bone loss? there is paramorphosis  20%. how does this account for your results? what alternatived could you use? probing? Periapicals or bitewings even ?

 

Results: 

The most important complication was loss if implant. you should comment on reparable and nonreparable complicaitons. the total implants lost where 6 for conical (total 53) and 2 screw retained (total 176). this is very high. and at the end there is a statement (line 456): "conical locking 455 connection implants and screw fixed implants; it was determined that the success rate of 456 the conical locking implant supported prosthetic restorations was higher than the screw 457 fixed implant supported prosthetic restorations ."

table 6 center the 0.80151 for total mesial average column 12 month interval .  

line 168-180: do you mean that for the same group (mesial bone loss screw retained compare 12m Vs 24m? )or at 12m compare mesial screw retained Vs mesial conical? please elaborate more in words to explain your table 5 .

 

Discussion should be more to the point to explain your results. it needs rewritting .

 

the conclusion as a separate section is missing 

 

 

 

 

 

 

 

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The aim of presented study was to evaluate the long- term clinical results of patients who received prosthetic restorations supported by implants with screw and conical locking implant abutment connection design. The idea is novel and the study design comprehensible. It was determined that the success rate of 456 the conical locking implant supported prosthetic restorations was higher than the screw 457 fixed implant supported prosthetic restorations. 
The article requires some minor linguistic revisions.

Author Response

2-The aim of presented study was to evaluate the long- term clinical results of patients who received prosthetic restorations supported by implants with screw and conical locking implant abutment connection design. The idea is novel and the study design comprehensible. It was determined that the success rate of 456 the conical locking implant supported prosthetic restorations was higher than the screw 457 fixed implant supported prosthetic restorations. 
The article requires some minor linguistic revisions.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Quite an interesting study on an evaluation of the clinical effects of implant rehabilitations different from a clinical point of view.
A poor habit of the authors in writing scientific papers is perceived with many doubts on some significant parts of the manuscript to be rewritten:
-The abstract section must begin with a short sentence on the problem that led to the realization of the study
-the conclusions section of the abstract is inserted too early, it talks about results and not conclusions, instead, which should define clinical implications of the results
-check that all the keywords are MESH terms from Pubmed
-the first paragraph of the introduction has no bibliographic references
-line 59-67: this part is really too obvious. The entire introduction section in general should be rewritten, focusing on the advantages and disadvantages of implant therapy in biomechanical and biological terms, all supported by international scientific literature
-The purpose section cannot have a bibliographic reference
-Insert the null hypotheses of the study at the end of the introduction section, which will be refuted at the end of the discussion
-Define in detail with a dedicated paragraph the inclusion and exclusion criteria
-how the sample size of the study was calculated
-for each material inserted, insert company, state and nation in brackets
-a table on the demographic characteristics of the patient group is missing, as these have important repercussions on the results in terms of ATC osteointegration
-a statistical analysis section is missing
-in the discussion section, immediately after the first paragraph, a sentence should be inserted that summarizes all the main results obtained
-in many of its parts the discussion is too long and focused on some studies explaining them in detail- The authors' effort is to make their own considerations that should then be compared to those of the studies cited
-A section dedicated to the strategies of recovery of compromised implants with innovative technologies such as laser. In this regard, I recommend inserting the following scientific work in the reference section that could help the reader:
Valenti C, Pagano S, Bozza S, Ciurnella E, Lomurno G, Capobianco B, Coniglio M, Cianetti S, Marinucci L. Use of the Er:YAG Laser in Conservative Dentistry: Evaluation of the Microbial Population in Carious Lesions. Materials (Basel). 2021 May 4;14(9):2387. doi: 10.3390/ma14092387. PMID: 34064339; PMCID: PMC8124663.
-a section on the limitations of the study is missing
-In the conclusions I would include a list of the main results by points

Comments on the Quality of English Language

good quality

Author Response

3-Comments and Suggestions for Authors

Quite an interesting study on an evaluation of the clinical effects of implant rehabilitations different from a clinical point of view.
A poor habit of the authors in writing scientific papers is perceived with many doubts on some significant parts of the manuscript to be rewritten:
-The abstract section must begin with a short sentence on the problem that led to the realization of the study
-the conclusions section of the abstract is inserted too early, it talks about results and not conclusions, instead, which should define clinical implications of the results
-check that all the keywords are MESH terms from Pubmed
-the first paragraph of the introduction has no bibliographic references 
-line 59-67: this part is really too obvious. The entire introduction section in general should be rewritten, focusing on the advantages and disadvantages of implant therapy in biomechanical and biological terms, all supported by international scientific literature
-The purpose section cannot have a bibliographic reference 
-Insert the null hypotheses of the study at the end of the introduction section, which will be refuted at the end of the discussion 
-Define in detail with a dedicated paragraph the inclusion and exclusion criteria 
-how the sample size of the study was calculated 
-for each material inserted, insert company, state and nation in brackets 
-a table on the demographic characteristics of the patient group is missing, as these have important repercussions on the results in terms of ATC osteointegration 
-a statistical analysis section is missing 
-in the discussion section, immediately after the first paragraph, a sentence should be inserted that summarizes all the main results obtained 
-in many of its parts the discussion is too long and focused on some studies explaining them in detail- The authors' effort is to make their own considerations that should then be compared to those of the studies cited 
-A section dedicated to the strategies of recovery of compromised implants with innovative technologies such as laser. In this regard, I recommend inserting the following scientific work in the reference section that could help the reader :
Valenti C, Pagano S, Bozza S, Ciurnella E, Lomurno G, Capobianco B, Coniglio M, Cianetti S, Marinucci L. Use of the Er:YAG Laser in Conservative Dentistry: Evaluation of the Microbial Population in Carious Lesions. Materials (Basel). 2021 May 4;14(9):2387. doi: 10.3390/ma14092387. PMID: 34064339; PMCID: PMC8124663.
-a section on the limitations of the study is missing
-In the conclusions I would include a list of the main results by points 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

The aim of this manuscript is to evaluate the long-term clinical complications and marginal bone losses of implant supported prosthetic restorations applied on implant systems with screwless conical locking connection and implant systems with traditional screw connection type.

This manuscript shows rich content and structured organization. Anyway, there are some necessary suggestions to make the article complete and fully readable. For these reasons, the manuscript requires major changes.

Please find below an enumerated list of comments on my review of the manuscript:

MAJOR POINTS:

INTRODUCTION:

LINE 36: Periodontitis, a chronic inflammatory disorder, is marked by a cascade of bacterial-induced immune responses, resulting in progressive destruction of periodontal tissues. And severe periodontitis is the primary cause of tooth loss in adults, leading to compromised masticatory function, malnutrition, and diminished quality of life (see, for reference: https://doi.org/10.1016/j.identj.2024.12.013)

LINE 59: Furthermore, regenerative procedures have received much interest in recent decades due to the demand for restoration and regeneration techniques of missing tissues and organs. In the dental field, several techniques have been proposed to increase bone or soft tissue around teeth, implants, or for future prosthetic rehabilitation. Among them, xenografts are most commonly used and diffused for oral regeneration, mainly for periodontal, peri-implant, and bone regeneration. In fact, there is a deep connection between bone loss and the application of bovine bone grafts for regenerative purposes, specifically in implant dentistry and periodontal therapy (see, for reference: https://doi.org/10.3390/ijms23095273). This is the major concern of this manuscript, which lack of a recent and organic background about the contribution of regenerative biomaterials, and among them, xenografts to regenerate lost bone and create a suitable foundation for implants.

This manuscript shows a clear introduction and context, also proposing a topic of great clinical impact. The manuscript also displays a clear flow, analyzing general prosthetic options and specific implant systems. Overall, the contents are rich, and the authors also give deep insight into some works.

Besides, there is a specific and detailed explanation for the methods used in this study: this is particularly significant, since the manuscript relies on a multitude of methodological and statistical analysis, to derive its conclusions. The methodology applied is overall correct, the results are reliable and adequately discussed.

The conclusions of this manuscript are well written and present an adequate balance between the description of previous findings and the results presented by the authors.

Finally, this manuscript also shows a basic structure, properly divided and looks like very informative on this topic. Furthermore, figures and tables are complete, organized in an organic manner and easy to read.

In conclusion, this manuscript is densely structured and organized. This manuscript provided a comprehensive analysis of current knowledge in this field. Moreover, this research has futuristic importance and could be potential for future research. However, major concerns of this manuscript are with the introductive section: for these reasons, I have major comments for this section, for improvement before acceptance for publication. The article is accurate and provides relevant information on the topic and I have some major points to make, that may help to improve the quality of the current manuscript and maximize its scientific impact. I would accept this manuscript if the comments are addressed properly.

 

Author Response

Comments and Suggestions for Authors

The aim of this manuscript is to evaluate the long-term clinical complications and marginal bone losses of implant supported prosthetic restorations applied on implant systems with screwless conical locking connection and implant systems with traditional screw connection type.

This manuscript shows rich content and structured organization. Anyway, there are some necessary suggestions to make the article complete and fully readable. For these reasons, the manuscript requires major changes.

Please find below an enumerated list of comments on my review of the manuscript:

MAJOR POINTS:

INTRODUCTION:

LINE 36: Periodontitis, a chronic inflammatory disorder, is marked by a cascade of bacterial-induced immune responses, resulting in progressive destruction of periodontal tissues. And severe periodontitis is the primary cause of tooth loss in adults, leading to compromised masticatory function, malnutrition, and diminished quality of life (see, for reference: https://doi.org/10.1016/j.identj.2024.12.013)

LINE 59: Furthermore, regenerative procedures have received much interest in recent decades due to the demand for restoration and regeneration techniques of missing tissues and organs. In the dental field, several techniques have been proposed to increase bone or soft tissue around teeth, implants, or for future prosthetic rehabilitation. Among them, xenografts are most commonly used and diffused for oral regeneration, mainly for periodontal, peri-implant, and bone regeneration. In fact, there is a deep connection between bone loss and the application of bovine bone grafts for regenerative purposes, specifically in implant dentistry and periodontal therapy (see, for reference: https://doi.org/10.3390/ijms23095273). This is the major concern of this manuscript, which lack of a recent and organic background about the contribution of regenerative biomaterials, and among them, xenografts to regenerate lost bone and create a suitable foundation for implants.

This manuscript shows a clear introduction and context, also proposing a topic of great clinical impact. The manuscript also displays a clear flow, analyzing general prosthetic options and specific implant systems. Overall, the contents are rich, and the authors also give deep insight into some works.

Besides, there is a specific and detailed explanation for the methods used in this study: this is particularly significant, since the manuscript relies on a multitude of methodological and statistical analysis, to derive its conclusions. The methodology applied is overall correct, the results are reliable and adequately discussed.

The conclusions of this manuscript are well written and present an adequate balance between the description of previous findings and the results presented by the authors.

Finally, this manuscript also shows a basic structure, properly divided and looks like very informative on this topic. Furthermore, figures and tables are complete, organized in an organic manner and easy to read.

In conclusion, this manuscript is densely structured and organized. This manuscript provided a comprehensive analysis of current knowledge in this field. Moreover, this research has futuristic importance and could be potential for future research. However, major concerns of this manuscript are with the introductive section: for these reasons, I have major comments for this section, for improvement before acceptance for publication. The article is accurate and provides relevant information on the topic and I have some major points to make, that may help to improve the quality of the current manuscript and maximize its scientific impact. I would accept this manuscript if the comments are addressed properly.

 

 

 

 

 

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript has been revised and all points have addressed meticulously.

 

I have nothing further to add.

 

There is typo with table 2 please correct: "Table 2. Distribution os Patients..." --> of

 

Thank you

Author Response

Review 1

Open Review

(x) I would not like to sign my review report
( ) I would like to sign my review report

Quality of English Language

( ) The English could be improved to more clearly express the research.
(x) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	(x)	( )	( )	( )
Is the research design appropriate?	(x)	( )	( )	( )
Are the methods adequately described?	(x)	( )	( )	( )
Are the results clearly presented?	(x)	( )	( )	( )
Are the conclusions supported by the results?	(x)	( )	( )	( )

Comments and Suggestions for Authors

The manuscript has been revised and all points have addressed meticulously.

 

I have nothing further to add.

 

There is typo with table 2 please correct: "Table 2. Distribution os Patients..." --> of

 

Thank you

 

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

all comments were added

Author Response

Review 3

Open Review

(x) I would not like to sign my review report
( ) I would like to sign my review report

Quality of English Language

( ) The English could be improved to more clearly express the research.
(x) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	(x)	( )	( )	( )
Is the research design appropriate?	(x)	( )	( )	( )
Are the methods adequately described?	(x)	( )	( )	( )
Are the results clearly presented?	(x)	( )	( )	( )
Are the conclusions supported by the results?	(x)	( )	( )	( )

Comments and Suggestions for Authors

all comments were added

 

Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

The authors should reconsider the previous suggestions. 

Specifically, in the introductive section of this manuscript, there is still no mention on the role of regenerative materials, among them also xenografts, to regenerate lost bone and create a suitable foundation for implants, according to recent scientific evidence. 

For these reasons, the authors should improve the introductive section of this manuscript, which needs of major revisions. 

Author Response

Review 4

Open Review

(x) I would not like to sign my review report
( ) I would like to sign my review report

Quality of English Language

( ) The English could be improved to more clearly express the research.
(x) The English is fine and does not require any improvement.

 

	Yes	Can be improved	Must be improved	Not applicable
Does the introduction provide sufficient background and include all relevant references?	( )	( )	(x)	( )
Is the research design appropriate?	(x)	( )	( )	( )
Are the methods adequately described?	(x)	( )	( )	( )
Are the results clearly presented?	(x)	( )	( )	( )
Are the conclusions supported by the results?	(x)	( )	( )	( )

Comments and Suggestions for Authors

The authors should reconsider the previous suggestions. 

Specifically, in the introductive section of this manuscript, there is still no mention on the role of regenerative materials, among them also xenografts, to regenerate lost bone and create a suitable foundation for implants, according to recent scientific evidence. 

For these reasons, the authors should improve the introductive section of this manuscript, which needs of major revisions. 

Review 4 (round 1,previous suggestions)

Author's Notes

Comments and Suggestions for Authors

The aim of this manuscript is to evaluate the long-term clinical complications and marginal bone losses of implant supported prosthetic restorations applied on implant systems with screwless conical locking connection and implant systems with traditional screw connection type.

This manuscript shows rich content and structured organization. Anyway, there are some necessary suggestions to make the article complete and fully readable. For these reasons, the manuscript requires major changes.

Please find below an enumerated list of comments on my review of the manuscript:

MAJOR POINTS:

INTRODUCTION:

LINE 36: Periodontitis, a chronic inflammatory disorder, is marked by a cascade of bacterial-induced immune responses, resulting in progressive destruction of periodontal tissues. And severe periodontitis is the primary cause of tooth loss in adults, leading to compromised masticatory function, malnutrition, and diminished quality of life (see, for reference: https://doi.org/10.1016/j.identj.2024.12.013 )

LINE 59: Furthermore, regenerative procedures have received much interest in recent decades due to the demand for restoration and regeneration techniques of missing tissues and organs. In the dental field, several techniques have been proposed to increase bone or soft tissue around teeth, implants, or for future prosthetic rehabilitation. Among them, xenografts are most commonly used and diffused for oral regeneration, mainly for periodontal, peri-implant, and bone regeneration. In fact, there is a deep connection between bone loss and the application of bovine bone grafts for regenerative purposes, specifically in implant dentistry and periodontal therapy (see, for reference: https://doi.org/10.3390/ijms23095273). This  is the major concern of this manuscript, which lack of a recent and organic background about the contribution of regenerative biomaterials, and among them, xenografts to regenerate lost bone and create a suitable foundation for implants.

This manuscript shows a clear introduction and context, also proposing a topic of great clinical impact. The manuscript also displays a clear flow, analyzing general prosthetic options and specific implant systems. Overall, the contents are rich, and the authors also give deep insight into some works.

Besides, there is a specific and detailed explanation for the methods used in this study: this is particularly significant, since the manuscript relies on a multitude of methodological and statistical analysis, to derive its conclusions. The methodology applied is overall correct, the results are reliable and adequately discussed.

The conclusions of this manuscript are well written and present an adequate balance between the description of previous findings and the results presented by the authors.

Finally, this manuscript also shows a basic structure, properly divided and looks like very informative on this topic. Furthermore, figures and tables are complete, organized in an organic manner and easy to read.

In conclusion, this manuscript is densely structured and organized. This manuscript provided a comprehensive analysis of current knowledge in this field. Moreover, this research has futuristic importance and could be potential for future research. However, major concerns of this manuscript are with the introductive section: for these reasons, I have major comments for this section, for improvement before acceptance for publication. The article is accurate and provides relevant information on the topic and I have some major points to make, that may help to improve the quality of the current manuscript and maximize its scientific impact. I would accept this manuscript if the comments are addressed properly.

 

 

 

Author Response File: Author Response.pdf

Round 3

Reviewer 4 Report

Comments and Suggestions for Authors

The authors have significantly improved the manuscript.