Temporary Anchorage Devices for the Replacement of Missing Maxillary Lateral Incisors in Growing Patients: An Integrative Systematic Review and a Case Study
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors1 The manuscript by a Soeima et al conducted a review on the currently available evidence regarding the use of orthodontic mini - implants (MI) as Temporary Anchorage Devices (TADs), and the impact of mini-implant insertion angulation on clinical outcomes with TADs was evaluated. They concluded that, TADs success and bone preservation may depend on insertion angulation, TAD size, and soft tissue conditions. All these findings are interesting and can be used as references for the reasonable use of TADs for maxillary lateral incisors in growing patients. The manuscript is proposed to be accepted after minor revision.
2 In the section of “3.1. Selection of Articles”, the number of the identified records was 123, and six duplicated records were removed, why was the number of the screened records 119（Figure 3） but not 117(123-6)? In addition, the number of the reports assessed for eligibility was 21, among which, 9 reports which were not related to MSI were excluded, and 3 systematic reviews were also excluded, why was the number of the studies included 7 rather than 9(21-9-3=9)? Please confirm them. If the final data are incorrect, please correct them. If they are right, please give explanations more clearly.
3 For the abbreviations of some phrases, such as TADs, their full designations should be given when they appeared in the body part of the manuscript for the first time. In this situation, the abbreviation should be given in a bracket after the full designation.
4 the format of the literatures in the “References” is inconsistent, for example, only the first letters of the first words in the titles of the articles in some literatures, such as literatures 1 and 3, were capitalized. While the first letters of all the words in the titles of the articles in the other literatures, such as literatures 2 and 10, were capitalized.
5 In Figure 4, the number of the TADs placed in a horizontal orientation seemed to be 10 when observed with naked eyes, but it was described as 9 in line 240 please confirm it or re-draw the figure.
6 123 articles which covered the period from April 10 to July 12, 2025 were retrieved and screened for this study, it would be better when more literatures covering a longer period were chosen for the statistical research.
Author Response
Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections in the filles below.
Comments 1: “The manuscript by a Soeima et al conducted a review on the currently available evidence regarding the use of orthodontic mini - implants (MI) as Temporary Anchorage Devices (TADs), and the impact of mini-implant insertion angulation on clinical outcomes with TADs was evaluated. They concluded that, TADs success and bone preservation may depend on insertion angulation, TAD size, and soft tissue conditions. All these findings are interesting and can be used as references for the reasonable use of TADs for maxillary lateral incisors in growing patients. The manuscript is proposed to be accepted after minor revision.”
Response 1: We would like to thank the reviewer for the positive feedback and thoughtful comments on our manuscript. We appreciate the recognition of the relevance of our findings regarding the influence of insertion angulation, mini-implant dimensions, and soft tissue conditions on the success of TADs and bone preservation. We have carefully revised the manuscript to address minor issues and improve clarity, as suggested. We hope the revised version meets the expectations for final acceptance.
Comment 2: In the section of “3.1. Selection of Articles”, the number of the identified records was 123, and six duplicated records were removed, why was the number of the screened records 119（Figure 3） but not 117(123-6)? In addition, the number of the reports assessed for eligibility was 21, among which, 9 reports which were not related to MSI were excluded, and 3 systematic reviews were also excluded, why was the number of the studies included 7 rather than 9(21-9-3=9)? Please confirm them. If the final data are incorrect, please correct them. If they are right, please give explanations more clearly.
Response 2: We thank the reviewer for the attentive reading and for pointing out the inconsistencies in the PRISMA flow diagram. Indeed, there was an error in the originally submitted figure, where the wrong numbers of records were reported. We sincerely apologise for this mistake. This has now been corrected: both the PRISMA flow diagram (Figure 3, page 7) and Table 2 (page 3) have been updated to accurately reflect the correct counts at each stage of the screening process. In addition, we have included another database in the search strategy to improve our research, however, this did not change the final number of studies included in the review. The text of the manuscript has also been revised accordingly to ensure consistency and clarity.
Comment 3: For the abbreviations of some phrases, such as TADs, their full designations should be given when they appeared in the body part of the manuscript for the first time. In this situation, the abbreviation should be given in a bracket after the full designation.
Response 3: We thank the reviewer for this important remark. We carefully revised the manuscript to ensure that all abbreviations are properly introduced upon their first occurrence in the body of the text, following scientific writing standards. The abbreviation Temporary Anchorage Devices (TADs) has now been written in full at its first mention in the Introduction (line 56), rather than appearing only in abbreviated form. Other abbreviations such as MLIA, PRISMA, PICO, JBI, and CBCT were already correctly introduced in full at their first mention in the manuscript, so no further changes were required in those cases.
Comment 4: The format of the literatures in the “References” is inconsistent, for example, only the first letters of the first words in the titles of the articles in some literatures, such as literatures 1 and 3, were capitalized. While the first letters of all the words in the titles of the articles in the other literatures, such as literatures 2 and 10, were capitalized.
Response 4: We thank the reviewer for this observation. We have revised the References section to ensure consistency in formatting. All article titles are now presented in sentence case, according to the journal’s guidelines (only the first letter of the first word and proper nouns capitalized). This correction has been applied throughout the reference list, ensuring uniformity across all entries.
Comment 5: In Figure 4, the number of the TADs placed in a horizontal orientation seemed to be 10 when observed with naked eyes, but it was described as 9 in line 240 please confirm it or re-draw the figure.
Response 5: We thank the reviewer for the careful observation. We confirm that Figure 4 is correct: the number of TADs placed in a horizontal orientation is 10. The inconsistency arose from a typographical error in the text at line 244, where the count was mistakenly reported as 9. We have corrected line 244 to “10” and updated the corresponding statistics/percentages so that Section 3.2.1 and Figure 4 are now fully consistent.
Comment 6: 123 articles which covered the period from April 10 to July 12, 2025 were retrieved and screened for this study, it would be better when more literatures covering a longer period were chosen for the statistical research.
Response 6: We thank the reviewer for this helpful suggestion. To clarify, our search did not apply any publication date restrictions. The wording “covering the period from April 10 to July 12, 2025” referred only to the dates on which the electronic searches were conducted, not to the range of publication years considered. The databases were queried from their inception to the search date, and the studies included in our review span the years 2007–2023. To avoid ambiguity, we have revised the Methods text (lines 97–99) to read: “Searches were performed between 10 April 2025 and 3 September 2025 across the three databases , with no publication date limits (from database inception to the search date).” The date range was updated because we subsequently included an additional database search. We also confirm that the reference lists of included studies were screened to identify additional relevant records. We believe this clarification addresses the concern regarding the time coverage of the literature.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe study reviewed the current evidence regarding the use of TADs for missing maxillary incisors in growing patients, followed by a case report. The topic is novel and will be of high interest to readers. A few comments should be addressed before acceptance for publication:
- The title should be revised to specifically describe the use of TADs for the replacement of missing maxillary lateral incisors.
- In the case report section, please provide additional details, including the patient’s age as well as the size and brand of the TADs used.
Author Response
Comment 1: The title should be revised to specifically describe the use of TADs for the replacement of missing maxillary lateral incisors.
Response 1: We agree with the reviewer. Our original title was “Temporary Anchorage Devices (TADs) for Congenitally Missing Maxillary Lateral Incisors in Growing Patients: Integrative Systematic Review and a Case Study.” We had shortened it for concision, but we acknowledge that the revised version introduced some ambiguity regarding the replacement purpose. Following the reviewer’s suggestion, we have revised the title to make this explicit: “Temporary Anchorage Devices for the Replacement of Missing Maxillary Lateral Incisors in Growing Patients: An Integrative Systematic Review and a Case Study.” We also removed the abbreviation “TAD” from the title, as we considered it appropriate in this context.
Comment 2: In the case report section, please provide additional details, including the patient’s age as well as the size and brand of the TADs used.
Response 2: We thank the reviewer for this observation. As suggested, we have included the requested details in section 3.3. Specifically, we now indicate that the clinical case refers to a 13-year-old male patient with bilateral agenesis, and that the TADs used were 14x2mm; Kubident®, Seville, Spain.
We would like to note a correction in Table 7, where the dimensions of the TADs employed in the case report were inaccurately reported. Confirmation with Professor Teresa Pinho established that the correct length is 14 mm. We sincerely apologise for this error.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe reviewed manuscript is a systematic review of the literature on the use of orthodontic mini implants as temporary anchorage devices for the maxillary lateral incisors in growing patients, also including a case study on a 13-year-old male patient with bilateral MLIA, which was rehabilitated using TADs.
The manuscript is excellently written and suitable for publication after minor revisions.
The authors developed the review very precisely and in accordance with the PRISMA guidelines. Protocols for classification and qualitative analysis were developed. The results are presented according to the mentioned protocols. Both, the discussion and conclusions are clear.
I have a few comments/questions:
- Using abbreviations (such as TADs) in the title is inappropriate.
- The scientific purpose should be emphasised more clearly. Consider using the guiding questions descripted on lines 90-92.
- The year’s range of searched publications is not precise (no year at April 10).
- 108 articles were found in the PubMed database. What is surprising, however, is the 10-fold smaller collection obtained from the WoS database. It is a pity that the search in the Scopus database was not repeated - the search performed by me indicated about 2500 publications since 1949 (without detailed filtering).
- Case study - I suggest clearly indicating the connection of the case with the presented review (justification). Explain the reason for the failure after 2 months (line 187) and whether the procedure was changed at the next insertion.
- The images presented in Fig. 1 and Fig. 2 are taken from articles [2] and [8]. It is not sufficient to insert the references, it is necessary to obtain permission from the copyright owner and include the appropriate information.
Author Response
Comment 1: Using abbreviations (such as TADs) in the title is inappropriate.
Response 1: We thank the reviewer for this guidance and agree that abbreviations should be avoided in the title. We have removed the abbreviation and revised the title accordingly. Revised title: “Temporary Anchorage Devices for the Replacement of Missing Maxillary Lateral Incisors in Growing Patients: An Integrative Systematic Review and a Case Study”. The abbreviation is now introduced only in the abstract and at first use in the main text
Comment 2: The scientific purpose should be emphasised more clearly. Consider using the guiding questions descripted on lines 90-92.
Response 2: We thank the reviewer for this helpful comment. As suggested, we used the guiding questions outlined on lines 90–92 to frame the scientific purpose. Accordingly, we added the following sentence at the end of the Introduction: “Therefore, the study evaluates the effectiveness of TADs for temporary replacement in permanent MLIA and examines whether a specific insertion angulation minimizes bone-level change adjacent to the TAD.” (line 68-71).
Comment 3: The year’s range of searched publications is not precise (no year at April 10).
Response 3: Thank you for pointing this out. We have added the missing year to the first date. The sentence now reads: “Searches were performed between 10 April 2025 and 3 September 2025 across the three databases ”. The date range was updated because we subsequently included an additional database search.
Comment 4: 108 articles were found in the PubMed database. What is surprising, however, is the 10-fold smaller collection obtained from the WoS database. It is a pity that the search in the Scopus database was not repeated - the search performed by me indicated about 2500 publications since 1949 (without detailed filtering).
Response 4: We thank the reviewer for this valuable observation. Following the suggestion, we have now included Scopus in the search strategy. This search retrieved only 17 results, and the addition did not alter the final set of included studies, as the records were either outside the scope of our eligibility criteria or duplicates of articles already identified through PubMed and Web of Science. We have also corrected the numerical inconsistencies present in the originally submitted version: both the PRISMA flow diagram and Table 2 have been revised to accurately reflect the updated counts. We have also added the two different search phrases that were used across the databases. In the initial version of the article, only one was reported. We considered it important to include both so that the search methodology can be fully replicated.
Comment 5: Case study - I suggest clearly indicating the connection of the case with the presented review (justification). Explain the reason for the failure after 2 months (line 187) and whether the procedure was changed at the next insertion.
Response 5: Thank you for the suggestion. We have clarified this in Section 3.3: the case is explicitly linked to the review’s objective (“it illustrates a complication associated with TADs rehabilitation “), the reason for failure at 2 months is identified as mobility following vertical placement, and the subsequent procedure was modified to a diagonal insertion angulation, yielding a stable outcome at 1-year follow-up.
Comment 6: The images presented in Fig. 1 and Fig. 2 are taken from articles [2] and [8]. It is not sufficient to insert the references, it is necessary to obtain permission from the copyright owner and include the appropriate information.
Response 6: Thank you for raising this point. Figures 1 and 2 come from articles [2] and [8], which are explicitly distributed under a Creative Commons Attribution license (“This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.”). Under CC BY, no additional permission is required for reproduction. Only images from these two CC BY sources were used; images from other relevant articles were not reproduced because they are under standard copyright/licensing terms that do not allow reuse without prior permission. To ensure full compliance, we have updated the figure captions to include “This is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)”.
