Comparison of Vertical Measurements Between Panoramic Radiograph Images and Corresponding Cone-Beam Computed Tomography Scans

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This retrospective study compares vertical measurements in the posterior maxilla obtained from panoramic radiographs (PR) and cone-beam computed tomography (CBCT) in 204 patients, comprising 341 paired measurements.

Two types of vertical measurements were evaluated:

i)        The vertical distance (VD) between the bone crest of the first or second molar (M1 or M2) and the floor of the maxillary sinus.

ii)       A geometrically constructed vertical distance in edentulous or partially edentulous regions, defined as the perpendicular distance between an auxiliary reference line and the sinus floor.

The authors report that the mean difference between CBCT and PR measurements was statistically significant (0.41 ± 1.03 mm), but not clinically relevant. They conclude that both imaging modalities are suitable for assessing vertical bone height in the posterior maxilla.

This comparative study addresses a clinically relevant question: the assessment of available bone height for implant planning in the posterior maxilla. The methodology is well-structured, with clearly defined inclusion and exclusion criteria, reproducibility checks, and appropriate statistical analysis. The large sample size (n = 341 measurements) further enhances the reliability of the findings.

To improve clarity and precision, the authors may consider the following minor revisions:

1.Provide further details on the validation and application of the 25% magnification factor used for PR images, as this assumption is critical for measurement accuracy.
2.The manuscript mentions potential CBCT artefacts, especially in the presence of metal restorations or root canal fillings. Did the authors observe any impact on measurement accuracy in such cases, even if subgroup analyses were not performed?
3.Ensure that all table legends consistently define abbreviations and statistical methods (e.g., SD, ERA). In Tables 1–4.
4.Correct typographical errors:
-For example, “defect hight” should be corrected to “defect height.”
-Regarding the second vertical measurement: Based on the Materials and Methods section, it appears the authors refer to a geometrically constructed vertical distance using an auxiliary line in edentulous areas, rather than measuring a defect directly (as illustrated in Fig. 4-2). If this interpretation is correct, the definition should be revised accordingly—for example: “a geometrically constructed vertical distance in edentulous or partially edentulous regions, defined as the perpendicular distance between an auxiliary line and the sinus floor.”
-Consider replacing the term “bone papilla,” which is typically used to describe interproximal soft tissue. “Bone crest” may be a more accurate term in this context.
5.Report exact p-values rather than stating “p = 0.000.”
6.A brief discussion on differences in radiation dose, cost, and accessibility between PR and CBCT would enhance the clinical relevance of the findings.

Once these minor revisions are addressed, the manuscript represents a valuable contribution to the field of prosthodontics and can be strongly recommended for publication in Prosthesis.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, all suggestions can be found in the attachment.

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This manuscript investigates the accuracy and reliability of vertical bone height measurements on panoramic radiographs (PR) compared to cone-beam computed tomography (CBCT) in the posterior maxilla. The study is well-structured, the data are clearly presented, and the conclusions are generally supported by the findings. However, the manuscript requires major revisions to address several methodological, interpretive, and clarity issues:

 

- The 25% magnification adjustment in PR measurements is mentioned, but the validation of this correction factor is unclear. Please clarify how this value was determined and whether it was verified for your specific device/settings.

- Plese include a brief paragraph on the inherent limitations of PR imaging, such as distortion, patient positioning, and superimposition.

The statistical results are clearly reported, but figures would enhance readability, especially to visualize the difference between PR and CBCT values. Please add boxplots or bar graphs showing distribution of measurements across methods and defect types.

The mean difference of 0.41 mm is statistically significant, but the clinical importance of this difference is not addressed. Please discuss what would be considered a clinically acceptable error in vertical bone measurements.

The Discussion is mostly descriptive. It lacks critical interpretation and clinical translation. What are the real-world implications of these findings for clinicians? When is CBCT required vs. when is PR sufficient?

Compare more broadly with recent literature, especially with other studies evaluating PR vs. CBCT measurement accuracy in implant planning.

Please discuss in depth limitations of the study

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

I would like to congratulate the authors on conducting this important research. The study addresses a relevant topic and contributes valuable insights to the field. However, I would like to offer a few comments that could help improve the overall quality and clarity of the manuscript.

 

1. Introduction

Since you mentioned the sinus lift procedure, I kindly suggest clarifying that this is not always a safe method, as there are certain contraindications for its application (for example, inflamed sinus mucosa). Moreover, since you already discuss implant-prosthetic therapy, it would be advisable, although not strictly necessary, to also mention alternative solutions, such as subperiosteal or zygomatic implants.

I would also recommend emphasizing more clearly how your study differs from previous research in this field, as this would strengthen the originality and impact of your work.

 

2. Materials and methods

The methodology is well described. However, I kindly suggest specifying who the examiners were and how many participated in the evaluation process.

 

3. Results

The results are clearly presented, well supported by tables, and adequately explained in the accompanying text.

 

4. Discussion

The discussion is well written, and the results are appropriately compared with findings from other studies. However, I suggest that you also state the limitations of your study, as this would provide a more balanced perspective. I would also recommend including a brief statement on what future studies should take into consideration, which would further highlight the relevance and applicability of your research.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you. The authors have made the necessary changes to improve the quality and clarity of this manuscript.

Author Response

Thank you very much. 

The authors are very pleased that the reviewers´ expectations have been met.

Reviewer 3 Report

Comments and Suggestions for Authors

none

Author Response

Thank you very much for the constructive critism. We very much appreciate your approval.