Effect of Post-Casting Cooling Rate on Clasp Complications in Co–Cr–Mo Removable Partial Dentures: 5-Year Retrospective Data

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Aim of the research and design is low quality. It is not completely clear what is investigated. What means term "thinner clasps"? Since all alloys should be treated according to manufacturers instruction and research doesn't show any significance in any investigated category, there's no interest for the readers to publish. My recommendation will be to reject the manuscript for publication. 

I'm not qualified to judge English language.

Author Response

Reviewer 1. Aim of the research and design is low quality. It is not completely clear what is investigated. What means term "thinner clasps"? Since all alloys should be treated according to manufacturers instruction and research doesn't show any significance in any investigated category, there's no interest for the readers to publish. My recommendation will be to reject the manuscript for publication. 

Response.  Dear reviewer, thank you for taking the time to read the manuscript.

Best regards

Reviewer 2 Report

Comments and Suggestions for Authors

Review of Manuscript No. prosthesis-3873192 entitled: Two Methods of Post-Casting Cooling of a Cr-Co-Mo Alloy, Slow Furnace Cooling and Ambient Air Cooling in Removable Partial Dentures: A Retrospective Study.

The manuscript submitted for review presents the results of a long-term observation of the use of removable partial dentures (RPDs) fabricated using the RLF method (test group) and those made using the RATA method (control group). The manuscript is well-organized; however, I recommend a few revisions before publication. The suggestions are provided in the order of appearance.

In the Abstract section, consider using the plural form RPDs instead of RPD in line 14.

In the Materials and Methods section, the materials used for denture fabrication should be described in detail, including brand, manufacturer, city, and country. It is also important to indicate whether the dentures were fabricated by a single technician or by multiple individuals, as this may be relevant when assessing the quality of the prostheses.

I suggest replacing the term graphic 1 and 2 with figure 1, figure 2 and placing the caption below the figure (line 116/175). The figure itself (Graphic 1) needs to be revised: remove the empty space from the horizontal axis and use the percentage symbol (%) only once in the vertical axis label—there’s no need to repeat the % sign next to each value.

All devices and reagents used in the study should be described not only by brand but also by manufacturer name, city, and country (e.g., line 199 – Broxo; line 128 – ultrasonic instruments, etc.).

Lines 131 and 132: the notation for H2O2 should be corrected (H₂O₂).

The abbreviation OLLH (line 129) should be properly expanded to Oxygen High-Level Laser Therapy. Standardize the use of RLF or LRF—for example, line 137 uses LRF in line 87 uses RLF, so the entire manuscript should be carefully reviewed for consistency.

Line 146: the GNU license should be added.

Lines 127 and 148–149: it is recommended to replace the term photo with figure; the figure caption should be placed below the image (please refer to the author guidelines). In Figure 2, a scale or magnification indicator should be included, and the description should specify the device used to capture the image.

To improve the consistency of the manuscript, the terminology referring to retention elements—namely “hook” and “clasp”—should be standardized. Throughout the text, tables, and figures, a single, consistent term should be used. In the context of dental prosthetics, the recommended term is clasp, as it is the professional designation for the component of a denture responsible for retention. Replace all instances of the word hook with clasp in both the main text and in the captions of tables and figures.

The reference list should be formatted according to the journal's author guidelines. Additionally, I recommend replacing literature older than 10 years (7 entries) with more recent publications to ensure the manuscript reflects current research findings and clinical practices.

Author Response

Dear reviewer, thank you for taking the time to read the manuscript and for your valuable suggestions.

Reviewer 2. In the Abstract section, consider using the plural form RPDs instead of RPD in line 14.

Response:

• The abstracts have been rewritten and corrected by changing RPD to RPD

Reviewer 2. In the Materials and Methods section, the materials used for denture fabrication should be described in detail, including brand, manufacturer, city, and country. It is also important to indicate whether the dentures were fabricated by a single technician or by multiple individuals, as this may be relevant when assessing the quality of the prostheses.

Response:

• In the materials and methods section, the alloy and its components were indicated, and the furnace brand was also included.
• It was specified that the laboratory was the same one that produced them, and the operator was the same one who produced them and evaluated them after 5 years.

Reviewer 2. I suggest replacing the term graphic 1 and 2 with figure 1, figure 2 and placing the caption below the figure (line 116/175). The figure itself (Graphic 1) needs to be revised: remove the empty space from the horizontal axis and use the percentage symbol (%) only once in the vertical axis label—there’s no need to repeat the % sign next to each value.

Response:

• the graphic terms in the figures have been corrected, the first figure has also been replaced and the % has been eliminated

Reviewer 2. All devices and reagents used in the study should be described not only by brand but also by manufacturer name, city, and country (e.g., line 199 – Broxo; line 128 – ultrasonic instruments, etc.).

Lines 131 and 132: the notation for H2O2 should be corrected (H₂O₂).

Response:

• This entire part of the manuscript has been eliminated and the manuscript has been re-modulated by eliminating references to patients due to the lack of an Ethics Committee even in the presence of a signed informed consent.

Reviewer 2. The abbreviation OLLH (line 129) should be properly expanded to Oxygen High-Level Laser Therapy. Standardize the use of RLF or LRF—for example, line 137 uses LRF in line 87 uses RLF, so the entire manuscript should be carefully reviewed for consistency.

Response:

• The abbreviations OLLH have been removed, as has the entire section regarding laser therapy.
• The RLF have been corrected to LRF (LRF is correct). I apologize for this careless error.

Reviewer 2. Line 146: the GNU license should be added.

Response:

• this part has been removed

Reviewer 2. Lines 127 and 148–149: it is recommended to replace the term photo with figure; the figure caption should be placed below the image (please refer to the author guidelines). In Figure 2, a scale or magnification indicator should be included, and the description should specify the device used to capture the image.

Response:

• The photo has been removed; three new photos have been added, highlighting the issues of the broken hook, the enlarged hook, and the modification of the prosthesis. Unfortunately, I noticed that the photo has been kept and not replaced with figure. (I'm attaching a new manuscript with this small change).

Reviewer 2. To improve the consistency of the manuscript, the terminology referring to retention elements—namely “hook” and “clasp”—should be standardized. Throughout the text, tables, and figures, a single, consistent term should be used. In the context of dental prosthetics, the recommended term is clasp, as it is the professional designation for the component of a denture responsible for retention. Replace all instances of the word hook with clasp in both the main text and in the captions of tables and figures.

Response:

• The text has been revised and standardized with “clasp”

 

 

Reviewer 2. The reference list should be formatted according to the journal's author guidelines. Additionally, I recommend replacing literature older than 10 years (7 entries) with more recent publications to ensure the manuscript reflects current research findings and clinical practices.

Response:

• Older publications have references that recent ones do not have, furthermore there are few works in the literature that discuss modifications to heat treatments, furthermore even as regards the insertion axis of the RPD, recent literature refers to the prosthetic implant and not to the RPD.

 

Your suggestions were very important; the manuscript was modified in many parts, maintaining the research focus, because the Ethics Committee is not present despite the signed informed consents being present.

Reviewer 3 Report

Comments and Suggestions for Authors

Please find the attached file. 
To meet scientific publication standards, your article requires significant effort to address inconsistencies in data presentation, improve the quality of visuals, and clarify methodological details.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

The English could be improved to more clearly express the research.

Author Response

Dear reviewer, thank you for taking the time to read the manuscript and for your valuable suggestions. They helped me enhance the manuscript. I've modified the title to include your valuable suggestion.

 

Reviewer 3. MAJOR LIMITAZION Very small sample without power justification; non-random allocation; multiple sources of confounding (Kennedy class imbalance, intentionally thinner clasps in the RLF/LRF group, variable laser use); unclear denominators for “rates”; internal inconsistencies in terminology (RLF vs LRF) and units/percentages; tables/graphs hard to follow. These issues currently preclude firm conclusions.

Response:

• Thank you for addressing the limitations. The manuscript has been revised to clarify the rationale for using Kennedy classes, specify the reason for the thinner hooks, and correct internal terminology inconsistencies.

 

Reviewer 3.  Title 1.  Accurate but wordy; repeating “cooling” twice; “retrospective study” is helpful; consider highlighting clinical outcome and follow-up duration. 2. Proposed title options (pick one): 3. “Effect of post-casting cooling rate on clasp complications in Co–Cr–Mo removable partial dentures: 5-year retrospective data”

Response:

• Thank you for your valuable suggestions. I've changed the title to include your suggestion: "Effect of post-casting cooling rate on clasp complications in Co–Cr–Mo removable partial dentures: 5-year retrospective data."

 

Reviewer 3.Abstract 4. Reported “rates” (e.g., 0.11%, 0.55%, 0.99%) contradict the raw counts and percentages later presented (e.g., 1/11 = 9.09%, 5/11 = 45.45%). The denominators are unclear, and the decimals appear off by \~×100. This must be corrected for internal consistency. 5. Lacks confidence intervals/effect sizes; does not state the deliberate “thinner clasps” in the slow-cooling group (a crucial confounder).

Response:

• The abstract has been modified and the data “0.11%, 0.55%, 0.99%” has been removed and the changes to the data have been corrected by inserting them into the results, and the changes to the subtle hooks/confounding factor have been inserted into the conclusions.

 

Introduction.

Reviewer 3. 6 Some citations are tangential (e.g., NiTi orthodontic wires) and could be trimmed or explicitly tied to precipitation-hardening mechanisms relevant to Co–Cr–Mo.

Response:

• Thanks for the suggestion. Unfortunately, there are no studies in the literature regarding heat treatment for RPDs. Many of them concern the mechanical properties, but are evaluated mechanically in completely different ways. The insertion of orthodontic wires is dictated by the fact that the temperature can modify a small, thin metal structure.

 

Reviewer 3. 7. The introduction implies cooling rate affects microstructure (good), but does not preview key metallurgical expectations (e.g., carbide distribution, grain-boundary precipitation, residual stress relief) for cast Co–Cr–Mo; add 2–3 sentences to set mechanistic hypotheses before clinical endpoints.

Response:

• Some specifications of metallic behavior have been included in the materials and methods.

 

 

 

 

Materials & Methods

Reviewer3.

8. LRF clasps were intentionally **thinner** than RATA clasps (“finished to be thinner”), so groups differ in both cooling and clasp thickness—precluding attribution of effects to cooling alone. This must be addressed prominently.

Response:

• This aspect was clearly specified in the materials and methods and reported in the conclusions. The hook was intentionally made thinner for aesthetic reasons in the LRF group to evaluate whether heat treatment actually increases the strength of a thinner hook compared to a thicker hook of the same material.

 

9. Kennedy classes differ between groups (LRF enriched for Class II; RATA enriched for Class III), which likely affects load paths and outcomes. Provide a baseline table with exact counts per Kennedy class and arch by group.

Response:

• Thank you for this specification. Figure 1 and Table 1 show how many RPDs were performed in the different Kennedy classes and whether they were higher or lower.

 

10. Specify alloy brand, exact composition, investment, burnout, casting machine, spruing, and finishing/polishing protocols to ensure reproducibility. Current text gives general steps for cooling only.

Response:

• Thank you for this suggestion. The alloy specification has been included in the text, but the steps for making an RPD have been intentionally omitted because they are well known and reproducible by any laboratory. Our manuscript focused on thin RPD clasps made using post-cast heat treatment. The materials used do not affect the product, and no manufacturing steps were changed except for cooling the flasks in the furnace.

 

11. For LRF, clarify furnace model, thermocouple control, cooling profile (actual temperature vs time), and how “door open 5 cm” was standardized.

Response:

• The oven brand has been entered, but any oven is useful; it doesn't change the result. Furthermore, the cooling profile is dictated until the cylinder cools (this varies according to multiple parameters, which from an engineering standpoint are very complex and difficult to manage unless you have a programmable oven where temperature, time, ventilation, and support play an important role). As for the thermocouple, it's the one from the Manfredi oven (oven brand included in the text thanks to your suggestion). The oven opening is irrelevant up to a few centimeters, as long as there is no air movement inside the oven. In our case, the opening was set to about 5 cm by eye, just enough to see the cylinders.

 

12.The image labeled "Photo 1: spirochetes, flora in motion" is unprofessional and does not meet the standards required for a scientific publication

Response:

• This photo has been removed and replaced with 3 photographs highlighting the issues of the broken hook, enlarged hook, and prosthetic modification

 

Reviewer3.  Statistics 13.  Fisher’s exact test is acceptable for small samples but does not account for repeated measures or varying time at risk. Please include effect sizes with 95% CIs and consider using incidence rate ratios (events per prosthesis-year) or time-to-event analyses. 14.Pre-specify primary vs. secondary outcomes, handle multiplicity, and include a power consideration (even if post hoc). 15.The IRB statement reads “Not applicable,” yet this is human subjects research with a defined protocol and follow-up; provide the Ethics Committee approval number or a waiver, and explain how consent for retrospective analysis was handled (you state that written consent was obtained).

Response:

• The statistics table has been modified by inserting your suggestions 95% CIs and inserted table 3 bias and power
• The text has been modified so as not to be bound by the Ethics Committee. The previous manuscript did not include the ethics committee because we do not have the reference number.

 

Reviewer3 Results 16.Counts and proportions are reported, but “rates” like 0.11% appear inconsistent with the denominators (e.g., 1/11 ≈ 9.09%). It appears that there is a decimal place or formatting error repeated in Tables 2–3 and the abstract; please correct all figures accordingly. 17.Include a baseline characteristics table (arch, Kennedy class, age, sex, abutment distribution, clasp thickness) to demonstrate group comparability. Current text notes clear imbalances. 18.Provide CIs alongside p-values and avoid interpreting trends as superiority when not significant. 19.Clarify whether “tooth mobility” was counted per prosthesis or per tooth; tables are labeled “(prosthesis),” but the phenomenon is tooth-level.

Response:

• The text of the results has been completely changed, including the errors you pointed out. The point about tooth mobility has been removed due to the lack of an ethics committee.

 

Reviewer3 Figures, Tables, and Numbering 20. Numbering and naming are inconsistent (“Graph 1,” “Graph 2,” “Photo 1”)— standardize to Figure 1, Figure 2, etc., per journal style. 21.Ensure every figure/table is cited in sequence; avoid gaps or repeats. 22.Tables 2–3 use “Hook” instead of “Clasp”—standardize terminology.

Response:

• All changes have been made by eliminating graphs and inserting figures, furthermore the term clasp has been standardized

 

Reviewer3 Discussion 23.Avoid claims of clinical superiority without significance and in the presence of confounding (thinner clasps in LRF, class imbalance).

Response:

• Thanks for the suggestion. The discussion has been modified to avoid assertions of superiority and instead introduce the true value of the LRF. Furthermore, thanks to your suggestion, a bias table has been added. Regarding class imbalance, this does not affect the research because the intention is not to standardize the LRF for a Kennedy class, also because it could not be done (too many individual variables). However, your suggestion has allowed us to reshape and improve the work in terms of its power..

 

Reviewer3 Conclusion 24.Given the nonrandomized design and deliberate differences in clasp thickness, these results should not be interpreted as causal effects of the cooling method.

Response:

• The conclusions have been completely re-modulated to better specify the results of the research

 

Reviewer3 Ethics & Transparency 25.Provide IRB approval/waiver details and registration (if applicable) or a clear rationale for “Not applicable.

Response:

• The manuscript has been completely revised and modified by eliminating references to patients as the ethics committee number is missing (only the signed informed consents were present).

 

Reviewer3 References 26.Reference #2 and #7 appear to be the same systematic review (Dawid et al.), listed twice with different formatting. Clean duplicates and ensure consistent style. 27.Reformat all entries to the journal’s reference style; verify PMIDs/DOIs; remove duplicates; correct author names and capitalization; and ensure year/volume/pages are present and accurate

Response:

• Thank you very much for reporting this nasty error, I have replaced reference 2. As for the references, they are taken directly from the database as they appear.

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for submission. Please see attached review document.

Comments for author File: Comments.docx

Author Response

Gentile revisore, grazie per aver dedicato del tempo alla lettura del manoscritto e per i suoi preziosi suggerimenti. Mi hanno aiutato a migliorarlo. Ho rivisto il titolo e apportato le modifiche necessarie sulla base dei suoi preziosi suggerimenti.

 

• Revisore 4. I metodi non sono chiaramente delineati. Si indica che si tratta di uno studio retrospettivo, ma in base alla revisione, sembra essere prospettico. Non è chiaro se i pazienti siano stati identificati retrospettivamente da cartelle cliniche in cui erano già stati fabbricati RPD e reclutati per partecipare a questo studio o se si tratti effettivamente di uno studio prospettico in cui i pazienti sono stati reclutati, i RPD sono stati fabbricati con uno dei due metodi, i partecipanti hanno ricevuto istruzioni igieniche e sono stati poi seguiti per un periodo di 5 anni. Si prega di chiarire.

Risposta:

• Il manoscritto è stato modificato per eliminare i riferimenti diretti ai pazienti, poiché manca il numero del comitato etico, nonostante disponiamo del consenso informato scritto e firmato. Pertanto, la sezione relativa alla mobilità dentale è stata eliminata e sono stati valutati solo tre aspetti, non quattro.

 

• Revisore 4. Sarebbe utile avere gli anni in cui è stato condotto questo studio quinquennale

Risposta:

• Purtroppo il periodo di produzione non è stato incluso perché lo abbiamo ritenuto non determinante nella ricerca.

 

• Revisore 4. Non è chiaro in che modo le variabili delineate siano in linea con l'obiettivo dello studio o con la frattura della fibbia. Questo aspetto deve essere chiarito nell'introduzione.

Risposta:

• Grazie per questo punto. L'introduzione riporta alcuni lavori che discutono le variazioni delle proprietà meccaniche con il trattamento termico, ma solo per valutare un aspetto diverso dalla caratteristica di resistenza che abbiamo considerato. Ci sono pochi lavori in letteratura che discutono le proprietà meccaniche con raffreddamento lento, e questi sono molto datati. Il collegamento con il gancio intende evidenziare che, nonostante lo spessore ridotto del gancio, la sua capacità di resistere alle sollecitazioni interne non varia con il raffreddamento lento. La sezione finale dell'introduzione è stata modificata per specificare meglio l'obiettivo.
• Revisore 4. Non è chiaro come i partecipanti siano stati reclutati e selezionati per partecipare allo studio. È stato effettuato un processo di screening? In caso affermativo, quanti potenziali partecipanti sono stati sottoposti a screening prima di ottenere il numero finale?

Risposta:

- Questa parte dello studio è stata rimossa a causa della mancanza del numero del comitato etico

 

• Revisore 4. Definisci "sottile" in relazione allo spessore delle chiusure. Qual è lo spessore accettabile per la chiusura RPD?

Risposta:

- Lo spessore di un gancio varia e dipende da molti fattori, tra cui la preforma di cera utilizzata. Il tipo di preforma utilizzata per ottenere 2/3 decimi di millimetro in meno è specificato nella sezione materiali e metodi alla fine.

 

• Revisore 4. Le righe 137-138 affermano: "In tutte le protesi parziali rimovibili ottenute con LRF, i ganci sono stati rifiniti in modo da essere più sottili rispetto ai ganci delle protesi parziali rimovibili ottenute con RATA...". Questo sembra introdurre un bias nello studio. Si prega di spiegarne la logica.

Risposta:

• Grazie per il suggerimento. La Tabella 3, "Limiti e potenziali distorsioni dello studio", è stata aggiunta dopo la discussione.

 

• Revisore 4. Il manoscritto fornisce informazioni sulla classificazione Kennedy per l'edentulia, ma non fornisce informazioni sul perché questa potrebbe essere importante e su come potrebbe influire sulle fratture con ganci sottili per protesi parziali rimovibili. Sarebbe utile introdurre maggiori informazioni in merito alle domande/obiettivi rilevanti per lo studio.

Risposta:

• Le classi Kennedy sono state incluse perché si riferiscono ai modelli effettivamente esaminati, il che ci ha permesso di non standardizzare i risultati in base alla classe Kennedy. Non influisce sulla frattura dei ganci. È stato specificato nel manoscritto.

 

• Revisore 4. La motivazione non è chiaramente descritta in relazione all'impatto di un'igiene orale meticolosa e del trattamento laser su ganci sottili e fratture. Questa informazione sembra fuori luogo e non sembra rilevante per le modalità di trattamento della protesi parziale rimovibile (RPD) e il rischio di frattura dei ganci. Questo è stato fatto come incentivo per i partecipanti che hanno accettato di partecipare allo studio?

 

Risposta:

• Questa parte dello studio è stata rimossa a causa della mancanza del numero del comitato etico

 

• Revisore 4. Alla riga 130, che descrive il trattamento laser, viene menzionata l'infiammazione gengivale. È stata valutata l'infiammazione gengivale? In caso affermativo, come è stata effettuata?

Risposta:

• Questa parte dello studio è stata rimossa a causa della mancanza del numero del comitato etico

 

• Revisore 4. Una volta fornita la motivazione per il punto n. 4, si prega di fornire i metodi per la raccolta della placca (ad esempio, sottogengivale vs sopragengivale, denti che erano agganciati, ecc.), quale strumento è stato utilizzato, quanti operatori, ecc.?

Risposta:

• Questa parte dello studio è stata rimossa a causa della mancanza del numero del comitato etico

 

• Revisore 4. Sembra che le tabelle e le figure inserite nella sezione metodi e materiali appartengano alla sezione risultati, soprattutto per quanto riguarda l'analisi dei dati. Si prega di inserire la sezione non appropriata.

Risposta:

• Grazie per il suggerimento. La Figura 1 è stata modificata, la Tabella 2 è stata aggiunta e la foto nella Tabella 3 è stata sostituita con tre foto diverse. La Tabella 2 e la Figura 2 sono nei risultati.

 

• Revisore 4. Discussione - Righe 174-185 afferma: "...la modifica della protesi dovuta a estrazioni dentarie, l'attivazione dei ganci dovuta alla perdita di ritenzione dovuta a un inserimento errato della protesi, la frattura dei ganci dovuta a continue sollecitazioni errate su di essi e la mobilità dei denti dovuta anch'essa a un inserimento errato della protesi, o la possibile progettazione errata di protesi ottenute con il metodo di raffreddamento lento in forno (LRF) e di altre protesi parziali rimovibili ottenute con il metodo di raffreddamento ad aria a temperatura ambiente (RATA)" sono gli elementi analizzati per lo studio. Sembra che nell'introduzione sia stato dichiarato un solo obiettivo e non siano state formulate domande o ipotesi. Questo aspetto deve essere chiarito in relazione al disegno dello studio.

Risposta:

• Questa sezione è stata rielaborata perché la mobilità dentale non è più presente. Tutti gli scritti sono stati corretti. L'obiettivo presentato nell'introduzione è stato mantenuto.

 

• Revisore 4. I dati non supportano le conclusioni e sono in qualche modo sopravvalutati. Sarebbe utile analizzare separatamente ciascun punto dati per valutare se influisca negativamente sulla frattura della fibbia.

Risposta:

• I dati sono stati esaminati e inseriti nella Tabella 2. Le conclusioni sono state riformulate per supportare i dati.

Dear reviewer, thank you for taking the time to read the paper. I really appreciated the various points of clarification and thank you for your valuable advice. The corrections are as follows:

• Methods are not clearly delineated. It is indicated that this is a retrospective study design but based on the review, it appears to be prospective. It is not clear if patients were identified retrospectively from records where RPDs have already been fabricated and recruited to participate in this study or whether this truly is a prospective study where patients were recruited, RPDs fabricated by either method, participants given hygiene instruction and then followed up over a 5-year period. Please clarify.

 

Response: The manuscript has been edited to eliminate direct references to patients because the ethics committee number is missing, even though we have the signed written informed consent. Therefore, the section regarding tooth mobility has been eliminated, and only three aspects, not four, have been evaluated. The 2017-2022 evaluation period has been introduced. The selection of the "line 132-134" prostheses has been clarified.

 

• It would be helpful to have the years in which this 5-year study was conducted.

 

Response: The materials and methods have been modified to better define time “line 132-134

 

• It is not clear how the outlined variables align with the study aim or clasp fracture. This needs to be clarified in the introduction.

 

Response: the goal in the introduction has been improved “line 78”

 

• It is not clear how participants were recruited and selected to participate in the study. Was there a screening process? If so, how many total potential participants were screened before the final number were obtained?

 

Response: No recruitment, just a routine dental checkup. A note has been added to lines 132-135 for clarification.

• Please define “thin” as it relates to the clasps thickness. What is acceptable thickness for the RPD clasp?

 

Response: Thanks for the specification. The thickness of the hook is determined by the type of preform used; any more durable finish will alter the thickness. Line 142-144 has been better specified.

 

• Line 137-138 says “In all RPDs obtained with LRF, the clasps were finished to be thinner than the clasps of the RPDs obtained with RATA…”. This seems introduce bias into the study. Please explain the rationale.

Response: Thanks for the suggestion. Table 3, "Limitations and Potential Biases of the Study," has been added after the discussion. Confounding factor included in the summary in the conclusions “ Line 27”.

 

• The manuscript provides information on Kennedy classification for edentulism but there is no information as to why this might be important and how it might impact thin clasp fracture for RPDs. It would be helpful to have more information introduced as to the relevant to the study question(s)/aim(s).

 

Response: Thank you for reiterating the point of clarification. The Kennedy classes were included because they refer to the actual models examined, which allowed us not to standardize the results based on the Kennedy class. This does not affect the fracture of the hooks. This was specified in the manuscript. It is further clarified in the objective in the introduction, line 78.

 

• The rationale is not clearly described as it relates to the impact of meticulous oral hygiene care and laser treatment on thin clasp and fracture. This information seems out of place and does not appear relevant to how the RPD is processed and the potential for clasp fracture. Was this done as an incentive for participants who agreed to join the study?

 

Response: This part of the study where patients are involved and cleaning or laser is discussed has been removed due to the lack of the ethics committee number.

 

• In line 130 which describes laser treatment, gingival inflammation is mentioned. Was gingival inflammation evaluated? If so, how was this done?

 

Response: The work has been modified and this part of the study has been removed due to the missing ethics committee number.

 

• Once rationale is provided for #4. Please provide methods for plaque collection (i.e., subgingival vs supragingival, teeth that were clasped, etc.), what instrumentused, how many operators, etc.?

 

Response: The work has been modified and this part of the study has been removed due to the missing ethics committee number.

 

• It seems the tables and figures placed in the methods and materials section belong in the results section, as especially as it relates to analysis of data. Please place inappropriate section.

Response: Thanks for the suggestion. Table 2 and Figure 3 are in the results.

 

 

• Discussion - Line 174-185 says"...modification of the prosthesis due to tooth extractions, the activation of theclasps due to the loss of retention due to incorrect insertion of the prosthesis, the fracture of the clasps due to continuous incorrect stress on them and tooth mobility also due to incorrect insertion of the prosthesis, or the possible incorrect design of prostheses obtainedwith a slow furnace cooling method (LRF) and other RPDs obtained with the room temperature air cooling method (RATA)” is what was analyzed for the study. There appears to be only be one stated aim in the introduction and no stated questions or hypotheses. This needs to be clarified as it relates to study design.

 

Response: Thanks again for reiterating this point. Actually, only one aspect was mentioned in the objective. The other two points are now mentioned in the introduction, lines 78-79.

 

• The data does not support the conclusions, and it is somewhat overstated. It would be helpful to address each of the data points separately as whether they adversely impact clasp fracture.

 

Response: The conclusions have been modified as indicated.

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

I have completed the review of the manuscript. I found the work to be of good quality, and I believe it meets the standards for publication.

I recommend accepting the paper for publication.

Comments on the Quality of English Language

Done

Author Response

Dear reviewer, thank you for appreciating the changes made thanks to your advice and suggestions.

Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for the corrections and the manuscript is much improved. There are still some minor edits needed to further enhance the presentation of the study. Please see attach comments.

Comments for author File: Comments.docx

Comments on the Quality of English Language

The English is overall good but could be improved by some grammatical edits related to length of some sentences and choice of wording. An example of this is the sentence - Line 214-215 - "This study allowed to exploit the increased mechanical characteristics to make the RPD clasps thinner and more aesthetic." This sentence could use editing for clarity.

Author Response

Dear reviewer, thank you for your time and for your crucial suggestions and corrections. The corrections made are as follows:

 

• All tables and figures should be titled with a description of the content of the table/figure. For example: Table 2 says "showing research results". A more appropriate title might be “Table 2: Comparison of the LRF versus RATA Techniques”, along with a description.

 

Response: All tables and figures have been revised and the description of Table 2 has been modified.

 

• Additionally, the first column of table 2 needs clarification. What does the terms Modification Prosthesis (what type of modification), Frattura Gancio, and Gancio allargati refer to in the table.

 

Response: The first column of Table 2 has been corrected. The phrase (rebasing) has been added to row 147.

 

• Table 1, the columns need to be better aligned.

 

Response: Thanks for the suggestion, I have aligned table 1 correctly.

 

• The manuscript would benefit from additional grammatical edits as there are some sentences that are very long as well as some more appropriate wording of sentences. For example, sentence 214-222.

 

Response: E’ stato modificato da linea 216 a 222

 

This study allowed to exploit the increased mechanical characteristics to make the RPD clasps thinner and more aesthetic. The statistical analysis revealed no statistically significant differences between the two post-cast alloy cooling methods (LRF and RATA). This conclusion holds true for all Kennedy edentulousness classes, both in the upper and lower arch, regardless of subclassification. However, these results underscore the importance of ongoing clinical monitoring. Evaluating RPDs over time is crucial, especially those with intentionally thinned clasps to improve their aesthetic appearance. Further evidence of this is the "clasp fracture" parameter, which showed a clear difference: 9.1% incidence for clasps obtained with the LRF method versus 18.2% for those obtained with RATA. Despite the lack of statistical significance, this trend suggests that the LRF method may offer a potential advantage in terms of reducing the risk of fractures over time, justifying careful post-delivery follow-up.

 

• The sentence “Only 3 RPD were modified” – Line 231 probably does not need a reference since it refers to the study results.

 

Response: Thanks for pointing out the mistake, I corrected it by adding the missing part.

“Only 3 RPD were modified, relined. The modifications to the prosthesis, however, did not affect the correct biomechanical functioning of the RPD. [28-29]”

Thanks for helping me improve the text

 

Author Response File: Author Response.docx