Clinical Efficacy of Treatment of Endodontic-Periodontal Lesions: A Systematic Scoping Review of Experimental Studies
Round 1
Reviewer 1 Report
The reviewer really appreciates the efforts of the authors to conduct this study which has good clinical significance. However, there are several scopes for improving the quality of the manuscript. The reviewer would like to suggest the following revision in the manuscript to make it suitable for publication
Please revise figure 1 with a uniformly sized font and white background of the textbox with the black font to make it readable.
The eligibility criteria need to be revised. Please mention the inclusion criteria and exclusion criteria separately for a better understanding
The research question” What is the clinical efficacy of the treatments performed in patients with endo-perio lesions?” need to be revised
Please explain the Risk of Bias analysis in detail.
The format of Table 1 is not uniform. The column stating endodontic intervention and periodontal intervention have different subheadings for each study. Sometimes author mentions a control group, experimental group and sometimes study group, sometimes group 1, group 2, etc. Please revise this section with a clear statement of the clinical trial applied in that study.
The main outcome mentioned in the table needs to be specific rather than copy-paste the entire result section of the article.
Author Response
Dear Reviewer 1: we are grateful for the constructive comments you provided, which helped us to improve the manuscript significantly.
Our responses to your comments are outlined below and highlighted in blue (to differentiate them from responses to other reviewers) in the new version.
Responses to Reviewer 1
- Please revise figure 1 with a uniformly sized font and white background of the textbox with the black font to make it readable.
Response: The figure was adjusted with other colors to improve its contrast.
- The eligibility criteria need to be revised. Please mention the inclusion criteria and exclusion criteria separately for a better understanding.
Response: The inclusion and exclusion criteria were presented separately in this new version.
- The research question” What is the clinical efficacy of the treatments performed in patients with endo-perio lesions?” need to be revised
Response: The research question was changed. In this new version it is:
This systematic scoping review aims to respond to the following questions. In patients presenting combined EPL, which is the efficacy of a) different endodontic treatments, b) different periodontal treatment, and c) of the timing between them in terms of PD reduction, CAL gain, pocket closure and bone defect fill?
- Please explain the Risk of Bias analysis in detail.
Response: The risk of bias was detailed. Moreover, the description of each criterion is presented in Table 2.
- The format of Table 1 is not uniform. The column stating endodontic intervention and periodontal intervention have different subheadings for each study. Sometimes author mentions a control group, experimental group and sometimes study group, sometimes group 1, group 2, etc. Please revise this section with a clear statement of the clinical trial applied in that study.
Response: The table was adjusted following the recommendations.
- The main outcome mentioned in the table needs to be specific rather than copy-paste the entire result section of the article.
Response: The recommendation was included.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The authors provide a scoping review assessing the efficacy of clinical procedures for the treatment of end-perio lesions. The manuscript focuses on a clinically relevant question and follows a sound methodology. Below are my comments to improve the quality.
Abstract
- In general, the abstract does not seem balanced in its parts. Too little space was given to M&M, and too much was given to conclusions. Being this a scoping review, most of the sentences included in the conclusions should be transferred to Results.
- Given the low quality of evidence, I recommend toning down the sentences 'The use of diode 20 laser has also shown efficacy in the resolution of EPL. Similarly, platelet-rich-fibrin (PRF) and Tita- 21 nium-prepared PRF were effective in resolving EPL.'
M&M
- The term bone status as an outcome is too general, please find a more specific one, such as bone defect fill.
- Data section and extraction sections in M&M could be expanded.
- I believe the included studies could be grouped in three different sections with respect to the focused question and the initial population recruited, as in another scoping review (doi: 10.1111/odi.13843). In particular, here the 3 questions could have been: in patients presenting combined EPL, which is the efficacy of a) different endodontic treatments, b) different periodontal treatment and c) of the timing between them in terms of PPD reduction, CAL gain, pocket closure and bone defect fill?
Results
- Since a new classification of EPL has been recently introduced (doi: 10.1002/JPER.16-0642), please make an effort to classify included work with the new gradings.
Table 1
- Please, correct "periodontitis state III".
- When providing means, it is advisable to add a measure of dispersion (standard deviation).
- It would be important to clearly express the time occurring from endo to perio treatment.
- Check carefully table 1 for typing errors.
Discussion
- In general, try to develop the discussion by clearly separating studies which assessed endo treatment, periodontal treatment or timing, because they may be suitable to answer different study questions.
- More than mean PPD reduction, it would be clinically relevant to assess which pockets achieved the endpoint of therapy (doi: 10.1111/jcpe.13547). If possible, try to evaluate pocket closure as an outcome of different treatment procedure.
Conclusion
- Please, follow the same recommendations as in the abstract, considering that it has not to be a copy and paste.
Author Response
Dear Reviewer 2: we are grateful for the constructive comments you provided, which helped us to improve the manuscript significantly.
Our responses to your comments are outlined below and highlighted in green (to differentiate them from responses to other reviewers) in the new version.
Responses to Reviewer 2
ABSTRACT
- In general, the abstract does not seem balanced in its parts. Too little space was given to M&M, and too much was given to conclusions. Being this a scoping review, most of the sentences included in the conclusions should be transferred to Results.
Response: The abstract was re-written considering all the recommendations. It is important to mention that IJERPH admits only 200 words in the abstract, and to that extent the abstract was adjusted.
- Given the low quality of evidence, I recommend toning down the sentences 'The use of diode 20 laser has also shown efficacy in the resolution of EPL. Similarly, platelet-rich-fibrin (PRF) and Tita- 21 nium-prepared PRF were effective in resolving EPL.'
Response: The observation was considered.
METHODS
- The term bone status as an outcome is too general, please find a more specific one, such as bone defect fill.
Response: Bone defect fill was included throughout the manuscript.
- Data section and extraction sections in M&M could be expanded.
Response: The observation was amended.
- I believe the included studies could be grouped in three different sections with respect to the focused question and the initial population recruited, as in another scoping review (doi: 10.1111/odi.13843). In particular, here the 3 questions could have been: in patients presenting combined EPL, which is the efficacy of a) different endodontic treatments, b) different periodontal treatment and c) of the timing between them in terms of PPD reduction, CAL gain, pocket closure and bone defect fill?
Response: The observation was incorporated.
RESULTS
- Since a new classification of EPL has been recently introduced (doi: 10.1002/JPER.16-0642), please make an effort to classify included work with the new gradings.
Response: A paragraph connecting the diagnoses presented by the trials and the new classification was added in the results section.
TABLE 1
- Please, correct "periodontitis state III".
Response: The error was fixed
- When providing means, it is advisable to add a measure of dispersion (standard deviation).
Response: The standard deviation was added. The study by Razi et al. did not display this information.
- It would be important to clearly express the time occurring from endo to perio treatment.
Response: This information was highlighted in the text (results section).
- Check carefullytable 1 for typing errors.
Response: Table 1 was carefully checked.
DISCUSSION
- In general, try to develop the discussion by clearly separating studies which assessed endo treatment, periodontal treatment or timing, because they may be suitable to answer different study questions.
Response: The recommendation was included.
- More than mean PPD reduction, it would be clinically relevant to assess which pockets achieved the endpoint of therapy (doi: 10.1111/jcpe.13547). If possible, try to evaluate pocket closure as an outcome of different treatment procedure.
Response: The recommendation was taken into account. Unfortunately, in the trials included in this review, and as reported in the systematic review by Citterio et al. [doi: 10.1111/jcpe.13547], pocket closure as an outcome is rarely reported.
CONCLUSION
- Please, follow the same recommendations as in the abstract, considering that it has not to be a copy and paste.
Response: The recommendation was included.
We appreciate the reviewer’s suggestions, which helped us improve the clarity of our manuscript. We hope that these revisions will make it acceptable for publication.
Thank you very much for considering our work. 


Professor and corresponding author.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comment
Thanks the authors to submit a study addressing “ Clinical efficacy of treatment of endodontic-periodontal lesions: A systematic scoping review of experimental studies.” This is an interesting topic. Here are some feedbacks for more information needed.
1. Introduction: Row 44, evaluating the efficacy of treatment o”f” endo-perio lesions.
2. Materials and methods: structurally instructed.
3. Results: In figure 1, the words over left row are vague, nor clear. Please revise it.
4. Discussion: All descriptions were well illustrated. But, please critically address the limitation of this study.
Minor revision is required for further consideration for publishing.
Author Response
Dear Reviewer 3: we are grateful for the constructive comments you provided, which helped us to improve the manuscript significantly.
Our responses to your comments are outlined below and highlighted in yellow (to differentiate them from responses to other reviewers) in the new version.
Responses to Reviewer 3
- Introduction: Row 44, evaluating the efficacy of treatment o”f” endo-perio lesions.
Response: The error was fixed.
- Results: In figure 1, the words over left row are vague, nor clear. Please revise it.
Response: The figure was set.
- Discussion: All descriptions were well illustrated. But, please critically address the limitation of this study.
Response: The limitations of the study were critically addressed.
We appreciate the reviewer’ suggestions, which helped us improve the clarity of our manuscript. We hope that these revisions will make it acceptable for publication.
Thank you very much for considering our work. 


Professor and corresponding author.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Thank you for the revision
Reviewer 2 Report
The authors have addressed all required changes and the manuscript is now suitable for publication.
