Treatment of Full and Partial Arches with Internal-Conical-Connection Dental Implants: Clinical Results after 5 Years of Follow-Up

Round 1

Reviewer 1 Report

Treatment of Full and Partial Arches with Internal-Conical-Connection and Platform-Switching Dental Implants: Clinical Results after 5 years of Follow-Up

 

 General comments:

 

The study deals with an important topic in the implant dentistry area. Marginal bone loss with platform switch continues to be an interesting topic that still needs a lot of data.

While reading to proposed manuscript there are some considerations that need to be addressed:

 

 

 

Introduction:

• The explanation of the rationale could be improved, mainly by discussing the different type of implant connections and platform switching, and interaction with the marginal bone loss.
• The plausibility and specific hypotheses should be clearly stated

 

 

Material and Methods:

 

• The study design needs to be properly addressed. The authors state that it was a prospective study with patients treated between 2009-17 (in the abstract) and between 2009-18 in the material and methods section.  
• Authors need to state the timetable for implant surgery which should be different than the timetable for the follow up period. To have at least 5 years follow up the surgeries would have to be performed up to 2012? Also that would correspond that the authors should have up-to-date data at the 9 year period follow up
• There is a major consideration regarding originality regarding the provided by the submitted manuscript since the results are exactly the same as provided in the abstract ( https://doi.org/10.1111/clr.118_13644) being the data stated till 2017 with the same number of patients and results.
• The protheses analysis (single, partial or full) was performed by patient or by implant?
• Subgroup analysis of number implants per patient should be performed to assess patient influence in Marginal bone Loss
• Implant success criteria should be stated
• Number of implants lost due during osteointegration period and during follow up need to be stated. I advise to present a figure with study design and follow up with number of patients and implants evaluated, number patients/patients lost during follow up, and implants lost due to periimplantitis, implants that failed according to success criteria, etc.
• According to the authors “Radiographs were taken at baseline (loading time) and at last follow-up visit which was analyzed and compared to verify any change in the peri-implant marginal bone level (Figure 1).” Altough figure 4 presents several time-points evaluated per implant.
• Follow up protocol- The authors need to mention the follow up controls during the 5 years follow up, since marginal bone loss is dependent on a good oral hygiene control
• Through the manuscript there are several mistakes were the decimals are separated by comma instead of points. (in text and in graphs)
• Since only one clinician performed the assessment how was calibrated? And how this integrates in the retrospective design proposed by the authors?

 

 

Results and Discussion:

 

 

Table 5 – I believe that creating so many subgroups will interfere with the statistical analysis since the authors first should create three main groups, single implant, partial (> 1 implant) and full fixed prostheses

 

Figure 2 – The legend is incorrect since it should state implant level

 

Authors should be cautious while discussing the smoking habits influence since according to their exclusion criteria only smokers till 10 cigarettes were included, thus heavy smokers were excluded.

 

 

It is this reviewer’s opinion that at this point the article should only be accepted with a major reformulation and several aspects need to be added to the manuscript in order to present some consistency.

Author Response

Please see the attachment with the answers to the reviewer's comments in red

Thank you very much 

Author Response File: Author Response.pdf

Reviewer 2 Report

Manuscript Title: Treatment of Full and Partial Arches with Internal-Conical-Connection and Platform-Switching Dental Implants: Clinical Results after 5 years of Follow-Up

Summary: The manuscript describes a 5 year follow study describing the outcomes of dental implant-based reconstructions with internal-conical-connection and platform-switching. This is an important and timely report that will be useful to clinicians as well as scientists who design dental implants. The following revisions are recommended.

 

 

Recommendation: Major Revisions

 

Major Revisions:

 

1. While the authors compare their findings about implant failure rates to other published studies, they do not comment on the relative failure rate with internal-conical-connection and internal hex or other types of dental implant-based reconstruction procedures. The authors should elaborate on this so that the relative success of Internal-Conical-Connection and Platform-Switching Dental Implants can be appreciated.
2. The authors conclude that smoking is the only statistically significant factor affecting bone loss. They should add a table / figure showing the data that compares the effect of sex, prosthesis type, smoking etc. on bone loss, showing the statistical p-values.
3. The authors should elaborate on the statistical tests used in this study, especially because of the varying numbers of patients with different conditions (Chi-square tests maybe appropriate). It not clear if the study is “powered enough” to detect differences. This is a major concern.

 

Minor Revisions:

 

1. If the authors have the patient data readily available, they could also analyze the effect of BMI or obesity / diabetic condition on bone loss and implant failure. This is optional since the study is not focused on these conditions.
2. The authors should also elaborate on the cases where per-implantitis was observed. Were there any special conditions that led to peri-implantitis? Were these associated with smoking for example?
3. Some grammatical errors and incomplete sentences. E.g.”..peri-implantitis was successfully in two different patients”

Author Response

Please see the attachment with the answers to the reviewer's comments in red 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors adressed the reviewers comments and it is this reviewer opinion that it should be accepted for publication.

Still minor changes needed:

 

1- "An overall success rate of 90,1% was calculated after 5 years of follow-up. " - the comma needs to be replaced by point

2- Figure 4- The commas to be changed by points

Author Response

commas were replaced in the manuscript text by points as recommended, in both figures and text.

Reviewer 2 Report

Most comments have been addressed

Author Response

minor english language revision was provided as recommended.