Long-Term Prognosis of Peri-Implantitis Treatment: A Systematic Review of Prospective Trials with More Than 3 Years of Follow-Up

Round 1

Reviewer 1 Report

I would like to congratulate the authors on their work. In their meta-analysis the authors analyze treatment outcomes for different approaches in the medium long-term treatment of periimplantitis. In the literature multiple approaches are applied (regenerative, resective, open flap debridement) in the surgical therapy of peri-implant disease. Approaches may further vary in presurgical treatment modalities, surface decontamination methods, etc. The findings of this literature review may be of interest to the clinician to anticipate the outcomes of the selected treatment approach.

The introduction is well-written and contains sufficient background information.

The materials and methods are suitable for the aim of the meta-analysis.

The authors correctly used the random-effect model in their statistical analysis to account for the differences in the treatment effect from study to study because of heterogeneity of methods in the included studies. However, the manuscript would benefit from the presentation of prediction intervals in figures 2-5 and in the discussion because for the clinician this is the predictor of the probability of positive treatment outcomes.

I would like to ask the authors why studies starting with less than 10 implants were excluded?

Results are clearly presented; figures and tables are clear and easy to comprehend.

Discussion and conclusions are supported by the results.

The language of the manuscript is clear and easy to understand. The only grammatical error I could find is a double period in row 52.

Bibliography needs some editing to adhere to journal guidelines. There is a redundant comma after the name of the last author in all the references.

Author Response

I would like to congratulate the authors on their work. In their meta-analysis the authors analyze treatment outcomes for different approaches in the medium long-term treatment of periimplantitis. In the literature multiple approaches are applied (regenerative, resective, open flap debridement) in the surgical therapy of peri-implant disease. Approaches may further vary in presurgical treatment modalities, surface decontamination methods, etc. The findings of this literature review may be of interest to the clinician to anticipate the outcomes of the selected treatment approach.
The introduction is well-written and contains sufficient background information.
The materials and methods are suitable for the aim of the meta-analysis.

• All Authors thank the Reviewer 1 for the favorable comments.

The authors correctly used the random-effect model in their statistical analysis to account for the differences in the treatment effect from study to study because of heterogeneity of methods in the included studies. However, the manuscript would benefit from the presentation of prediction intervals in figures 2-5 and in the discussion because for the clinician this is the predictor of the probability of positive treatment outcomes.

• As reviewed by other 2 reviewers, they found the manuscript as it presents is suitable for publication. Nonetheless, we have also worked with our statistician to perform this analysis as suggested by the reviewer.  Please let us know if this is indeed necessary since it will take us some time to complete and it will pass the deadline recommended by the assigned editor.   

I would like to ask the authors why studies starting with less than 10 implants were excluded?

• We thank the Reviewer for the relevant question. Studies starting with less than 10 implants in each group were considered having high risk of selection bias. In addition, with an estimated 0.6 mm effect size pocket depth reduction, under α = 0.05 and power = 0.8, the minimum sample size enrolled in a clinical prospective study was calculated to be 10 implants for each group of treatment.

Results are clearly presented; figures and tables are clear and easy to comprehend.
Discussion and conclusions are supported by the results.

• All Authors thank the Reviewer 1 for your nice compliments.

The language of the manuscript is clear and easy to understand. The only grammatical error I could find is a double period in row 52.

• The double period has been removed.

Bibliography needs some editing to adhere to journal guidelines. There is a redundant comma after the name of the last author in all the references.

• The redundant comma after the name of the last author was removed and the references were modified to adhere to the journal guidelines.

Reviewer 2 Report

Introduction:

• Well-structured introduction with good overview of outcomes of dental implants.
• Line 48: “the interest in treatmet of …”

 

Methods:

• Line 73: the list of journals that are considered most relevant should be listed and detailed better so that it is a reproducible search method.

 

Statistical analysis:

• Clear description of the grouping and the statistical methods.

 

Results:

• Selection process is very well explained and very appropriate.

 

Intervention and comparison:

• This can be stronger if there is comparison between techniques.
• Also, the information of decontamination can be presented in less confusing matter in a table.

 

Outcomes:

• Figure 2-5 need to be simplified and clearer. They are hard to follow.

 

Discussion:

• Clear without issues

 

Conclusion:

• This is needs to be divided into clearer and shorter sentences.

Author Response

Introduction:
Well-structured introduction with good overview of outcomes of dental implants.
Line 48: “the interest in treatmet of …”

• All the Authors thank the Reviewer 2 for their relevant comments. The sentence in line 48 was corrected as recommended.

Methods:
Line 73: the list of journals that are considered most relevant should be listed and detailed better so that it is a reproducible search method.

• The manuscript was updated with the names of the scientific journals that were used for the journal-based search.

Statistical analysis:
Clear description of the grouping and the statistical methods.
Results:
Selection process is very well explained and very appropriate.

• We thank the Reviewer for the positive feedback.

Intervention and comparison:
This can be stronger if there is comparison between techniques.

• We thank the Reviewer 2 for this important comment. A quantitative comparison of outcomes among different techniques was voluntarily omitted due to the large heterogeneity among existing studies and because most of the studies lack a control group.

Also, the information of decontamination can be presented in less confusing matter in a table.

• All information on treatment methodologies was included in Table 3 under the columns “Pre-treatment”, “Surgical treatment” and “Post-treatment”.

Outcomes:
Figure 2-5 need to be simplified and clearer. They are hard to follow.

• Explanation on how to read the plots presented in Figures 2 to 5 was added to the legend of each figure.

Discussion:
Clear without issues
Conclusion:
This is needs to be divided into clearer and shorter sentences.

• The conclusions were simplified and divided in shorter sentences.

 

Reviewer 3 Report

Authors of the meta-analysis manuscript titles “Long-Term Prognosis of Peri-Implantitis Treatment: A  Systematic Review of Prospective Trials with More  Than 3 Years of Follow-Up” have attempted to review the outcomes of therapies aimed at peri-implantitis treatment”.

The manuscript is well written, aimed at a quite specialized community with the most important discussion part properly supported by attached statistical data. Throughout the text I have found a few minor issues, e.g., Figure 1, “27 records delated…” and so a proofread I necessary.

Author Response

Authors of the meta-analysis manuscript titles “Long-Term Prognosis of Peri-Implantitis Treatment: A  Systematic Review of Prospective Trials with More  Than 3 Years of Follow-Up” have attempted to review the outcomes of therapies aimed at peri-implantitis treatment”. The manuscript is well written, aimed at a quite specialized community with the most important discussion part properly supported by attached statistical data. Throughout the text I have found a few minor issues, e.g., Figure 1, “27 records delated…” and so a proofread I necessary.

• All the Authors thank the Reviewer 3 for revising the submitted manuscript. The term “delated” was corrected and the manuscript was revised by a native English with experience in scientific writing.