Retrospective Study on Tooth Shell Technique Using Endodontically Treated Teeth in Lateral Ridge Augmentation

Round 1

Reviewer 1 Report

General comments:

The Title should be changed or modified as “Retrospective Study on Tooth Shell Technique By Using Endodontically Treated Teeth in Lateral Ridge Augmentation.”

The author proposed an interesting and practical article considering using the endodontically treated teeth as a graft for lateral ridge augmentation while applying the tooth shell technique. The introduction provides a good background review on the topical include adequated relevant references.

The major problem in this article is the format of the data presented—the author using PL, RL, and IL for data presentation. This study aims to assess the feasibility of using endodontically treated teeth in the tooth shell technique. Only 27 in 45 sites of the implant have complete data for image analysis in such retrospective research. The numbers of enrolled patients or dental implants were not the same in Table 2 and Table 3. The author should declare the reason or kick out the incomplete data in table I for a more reasonable result presentation.

Furthermore, the reviewer also suggests the authors using sites of implant or implant-level only instead of patient-level and regional-level in their data presentation. Finally, there are some ambiguous augment in the discussion that should be clarified. For the above reasons, this article cannot be accepted for publication in a current manner, although the author proposed an interesting article. The reviewer will encourage the authors to revise their manuscript substantially to meet the requirement of our journal.

Specific comments:

Title：

The Title should be changed or modified as “Retrospective Study on Tooth Shell Technique By Using Endodontically Treated Teeth in Lateral Ridge Augmentation.”

Abstract：

The format and length of the abstract are adequate. However, the results and data may be changed as the table of results may be revised according to the reviewer’s recommendations while re-submission.

Introdcton：

The introduction provides a clear background review on the topical include adequated relevant references.

Materials and Methods:

1. The major problem in this article is the format of the data presented—the author using PL, RL, and IL for data presentation as in Table 2. This study aims to assess the feasibility of using endodontically treated teeth in the tooth shell technique. Only 27 in 45 sites of the implant have complete data ( with measurements at time T1 and T2) for image analysis in such retrospective research. The numbers of enrolled patients or dental implants were not the same in Table 2 and Table 3. The author should declare why not all 45 sites of implants have complete data or removed the incomplete data as in Table I for a more reasonable result presentation.

Discussion

Finally, there are some ambiguous augment in the discussion that should be clarified.

1. For example, as shown in 403-404, “The aim of the present retrospective study was to assess the feasibility of using endodontically treated teeth for lateral ridge augmentation by means of the tooth shell technique.”However, from the material and method, after trimming the tooth, it seems that the authors use the treated dentin matrix for bone augmentation. The reviewer will encourage the author to use treated dentine instead of the whole tooth to avoid ambiguity.

 

2. For example, as shown in 436-439 ”Thermal treatment such as autoclavation as an alternative for the decontamination of the dentin material prior to grafting may also result in protein denaturation. A preclinical animal study reported a significantly decreased level of osseointegration (bone-implant contact) if the dentin was pretreated by autoclavation compared to untreated dentin (18).” Recently, some articles considering the autoclave treated dentine matrix can still promote stem cell proliferation and differentiation and might provide an ideal biomaterial for optimizing the regeneration of tooth material. The reviewer will encourage the author to consider autoclaving on treated dentine matrix for clinical application in the future.

Author Response

Reviewer 1

General comments:

The Title should be changed or modified as “Retrospective Study on Tooth Shell Technique By Using Endodontically Treated Teeth in Lateral Ridge Augmentation.”

• We changed the title as suggested.

The author proposed an interesting and practical article considering using the endodontically treated teeth as a graft for lateral ridge augmentation while applying the tooth shell technique. The introduction provides a good background review on the topical include adequated relevant references.

The major problem in this article is the format of the data presented—the author using PL, RL, and IL for data presentation. This study aims to assess the feasibility of using endodontically treated teeth in the tooth shell technique. Only 27 in 45 sites of the implant have complete data for image analysis in such retrospective research. The numbers of enrolled patients or dental implants were not the same in Table 2 and Table 3. The author should declare the reason or kick out the incomplete data in table I for a more reasonable result presentation.

• In Table 3, 4 and 5 in the first column, we made a careless mistake. We entered wrong numbers by mistake. All records were complete. We have corrected the numbers in the first column of Table 3, 4 and 5.

 

Furthermore, the reviewer also suggests the authors using sites of implant or implant-level only instead of patient-level and regional-level in their data presentation. Finally, there are some ambiguous augment in the discussion that should be clarified. For the above reasons, this article cannot be accepted for publication in a current manner, although the author proposed an interesting article. The reviewer will encourage the authors to revise their manuscript substantially to meet the requirement of our journal.

 

• We think it makes sense to make the evaluations on PL, RL and IL. If, for example, complications or severe resorptions occur on all implants in a patient with many implants, then this has a significantly greater impact on IL than a patient with only one implant. In this case, the results are not adequately represented on IL and can be misinterpreted. That is why we would like to leave the evaluations on three levels.
• We have revised the discussion accordingly.

 

Specific comments:

Title：

The Title should be changed or modified as “Retrospective Study on Tooth Shell Technique By Using Endodontically Treated Teeth in Lateral Ridge Augmentation.”

• We changed the title as suggested.

Abstract：

The format and length of the abstract are adequate. However, the results and data may be changed as the table of results may be revised according to the reviewer’s recommendations while re-submission.

 

• In the abstract we have given the values ​​at patient level. In order to avoid misunderstandings, we have described this in more detail.

 

Introdcton：

The introduction provides a clear background review on the topical include adequated relevant references.

Materials and Methods:

1. The major problem in this article is the format of the data presented—the author using PL, RL, and IL for data presentation as in Table 2. This study aims to assess the feasibility of using endodontically treated teeth in the tooth shell technique. Only 27 in 45 sites of the implant have complete data ( with measurements at time T1 and T2) for image analysis in such retrospective research. The numbers of enrolled patients or dental implants were not the same in Table 2 and Table 3. The author should declare why not all 45 sites of implants have complete data or removed the incomplete data as in Table I for a more reasonable result presentation.

 

• In Tables 3, 4 and 5 in the first column, we made a careless mistake. We entered wrong numbers by mistake. All records were complete. We have corrected the numbers in the first column of Table 3, 4 and 5.

 

 

Discussion

Finally, there are some ambiguous augment in the discussion that should be clarified.

1. For example, as shown in 403-404, “The aim of the present retrospective study was to assess the feasibility of using endodontically treated teeth for lateral ridge augmentation by means of the tooth shell technique.”However, from the material and method, after trimming the tooth, it seems that the authors use the treated dentin matrix for bone augmentation. The reviewer will encourage the author to use treated dentine instead of the whole tooth to avoid ambiguity.

 

• We have adjusted the sentence as follows:

The aim of the present retrospective study was to assess the feasibility of using reconditioned dentine from endodontically treated teeth for lateral ridge augmentation by means of the tooth shell technique.

 

1. For example, as shown in 436-439 ”Thermal treatment such as autoclavation as an alternative for the decontamination of the dentin material prior to grafting may also result in protein denaturation. A preclinical animal study reported a significantly decreased level of osseointegration (bone-implant contact) if the dentin was pretreated by autoclavation compared to untreated dentin (18).” Recently, some articles considering the autoclave treated dentine matrix can still promote stem cell proliferation and differentiation and might provide an ideal biomaterial for optimizing the regeneration of tooth material. The reviewer will encourage the author to consider autoclaving on treated dentine matrix for clinical application in the future.

 

• We added the following:

“In contrast, other animal models provided some evidence that in autoclaved dentin matrix dental pulp stem cells were preserved and kept the capability to promote new tissue formation.“

Reviewer 2 Report

This is an interesting retrospective study, well conducted and well written. I would only suggest to move Table 1 in Results section. 

Author Response

Reviewer 2

 

Comments and Suggestions for Authors

This is an interesting retrospective study, well conducted and well written. I would only suggest to move Table 1 in Results section. 

 

• We have moved Table 1 in the results section

 

Round 2

Reviewer 1 Report

General comments

The authors have revised their manuscript according to the review's previous suggestions. Therefore they are closer to meet the high standard of our journal. However, some problems need to be clarified before a further determination on publication. Therefore, minor revision is advised in this stage.

Specific comments

1. In the statistical analyses on page 8, Line 287, the reviewer will recommend the authors describe the definite p-value for static significance. For example, p<0.05 is statically significant.

2. In table 3,  at T2, the p-value is 0.029, 0.038, and 0.035 between ETT and NETT in PL, RL, and IL groups at L4. Thus, it seems that statically significance exists in this Time of measurement. The reviewer will encourage the authors to confirm the data or discuss why there exists such a difference at this location during implant exposure. This may be a key point in determining the coherence of this article in its results. Furthermore, table 4 may change to table 3, 4  at Line  349 page 10 since the data are also shown in table 3.

Author Response

Review Report Round 2

 

General comments

The authors have revised their manuscript according to the review's previous suggestions. Therefore they are closer to meet the high standard of our journal. However, some problems need to be clarified before a further determination on publication. Therefore, minor revision is advised in this stage.

Specific comments

1. In the statistical analyses on page 8, Line 287, the reviewer will recommend the authors describe the definite p-value for static significance. For example, p<0.05 is statically significant.

 

• We added the following:

A probability of error of p < 0.05 was interpreted as significant.

 

2. In table 3,  at T2, the p-value is 0.029, 0.038, and 0.035 between ETT and NETT in PL, RL, and IL groups at L4. Thus, it seems that statically significance exists in this Time of measurement. The reviewer will encourage the authors to confirm the data or discuss why there exists such a difference at this location during implant exposure. This may be a key point in determining the coherence of this article in its results. Furthermore, table 4 may change to table 3, 4  at Line  349 page 10 since the data are also shown in table 3.

 

• We added the following to material and methods:

At time T2, the mean buccal lamella width at L4 was significantly lower for NETT than for ETT at implant, region and patient level.We added the following to the discussion:

 

• We added the following to the discussion:

At time T2, the mean buccal lamella width at L4 was significantly lower for NETT than for ETT at implant, region and patient level. However, these values ​​only show the comparison of the widths at a certain point in time and not the resorption over time.

 

• Table 3 shows only the datas of the mean bucco-palatal alveolar ridge width and the mean buccal lamella width at T1 and T2. Table 4 shows the mean resorption of bucco-oral alveolar ridge bone width and buccal lamella bone plate from T1 to T2. We therefore think that it makes sense to present these values ​​in separate tables.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.