Postoperative Stability of Patients Undergoing Orthognathic Surgery with Orthodontic Treatment Using Clear Aligners: A Preliminary Study
Round 1
Reviewer 1 Report
Dear authors Although it is a well-designed work, I do not think that with the number
of individuals that comprise it, not even being the same for each
comparison group, the results can be extrapolated. I think this publication should be in a local magazine
Author Response
Response to the comments by Reviewer #1
- I do not think that with the number of individuals that comprise it, not even being the same for each comparison group, the results can be extrapolated.
Response:
Thank you for your comment.
Only 5 of those who underwent orthognathic surgery during the study period were patients who had undergone orthodontic treatment using clear aligners before surgery, and the majority were patients who had undergone preoperative orthodontic treatment using braces.
Since the number of experimental groups was too small (5), 10 control groups were selected to match the control group with a control group with a similar number to the experimental group. The control group was randomly selected from among the patients who underwent orthognathic surgery during the study period.
Therefore, this study was prepared as a preliminary study with a small number of experimental groups. Based on this preliminary study, we expect that more orthodontic patients using more clear aligners will increase and papers will be published.
Reviewer 2 Report
This manuscript is to evaluate the postoperative stability of patients undergoing orthognathic surgery with a clear aligner and fixed appliance. It is interesting and important for orthodontic treatment guidelines.
- Please address the indications of patient selection for a clear aligner and fixed appliance. Why the patient numbers are different between the two groups. Especially, 5 patients are not enough for statistical calculation or definitive conclusion.
- Please add the description of Fig.3~Fig.7 and Fig. 10 in the materials and method section. It seems to be the key point of a clear aligner in these figures.
- To be better, please add the clinical figure of the fixed appliance in Fig. 10.
- More references related to this topic or the factors affecting long-term stability were suggested.
Author Response
Response to the comments by Reviewer #2
- Please address the indications of patient selection for a clear aligner and fixed appliance. Why the patient numbers are different between the two groups. Especially, 5 patients are not enough for statistical calculation or definitive conclusion.
Response:
Thank you for your comment.
Only 5 of those who underwent orthognathic surgery during the study period were patients who had undergone orthodontic treatment using clear aligners before surgery, and the majority were patients who had undergone preoperative orthodontic treatment using braces.
Since the number of experimental groups was too small (5), 10 control groups were selected to match the control group with a control group with a similar number to the experimental group. The control group was randomly selected from among the patients who underwent orthognathic surgery during the study period.
Therefore, this study was prepared as a preliminary study with a small number of experimental groups. Based on this preliminary study, we expect that more orthodontic patients using more clear aligners will increase and papers will be published.
- Please add the description of Fig.3~Fig.7 and Fig. 10 in the materials and method section. It seems to be the key point of a clear aligner in these figures.
Response:
We agree with your opinion.
The description under the figure was supplemented because the content seemed insufficient or needed to be corrected for the reader to easily understand the figure, and it is marked in red.
- To be better, please add the clinical figure of the fixed appliance in Fig. 10.
Response:
A clinical picture during orthognathic surgery of a patient who had undergone preoperative orthodontic treatment using fixed appliance was added.
- More references related to this topic or the factors affecting long-term stability were suggested.
Response:
Thank you for your comment.
Additional references related to this topic were written in discussion and marked in red. However, it was difficult to find a study on the stability of orthognathic surgery using clear aligners. In this preliminary study, stability was considered, and more advanced research is expected in the future.
Also, there is a systematic review that orthodontic treatment using clear aligners has no significant difference in stability and occlusal characteristics compared to conventional orthodontic appliance[13].
Another advantage of orthodontic treatment using clear aligners is that the brackets physically interfere with tooth brushing, making oral hygiene management difficult, but clear aligners do not. These removable clear aligners can also reduce the incidence of white spot lesions on teeth[15]. In a similar vein, according to Sfondrini et al, there was also a report that there was no significant difference in periodontal and microbiological parameters in patients undergoing correction with a clear aligner for 2 months compared with patients who did not receive orthodontic treatment[16].
According to a large cohort of clear aligners therapy patients, 45.5% of patients wore the aligner for 22 hours or more a day, while 25.7% wore it for less than 11 hours[19]. Since orthodontic treatment is required after surgery[20], the dentist and the patient must communicate in order to cooperate with the patient, and sometimes the doctor must induce the patient to show better compliance[21].
Reviewer 3 Report
Thanks for letting me review this groundbreaking work.
In order to be published I would suggest some changes:
Abstract correctly described
To add some specific keywords
Introduction, also indicate in favor of invisible aligners the lack of microbiological variation with patients with or without aligners, I am attaching the reference:
Microbiological changes during orthodontic aligner therapy: A prospective clinical trial
,Materials and methods, there is no consensus from the ethics committee and the sample size. If there is no approval from the ethics committee, provide a formal copy of the informed consent.
results in line with the aim of the study
Discussion, to add references on the home maintenance of these patients in the postoperative phase.
Conclusions, in line with the previous points
Author Response
Response to the comments by Reviewer #3
- To add some specific keywords
Response:
We agree with your opinion.
Since the keywords previously written seem insufficient for many readers to search for this study, additional keywords were added.
Keywords: Orthognathic surgery; Clear aligner; Invisalign; Stability; Preoperative orthodontic treatment; CAD-CAM; 3D printer
- Introduction, also indicate in favor of invisible aligners the lack of microbiological variation with patients with or without aligners
Response:
The reference you provided was a very well-written and elaborate study, and it was helpful for the discussion of this paper. For this reason, I have added content to the discussion. Thanks for letting me know about good research.
In a similar vein, according to Sfondrini et al, there was also a report that there was no significant difference in periodontal and microbiological parameters in patients undergo-ing correction with a clear aligner for 2 months compared with patients who did not re-ceive orthodontic treatment[16].
- Materials and methods, there is no consensus from the ethics committee and the sample size. If there is no approval from the ethics committee, provide a formal copy of the informed consent.
Response:
Thank you for your comment.
We submit the PDF file of ‘Confirmation Sheet of IRB Approval Notification’ issued by this hospital along with the response to the revision. The number of study subjects was considered when they were approved by the ethics committee.
- Discussion, to add references on the home maintenance of these patients in the postoperative phase.
Response:
Thank you for your comment.
An additional discussion was written on oral hygiene management and patient compliances.
Another advantage of orthodontic treatment using clear aligners is that the brackets physically interfere with tooth brushing, making oral hygiene management difficult, but clear aligners do not. These removable clear aligners can also reduce the incidence of white spot lesions on teeth[15].
According to a large cohort of clear aligners therapy patients, 45.5% of patients wore the aligner for 22 hours or more a day, while 25.7% wore it for less than 11 hours[19]. Since orthodontic treatment is required after surgery[20], the dentist and the patient must communicate in order to cooperate with the patient, and sometimes the doctor must induce the patient to show better compliance[21].
Round 2
Reviewer 1 Report
Dear Authors
I still think that it is compulsory to have a experimental group with a higher number of patients to extrapolate results.
Reviewer 2 Report
accept
