Retrospective Study of the Association between Peri-Implantitis and Keratinized Mucosa

Round 1

Reviewer 1 Report

Dear Authors,

The article: 'Retrospective study of the association between peri-implantitis and keratinized mucosa' was to compare the amount of keratinized mucosa around healthy implants versus implants in patients with peri-implantitis, in order to analyze its influence on esthetics and on the development of this pathology, and to study the possible influence of keratinized mucosa on various clinical parameters.

Affiliation: remove academic titles, merge affiliation. Add email addresses of co-authors.

Numerous punctuation mistakes should be corrected. 

The introduction is well written. 

Materials and methods

last line in: 'Setting and participants'

delate 'on the placement date' or expand a thought

The p value should be written in italic

Discussion is clearly presented.

CITATIONS: Schrott et al., observed that in patients with proper oral hygiene who received regular implant maintenance therapy, implants with reduced KM (<2 mm) were more prone to plaque accumulation and bleeding, as well as recession [15]. SHOULD BE
Schrott et al. [15], observed that in patients with proper oral hygiene who received regular implant maintenance therapy, implants with reduced KM (<2 mm) were more prone to plaque accumulation and bleeding, as well as recession. 

Add table with abbeviations before references.

References should be prepared according MDPI guidelines.

 Article can be accepted after major revision.

Author Response

Response Reviewer 1

 

First of all thank you for your suggestions to improve our article, below I attach the changes we have made based on your recommendations.

 

1. Affiliation: remove academic titles, merge affiliation. Add email addresses of co-authors.

Thank you for your suggestion. We have modified it:

Carla Fons-Badal ^a, Carlos Labaig-Rueda ^º, Rubén Agustín-Panadero ^º,*, Maria Fernanda Solá-Ruiz ^º, Ana Roig-Vanaclocha ^a , Lucía Fernadez-Estevan ^º and Antonio Fons-Font ^º.

^a Department of Oral Medicine, Faculty of Medicine and Dentistry, University of Valencia, Spain.

     [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]

 

2. Numerous punctuation mistakes should be corrected. 

Thank you for pointing this out, we have reviewed the text with our translator to correct it.

 

3. Materials and methods

• last line in: 'Setting and participants' delate 'on the placement date' or expand a thought: Thank you for pointing this out, we have delate it. We apologize for this mistake.
• The p value should be written in italic. Thank you for pointing this out, we have changed it.

 

4. CITATIONS: Schrott et al., observed that in patients with proper oral hygiene who received regular implant maintenance therapy, implants with reduced KM (<2 mm) were more prone to plaque accumulation and bleeding, as well as recession [15]. SHOULD BE
   Schrott et al. [15], observed that in patients with proper oral hygiene who received regular implant maintenance therapy, implants with reduced KM (<2 mm) were more prone to plaque accumulation and bleeding, as well as recession.

Thank you for your consideration, we have changed it in the text. We have changed all the references that were in the same conditions. For example: " Rocuzzo et al. [20], conducted a 10-year prospective study and observed that implants that were not surrounded by KM were more prone to plaque accumulation..."

5. Add table with abbeviations before references.

Thank you for your suggestion. We have added it:

KM	keratinized mucosa
GEE	generalized estimating equations
OR	odds ratio
BOP	bleeding on probing
PD	probing depth
BL	bone level
PI	peri-implantitis

 

6. References should be prepared according MDPI guidelines.

Thank you for pointing this out, we have modified it. For example:  

1. Schwarz, F.; Derks, J.; Monje, A.; Wang, H.L. Peri-implantitis. J Clinical Periodontol. 2018, Jun;45 Suppl 20: S246-S266.

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Abstract: The acronym KM is introduced without a definition

 

Introduction:

I don’t follow why the authors mention that 80% of patients with implants have mucositis?  Is that correct?

 

Please define what is defined as the absence of keratinized mucosa.

 

 

MM:

The exclusion criteria of immunosuppressive diseases is very broad. Is the presence of diabetes for example, considered as an exclusion criteria?

 

Results:

It would be good to add in table 1 the presence of absence of systemic diseases, and to mention the most common per group, and to include the presence or absence of systemic disease in the multiple logistic model

 

It should be added in table 1 if the implants were solitary or multiple, as this is a factor that would influence hygiene.

 

I would not suggest to present the conclusion as a list of bullet points.

Author Response

Reviewer 2

 

First of all thank you for your suggestions to improve our article, below I attach the changes we have made based on your recommendations.

 

1. Abstract: The acronym KM is introduced without a definition

Thank you for pointing this out, we have changed it:

"The presence of keratinized mucosa around the implants seems to be associated..."

 

 

2. Introduction:

I don’t follow why the authors mention that 80% of patients with implants have mucositis?  Is that correct?

In the conclusions of Zitzmann and Berglundh's article (reference number 3) it is pointed out that peri-implant mucositis occurred in approximately 80% of the subjects and in 50% of the implants and peri-implantitis was found in 28% and > or =56% of subjects and in 12% and 43% of implant sites. In our study we only contemplated peri-implantitis and healthy implants, but we considered that it was interesting to know this information in the introduction.

 

Please define what is defined as the absence of keratinized mucosa.

Thank you for your suggestion. We have added this definition in the introduction:

" The absence of KM is considered when there is no band of keratinized tissue around implants and is one of the most controversial issues..."

 

3. MM:

The exclusion criteria of immunosuppressive diseases is very broad. Is the presence of diabetes for example, considered as an exclusion criteria?

Thank you for pointing this out. Patients whose diseases could modify their immune system, including diabetes, were not included in the study. We have pointed it out in the text so that there is no confusion:

"... and without immunosuppressive pathologies, including diabetes, since it is a risk factor for peri-implantitis with extensive scientific evidence and we want to prevent it from influencing our results."

 

4. Results:

It would be good to add in table 1 the presence of absence of systemic diseases, and to mention the most common per group, and to include the presence or absence of systemic disease in the multiple logistic model

The most common systemic diseases were hypertension and hypercholesterolemia. The rest of pathologies, such as hypothyroidism, appeared in isolation. As their influence is not described in the literature and there was not a sufficient number of pathologies to define study groups that were statistically significant, we decided not to include them in the statistics. We have added a description of the diseases found in the results:

"The most common pathologies presented by the patients were hypertension and hypercholesterolemia in both groups, but their influence is not described in the literature

 

It should be added in table 1 if the implants were solitary or multiple, as this is a factor that would influence hygiene.

Thank you for your suggestion. We have added it to the table 1, to results and also to discussion:

 

"Most implants in both groups were multiple, 82% in peri-implantitis group and 66% in control group, but the difference between them were not statistically significant."

 

Multiple implants

66%

82%

 

 

"In addition, the percentage of multiple implants was higher in the peri-implantitis group, which could difficult hygiene, although these differences were not statistically significant."

 

5. I would not suggest to present the conclusion as a list of bullet points.

Thank you for your suggestion. We have modified it:

1. The presence of KM around the implants seems to have been associated with peri-implantitis and with a transparency of the peri-implant tissues.
2. The absence of KM appears to have an impact on certain clinical parameters: recession is augmented in implants with absence of KM; hygiene is facilitated when implants are surrounded by KM, therefore the plaque index is lower; probing depth tends to increase in implants without KM; bleeding and suppuration are reduced in the presence of KM and bone level tends to be lower in implants without KM.
3. Further researchs are needed in this field to clarify the relationship between KM and peri-implantitis.

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Article can be accepted after Editor decision.

Reviewer 2 Report

The authors have made all my suggested changes