A Modified Hyrax-Type Expander Is Effective for Distal Bodily Movement of the Maxillary First Molar
Round 1
Reviewer 1 Report
The article is very interesting
Author Response
Dear Reviewer 1
We would like to thank the reviewers and editors for reviewing our manuscript. Thank you for your interest in our manuscript. We received suggestions from other reviewers. We have revised the manuscript based on the reviewer comments. Please consider the attached manuscript that has been revised.
We hope you find our manuscript suitable for publication and look forward to hearing from you.
Sincerely,
Ken Miyazawa, DDS, PhD,
Department of Orthodontics
School of Dentistry, Aichi-Gakuin University
2-11 Suemori-Dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
Tel: +81-52-751-7181, Ext: 5378
Fax: +81-52-751-8900
E-mail: [email protected]
Reviewer 2 Report
I think is a interesting case report, well documented specially the images and drawings
Author Response
Dear Reviewer 2
We would like to thank the reviewers and editors for reviewing our manuscript. Thank you for your interest in our manuscript. We received suggestions from other reviewers. We have revised the manuscript based on the reviewer comments. Please consider the attached manuscript that has been revised.
We hope you find our manuscript suitable for publication and look forward to hearing from you.
Sincerely,
Ken Miyazawa, DDS, PhD,
Department of Orthodontics
School of Dentistry, Aichi-Gakuin University
2-11 Suemori-Dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
Tel: +81-52-751-7181, Ext: 5378
Fax: +81-52-751-8900
E-mail: [email protected]
Reviewer 3 Report
Dear Authors,
the case report treated is very interesting. The manuscript is well written, but I have a few observations to make:
The introduction should be a little longer and should have more recent bibliographic references.
The clinical case is well described and reproducible without problem.
The results are well represented. The figures are very beautiful and well described.
The discussion is fine. The conclusion is fine
Increase and update bibliographic references.
Author Response
Dear Reviewer 3
We would like to thank the reviewers and editors for reviewing our manuscript. We have revised the manuscript based on the reviewer comments. Please find our point-by-point responses to the comments below.
<Response to Reviewer 3 Comments>
Comments from Reviewer 3
Point 1: The introduction should be a little longer and should have more recent bibliographic references. Increase and update bibliographic references.
[Response to point 1]
Thank you for your comment.
The Introduction section has been lengthened and more recent references have been added. I have incorporated the new references into the list and rearranged them in order of their appearance in the text.
We hope you find our manuscript suitable for publication and look forward to hearing from you.
Sincerely,
Ken Miyazawa, DDS, PhD,
Department of Orthodontics
School of Dentistry, Aichi-Gakuin University
2-11 Suemori-Dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
Tel: +81-52-751-7181, Ext: 5378
Fax: +81-52-751-8900
E-mail: [email protected]
Reviewer 4 Report
Thank you very much for sharing a clinical case that uses a different option than usual. However, I would like to point out that this option does not seem to me to be the most appropriate for the case, since there are more predictable and adequate paths from the perspective of patient comfort. Your option is extremely old-fashioned and only results in a cooperating Patient, so it is not easily applied to a relevant population. Objectively, you achieved the desired result, but you used a path that was too "inventive", which has many other options that are much simpler, not only for the clinician but also for the patient.
Author Response
Dear Reviewer 4
We would like to thank the reviewers and editors for reviewing our manuscript. We have revised the manuscript based on the reviewer comments. Please find our point-by-point responses to the comments below.
<Response to Reviewer 4 Comments>
Comments from Reviewer 4
Point 1: However, I would like to point out that this option does not seem to me to be the most appropriate for the case, since there are more predictable and adequate paths from the perspective of patient comfort.
[Response to point 1] Thank you for your comment. There were several possible treatment options for the maxillary canine eruption disturbance in the present case, but after discussing their advantages and disadvantages with the patient, we decided to use this treatment method. These details have been added to the Treatment Alternatives section (p6, Line 175 to p7, Line 198).
Point 2: Your option is extremely old-fashioned and only results in a cooperating Patient, so it is not easily applied to a relevant population. Objectively, you achieved the desired result, but you used a path that was too "inventive", which has many other options that are much simpler, not only for the clinician but also for the patient.
[Response to point 2] It is true that traction of a maxillary canine and distal movement of a maxillary molar can be achieved using anchor screws, which is a common practice nowadays. However, we believe that the treatment method described in this paper is an effective alternative in patients for whom orthodontic treatment using anchor screws is not an option for reasons such as patient refusal, young age, insufficient bone thickness, and prior screw dropout. In addition, commonly used maxillary molar distal movement appliances, including the pendulum and Greenfield molar distalizer appliances, have been reported to cause distal inclination of the maxillary first molar while it is being moved distally. Therefore, we designed our appliance to be strong enough to prevent distal inclination of the first molar to the extent possible. These details have been added to the Treatment Alternatives section (p7, Line 199 to 209) and the Conclusions section (p14, Line 422 to 425).
We hope you find our manuscript suitable for publication and look forward to hearing from you.
Sincerely,
Ken Miyazawa, DDS, PhD,
Department of Orthodontics
School of Dentistry, Aichi-Gakuin University
2-11 Suemori-Dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
Tel: +81-52-751-7181, Ext: 5378
Fax: +81-52-751-8900
E-mail: [email protected]
Reviewer 5 Report
Dear authors, this paper is an interesting approach to impacted canine treatment. In section Diagnosis is the following sentence: "The facial features were symmetrical in the frontal view, with the maxillary midline 49 coinciding with the facial midline and the mandibular midline deviated 1.5 mm to the left 50 when smiling". There is no photograph of the patient smiling so we cannot be sure if it is right. You also mentioned that the upper left first molar was inclined mesialy. Have You maybe consider the fact that it is due to premature loss of deciduous teeth. My suggestion is to explain the treatment plan, because it is unusual to extract the second molar in such a case. Have You consider the extraction of lower left third molar, because of no occlusal contact due to reduced number of teeth in upper left segment. And finally, we have a lot of bone borne appliances indisposition for such complex cases.
Author Response
Dear Reviewer 5
We would like to thank the reviewers and editors for reviewing our manuscript. We have revised the manuscript based on the reviewer comments. Please find our point-by-point responses to the comments below.
<Response to Reviewer 5 Comments>
Comments from Reviewer 5
Point 1: In section Diagnosis is the following sentence: "The facial features were symmetrical in the frontal view, with the maxillary midline coinciding with the facial midline and the mandibular midline deviated 1.5 mm to the left when smiling". There is no photograph of the patient smiling so we cannot be sure if it is right.
[Response to point 1] Thank you for your comment.
We changed the facial photographs of the patient when smiling before the start of treatment. Although these may not be good smile photos, we chose the ones in which the maxillary and mandibular midlines could be easily identified (p3, Line 93).
Also, the previous version of the manuscript stated that the mandibular midline was deviated to the left but this was incorrect. The patient’s mandibular midline was actually deviated to the right. This error has been corrected in the revised version of the manuscript. The corresponding text in the Diagnosis and Etiology section has also been corrected (p2, Line 80).
Point 2: You also mentioned that the upper left first molar was inclined mesialy. Have You maybe consider the fact that it is due to premature loss of deciduous teeth.
[Response to point 2] The patient was 14 years old at the initial visit, and neither he nor his guardians were aware of or remembered whether there were any abnormalities in tooth replacement or premature loss of teeth during the deciduous-to-permanent dentition phase. These details have been added to the Diagnosis and Etiology section (p2, Line 84 to 86). We also found some literature on premature tooth loss and canine eruption disturbances and have added references to these studies to the Introduction section (p1, Line 34 to 42).
Point 3: My suggestion is to explain the treatment plan, because it is unusual to extract the second molar in such a case.
[Response to point 3] The reason the treatment method was chosen for the present patient is described in the Treatment Alternatives section (p6, Line 175 to p7, Line 198). Details of the treatment plan have also been added to the Treatment Objectives section (p6, Line 164 to 170).
Point 4: Have You consider the extraction of lower left third molar, because of no occlusal contact due to reduced number of teeth in upper left segment.
[Response to point 4] As a result of treatment, the mandibular left third molar does not have occlusal contact with the maxillary left molars. We thus encouraged the patient to have the tooth extracted, but he has not yet done so for his own reasons. However, we are still urging him to have the tooth extracted.
Regarding this fact, the Treatment Results section of the original version of the manuscript stated “The maxillary right third molar and mandibular right and left third molars are impacted and scheduled for extraction” (p7, Line 276 to 278). In the revised manuscript, text about the extraction of the third molar has been added to the Treatment Progress section (p7, Line 240 to 244).
Point 5: And finally, we have a lot of bone borne appliances indisposition for such complex cases.
[Response to point 5] It is true that traction of a maxillary canine and distal movement of a maxillary molar can be achieved using anchor screws, which is a common practice nowadays. However, we believe that the treatment method described in this paper is worth reporting because it is an effective alternative in patients for whom orthodontic treatment using anchor screws is not an option for reasons such as patient refusal, young age, insufficient bone thickness, and prior screw dropout. The relevant text has been added to the Treatment Alternatives section (p7, Line 199 to 209) and the Conclusions section (p14, Line 422 to 425).
We hope you find our manuscript suitable for publication and look forward to hearing from you.
Sincerely,
Ken Miyazawa, DDS, PhD,
Department of Orthodontics
School of Dentistry, Aichi-Gakuin University
2-11 Suemori-Dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
Tel: +81-52-751-7181, Ext: 5378
Fax: +81-52-751-8900
E-mail: [email protected]
Round 2
Reviewer 5 Report
Dear authors, thank You for taking my suggestion into consideration .
