Preliminary Approach for Open Lateral Window Technique for Successful Maxillary Sinus Augmentation in the Unrepairable Wide Perforation Area of Schneiderian Membrane

Round 1

Reviewer 1 Report

Dear authors! I would like to comment on the following issues: 

-Introduction needs rewritten in order to properly address the clinical problem that you are trying to solve. Why previous protocols are not enough for some cases? what are the disadvantages of what is proposed until today that you wanted to address in your case? Make clear what has driven you to consider doing this technique? You should then mention the current protocols and what you are trying to experience with your surgical print. Some of the information needed are written in the part of discussion (lines 253-297) and should be transferred to the introduction part.

-In the description of the surgical procedure (lines 64-87) you may consider of doing a graphical plot to better describe your revised protocol.

-From ethics point of view have you consider taking a permission from your association in order to perform the procedures? were patients informed of the risks of placing implants simuoultaneously with the grafts (you missed implant 26). Please mention.

- Discussion part need serious refreshing. from lines 253 to 297 you are describing what a someone can find in a book chapter without adding something to the story. You should select the information and write it according to the problems you faced or the issues that you tried to address in your clinical approach. It seems as if you accidentally did what you did with no real explanation of why you choose to do what you did. You should also write about the difficulties the team encountered during surgery and what are your next plans for improving your approach.   

Conclusion section needs also improvement. The presentation is basic and not convincing. 

Overall your reference list should be refreshed with modern references as surgical procedures and materials have long changed since 1980s or even 1990s. 

Thank you for your effort!

Author Response

Thank you very much for your review and comments.  Please see below our responses.

-Introduction needs rewritten in order to properly address the clinical problem that you are trying to solve. Why previous protocols are not enough for some cases? what are the disadvantages of what is proposed until today that you wanted to address in your case? Make clear what has driven you to consider doing this technique? You should then mention the current protocols and what you are trying to experience with your surgical print. Some of the information needed are written in the part of discussion (lines 253-297) and should be transferred to the introduction part.​

Rewritten as requested see highlighted sections

-In the description of the surgical procedure (lines 64-87) you may consider of doing a graphical plot to better describe your revised protocol. ​

Thank you for the great proposal.  Rather than an illustration, wording has been changed to describe the protocol more clearly.

-From ethics point of view have you consider taking a permission from your association in order to perform the procedures? were patients informed of the risks of placing implants simuoultaneously with the grafts (you missed implant 26). Please mention.-​

We added a section that patients were given informed consent

- Discussion part need serious refreshing. from lines 253 to 297 you are describing what a someone can find in a book chapter without adding something to the story. You should select the information and write it according to the problems you faced or the issues that you tried to address in your clinical approach. It seems as if you accidentally did what you did with no real explanation of why you choose to do what you did. You should also write about the difficulties the team encountered during surgery and what are your next plans for improving your approach.   ​

We included limitations and tried to address this section.

Conclusion section needs also improvement. The presentation is basic and not convincing.

Done and rewritten

Overall your reference list should be refreshed with modern references as surgical procedures and materials have long changed since 1980s or even 1990s. -

Thank you for the suggestion.  Classic literature gives us the standard and transition of care, although there are recent publications, classic lit allows us to understand the foundation of the clinical decision tree.

Reviewer 2 Report

I congratulate the authors on performing this research, however having written that, I do have some questions:

 

1.     I would consider adding “preliminary report” to the title, due to the low number of presented cases.

2.     In my clinical experience I have seen multiple cases of open sinus lifting procedures, that unfortunately resulted in chronic rhinosinusitis, hemorrhage or ostium blockage. Although I applaud the authors on achieving such positive results, I do have my concerns regarding the occurrence of fistula in proposed approach.

3. Please elaborate on the limitations of performed study.
4. Due to low height of residual bone, there is a high possibility of displacing the implants into the sinus cavity. What methods have been adopted to prevent such situation, if any.
5. Have you recorded the duration of each surgical intervention? Such variable may have had an influence on some of the study outcomes.
6. Facial edema was evaluated qualitatively (moderate facial swelling?) although quantitative methods have been described in the literature. Please report references about the methods you have adopted.

Author Response

Thank you very much for your review and suggestions.  Please see our responses below.  

1. I would consider adding “preliminary report” to the title, due to the low number of presented cases.

Done.

2. In my clinical experience I have seen multiple cases of open sinus lifting procedures, that unfortunately resulted in chronic rhinosinusitis, hemorrhage or ostium blockage. Although I applaud the authors on achieving such positive results, I do have my concerns regarding the occurrence of fistula in proposed approach.
3. Please elaborate on the limitations of performed study.- Completed in dicussion 
4. Due to low height of residual bone, there is a high possibility of displacing the implants into the sinus cavity. What methods have been adopted to prevent such situation, if any.- Completed in discussion 
5. Have you recorded the duration of each surgical intervention? Such variable may have had an influence on some of the study outcomes.- No, surgical duration has not been recorded but the average time spent on surgeries did not deviate much from standard procedures.
6. Facial edema was evaluated qualitatively (moderate facial swelling?) although quantitative methods have been described in the literature. Please report references about the methods you have adopted.​Thank you very much for the suggestion.  We were not aware of any quantitative methods of evaluating facial edema.  The word "moderate" was used to describe the normal or expected amount of edema after such surgical procedures.

 

Round 2

Reviewer 1 Report

Revised version is accepted.

Minor spelling and language issues need to be addressed. Thank you for the effort!

Reviewer 2 Report

Dear Authors, I still have a couple of remarks, however I will wait for you to publish results of clinical research, not only a series of 3 cases, basing on which is hard to evaluate the exact usefulness of the method.