Impact and Stability of Mandibular Setback after Intraoral Vertical Ramus Osteotomy

Round 1

Reviewer 1 Report

Dear Authors,

thank you very much. for your submission.

The introduction is very interesting to read with an historical excursion. You could add in your analysis these two important papers.

Ugolini A, Mapelli A, Segù M, Zago M, Codari M, Sforza C. Three-dimensional mandibular motion in skeletal Class III patients. Cranio. 2018 Mar;36(2):113-120. doi: 10.1080/08869634.2017.1299830. Epub 2017 Mar 17. PMID: 28303737.

Ugolini A, Mapelli A, Segù M, Galante D, Sidequersky FV, Sforza C. Kinematic analysis of mandibular motion before and after orthognathic surgery for skeletal Class III malocclusion: A pilot study. Cranio. 2017 Mar;35(2):94-100. doi: 10.1080/08869634.2016.1154681. Epub 2016 Apr 6. PMID: 27077258.

You analyzed the IVRO very accurately in term of cephalometric variables, TMJ dysfunction, neurosensory dysfunction, IMF compliance and osteotomy. design.

I'd like to read a  comparison with other surgical techniques. 

Author Response

First of all thank you for your valuable comments.

Point 1: 

The introduction is very interesting to read with an historical excursion. You could add in your analysis these two important papers.

Ugolini A, Mapelli A, Segù M, Zago M, Codari M, Sforza C. Three-dimensional mandibular motion in skeletal Class III patients. Cranio. 2018 Mar;36(2):113-120. doi: 10.1080/08869634.2017.1299830. Epub 2017 Mar 17. PMID: 28303737.

Ugolini A, Mapelli A, Segù M, Galante D, Sidequersky FV, Sforza C. Kinematic analysis of mandibular motion before and after orthognathic surgery for skeletal Class III malocclusion: A pilot study. Cranio. 2017 Mar;35(2):94-100. doi: 10.1080/08869634.2016.1154681. Epub 2016 Apr 6. PMID: 27077258.

 

Response 1: We have read the articles you recommended. we added to our discussion on TMJ dysfunction a reference of the paper "Three-dimensional mandibular motion in skeletal Class III patients".
The article is numbered in the references as a 27 reference.

Point 2: I'd like to read a  comparison with other surgical techniques. 

Response 2: Our article focuses on VRO technique for the treatment of mandibular prognathism. The article provide update evaluation on skeletal and dental stability the technique complications rate.

These days we are working on another article that reviews and compares the complications and stability rate between VRO and SSO for the of mandibular prognathism. 

Reviewer 2 Report

Any exclusion criteria for the study recruiting?

Any CBCT data to show bone healing?

Any data to show soft tissue improvement?

 

Author Response

First of all thank you for your valuable comments.

Point 1: Any exclusion criteria for the study recruiting?

 

Response 1: Exclusion criteria: patients who had surgery that included SSO on one side of the ramus and VRO on the other side, patients who did not have sufficient follow-up/records post surgery.

 

Point 2: Any CBCT data to show bone healing?

 

Response 2: In our current article we did not rely on CBCT imaging to assess bone healing, we relied on clinical examination and post-operative cephalometric imaging.

 

Point 3: Any CBCT data to show bone healing?

 

Response 3: In our current article we did not evaluate soft tissue improvement but it could be an interesting topic for our next study.

Reviewer 3 Report

In the title, "Impact" seems to be ambitious so better to remove this from title. Stability assessment conveys the purpose of the study

In the Introduction, 2nd paragraph has no citations, should be cited.
There may be a mention of similar studies already done in the same population.
The study included retrospective data from 2005 to 2021 and it may have biases like the differences in the quality of radiographs, techniques and equipment used for radiographs, wearing off of the radiographs taken many years ago. How were these biases overcome and should be included in the limitations of this study. 
Conclusion is short, better to mention some recommendation for future studies.

Author Response

First of all thank you for your valuable comments.

Point 1: In the title, "Impact" seems to be ambitious so better to remove this from title. Stability assessment conveys the purpose of the study.

Response 1: We referred for "impact" in our title because our article not only assess the stability of the technique, but also TMJ and neurosensory functions, as well as IMF compliance.

Point 2: In the Introduction, 2nd paragraph has no citations, should be cited.

Response 2: We added a reference to the 2nd paragraph in the introduction.

Point 3: There may be a mention of similar studies already done in the same population.

Response 3: We mentioned studies that evaluate IVRO on similar parameter is in our article. are there any specific articles will should referred to ? 

Point 4: The study included retrospective data from 2005 to 2021 and it may have biases like the differences in the quality of radiographs, techniques and equipment used for radiographs, wearing off of the radiographs taken many years ago. How were these biases overcome and should be included in the limitations of this study. 

Response 4: All our radiographs were taken using the same X-ray machine that located in our out-patients clinic. The photographs were saved in a digital copy in the patient's file. It worth mention that 6 years ago the x ray machine was replaced by an update version. 

Point 5: Conclusion is short, better to mention some recommendation for future studies.

Response 5: We added a recommendation for future studies in the conclusion paragraph.