Assessing the Impact of Maxillomandibular Difference on the Success of Orthodontic Decompensation Preparation in Orthognathic Surgical Skeletal Class-III Patients

Round 1

Reviewer 1 Report (New Reviewer)

Dear authors, thank you for the opportunity of reviewing your work. However I found significant criticism in your work that made me considered for a rejection. 

- there is no sample size calculation

- there is no information regarding the orthodontic kind of preparation. For example there is no information regarding the use for teeth extraction for the preparation. I expect that a non-extraction orthodontic preparation can determine a more proclined incisors proclination 

- the results have a limited scientific soundness. You are demonstrating (with the limitations that I have written before) that the higher the discrepancy the higher the difficulty in achieving a proper incisors decompensation and this is not a novel result. Furthermore it is already known that achieving a proper incisor decompensation is more difficult in the maxillary than in the mandible in a class III

 

Author Response

• there is no sample size calculation
• the sample size was decided with the statistician we can provide a sample calculation, we didn't think it was necessary to show the calculation of the sample size in the article itself, but we can provide it.
• there is no information regarding the orthodontic kind of preparation. For example there is no information regarding the use for teeth extraction for the preparation. I expect that a non-extraction orthodontic preparation can determine a more proclined incisors proclination
• true, we will add the orthodontic preparation type in the article, all the preparation was done without extraction, thank you for the input.

- the results have a limited scientific soundness. You are demonstrating (with the limitations that I have written before) that the higher the discrepancy the higher the difficulty in achieving a proper incisors decompensation and this is not a novel result. Furthermore it is already known that achieving a proper incisor decompensation is more difficult in the maxillary than in the mandible in a class III
not true ,  we are not only applying the mentioned above , the correlation between discrepancy and the difficulty of achieving a proper incisors decompensation is well know, but we are apply a relationship between the size of the mandibule as well as the maxilla to the discrepancy, we are saying that the more CO-A length the more discrepancy we have. 
we are also mentioning the limitation of the orthodontic analysis which was done by 2d analysis rather than 3d analysis.

thank you for the input you have given, it was very enriching, we will take your points into consideration for the future and so.

Reviewer 2 Report (Previous Reviewer 1)

The present study entitled "Success of orthodontic decompensation preparation in orthognathic surgical skeletal class III patients" aimed to verify the correlation between orthodontic decompensation the maxillomandibular difference, evaluating whether the severity of the deformity and associated with the orthodontist's difficulty in achieving an accurate result in orthodontic decompensation preparation.

However, the manuscript should be subject to some corrections to improve its quality.

 

1.      Introduction

 

“Over the years, The classification has been modified, for diagnostic purposes, to facial structure classification as well”, please correct "The" to "the".

 

“As mentioned above, class-III occlusion is a condition in which the mandibular first molar is positioned anterior to the maxillary molar”, please eliminate " As mentioned above ".

 

I believe that the introduction is excessively long. A lot of information is redundant in my opinion, since the work is aimed at specialists in the field who are familiar with the main cephalometric points. Therefore, I consider that the following part should be reworded to make it shorter and more concise or, alternatively, moved to the “materials and methos” paragraph:

" The lateral cephalometric radiograph is the diagnostic tool that serves as the gold

standard in evaluating soft and hard tissue prior to orthodontic treatment, as well as for

the evaluation and planning of orthognathic surgery using a list of standard-specific structures and measurements 14,15. Part of the points (landmarks) on the cephalometric radio[1]graph include 4

: A point (subnasal)- the most concave point of the maxilla; B point (supra[1]mental)- the most concave point on mandibular symphysis; N point (nasion) – the most

anterior point on frontonasal suture; Or (orbitale) – the most inferior point on the margin

of orbit; Po (porion) – the most superior point of outline of external auditory meatus; Anterior nasal spine (ANS) – the anterior point on maxillary bone; Posterior nasal spine

(PNS) - posterior limit of bony palate or maxilla; condylion (Co) – the most posterior/superior point on the condyle of mandible; Gnathion (Gn) - Point located perpendicular on

mandibular symphysis; Gonion (Go) - The most posterior inferior point on the angle of

the mandible.

Based on the anatomical landmarks, there are a few planes addressed on the radio[1]graph: Frankfort horizontal plane (FH: Or–Po) - represents the habitual postural position

of the head; the Palatal plane (PP: ANS-PNS) - represents the plane of the maxilla; Mandibular plane (MP: Go-Gn) – represents the lower border of the mandible; U1 – upper

incisor tooth plane, from the incisal edge to the root apex of the upper incisor tooth; L1 -

lower incisor tooth plane, from the incisal edge to the root apex of the lower incisor tooth;"

 

Please better formulate the objectives of the study.

 

4.      Conclusion

I believe the conclusions are excessively long and verbose, please make them more concise.

Kindly,review punctuation and spelling.

In conclusion, I believe the paper is well written and structured, and can provide valuable support to the clinician facing such a therapeutic challenge. Therefore, in my opinion, it is suitable for publication after making the changes indicated earlier.

Kindly,review punctuation and spelling.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report (New Reviewer)

The manuscript entitled "Success of orthodontic decompensation preparation in orthognathic surgical skeletal class III patients" is problematic on several levels. Firstly, the null hypothesis/Aim is unclear. Meaning, dental decompensation is described by the authors and is understood to require planning, however, no method of doing so is described. In addition, it is not clear from the data that the difficulty in doing so is in fact more "problematic" in the maxillary incisors.  There is no relevant clinical outcome derived from the analysis of the cephalometric data. Meaning, that to conclude that there is difficulty in determining the needed pre-surgical orthodontic decompensations being more difficult in the maxillary incisors than of the mandibular incisors does not improve our body of knowledge. Furthermore, it is unclear from the data how this conclusion is derived.

The authors should consult with an English language service to improve the quality of the text.

The authors quote a reference by "Angel" when the proper reference should be credited to "Angle". Also, the authors stated that they submitted and received approval from an "international" review board (IRB), however, the proper delineation is "INSTITUTIONAL" review board (IRB).

The authors made no reference to the level of significance they "set" their p-value to, therefore, it is impossible to determine the relationship of the stated conclusions to that of the data presented.

This manuscript requires revision before it can be considered for publication

There are multiple grammatic errors and misspellings in the manuscript. These will need to be addressed prior to consideration for publication.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report (New Reviewer)

Dear authors, 

 

Author Response

thanks

Reviewer 3 Report (New Reviewer)

The authors contend that that the skeletal difference between the jaws are related to the greater difficulty in resolving maxillary incisor decompensation. This contention can also be arrived at without experimental data given that the subjects enrolled in the present study have relatively retruded maxilla’s with proclined incisors and were treated  non-extraction. Hence, it is more difficult to decompensate these teeth because space needs to be created to do so, versus retroclined lower incisors which only require proclination.

This seemingly obvious interdependence requires an explanation by the authors including relating this to their findings and conclusions

There are still some grammatical errors which require addressing.

Author Response

Thank you for your prompt reply 

your valuable notice will be taken into account, 
the importance of our finding is that orthodontic treatment should consider the maxilla more. Mandibular diff,
the findings showed that even with a large MM diff, the orthodontics still didn't choose to extract teeth or any other treatment to get to decompensate teeth probably; our study shows the connection as well as criticism to the orthodontic treatment of 50 patients.

Ill add the following to the new manuscript for clarification.
thanks you again

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

 

Credo che gli autori abbiano affrontato un argomento molto interessante sia clinicamente e teoricamente, ma con un approccio un po 'datato a causa di Progressi nei sistemi di scansione e nel software di reverse engineering per il settore medicale applicazioni. Le terze classi scheletriche sono tra le malocclusioni più complesse per l'ortodontista da trattare e presentare una vera sfida. In tale contesto, Il presente studio, che mira a valutare la preparazione ortodontica di pazienti con deformità facciale di classe III ed esplorare se esiste un correlazione tra la gravità della deformità e l'ortodontista difficoltà nel raggiungere un risultato accurato in scompenso ortodontico preparazione, è di interesse.

Tuttavia, a mio parere, in relazione a nuovi approcci diagnostici e nuovi software disponibile, credo che parlando esclusivamente di parametri derivati dagli studi cefalometrici è riduttivo. Pertanto, credo che approfondire la possibilità di pianificare lo scompenso e la progettazione chirurgica utilizzando nuovi I sistemi che sfruttano lo studio scheletrico 3D sono molto più interessanti.

1. Inserisci un breve paragrafo sulla possibilità di gestire questo tipo di paziente attraverso nuovi software per lo studio 3D di modelli scheletrici e dentali.

2. Ritengo che il La descrizione di tutte le classi di angoli è superflua. Il manoscritto è destinato a specialisti del settore che non hanno bisogno di una descrizione accurata. Vorrei eliminare completamente tutta la seguente parte "Denti e scheletrico relazione si basano sulla classificazione di Angel ....... La classificazione è stata modificato, a fini diagnostici, alla classificazione della struttura facciale come beh."

3. Definire meglio il Obiettivi dello studio: c'è una differenza tra quanto descritto nel abstract e quanto affermato nell'introduzione.

4. Riformulare il Conclusioni

English version 4.12 

I believe that the authors have addressed a very interesting topic both clinically and theoretically, but with a somewhat dated approach due to advances in scanning systems and reverse engineering software for medical applications. The third skeletal classes are among the most complex malocclusions for the orthodontist to treat and present a real challenge. In this context, The present study, which aims to evaluate the orthodontic preparation of patients with class III facial deformities and explore whether there is a correlation between the severity of the deformity and the orthodontist difficulty in achieving an accurate result in orthodontic decompensation preparation, is of interest.

However, in my opinion, in relation to new diagnostic approaches and new software available, I believe that speaking exclusively of parameters derived from cephalometric studies is reductive. Therefore, I believe that deepening the possibility of planning decompensation and surgical design using new systems that exploit 3D skeletal study are much more interesting.

 

1. Insert a short paragraph on the possibility of managing this type of patient through new software for the 3D study of skeletal and dental models.

 

2. I consider that the Description of all classes of angles is superfluous. The manuscript is intended for specialists in the field who do not need an accurate description. I would like to completely delete all the following part "Teeth and skeletal relationship are based on Angel's classification....... The classification has been changed, for diagnostic purposes, to the classification of facial structure as well."

 

3. Define better the objectives of the study: there is a difference between what is described in the abstract and what is stated in the introduction.

 

4. Reformulate the Conclusions