Novel Digital Technique to Analyze the Influence of the Operator Experience on the Accuracy of the Orthodontic Micro-Screws Placement

Round 1

Reviewer 1 Report

This is a very contemporary study in the field of orthodontics used »biomaterials« to enhance orthodontic tooth movement. The aim of the study is very clear: to analyze the influence of the operator experience on the accuracy of the orthodontic self-tapping micro-screws placement in a group of 60 orthodontic self-tapping micro-screws which were further randomly distributed into two study groups that differed according to examiners with different clinical expertise (student and specialist).

Cone-beam computed tomography scans and intraoral scans were performed before and after the orthodontic self-tapping micro-screws placement and uploaded in 3D implant-planning software to analyze the deviation angle and the horizontal deviation measured at the coronal entry point and apical endpoint between orthodontic micro-screws planned and performed. Intraoperative complications as root perforations after the orthodontic self-tapping micro-screws placement and the fracture of the orthodontic self-tapping micro-screws during their placement were analyzed. 

The aim of the study was clearly stated, however in the methods a more precise analysis of the materials used in the micro-screw should be presented and described. This is verz important and is missing in the introduction, methods and conclusion section of this manuscrpt.

In conclusion, the results show that the experience of the operator influence on the accuracy of orthodontic micro-screws placement; resulting less intraoperative complications. However, the authors should present a more detailed conclusion regarding the materials used in mini-screws (metals) for orthodontic tooth movement.

Author Response

Dear Author 1,

I’m pleased to resubmit the manuscript of the work entitled, “Novel Digital Technique to Analyze the Influence of the Operator Experience on the Accuracy of the Orthodontic Micro-screws Placement”.

Reviewer 1: The aim of the study was clearly stated, however in the methods a more precise analysis of the materials used in the micro-screw should be presented and described. This is verz important and is missing in the introduction, methods and conclusion section of this manuscrpt.

In conclusion, the results show that the experience of the operator influence on the accuracy of orthodontic micro-screws placement; resulting less intraoperative complications. However, the authors should present a more detailed conclusion regarding the materials used in mini-screws (metals) for orthodontic tooth movement.

Response: In order to respond to the reviewer 1 comment, we have added some sentences at the Introduction, Material and methods and Conclusion sections of the manuscript.

We take this opportunity to thank the recommendations and suggestions made by the reviewer to improve the document.

Yours sincerely,

Reviewer 2 Report

The authors of the manuscript focused on  novel digital technique in dental surgery. In the manuscript analyzed the influence of the surgeon's experience on the accuracy of the orthodontic self-tapping micro-screws placement.

In part the materials and methods miss age composition of the studied population. I positively evaluate the novel digital technique used in manuscript.

Table and figures in the text are very clearly written.

In the results, the authors should describe more describe whether there were any postoperative complications.

The discussion needs to be extended to the following facts.

Page 10, lines 226-242: The authors describe various intraoperative complications. It is necessary to think about bleeding complications. In the literature, the incidence of postoperative bleeding after invasive dental treatments in patients with appropriate hemostasis is estimated at between 0.2% and 3.3%, while the occurrence of postoperative bleeding after oral surgery in patients with hemostasis disorders is in the range 8.6%–32.1%. It is very difficult to manage patients with congenital bleeding disorders (von Willebrand disease) that require careful attention. It is in these patients that dental procedures are often required due to frequent mucosal bleeding. Treatment should be adjusted in these patients to prevent bleeding. It is also appropriate to quote this publications : Simurda  et al. Successful Use of a Highly Purified Plasma von Willebrand Factor Concentrate Containing Little FVIII for the Long-Term Prophylaxis of Severe (Type 3) von Willebrand's Disease. Semin Thromb Hemost. 2017 Sep;43(6):639-641.doi: 10.1055/s-0037-1603362. and De Padua V et t al. Dental invasive procedures in von Willebrand disease outpatients treated with high purity FVIII/VWF complex concentrate (Fanhdi®): experience of a single center. Heliyon. 2020;6(2):e03426. doi:10.1016/j.heliyon.2020.e03426

I have to say that with these 33 references there are only 9 references newer than 5 years old. Therefore, it is necessary to add newer refence.

The conclusion is short but concise.

Author Response

Dear Reviewer 2,

I’m pleased to resubmit the manuscript of the work entitled, “Novel Digital Technique to Analyze the Influence of the Operator Experience on the Accuracy of the Orthodontic Micro-screws Placement”.

Reviewer 2: In part the materials and methods miss age composition of the studied population. I positively evaluate the novel digital technique used in manuscript.

Response: In order to adapt to the reviewer 2 comments, we clarified the age composition of the studied population at the Material and Methods section.

Reviewer 2: In the results, the authors should describe more describe whether there were any postoperative complications.

Response: In order to respond to the reviewer 2 comments, we clarified that in this in vitro study there were no more postoperative complications than the root perforations noted in the Results section.

Reviewer 2: The discussion needs to be extended to the following facts. Page 10, lines 226-242: The authors describe various intraoperative complications. It is necessary to think about bleeding complications. In the literature, the incidence of postoperative bleeding after invasive dental treatments in patients with appropriate hemostasis is estimated at between 0.2% and 3.3%, while the occurrence of postoperative bleeding after oral surgery in patients with hemostasis disorders is in the range 8.6%–32.1%. It is very difficult to manage patients with congenital bleeding disorders (von Willebrand disease) that require careful attention. It is in these patients that dental procedures are often required due to frequent mucosal bleeding. Treatment should be adjusted in these patients to prevent bleeding. It is also appropriate to quote this publications : Simurda et al. Successful Use of a Highly Purified Plasma von Willebrand Factor Concentrate Containing Little FVIII for the Long-Term Prophylaxis of Severe (Type 3) von Willebrand's Disease. Semin Thromb Hemost. 2017 Sep;43(6):639-641.doi: 10.1055/s-0037-1603362. and De Padua V et t al. Dental invasive procedures in von Willebrand disease outpatients treated with high purity FVIII/VWF complex concentrate (Fanhdi®): experience of a single center. Heliyon. 2020;6(2):e03426. doi:10.1016/j.heliyon.2020.e03426

Response: In order to adapt to the reviewer 2 comments, we have added a sentence in the Discussion section.

We take this opportunity to thank the recommendations and suggestions made by the reviewers to improve the document.

Yours sincerely,

Round 2

Reviewer 2 Report

The presented manuscript has been corrected in response to the suggestions. The authors have followed the recommendations of the reviewers. After the revision, the provided data and interpretation of the results became more clear. I would like to thank the authors for resubmitting the manuscript and explaining the obscure points from the previous version.

For final corrections, it is necessary to correctly number the newly added references, subsequently the revised manuscript can be accepted for publication.