Correlation between Mesio-Distal Angulation and Bucco.-Lingual Inclination of First and Second Maxillary Premolars Evaluated with Panoramic Radiography and Cone-Beam Computed Tomography
, Riccardo Nucera 2, Angela Militi 2, Alessandra Lucchese 3,4,5, Marco Portelli 2,* and Alberto Caprioglio 6Round 1
Reviewer 1 Report
Dear Authors, first of all I would like to congratulate You on your work. The topic Is of great clinical relevance. However, I believe that the article could be improved. Please, take a note of some suggestions.
1) Introduction- this section is too long and should be more focused on the topic in question. I suggest limiting general information regarding both diagnostic tools. Moreover, the aim of the study (line 85) needs rewriting, as it is not clear.
2) Materials and methods- this section is well organized. My biggest concern is the number of participants. As far as I understand 45 patients, and 15 CBCT were analyzed. This sample is very small. In the next paragraph (line 149) sample size calculation is briefly mentioned. Please, describe this part meticulously as this is very important. To be honest, the number of analyzed CBCTs is one of my biggest concerns regarding your manuscript. For retrospective studies the sample should be as big as possible to strengthen the outcomes.
What is more, please tell how many people were responsible for analysis of OPGs and CBCTs? Were they calibrated? Please describe calibration process. If calibration was not carried out, this is very serious disadvantage of the study and should be thoroughly described in appropriate section in Discussion.
3) Statistical analysis is very basic. Only correlations were calculated. The sentence from lines 165-167 should be put in Results section.
4) Results- only one table summarizes the observations. Moreover, the only observed correlations are weak in nature. It should be checked using biggest sample.
5) Discussion- this paragraph should be rearranged. It is very chaotic. Please do not repeat information from Introduction and try to be more focused. Rewrite this section using following paragraphs: main results and clinical relevance; comparison with other studies; advantages and disadvantages of the study; conclusions and suggestions for future studies.
6) Conclusions- try to simplify this section.
Taking everything in consideration, I strongly suggest that you rearrange the manuscript (especially Introduction and Discussion) and enlarge the sample size. Please, be more focused on the topic and do not repeat the same information several times. Describe sample size calculation and calibration. I believe that your manuscript would have much more relevance after suggested improvements.
Author Response
Dear reviewer
thank you so much for your suggestions, we revised the manuscript following your indications and I report below the responses to your observations
- Introduction- this section is too long and should be more focused on the topic in question. I suggest limiting general information regarding both diagnostic tools. Moreover, the aim of the study (line 85) needs rewriting, as it is not clear.
Introduction section has been reduced, focusing on topic in question, and on the basis of reviewer’s suggestion the the aim of the study has been rephrased in this way:
“The aim of this retrospective clinical study was to evaluate the reliability of the measurement of the mesio-distal angulation of the first and second premolar on orthopantomographic radiography; for this purpose a comparative evaluation was made with the measurements of the mesio-distal angulation and the buccolingual inclination of the same dental elements through CBCT images”
2) Materials and methods- this section is well organized. My biggest concern is the number of participants. As far as I understand 45 patients, and 15 CBCT were analyzed. This sample is very small. In the next paragraph (line 149) sample size calculation is briefly mentioned. Please, describe this part meticulously as this is very important. To be honest, the number of analyzed CBCTs is one of my biggest concerns regarding your manuscript. For retrospective studies the sample should be as big as possible to strengthen the outcomes.
Sample size of at least 9 subjects was necessary to detect a power of 0.8. Sample size was calculated on three subjects on the angular measurements of upper first premolar (difference between means=1.5 degrees; SD=1.1 degrees).
What is more, please tell how many people were responsible for analysis of OPGs and CBCTs? Were they calibrated? Please describe calibration process. If calibration was not carried out, this is very serious disadvantage of the study and should be thoroughly described in appropriate section in Discussion.
Calibration was performed by two different expert operators to the person who performed the measurements in two different times and double blinded. Then the main operator, once calibrated, performed the measurements twice with a month distance for all the patients. Therefore, the mean error and 95% confidence intervals (CIs) between the repeated recordings were calculated using the MME variance estimator. The measurement error for angular measurements was 0.9 degrees (range 0.5 and 1.2 degrees).
3) Statistical analysis is very basic. Only correlations were calculated. The sentence from lines 165-167 should be put in Results section.
As suggested he sentence from lines 165-167 has been inserted in Results section.
4) Results- only one table summarizes the observations. Moreover, the only observed correlations are weak in nature. It should be checked using biggest sample.
The graphical representation of the results has been reported in a single table to be synthesized efficiently. About sample size, considering that have fully satisfied the power analysis, the results of the study can be considered valid.
5) Discussion- this paragraph should be rearranged. It is very chaotic. Please do not repeat information from Introduction and try to be more focused. Rewrite this section using following paragraphs: main results and clinical relevance; comparison with other studies; advantages and disadvantages of the study; conclusions and suggestions for future studies.
Discussion section has been completely revised and following reviewers suggestion we removed informations yet present in the introduction part and we have reorganized the discussion in specific pharagraphs.
6) Conclusions- try to simplify this section.
Conclusion section has been completely revised
I hope that the corrections made fully satisfy the suggestions proposed
Reviewer 2 Report
I would suggest that saying that a radiographic technique has the remarkable disadvantage of producing a 2 dimensional image is not very scientific or appropriate as all conventional radiographic techniques do this.
lines 97-99 need rephrased
You need to define the abbreviation FACC in the text. You give it in table 1, but without the abbreviation
Author Response
Dear reviewer thank you so much for your suggestions, we revised the manuscript following your indications and I report below the responses to your observations
I would suggest that saying that a radiographic technique has the remarkable disadvantage of producing a 2 dimensional image is not very scientific or appropriate as all conventional radiographic techniques do this.
“panoramic radiograph has the remarkable disadvantage of providing a two-dimensional representation of a three-dimensional structure, produced by a nonparallel beam that gives a distorted and magnified image”
The statement on the bidimensionality of orthopantomographic examination was mostly related to the problem of image distortion due to the radiological technique. On the basis of reviewer’s suggestion the sentence has been rephrased in this way:
“panoramic radiograph has the remarkable disadvantage of providing a radiographic projection produced by a nonparallel beam that gives a distorted and magnified image”
lines 97-99 need rephrased
The lines 97-99 have been completely rephrased
You need to define the abbreviation FACC in the text. You give it in table 1, but without the abbreviation
The abbreviation FACC Facial Axis Clinical Crown, has been defined in the text
I hope that the corrections made fully satisfy the suggestions proposed
Round 2
Reviewer 1 Report
Thank You for considering all suggestions. I think that the manuscript needs professional language correction.
In the introduction (page 2, lines 74-...) You mention different application of CBCT in dentistry. Please add that it may also be used for planning orthodontic treatment (assessment of tooth inclination and root positions), as it has been recently described by
Kalina, Zadurska, Górski: Posthortodontic lower incisor and canine inclination and labial gingival recession in adult patients. J Orofac Orthop 2020.
Author Response
Dear reviewer
thank you so much for the suggestion about the reference, that has been inserted as requested.
English language correction has been performed, and we hope that the revised version of the manuscript can be considered suitable for pubblication.
Thank you so much for the time spent to revise our manuscript and for all the suggestions proposed to improve it.
My best regards
Marco Portelli
