Frequency of Additional Congenital Dental Anomalies in Children with Cleft Lip, Alveolar and Palate
Round 1
Reviewer 1 Report
Dear Authors,
this is a retrospective study aimed to evaluate the frequency and the risk factors for maxillary canines impaction, in a population affected by Cleft lip and palate.
The research is interesting. please provide more detail on this points:
- How do you set the nuber of the examined subjects? You stated that they were randomly selected, can you clarify the randomization method?
- The measures were taken by a trained researcher. Did he evaluated the intra-examiner method error?
Author Response
- How do you set the number of the examined subjects? You stated that they were randomly selected, can you clarify the randomization method?
Response 1: It is for us the great success you appreciate our research.
In our study we wanted to asses the examined issues in the high drafted sample. The randomized method was not the simple randomization because we selected the almost equal number of male and female patients as well as was we performed a patient selection from two surgeons. Due to rather small trial, to avoid the false result we used a kind of block randomization.
2. The measures were taken by a trained researcher. Did he evaluated the intra-examiner method error?
Response 2: We didn’t contain the information about this evaluation in the article because the measurement method was quite simple and the reasercher was well trained. Intra-examiner reliability was checked after two weeks with selected measurements repetition and it demonstrated a high satisfactory percentage of agreement.
Reviewer 2 Report
Your paper is based on a rather small number of cases. You have not really found surprisingly new facts on the number of unerupted canines. You should add a radiograph includind the drawing of the angle of the of the unerupted canine.
It is recommended to undertake a multi- center study in order to get more valid results which go beyond those already cited by you in the discussed litterature.
Please have your manuscript corrected by a native English speaker.
Author Response
Your paper is based on a rather small number of cases. You have not really found surprisingly new facts on the number of unerupted canines. You should add a radiograph includind the drawing of the angle of the of the unerupted canine.
Response 1: Thank You for your suggestions. The number of cases in our study was limited to high drafted group of patients treated by team of two surgeons and two orthodontists, we also wanted to undertake randomization. We tried to avoid all factors which could make our resarch less valuable and in cleft patient treatment it is very easy to change the management.
In our futher research plan we want to add the results from another center as well as compare our results with novel approach we started five years ago.
The several reports from the literature found the impaction of the maxillary canines as very common complication in cleft patients treatment. We didn’t noted this problem in our clinic and we made an attempt to find clinical factor improving initial unfovarable canine position in our cleft patients.
According to your suggestion we added the radiograph with drawing of unerupted canine angle measurement.
It is recommended to undertake a multi- center study in order to get more valid results which go beyond those already cited by you in the discussed litterature.
Response 2. It would be a high value of publication if we could find a cooperation with another centers from the world. Opportunity to present our result is a big chance for us. It is our scientific aim to show our findings for broad group of specialists and possible coworkers.
Please have your manuscript corrected by a native English speaker.
Response 3. Due to your recommendation the appropriate language editing will be perform by the MDPI Author Services with native English speaker
Reviewer 3 Report
This paper reports the results of investigation of congenital dental anomalies in children with nonsyndromic cleft lip, alveolar and/without palate (CL/P). Fifty six patients were examined using panoramic radiographs.
Patients with cleft were exposed to unfavorable position of unerupted maxillary canines. The frequency of hypodontia and hyperdontia were high in the maxillary lateral incisor on the cleft side. These results were interesting but already reported in previous studies. The influence of particular procedures (expansion of the maxilla, secondary alveolar bone grafting, unresorbed deciduous canine extraction) were not found. The author should emphasize the importance of this study.
A schematic drawing of the method for the measurement of inclination angles of the unerupted maxillary canines might helpful for readers. The examination of canines were performed on both sides of the jaw. However, the results of healthy side are not presented. The results should be presented in Table 1. The total number of canine is 112.
For minor problems, “additional congenital anomalies” in the title should be “additional congenital dental anomalies” because “additional congenital anomalies” suggests anomalies in other organ such as a cardiac disease. It is the same in the abstract. “untreated children with cleft (line 47)” also should be described “untreated occlusion in children with clefts ”. It is confusing with the patients with unrepaired clefts.
Author Response
This paper reports the results of investigation of congenital dental anomalies in children with nonsyndromic cleft lip, alveolar and/without palate (CL/P). Fifty six patients were examined using panoramic radiographs.
Patients with cleft were exposed to unfavorable position of unerupted maxillary canines. The frequency of hypodontia and hyperdontia were high in the maxillary lateral incisor on the cleft side. These results were interesting but already reported in previous studies. The influence of particular procedures (expansion of the maxilla, secondary alveolar bone grafting, unresorbed deciduous canine extraction) were not found. The author should emphasize the importance of this study.
Response 1: Thank You for your comprehensive review. Our study was an attempt to find clinical factor influencing the improvement of initial unfovarable canine position in cleft patients. Recognizing of this factor could allow to fix the exact procedure in ortho-surgical management of cleft patients. Since we didn’t find statistically important single factor we emphasized in the end of Discussion the total impact of multidisciplinary care undertaken in our University Center. According to your suggestion we added this issue to Conclusions emphasizing the study importance.
A schematic drawing of the method for the measurement of inclination angles of the unerupted maxillary canines might helpful for readers. The examination of canines were performed on both sides of the jaw. However, the results of healthy side are not presented. The results should be presented in Table 1. The total number of canine is 112.
Response 2: Following your proper suggestion we added schematic drawing of the measurement method. We also presented more clear, extensive results in Table 1.
For minor problems, “additional congenital anomalies” in the title should be “additional congenital dental anomalies” because “additional congenital anomalies” suggests anomalies in other organ such as a cardiac disease. It is the same in the abstract. “untreated children with cleft (line 47)” also should be described “untreated occlusion in children with clefts ”. It is confusing with the patients with unrepaired clefts.
Response 3: The appriopriate changes were made in the title and abstract.
Round 2
Reviewer 2 Report
Your study has a correct design but is based on a rather low number of cases. Thus it cannot present really new scientific findings.
You should try another approach with your design including several or all cleft centers in Poland. This could probably reveal new facts concerning the frequency of additional dental anomaliesw in cleft patients.
Thank you for having added the ortopantomogram with the canine angle.
Author Response
Thank you for your consideration and effort analyzing our manuscript.
Analyzing literature we met groups with more than fifty and less than fifty examined patients and the results were different: in small examined groups the number of impacted canines was high but in bigger was low. In our 56 patients examined group we have low score of impacted canines, so our study participated in scientific discussion about influence of surgical impact in cleft treatment. As I mentioned previously, the aim of study was avoiding the influence of different surgeons techniques and we wanted to make scientific assessment of our center approach. We try to offer for the cleft children the best possible solution of treatment.
Due to your recommendations another study with more Polish cleft centers is now developing by our team.
Let me conclude by expressing my thanks to your review comments
