Comparison of Efficacy between Three-Dimensional Printing and Manual-Bending Implants for Inferomedial Orbital Fracture: A Retrospective Study
Round 1
Reviewer 1 Report
In ‘Comparison of Efficacy between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture’, Kim et al. performed a clinical study with 32 patients testing these two treatments. They found the 3D printed implants returned the volume of the lesioned side to normal while the manually prepared implants did not. The 3D printed device was based on standardized radiologic images of 100 cadavers.
Main comments:
- It would be interesting to add a picture of the device.
- For the statistical analysis, is it appropriate to perform a repeated-measures ANOVA when comparing the pre- and post-operative volumes of the experimental side with the volume of the control side? Is the natural symmetry/asymmetry of the orbital volume on the two sides that exact?
Author Response
Response to Reviewer 1 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Thank you for your consideration. We look forward to hearing from you.
Point 1: It would be interesting to add a picture of the device.
Response 1: We agree with your suggestion. Thus, new figure 1 was added to describe the process of design and creation of 3D standardized orbital implants.
Point 2: For the statistical analysis, is it appropriate to perform a repeated-measures ANOVA when comparing the pre- and post-operative volumes of the experimental side with the volume of the control side?
Response 2: Thank you for the question. What we wanted to say in the statistical analysis was to find out if there was a difference in volume by comparing each of the three columns: pre-operative volumes, post-operative volumes of the lesion side, and the volume of the normal side. This is not simply to compare the preoperative and postoperative volumes of the lesion side compared to the normal side, but furthermore, to prove the effectiveness of the surgery by comparing the preoperative and postoperative volumes of the lesion side.
Point 3: Is the natural symmetry/asymmetry of the orbital volume on the two sides that exact?
Response 3: According to the J. Jansen, et al., (1) differences between right and left orbital volumes and contours are clinically minor. Then the mirroring tool, the rapid prototype model for the reconstruction of orbit can be used on the evidenced-based medicine. We added this information in the discussion section.
- Jansen J, Dubois L, Schreurs R, Gooris PJJ, Maal TJJ, Beenen LF, et al. Should Virtual Mirroring Be Used in the Preoperative Planning of an Orbital Reconstruction? J Oral Maxillofac Surg. 2018;76(2):380-7. Epub 2017/11/05. doi: 10.1016/j.joms.2017.09.018. PubMed PMID: 29100830.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Thank you very much for the opportunity to review a paper on the interesting and narrow topic of orbital wall reconstruction using 3D printing.
Unfortunately, in its current form, the paper cannot be published in Applied Sciences.
The paper is unreadable and chaotic. Many inaccuracies in the paper prevent the reader from logically understanding the topic.
For example, the size of the study group - in 3 places there are different numbers - 100, 10, 32.
Unfortunately in the present form I am obliged to reject the paper.
Author Response
Response to Reviewer 2 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Thank you for your consideration. We look forward to hearing from you.
Point 1: Thank you very much for the opportunity to review a paper on the interesting and narrow topic of orbital wall reconstruction using 3D printing.
Unfortunately, in its current form, the paper cannot be published in Applied Sciences.
The paper is unreadable and chaotic. Many inaccuracies in the paper prevent the reader from logically understanding the topic.
For example, the size of the study group - in 3 places there are different numbers - 100, 10, 32.
Unfortunately in the present form I am obliged to reject the paper.
Response 1: Thank you for your review. We regret that our manuscript did not meet your standards. However, regarding the size of the study groups, the 3D printed orbital implant used in the 32 patients included in the present study was manufactured in the previsous study by the same authors. To explain this, we only cited information from 100 cadavers and pilot study for 10 patients to explain the background described in the previous study, "Kim JH, et al., Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant. J Anat. 2020;236(5):923-30". Reading it again with this in mind will make it easier to understand. In addition, it was intended to reveal that the data used in the previous study for each size 100 and 10 was supplemented by adding 'In the previous study' to the first sentence in the section of Fabrication of 3D-printed orbital implant of 2. Materials and Methods.
Author Response File: Author Response.docx
Reviewer 3 Report
The authors conducted a retrospective study to compare the treatment outcome of inferomedial orbital fracture 3D printing VS manual bending implants.
The study is well conducted and written but for publication the following points are important to be considered:
Title: Please include the study design in the title.
Abstract:
-please add the aim of the study to the abstract section
-Li 24 replace were with was in "group B were treated using a manual"
-Li 27 correct group to groups
Introduction:
- The introduction section is too short, please add more rational for conducting the study and the current stand of the knowledge of this topic
- Li 34 replace a with an in "a inferomedial orbital fracture"
- Li 48 correct tomography to tomographies
Materials and Methods:
- Li 68 replace were with was in "group B were treated......."
- Li 72 correct were to was
- Li 73 please revise the information about the software 3-Matic (version ......., Materialise, Leuven, Belgium)
- Please add informations about Ethical approval
Results:
- is the number of included patients (32, 16 for each group) was accidental found or the authors selected equally number of patients for each group?
Discussion:
Please add the limitations of the study
Author Response
Response to Reviewer 3 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Thank you for your consideration. We look forward to hearing from you.
The authors conducted a retrospective study to compare the treatment outcome of inferomedial orbital fracture 3D printing VS manual bending implants.
The study is well conducted and written but for publication the following points are important to be considered:
Point 1: Title: Please include the study design in the title.
Response 1: We agree with your suggestion. We added ‘: a retrospective study’ in the end of title.
Abstract:
Point 2: -please add the aim of the study to the abstract section
Response 2: Thank you for the suggestion. We added the aim of the study in the section of abstract.
Point 3: -Li 24 replace were with was in "group B were treated using a manual"
Response 3: Thank you for the correction. We rectified it.
Point 4: -Li 27 correct group to groups
Response 4: Thank you for the correction. We rectified it.
Introduction:
Point 5: The introduction section is too short, please add more rational for conducting the study and the current stand of the knowledge of this topic
Response 5: We agree with your suggestion. We added the history of the orbital implant in the section of introduction.
Point 6: Li 34 replace a with an in "a inferomedial orbital fracture"
Response 6: Thank you for the correction. We rectified it.
Point 7: Li 48 correct tomography to tomographies
Response 7: Thank you for the correction. We rectified it.
Materials and Methods:
Point 8: Li 68 replace were with was in "group B were treated......."
Response 8: Thank you for the correction. We rectified it.
Point 9: Li 72 correct were to was
Response 9: Thank you for the correction. We rectified it.
Point 10: Li 73 please revise the information about the software 3-Matic (version ......., Materialise, Leuven, Belgium)
Response 10: Thank you for the correction. We added it.
Point 11: Please add informations about Ethical approval
Response 11: We added it in the beginning of Materials and Methods.
Results:
Point 12: is the number of included patients (32, 16 for each group) was accidental found or the authors selected equally number of patients for each group?
Response 12: We just sorted the patients by organizing the medical records according to the criteria, and it happened accidentally that the number of patients included in each group was the same.
Discussion:
Point 13: Please add the limitations of the study
Response 13: Thank you for the suggestion. We added the limitation in the end of the discussion.
Author Response File: Author Response.docx
Reviewer 4 Report
Could you include Hertel measurements?
also, for non repaired fractures, unlikely to develop
diplopia or vision loss if no surgery is done (
vision loss or diplopia would have to have been present t relegated to injury
Initially. There’s nothing to do with choosing not to have surgery
Author Response
Response to Reviewer 4 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Thank you for your consideration. We look forward to hearing from you.
Point 1: Could you include Hertel measurements?
Response 1: Table 1 described the complications including exophthalmos before and after surgery. Data were obtained by an ophthalmologist, but unfortunately, only the presence or absence of exophthalmos was recorded, and Hertel measurements were not recorded as medical records. However, you can indirectly figure it out from Table 1.
Point 2: also, for non repaired fractures, unlikely to develop diplopia or vision loss if no surgery is done (vision loss or diplopia would have to have been present t relegated to injury Initially. There’s nothing to do with choosing not to have surgery
Response 2: The text appears to have been partially deleted or modified. To answer by analogy with the original sentence, it is highly likely that complications like dystopia and diplopia remained in the complex orbital fracture, which the authors took as indications for surgery, if not operated. The sequelae will be more severe when the inferomedial orbital wall is not surgically reconstructed.
Author Response File: Author Response.docx
Reviewer 5 Report
In their study, the authors deal with the comparison of an implant for an inferomedial orbital fracture made by 3D printing and manual technique. Based on the evaluation of CT images, the shape of the implant was determined. The study involved 32 patients, which were divided into 2 groups.
In the Introduction, the authors describe the need for an implant for an inferomedial orbital fracture, what materials they are made of, as well as complications arising after surgery.
In the chapter Materials and Methods, the criteria for selecting patients resp. their exclusion from the study. Furthermore, the authors defined patients in Group A and in Group B. I recommend adding a link to Table 1.
In the next part, the authors focus on the fabrication of 3D-printed orbital implants. Missing information about manual-beding implant - manufacturer, material, implant thickness ...
Line 87 - you write that the implant was made with a thickness of 8 mm, but you also state 0.8 mm - which data is correct?
In Conclusion, there are basic characteristics and demographic data on patients and evaluation of the obtained data according to selected statistical methods. The results are clearly described and graphically processed. In the Discussion, the authors substantiated their study with a sufficient number of references.
The article is written clearly, but there is a lack of information that the reader must look for from previous studies of the authors, but not all of them are accessible.
Therefore, I recommend the authors add basic information such as:
- information on 100 adult cadavers - how many were M/F, age average, ...
- information on patients who are in group A and in group B - how many were M/F, age average, ...
- what 3D printer technology was used, printing parameters, postprocessing, how long one implant was produced, how long it took to print, sterilization of the implant
- used polycaprolactone for 3D printing - was purchased or prepared by the authors themselves,
Recommended Edits:
- references are written in square brackets
- description Tab. is written above the table
Author Response
Response to Reviewer 5 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Thank you for your consideration. We look forward to hearing from you.
In their study, the authors deal with the comparison of an implant for an inferomedial orbital fracture made by 3D printing and manual technique. Based on the evaluation of CT images, the shape of the implant was determined. The study involved 32 patients, which were divided into 2 groups.
In the Introduction, the authors describe the need for an implant for an inferomedial orbital fracture, what materials they are made of, as well as complications arising after surgery.
In the chapter Materials and Methods, the criteria for selecting patients resp. their exclusion from the study. Furthermore, the authors defined patients in Group A and in Group B. I recommend adding a link to Table 1.
In the next part, the authors focus on the fabrication of 3D-printed orbital implants.
Point 1: Missing information about manual-beding implant - manufacturer, material, implant thickness ...
Response 1: Thank you for the comment. We added it in the section of Materials and Methods.
Point 2: Line 87 - you write that the implant was made with a thickness of 8 mm, but you also state 0.8 mm - which data is correct?
Response 2: Thank you for the comment. 0.8mm is correct. We changed it.
In Conclusion, there are basic characteristics and demographic data on patients and evaluation of the obtained data according to selected statistical methods. The results are clearly described and graphically processed. In the Discussion, the authors substantiated their study with a sufficient number of references.
The article is written clearly, but there is a lack of information that the reader must look for from previous studies of the authors, but not all of them are accessible.
Therefore, I recommend the authors add basic information such as:
- information on 100 adult cadavers - how many were M/F, age average, ...
Response: We added it in the section of Discussion with red font.
- information on patients who are in group A and in group B - how many were M/F, age average, ...
Response: Thank you for the suggestions, but Table 1 already described it with statistical analysis.
- what 3D printer technology was used, printing parameters, postprocessing, how long one implant was produced, how long it took to print, sterilization of the implant
Response: We added it in the section of Materials and Methods with blue font.
- used polycaprolactone for 3D printing - was purchased or prepared by the authors themselves,
Response: The TnR Mesh implant, the standardized 3D printed orbital implant, was marketed by T&R Biofab Co., Ltd., which the authors purchased and used. We described it in the section of Materials and Methods.
Recommended Edits:
- references are written in square brackets
Response: Thank you for the suggestion. We correct them.
- description Tab. is written above the table
Response: Thank you for the suggestion. We correct them.
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
Unfortunately, I stand by my decision that the paper cannot be published in Applied Sciences in its current form.
The paper is still unreadable and chaotic. Many inaccuracies in the article do not allow the reader to understand the topic logically.
Unfortunately, in its current form, I am forced to reject the work.
Author Response
Response to Reviewer 2 Comments
We wish to re-submit the manuscript titled “Comparison of Efficacy Between Three-dimensional Printing and Manual-bending Implants for Inferomedial Orbital Fracture.” The manuscript ID is applsci-1307629.
We thank you and the reviewers for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. We look forward to working with you and the reviewers to move this manuscript closer to publication in the Applied Sciences.
The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewers’ suggestions.
Point 1: Unfortunately, I stand by my decision that the paper cannot be published in Applied Sciences in its current form.
The paper is still unreadable and chaotic. Many inaccuracies in the article do not allow the reader to understand the topic logically.
Unfortunately, in its current form, I am forced to reject the work.
Response 1: Thank you for your review. We regret that our manuscript did not meet your standards.
Author Response File: Author Response.docx
Reviewer 5 Report
Thank you for processing my comments,
I recommend the article for publication
Round 3
Reviewer 2 Report
After corrections made to the text by the authors in the reviewer's opinion in its present form, it can be published in MDPI Applied Sciences.
