Calcium Sulfate in Implantology (Biphasic Calcium Sul-Fate/Hydroxyapatite, BCS/HA, Bond Apatite^®): Review of the Literature and Case Reports

Round 1

Reviewer 1 Report

The authors have performed a critical analysis from existing literature to identify the efficacy of Calcium Sulfate as a grafting material for guided bone regeneration, and complemented the findings with the help of a series of case studies. The  manuscript is generally well-written and adds significant value to the knowledge base, but certain points needs to be addressed while preparing the manuscript. There are some formatting issues in the manuscript which makes pages 8-12, 13, 15, and 17 completely/ partially illegible. Also, Fig. 1 and Table 1 contain some red underlines due to formatting issues. 

The authors are also required to elaborate on the following aspects-

1. What is the absorption rate of CaSo4/ bond apatite? How does it compare with the growth rate of the tissue? How to address the mismatch occurring from faster absorption and slower regeneration?

2. Does the volume of the defect play any role in determining the rate and quality of tissue regeneration?

3. How do the age of the patients, location of the defect, and the loading condition affect the tissue regeneration?

4. Is it possible to use bone cement/PMMA instead of NaCl for shaping the bond apatite material?

Author Response

Thank you very much for your comments and your time, we answer all comments. We have enclosed a response letter and hope you find them suitable.
Your soncerely

 

José López

Author Response File: Author Response.pdf

Reviewer 2 Report

Figure 15 and figure 16 figure captions should be switched.

The authors are requested to provide the ethical approval certificate to conduct and report the case report.

The authors are requested to report the follow up of the cases now and if there is any failures observed to recent dates.

Provide a diagrammatic illustration for the mechanism of bone regeneration induced by the tested bone graft. and the role of sodium chloride in the reaction.

Provide a brief comparison between the currently tested material and commonly used bioactive materials such as 45S5 bioglass.

Provide a table having the exact chemical composition of the tested material.

Avoid using commercial brand names and use scientific description of the material.

 

Author Response

Thank you very much for your comments and your time, we answer all comments. We have enclosed a response letter and hope you find them suitable.
Your soncerely

José López

Author Response File: Author Response.pdf

Reviewer 3 Report

In this manuscript, the authors reviewed research articles on the use of calcium sulfate in implantology and provided a series of case reports. Synthetic graft materials such as calcium sulfate is commonly used in the clinic to treat bone defects or during bone augmentation. The accumulating clinical evidence about the safety and efficacies (including short-term and long-term outcomes) requires careful and systematic evaluations. Despite the merit of interrogating a clinically important question and combining literature review with first-hand case reports, significant conceptual and methodological issues were noted.

 

1.     The Introduction didn’t give sufficient background information. For instance, it would be useful to summarize at least briefly the available in vitro, in vivo, and clinical evidence for this material, and what the current knowledge gap is. It would be great to clarify why calcium sulfate (or specifically the Bond Apatite) is different from other alloplastic graft materials. 

 

2.     Aim of the review: it is unclear if the goal was to review literatures on calcium sulfate or specifically the Bond Apatite preparation. The title and the case repots seem more specific to the Bond Apatite; the literature search strategies (key words) and inclusion criteria appear to be generic.

 

3.     The literatures search through PubMed was done using keywords only (with some repetition, e.g., “dental”, “dental surgery”) without using more advanced methods such as the MeSH Terms which would significantly facilitate searching. It should be noted that many relevant literatures could have been missed during the process. Also, the way studies were selected was unusual. Are the authors sure about the selection was done in a systemic manner? How could the inclusion criteria be applied to the articles even before reading the title, as described in the Materials and Methods? 

 

4.     The result section (section 3.4) was mostly descriptive. The authors should at least evaluate quality of each study, compare findings across different studies, and summarize interpretations into a refined conclusion. Providing more synthesis of the available data (either quantitatively or qualitatively) would be more helpful for the readers or for the purpose of implementing evidence-based medicine than just describing the findings and conclusions for each study.

 

 

5.     It is a minor issue but scale bars are missing in the histology data. It would also be helpful to indicate important structures (e.g., using arrows) in the histology micrography, as most readers of the journal do not have a biomedical background or the expertise in histology/pathology.

Author Response

Thank you very much for your comments
Attached response letter

José López

Author Response File: Author Response.pdf

Reviewer 4 Report

This study aims to review the existing literature on calcium sulfate in oral surgery and expose various clinical cases using Bond Apatite® as a bone graft material in different situations. The following PICO (Patient, Intervention, Comparison, Outcome) question was framed: Does the use of calcium sulfate as a material in guided bone regeneration in dentistry have better results compared to other bone graft materials?

The topic is original and previous review are not there on this topic. It adds to the subject area i.e. bone grafting in dentistry by providing the literature data and clinical case reports as compared with other published material.

Conclusions consistent with the evidence and arguments presented and addressed the main question.
The paper is well written. However, minor spell check is required. Write standard format for tooth numbering for example write 43 instead of 4.3

This paper includes tables or figures, But the labelling is not so much clear.

Please provide the following:

Clarity in table 1 is not there, please modify the same.

In Fig 4, labelling is not clear and seems to be incomplete. Please correct

In Fig 4, 7, 11 and 15 what do you mean by control. Explain and modify the labelling.

In Fig 5, 9 and 13 mention IOPA (Intra oral periapical radiograph instead of just periapical.

Fig 8, 12, 17,20 and 23 please puts arrows on figure indicating the remains of inorganic material and newly formed bone trabeculae as figures are not so clear.

Author Response

Thank you very much for your comments and your time, we answer all comments. We have enclosed a response letter and hope you find them suitable.
Your soncerely

José López

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors have satisfactorily addressed the comments raised during the first revision. However, the language needs to be further improved for readability. Also, the tables are pasted as images in the manuscript, and the proofing underlines (red and blue) in the word document is present in the tables, which must be taken care of.

Author Response

Thank you very much for your comments
Attached response letter

José López

Author Response File: Author Response.pdf

Reviewer 4 Report

This study aims to review the existing literature on calcium sulfate in oral surgery and expose various clinical cases using Bond Apatite® as a bone graft material in different situations. The following PICO (Patient, Intervention, Comparison, Outcome) question was framed: Does the use of calcium sulfate as a material in guided bone regeneration in dentistry have better results compared to other bone graft materials?

The topic is original and previous reviews are not there on this topic. It adds to the subject area i.e. bone grafting in dentistry by providing the literature data and clinical case reports as compared with other published material.

Conclusions consistent with the evidence and arguments presented and addressed the main question.
The paper is well written. However, a minor spell check is required. Write standard format for tooth numbering for example write 43 instead of 4.3

This paper includes tables or figures, But the labeling is not so clear.

Please provide the following:

The clarity in table 1 is not there, please modify the same.

In Fig 4, the labeling is not clear and seems to be incomplete. Please correct

In Fig 4, 7, 11 and 15 what do you mean by control? Explain and modify the labeling.

Fig 5, 9 and 13 mention IOPA (Intraoral periapical radiograph instead of just periapical.

 

Fig 8, 12, 17,20 and 23 please put arrows on the figure indicating the remains of inorganic material and newly formed bone trabeculae as the figures are not so clear.

Author Response

Thank you very much for your comments
Attached response letter

José López

Author Response File: Author Response.pdf