Three-Dimensional Accuracy of Surgical Guides for Static Computer-Aided Implant Surgery: A Systematic Review
, Mariani Pierluigi 2,*,†, Khrystyna Zhurakivska 1, Chiara Digregorio 1, Eleonora Lo Muzio 1,3 and Luigi Laino 2
Round 1
Reviewer 1 Report
This manuscript is complete and correctly written
Author Response
Dear reviewer,
I thank you for your judgments.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Very interesting investigation and results, in discussion pay attention on spaces and some English words.
In conclusion suggestion - the best technology for producing guides...
Author Response
Dear reviewer,
I thank you for your judgments and comments. We have tried to improve the manuscript based on the comments of the reviewers, hoping that these will be sufficient to better clarify some aspects that aroused some concern.
Author Response File: Author Response.docx
Reviewer 3 Report
Dear authors, despite your study does not bring scientific breakthrough, concluding that there is a very few, if any, evidence proving milling or 3D printing with better accuracy for surgical guides manufacturing, is important. Here I provide you some suggestions for improvements.
Regarding the Introduction chapter:
- Start by providing a brief overview of computer-assisted implant surgery in context. This will help to align the study and explain why it is important. - Focus more on automatic computer-guided surgery, as this is the primary focus of the research. Discuss the importance of shape accuracy of surgical guides in this approach. - Review more the literature on accuracy of surgical guides. Highlight gaps in the literature and identify research questions that need to be addressed. - State the purpose of the study more clearly. And what do you plan to achieve by this paper..
Regarding the Material and Methods chapter:
The systematic review in this manuscript was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and the Patient or Population, Intervention, Control or Comparison, and Outcome (PICO) approach. Ethics approval was not required for this review. The bias of the studies included in the review was classified as high, medium, or low risk based on the number of "yes" marks received. The studies were selected based on eligibility criteria and a flowchart of the selection process is provided. Only 11 papers met the eligibility criteria and were included in the qualitative synthesis. The excluded papers and reasons for exclusion are detailed in Supplementary Material 1. The accuracy of implant surgical guides produced with desktop stereolithographic 3-dimensional printers was measured in one of the studies included in the review, with statistical analysis carried out. The Figure 1 is not properly readable and quality must be improved. It is also not clear if the review is registered in compulsory registers of systematic reviews.
Regarding the Discussion chapter:
Here are 6 suggestions on how to improve the discussion chapter of theis manuscript:
Provide a more concise overview of the findings. The discussion is currently quite long and detailed, which makes it difficult to follow. A more concise overview would help readers to understand the main findings of the study and how they fit into the existing literature.
Strengthen the discussion of the limitations of the study. The discussion currently mentions some of the limitations of the study, such as the heterogeneity of the included studies and the lack of quantitative synthesis of the results. However, these limitations could be discussed in more detail. For example, the authors could discuss how the heterogeneity of the studies affected the results of the review and how the lack of quantitative synthesis limited the conclusions that could be drawn.
Consider discussing that biocompatible 3D printing has an advantage over milling in dental applications for large-scale facial customized appliances in patients with craniofacial disorders. A study "Use of optical scanning and 3D printing to fabricate customized appliances for patients with craniofacial disorders" https://doi.org/10.1053/j.sodo.2022.10.005 which concludes that 3D printing can be a viable option for fabricating large-scale appliances with sizes larger than implant guides, albeit also noted that more research is needed to investigate the accuracy of 3D-printed appliances and to identify the factors that can influence their accuracy.
Provide more specific recommendations for future research. The discussion currently ends with a general statement that future research is needed to investigate the accuracy of surgical guides. The authors could provide more specific recommendations for future research, such as studies that compare the accuracy of different manufacturing technologies or studies that investigate the effects of different printing parameters on the accuracy of surgical guides.
Improve the writing style. The writing style of the discussion could be improved in a few ways. First, the authors could use more active voice instead of passive voice. Second, the authors could break up the text into shorter paragraphs to make it easier to read. Third, the authors could use more specific language and avoid jargon.
Correct some grammatical errors. The discussion contains a few grammatical errors, such as "the precision referred to the surface accuracy" and "the printing orientation appeared to affect the accuracy of the surgical guides". These errors should be corrected before the manuscript is submitted for publication.
Regarding the Conclusions chapter:
Strengthen the conclusion by stating the main findings of the study more clearly. The conclusion currently states that there is "very few, if any, evidence" to support the use of either milling or 3D printing for surgical guides. However, the discussion chapter of the review provides more specific findings, such as the fact that milling may achieve better results in terms of a reduced variation. The conclusion should be revised to state these findings more clearly.
Provide more specific recommendations for future research. The conclusion currently states that future studies are "encouraged" to investigate the accuracy of surgical guides. However, the review does not provide any specific recommendations for how these studies should be conducted. The conclusion should be revised to provide more specific recommendations, such as suggesting that future studies should use a homogeneous evaluation system or that they should focus on specific factors that influence the accuracy of surgical guides.
is sufficient
Author Response
Dear reviewer,
I thank you for your judgments and comments, and for the valuable contribution that your reviews will give to this work. We have tried to improve the manuscript based on the comments of the reviewers, hoping that these will be sufficient to better clarify some aspects that aroused some concern.
Below are the comments of the individual point, and the relative responses. In the manuscript, the changes requested by each of the reviewers were highlighted.
Sincerely,
Pierluigi Mariani
- Regarding the Introduction chapter:
Start by providing a brief overview of computer-assisted implant surgery in context. This will help to align the study and explain why it is important. - Focus more on automatic computer-guided surgery, as this is the primary focus of the research. Discuss the importance of shape accuracy of surgical guides in this approach. - Review more the literature on accuracy of surgical guides. Highlight gaps in the literature and identify research questions that need to be addressed. - State the purpose of the study more clearly. And what do you plan to achieve by this paper.
Answer: we have modified the introduction, as was you suggested moreover we have updated the literature also highlighting the gaps in the current literature and we have better clarified the objective of the study.
- Regarding the Material and Methods chapter:
The systematic review in this manuscript was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and the Patient or Population, Intervention, Control or Comparison, and Outcome (PICO) approach. Ethics approval was not required for this review. The bias of the studies included in the review was classified as high, medium, or low risk based on the number of "yes" marks received. The studies were selected based on eligibility criteria and a flowchart of the selection process is provided. Only 11 papers met the eligibility criteria and were included in the qualitative synthesis. The excluded papers and reasons for exclusion are detailed in Supplementary Material 1. The accuracy of implant surgical guides produced with desktop stereolithographic 3-dimensional printers was measured in one of the studies included in the review, with statistical analysis carried out. The Figure 1 is not properly readable and quality must be improved. It is also not clear if the review is registered in compulsory registers of systematic reviews.
Answer: We have replaced figure 1, inserting the recommended prism flow chart, we hope this is of better quality than the previous one. We have reported that the protocol of the review was registered on the PROSPERO database.
-Regarding the Discussion chapter:
Here are 6 suggestions on how to improve the discussion chapter of theis manuscript:
-Provide a more concise overview of the findings. The discussion is currently quite long and detailed, which makes it difficult to follow. A more concise overview would help readers to understand the main findings of the study and how they fit into the existing literature.
Answer: We have shortened the discussion and reported the results in a more concise way and we have also restructured it into paragraphs to make the reading more understandable, as you suggested in a subsequent comment.
Strengthen the discussion of the limitations of the study. The discussion currently mentions some of the limitations of the study, such as the heterogeneity of the included studies and the lack of quantitative synthesis of the results. However, these limitations could be discussed in more detail. For example, the authors could discuss how the heterogeneity of the studies affected the results of the review and how the lack of quantitative synthesis limited the conclusions that could be drawn.
Answer: Following your valuable comment, we have improved this topic. We further argued the limitation of the study and explained how the lack of quantitative analysis did not allow us to obtain statistically significant overall results. We have inserted this paragraph at the end of the discussions.
Consider discussing that biocompatible 3D printing has an advantage over milling in dental applications for large-scale facial customized appliances in patients with craniofacial disorders. A study "Use of optical scanning and 3D printing to fabricate customized appliances for patients with craniofacial disorders" https://doi.org/10.1053/j.sodo.2022.10.005 which concludes that 3D printing can be a viable option for fabricating large-scale appliances with sizes larger than implant guides, albeit also noted that more research is needed to investigate the accuracy of 3D-printed appliances and to identify the factors that can influence their accuracy.
Answer: We have discussed this topic and we update the bibliography with this citation.
Provide more specific recommendations for future research. The discussion currently ends with a general statement that future research is needed to investigate the accuracy of surgical guides. The authors could provide more specific recommendations for future research, such as studies that compare the accuracy of different manufacturing technologies or studies that investigate the effects of different printing parameters on the accuracy of surgical guides.
Answer: We have included these recommendations for future studies in the conclusions as you also suggested in the comment on the conclusions, giving more precise and concise indications.
Improve the writing style. The writing style of the discussion could be improved in a few ways. First, the authors could use more active voice instead of passive voice. Second, the authors could break up the text into shorter paragraphs to make it easier to read. Third, the authors could use more specific language and avoid jargon.
Correct some grammatical errors. The discussion contains a few grammatical errors, such as "the precision referred to the surface accuracy" and "the printing orientation appeared to affect the accuracy of the surgical guides". These errors should be corrected before the manuscript is submitted for publication.
Answer: We appreciated this comment, we divided the discussion and the results sections into paragraphs, reviewed the English grammar and corrected the errors suggested by you.
- Regarding the Conclusions chapter:
- Strengthen the conclusion by stating the main findings of the study more clearly. The conclusion currently states that there is "very few, if any, evidence" to support the use of either milling or 3D printing for surgical guides. However, the discussion chapter of the review provides more specific findings, such as the fact that milling may achieve better results in terms of a reduced variation. The conclusion should be revised to state these findings more clearly.
Answer: We have revised the conclusions with more concise findings and less misleading results.
- Provide more specific recommendations for future research. The conclusion currently states that future studies are "encouraged" to investigate the accuracy of surgical guides. However, the review does not provide any specific recommendations for how these studies should be conducted. The conclusion should be revised to provide more specific recommendations, such as suggesting that future studies should use a homogeneous evaluation system or that they should focus on specific factors that influence the accuracy of surgical guides.
Answer: We have added more specific recommendations for future studies added indicating how the parameters used for the measurements should be reported and what aspects to investigate.
Author Response File: Author Response.docx
Round 2
Reviewer 3 Report
just the references on the literature in text seem to be not proper syntax - shall be caputal numbers brackets, now ste as superinfex...
is fine
