An in vitro study in separating tensile loads during maxillo-mandibular fixation using wire and/or elastics

Sudeep Pawa; Surakit Visuttiwattanakorn

doi:10.1371/journal.pone.0300481

Peer Review History

Original SubmissionMay 11, 2023
4 Jul 2023 Decision Letter - Sompop Bencharit, Editor PONE-D-23-14421An In Vitro Study in Separating Tensile Loads during Maxillo-Mandibular Fixation using Wire and/or ElasticsPLOS ONE Dear Dr. Visuttiwattanakorn, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ==============================Please address the comments from the reviewers and editor. Please pay attention to the following comments. 1) Abstract: Condense the introduction in the abstract and focus more on the meaning of the findings and their clinical implications. 2) General format: Ensure that the manuscript follows the PLOS ONE format by consulting the information for authors. 3) Introduction: Improve the introduction by clearly stating the research problem or objective, establishing the need for further investigation, discussing the advantages and limitations of different fixation methods, and restructuring the content for better organization and flow. 4) Methods: Add information on how the model simulates clinical situations or discuss the application of the results to clinical patients if no clinical validation is available. 5) Discussion and Conclusion: Separate the Discussion and Conclusion sections, following a format that highlights important results, compares them with previous studies, discusses study limitations, and indicates clinical implications and future research. Move Figure 7 to the Results section. 6) Conclusion: Provide a clear summary of the results in terms of addressing the hypothesis, considering the manuscript's lack of a clear clinical problem and hypothesis. ============================== Please submit your revised manuscript by Aug 18 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. 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Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Sompop Bencharit, DDS, MS, PhD, FACP Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. 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We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: 1. You may seek permission from the original copyright holder of Figures 1, 2, 3, and 4 to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. 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If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. Additional Editor Comments: Thank you for submitting your work to PLOS ONE. The reviewers have provided a range of feedback, including suggestions for minor revision and acceptance. In addition to addressing the reviewers' comments, I request that you make the following revisions to the manuscript: 1) Abstract: Condense the first three sentences into one to provide a concise overview. Focus more on explaining the meaning of the findings and their clinical implications. 2) General format: Ensure that the manuscript follows the PLOS ONE format. Please consult the information for authors to ensure compliance. 3) Introduction: Although the introduction provides a comprehensive overview of intermaxillary fixation (IMF) or maxillo-mandibular fixation (MMF), there are areas for improvement: 3.1) Clearly state the research problem or objective in a concise manner. Highlight the specific research question or knowledge gap that the study aims to address. 3.2) Establish the need for further investigation or improvement by discussing the limitations, challenges, or evidence gaps associated with current techniques. Justify the need for the study by providing relevant information from the literature. 3.3) Elaborate on the advantages and limitations of orthodontic latex elastics as an alternative to wire ligatures. Briefly discuss the advantages and disadvantages of different fixation methods to enhance the reader's understanding of the research context. 3.4) Restructure the introduction to ensure a logical flow and organization of information. Improve transitions between ideas to present a coherent and logical progression of concepts. 4) Methods: While the methods provide sufficient experimental details, include information on how the model simulates clinical situations. If there is clinical validation, provide relevant details. If not, discuss how the results can be applied to clinical patients. 5) Discussion and Conclusion: Separate the Discussion and Conclusion sections. The Discussion should follow this format: 4.1) highlight important results, 4.2) compare the results with previous studies, 4.3) discuss the limitations of the study, and 4.4) indicate clinical implications and suggest future studies. Move Figure 7 from the Discussion section to the Results section. 6) Conclusion: Provide a clear and direct summary of the results in terms of addressing the hypothesis. Since the manuscript lacks a clear clinical problem and hypothesis, ensure the conclusion is based on the obtained results. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: To begin with English language editing services very much needed for manuscript. This is a CAD based design which was utilised for this invitro study . Wat was the printing material utilised for this study???? Please provide justifications and citations to say the model material doesn’t interferes with testing results. Please justify your sample size Please add more correct citations under discussion. Total references of 13 for an original article is unacceptable. Wat is new in this study when compared to previously published articles on similar topic. Please provide relevant citations to your materials and methods section. Your study is on tensile load only. Wat about shear loads acting on mandible at time of Fixation. Anything included in your study ??? Reviewer #2: Nice preclinical project, not without its limitations as noted. Well written and documented. A couple of minor suggestions: 1. although the outcomes will not change, I would recommend indicating the parameters that were tested and to what level they were tested when completing the power analysis. 2. Not being an OMS or orthodontist and being familiar with the up to date state of MMF and arrangement of wires and elastics commonly used in MMF, it might help the reader to know what currently is the standard configuration that is taught and used in clinical practice to achieve fixation. If internal fixation is used is external fixation even needed? The OMS department in my current institution rarely in orthognatic cases uses external fixation once the internal fixation is placed. I would make comment of the current gold standard, and in what cases would you prefer external vs internal fixation. Additionally, I would also maybe make more comment of the consequences of inadequate fixation in the introduction. 3. Discuss experimental model limitations in greater detail and contrasting to what is done clinically- while MM bone fixation screws may be used (I am guessing not usually one for every tooth as used in this model), as indicated orthodontic brackets +- MMF screws are more commonly used. Why was one screw used for every tooth? What was the rationale? Why were orthodontic brackets not used if this is more commonly used in clinical practice? If repeating or extending this experimental model to study the effects of lateral forces, I would suggest integrating orthodontic brackets into the model (if you are able to find a way to bond to the custom 'dental model') to better represent what may be done clinically. This may be a point for discussion in the limitations of this preclinical model, along with discussion of any potential differences in the size of the custom fixation screw that was used in this study, to what it commonly available on the market (they seem quite large in diameter and not what may be used clinically). Granted this is a preclinical study with obvious limitations, clinical correlation and deeper discussion on model limitations is helpful for the reader as if products/screws that are used are not commercially available or the set up is not as it would be in a real situation then the results have minimal clinical meaning. Other than that, nice project. I would be interested to see as you mentioned how it would fare up with lateral movements which if the patient is a bruxer may be the time when potentially higher forces are generated and this could impact the fixation. Reviewer #3: The study is well designed and the manuscript is also acceptable for publication. However, it would be better if the clinical implication(s) of the in vitro findings are highlighted. The article seems to lack novelty. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Prof Dr. Hariharan Ramakrishnan Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0300481.r001
Revision 1
3 Sep 2023 Author Response Dear Editor and Reviewers, On behalf of all authors, we are grateful for your helpful in-depth feedback on our manuscript. We hope that you consider all raised points to be adequately addressed by our revised manuscript as described below and that the revised manuscript qualifies for publication. Kind Regards, Surakit Visutiwattanakorn Editor Comments 1. Abstract: Condense the first three sentences into one to provide a concise overview. Focus more on explaining the meaning of the findings and their clinical implications. The abstract has been revised to provide a more concise overview of the manuscript. 2. General format: Ensure that the manuscript follows the PLOS ONE format. Please consult the information for authors to ensure compliance. The manuscript has been edited to follow the PLOS ONE format as written on the “information for authors” page. 3. Introduction: Although the introduction provides a comprehensive overview of intermaxillary fixation (IMF) or maxillo-mandibular fixation (MMF), there are areas for improvement: 3.1) Clearly state the research problem or objective in a concise manner. Highlight the specific research question or knowledge gap that the study aims to address. 3.2) Establish the need for further investigation or improvement by discussing the limitations, challenges, or evidence gaps associated with current techniques. Justify the need for the study by providing relevant information from the literature. 3.3) Elaborate on the advantages and limitations of orthodontic latex elastics as an alternative to wire ligatures. Briefly discuss the advantages and disadvantages of different fixation methods to enhance the reader's understanding of the research context. 3.4) Restructure the introduction to ensure a logical flow and organization of information. Improve transitions between ideas to present a coherent and logical progression of concepts. The introduction has been rewritten and involves all the changes recommended by the editor and reviewers. The research problem and objectives have been clearly stated so that the reader clearly understands the knowledge gap and what this study aims to address. 4. Methods: While the methods provide sufficient experimental details, include information on how the model simulates clinical situations. If there is clinical validation, provide relevant details. If not, discuss how the results can be applied to clinical patients. The materials and methods have been reformatted to better explain how the custom-made models simulate real-life scenarios. The purpose of the study has been stated to further discuss how the results can be applied. 5. Discussion and Conclusion: Separate the Discussion and Conclusion sections. The Discussion should follow this format: 4.1) highlight important results, 4.2) compare the results with previous studies, 4.3) discuss the limitations of the study, and 4.4) indicate clinical implications and suggest future studies. Move Figure 7 from the Discussion section to the Results section. The discussion and conclusion sections have been separated as recommended. Figure 7 has been moved and re-cited within the results section. 6. Conclusion: Provide a clear and direct summary of the results in terms of addressing the hypothesis. Since the manuscript lacks a clear clinical problem and hypothesis, ensure the conclusion is based on the obtained results. The conclusion has been totally re-written as per the editors and reviewer’s recommendation. Journal Requirements 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. I have re-formatted my manuscript according the PLOS ONE’s style requirements. Please let me know if any additional changes need to be made. 2. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. I have updated my profile to include my ORCID iD in the Editorial Manager Portal. 3. We note that Figures 1, 2, 3, and 4 in your submission contain copyrighted images. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. Figures 1-4 are original photographs taken by Sudeep Pawa during the experimentation phase of this study. Is it still necessary to have the copyright paperwork for this situation? Reviewer #1: To begin with - English language editing services very much needed for manuscript. - This is a CAD based design which was utilised for this invitro study . Wat was the printing material utilised for this study???? - Please provide justifications and citations to say the model material doesn’t interferes with testing results. - Please justify your sample size - Please add more correct citations under discussion. Total references of 13 for an original article is unacceptable. - Wat is new in this study when compared to previously published articles on similar topic. - Please provide relevant citations to your materials and methods section. - Your study is on tensile load only. Wat about shear loads acting on mandible at time of Fixation. Anything included in your study ??? Reply to Reviewer # 1 We sincerely appreciate your insightful and thorough review of our manuscript. The manuscript has undergone grammatical revisions. As detailed within, the customized models were created through the utilization of Computer-Aided Design (CAD) and subsequently fabricated via Computer-Aided Manufacturing (CAM). These models were constructed utilizing Stainless Steel as the chosen material. While material selection lacks specific justification, it is worth noting that material properties did not influence this study's scope, which solely focused on analyzing Tensile Loads causing separation between the two models. In the context of sample size, considering our status as a pilot study embarking on the pioneering examination of tensile loads in Maxillo-Mandibular Fixation, an initial pilot study was conducted. Sample size determination was carried out employing Stata/SE 15.1 for power analysis concerning one-way analysis of variance. This calculation incorporated a statistical significance level of 0.001, alongside a power value of 0.99, drawing on insights garnered from the pilot study's data. Given the absence of prior experimental investigations into tensile loads encompassing varied patterns during maxillo-mandibular fixation, it is important to acknowledge that direct comparisons with previous research cannot be made. Furthermore, with regards to shear loads impacting the mandible, the study was intentionally designed to explore vertical (unidirectional) forces exclusively. It is acknowledged that this design choice represents a limitation within our study. Reviewer #2: Nice preclinical project, not without its limitations as noted. Well written and documented. A couple of minor suggestions: 1. although the outcomes will not change, I would recommend indicating the parameters that were tested and to what level they were tested when completing the power analysis. 2. Not being an OMS or orthodontist and being familiar with the up to date state of MMF and arrangement of wires and elastics commonly used in MMF, it might help the reader to know what currently is the standard configuration that is taught and used in clinical practice to achieve fixation. If internal fixation is used is external fixation even needed? The OMS department in my current institution rarely in orthognatic cases uses external fixation once the internal fixation is placed. I would make comment of the current gold standard, and in what cases would you prefer external vs internal fixation. Additionally, I would also maybe make more comment of the consequences of inadequate fixation in the introduction. 3. Discuss experimental model limitations in greater detail and contrasting to what is done clinically- while MM bone fixation screws may be used (I am guessing not usually one for every tooth as used in this model), as indicated orthodontic brackets +- MMF screws are more commonly used. Why was one screw used for every tooth? What was the rationale? Why were orthodontic brackets not used if this is more commonly used in clinical practice? If repeating or extending this experimental model to study the effects of lateral forces, I would suggest integrating orthodontic brackets into the model (if you are able to find a way to bond to the custom 'dental model') to better represent what may be done clinically. This may be a point for discussion in the limitations of this preclinical model, along with discussion of any potential differences in the size of the custom fixation screw that was used in this study, to what it commonly available on the market (they seem quite large in diameter and not what may be used clinically). Granted this is a preclinical study with obvious limitations, clinical correlation and deeper discussion on model limitations is helpful for the reader as if products/screws that are used are not commercially available or the set up is not as it would be in a real situation then the results have minimal clinical meaning. Other than that, nice project. I would be interested to see as you mentioned how it would fare up with lateral movements which if the patient is a bruxer may be the time when potentially higher forces are generated and this could impact the fixation. Reply to Reviewer # 2 We sincerely appreciate your insightful and thorough review of our manuscript. The study has taken steps to enhance reader comprehension by rephrasing the study's parameters and detailing confidence levels or p-values. Regarding the established benchmark for achieving satisfactory Maxillomandibular Fixation (MMF), it's important to note that both techniques continue to be employed globally without a definitive consensus on a superior method. Concerning internal and external fixation, External Fixation (MMF) is frequently employed to facilitate precise and anatomical internal fixation. In the postoperative phase, external fixation serves to guide occlusion training in numerous instances. The introduction has now been supplemented with information on the ramifications of insufficient MMF. For the purpose of this pilot study and to mitigate variables influencing outcomes, the authors opted for the use of screws instead of orthodontic brackets. This strategic choice eliminated potential factors tied to bracket bond strength, which would have been pertinent had brackets been employed. Clear delineations have been provided about the study's limitations, along with suggestions for future research based on this study's findings Reviewer #3: The study is well designed and the manuscript is also acceptable for publication. However, it would be better if the clinical implication(s) of the in vitro findings are highlighted. The article seems to lack novelty. Reply to Reviewer # 3 We sincerely appreciate your insightful and thorough review of our manuscript. Clinical implications of this in vitro study have been added. We hope that the changes are sufficient to qualify for publication. Attachments Attachment Submitted filename: Rebuttal Letter.docx https://doi.org/10.1371/journal.pone.0300481.r002
17 Oct 2023 Decision Letter - Sompop Bencharit, Editor PONE-D-23-14421R1An In Vitro Study in Separating Tensile Loads during Maxillo-Mandibular Fixation using Wire and/or ElasticsPLOS ONE Dear Dr. Visuttiwattanakorn, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== While the reviewers felt that the revised manuscript is much improved, there are some minor issues as well as the study rationale needed to be addressed. Please address these comments thoroughly. ============================== Please submit your revised manuscript by Dec 01 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Sompop Bencharit, DDS, MS, PhD, FACP Academic Editor PLOS ONE Additional Editor Comments: While the reviewers felt that the revised manuscript is much improved, there are some minor issues as well as the study rationale needed to be addressed. Please address these comments thoroughly. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I still see Abstract is not a structured one . Please provide a structured abstract. Please provide all data related to this study in a repository or a supplemental file . I meant all those files which had not been mentioned in the revised manuscript. Reviewer #2: - I question the use, discussion and relevance of reference #13 on line 234. It appears the study referenced is in relation to a persons ability to pull down on a level with their arm in a seating and standing position. I fail to see how this study is relevant to the discussion of forces that could potentially be applied in the oral region. I am sure there are more appropriate references to discuss, allowing for a clinical correlation/relevance. This may also enlighten us as to if doing the combined fixation is the way to go, or is the additional stability achieved in this model irrelevant and so standard wire fixation is all that is needed? - another clinical relevance note - forces from the elastics degrade over time and so if this type of fixation is needed for some time, elastics will need to be replaced. - I would move the discussion on model limitations to the end of the discussion section and not in the conclusions section Reviewer #3: Dear doctor, despite your efforts, your experimental model has several inadequacies, that make the results invalid for clinical interpretation. The experimental model is merely indicating the tensile properties of various materials and is not even a faint replication of the clinical situation. The results obtained from this study are insignificant as long as they do not have any strong correlation with the clinical situation. Combining two materials will always give the concluded result. Please provide a strong rationale for your study, to justify its publication. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Prof Dr Hariharan Ramakrishnan Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-23-14421_R1_reviewer.pdf https://doi.org/10.1371/journal.pone.0300481.r003
Revision 2
19 Nov 2023 Author Response Rebuttal Letter November 20th 2023, Dear Editor and Reviewers, On behalf of all authors, we are grateful for your helpful in-depth feedback on our manuscript. We hope that you consider all raised points to be adequately addressed by our revised manuscript as described below and that the revised manuscript qualifies for publication. Kind Regards, Surakit Visutiwattanakorn Reviewer #1: I still see Abstract is not a structured one . Please provide a structured abstract. Please provide all data related to this study in a repository or a supplemental file . I meant all those files which had not been mentioned in the revised manuscript. Reply to Reviewer #1: Thank you for your kind acknowledgment of our comprehensive review of your manuscript. We are glad to inform you that the abstract has been meticulously re-written and restructured to enhance clarity, facilitating a more effective understanding of the study's purpose and results.Additionally, we have included files that contain data from the Instron 5566 Universal Testing Machine ensuring transparency and completeness, in this research. Reviewer #2: I question the use, discussion and relevance of reference #13 on line 234. It appears the study referenced is in relation to a persons ability to pull down on a level with their arm in a seating and standing position. I fail to see how this study is relevant to the discussion of forces that could potentially be applied in the oral region. I am sure there are more appropriate references to discuss, allowing for a clinical correlation/relevance. This may also enlighten us as to if doing the combined fixation is the way to go, or is the additional stability achieved in this model irrelevant and so standard wire fixation is all that is needed? - another clinical relevance note - forces from the elastics degrade over time and so if this type of fixation is needed for some time, elastics will need to be replaced. - I would move the discussion on model limitations to the end of the discussion section and not in the conclusions section Reply to Reviewer #2: We truly value your thorough examination of our manuscript. Reference #13 was carefully selected as a benchmark, in our study due to its relevance in assessing the forces applied to the maxillo unit during intraoperative reduction and fixation. Our main goal was to present the findings from our in vitro experiments regarding the forces needed to cause separation of models during fixation. It is essential to clarify that our investigation focused on the intraoperative phase, examining the immediate effects of intermaxillary fixation, rather than addressing potential degradation of elastics over time, which may be a significant factor in the post-operative period. Our aim was to offer a numerical representation derived from in vitro experiments, intending to establish a reference point for future clinical studies. The discussion on model limitations has also been moved to the discussion section. Reviewer #3: Dear doctor, despite your efforts, your experimental model has several inadequacies, that make the results invalid for clinical interpretation. The experimental model is merely indicating the tensile properties of various materials and is not even a faint replication of the clinical situation. The results obtained from this study are insignificant as long as they do not have any strong correlation with the clinical situation. Combining two materials will always give the concluded result. Please provide a strong rationale for your study, to justify its publication. Reply to Reviewer #3: Given the absence of prior experimental investigations into tensile loads encompassing varied patterns during maxillo-mandibular fixation, it is important to acknowledge that direct comparisons with previous research cannot be made. Furthermore, with regards to shear loads impacting the mandible, the study was intentionally designed to explore vertical (unidirectional) forces exclusively. It is acknowledged that this design choice represents a limitation within our study. For the purpose of this pilot study and to mitigate variables influencing outcomes, the authors opted for the use of screws instead of orthodontic brackets. This strategic choice eliminated potential factors tied to bracket bond strength, which would have been pertinent had brackets been employed. Clear delineations have been provided about the study's limitations, along with suggestions for future research based on this study's findings. Our goal was to provide an in vitro numerical representative value that would serve as a reference for future clinical studies. Attachments Attachment Submitted filename: Rebuttal Letter.docx https://doi.org/10.1371/journal.pone.0300481.r004
27 Feb 2024 Decision Letter - Sompop Bencharit, Editor An In Vitro Study in Separating Tensile Loads during Maxillo-Mandibular Fixation using Wire and/or Elastics PONE-D-23-14421R2 Dear Dr. Visuttiwattanakorn, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: (No Response) ****** 3. 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Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes Reviewer #3: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: (No Response) Reviewer #3: The authors have addressed the shortcomings in the prior submission satisfactorily. They have acknowledged the limitations of the study. Clinicians must exercise caution while interpreting the concluded results. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Prof Dr Hariharan Ramakrishnan Reviewer #2: No Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0300481.r005
Formally Accepted
5 Mar 2024 Acceptance Letter - Sompop Bencharit, Editor PONE-D-23-14421R2 PLOS ONE Dear Dr. Visuttiwattanakorn, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. PLOS Manuscript Reassignment Staff Editor PLOS ONE https://doi.org/10.1371/journal.pone.0300481.r006

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