PONE-D-23-29819Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: A CBCT studyPLOS ONE

Dear Dr. Nakaparksin,

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Kind regards,

Johari Yap Abdullah, B.S. & I.T, GradDip ICT, M.Sc, Ph.D.

Academic Editor

PLOS ONE

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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: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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: Yes

Reviewer #2: Yes

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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: Yes

Reviewer #2: Yes

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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: This study was conducted to determine the probability of immediate implant placement in the esthetic zone using four different implant directions. In general, the findings can be potentially applied for dental implant treatment planning.

Comments:

1. Manuscript is well written but it can be further improved with adequate proofreading (e.g. paragraph from line 66 to 77). Please do the needful.

2. Table 2: 'each relation' - can be more specific (e.g. anatomical relation, etc)

3. Conclusion: The authors state that "the use of angulated screw is essential to increase the probability of screw retained implant prosthesis".

Can the authors explain further on the relevance of this statement in relation to the statement problem and the purpose of this study?

Reviewer #2: The authors conducted a CBCT study, aiming to determine the probability of IIP in the esthetic zone, using four different implant directions. The topic is clinically relevant and the manuscript is well presented. However, some sections may need further clarification.

Abstract

1. Line 14: Please specify the number of patients as well.

2. Line 15: Please specify the method used to come up with the probability of 76.11%. What’s the diameter of the implants? Was angulated screw channel (ASC) included in this calculation?

3. Line 18: What is “limited restorability angulation for cement retained implant prosthesis (middle half)”? This description is confusing. Please revise.

Material and Method

1. Line 90: How did you determine a number of 120 CBCT scans is sufficient for the study?

2. For the inclusion/exclusion criteria, did you have any criteria to assess if the patient’s anterior teeth were misaligned?

3. Line 132: Any citations you could provide to support the use of 4 mm as the threshold?

4. The authors should elaborate on the methods used to determine the long axis of the tooth, the angulation/direction of the planned implant, etc.

Results

1. How did you decide the implant length and diameter for central incisors, lateral incisors and canines? For example, is it practical to place a 5mm-diameter implant at a canine location, or to place a 16mm- or even 18mm-long implant?

Discussion

1. There are two very similar studies published in 2022 and 2023. The authors must provide comments on these two studies, and elaborate on how the current study can add more information to the currently available evidence.

Erin K Edmondson, Pedro M Trejo, Nikolaos Soldatos, Robin L Weltman. The ability to screw-retain single implant-supported restorations in the anterior maxilla: A CBCT analysis. J Prosthet Dent. 2022 Sep;128(3):443-449.

Joseph Y K Kan, Kitichai Rungcharassaeng, Pongrapee Kamolroongwarakul, Guo-Hao Lin, Hiroyuki Matsuda, Shi Yin, Hom-Lay Wang, Dennis Tarnow, Jaime L Lozada. Frequency of screw-retained angulated screw channel single crown following immediate implant placement and provisionalization in the esthetic zone: A cone beam computed tomography study/ Clin Implant Dent Relat Res. 2023 Oct;25(5):789-794.

2. The authors should comment on the limitations of the current study.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-29819R1Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: A CBCT studyPLOS ONE

Dear Dr. Nakaparksin,

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 submit your revised manuscript by Apr 11 2024 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Johari Yap Abdullah, B.S. & I.T, GradDip ICT, M.Sc, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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: All comments have been addressed

Reviewer #2: (No Response)

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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

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

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: Yes

Reviewer #2: Yes

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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

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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: All comments and recommendations have been satisfactorily addressed.

Clear clarification was made on issues raised from the first review.

The amendments are well highlighted in the manuscript. Thank you.

Reviewer #2: While the authors adequately addressed most concerns in the "Author's Response to Reviewer Comments," it is noted that the manuscript itself has undergone only minimal revision. It is requested to incorporate the information provided in the Author's Response directly into the manuscript to ensure a more comprehensive presentation.

The specific details from the "Author's Response to Reviewer Comments" that need to be included in the manuscript are as follows:

Answer for using angulated screw channel of not: 548 teeth from 720 teeth (548/720) can be performed IIP in esthetic zone. The diameter of 3.3, 3.5, 4.1, 4.5 and 5 mm were used in all maxillary anterior teeth (central incisor, lateral incisor, canine). The diameter of 2.9 mm is used in lateral incisor only. The angulated screw channel was included in the calculation of all implant diameter except diameter of 2.9 mm was not included.

Answer for clarifying “limited restorability angulation for cement retained implant prosthesis": It is the most buccal angulation that allow for IIP in esthetic zone in cement retained implant prosthesis, which often in the middle of individual tooth, hence referred to as “middle half”. Even though, there are some possibilities to restore implant in more extreme buccal angulation with implant platform being more apical and palatal, there is an increased risk of complication.

Answer for sample size calculation:

The purpose of this study is to determine the probability of IIP in esthetic zone using four different implant directions. This design of the study has not been performed yet. So, there will be no similarity in statistical data for this study.

The sample size calculation for estimating proportion will be used as shown in the formula (in Response to reviewers):

According to the retrospective study of Ashok Velayudhan et al. in 2020 that the objective related to the current study showed that in a total of 77 implants placed in the anterior maxilla, with 21 of them being immediate implants, 6 (or 7.8%) of 21 immediate implants were placed in the anterior maxilla alone.

The output of the sample size calculation is 114. The 120 patients are sufficient for our study. --> This must be mentioned in the manuscript.

Answer for misaligned teeth as an exclusion criterion: Upper anterior teeth (canine-canine) misaligned is considered to exclusion criteria, which did not include in the sample size of our study.

Answer to elaborate on the methods used to determine the long axis of the tooth, the angulation/direction of the planned implant:

The line drawn from incisal edge to root apex was long axis of the tooth.

The point between incisal edge to CEJ was marked as point M. The point between the center of the most prominent point of cingulum to the incisal edge was marked as point S.

- In traditional cement retained implant prosthesis (incisal edge), long axis of implant will coincide with incisal edge.

- In traditional screw retained implant prosthesis (screw retained), long axis of implant will coincide with point S.

- In limit angulation for angulated screw channel (angle screw), long axis of implant will coincide at the point that an angle up to 25° from traditional screw retained.

- In limit restorability angulation for cement retained implant prosthesis (middle half), long axis of implant will coincide with point M. --> Please add all of them to your manuscript.

Discussion

Answer related to the two recent studies:

In Erin K Edmondson study was virtual implant planning by Simplant® Pro17.01; Dentsply Sirona in screw retained implant direction using straight or an angled screw channel abutment with different angulation (5°, 10°, 15°). The process is not IIP, therefore the method to placed implant was different from our study. The implant diameter for each site was fix based on standards for each tooth type (canine and central incisor 4.3 mm, lateral incisor 3.5 mm). The implant length was 10 mm for all implant.

In Joseph Y K Kan study investigate the probability of using straight screw-channel screw-retained restoration for immediate implant placement in maxillary anterior teeth. The method of this study was different from our study. The mid sagittal image of each maxillary teeth with vertical and horizontal scale bars was screen-captured and transferred to Keynote. The digital template for 3.5 mm diameter was used in central incisor and lateral incisor. The digital template for 4.3 mm diameter was used in central incisor and canine. The implant length was 13, 15 and 18 mm. Additional line added to digital template as a guide for IIP. All CBCT images were classified as contraindicated or indicated by two examiners.

In our study was virtual implant planning by Implant Studio® to determine the probability of IIP in esthetic zone. The directions of implant that added for more than the two mentioned study (Erin K Edmondson and Joseph Y K Kan) were cement retained implant prosthesis, angulated screw channel at the 25° angulation and the middle of individual tooth. Various size of diameter (2.9, 3.3, 3.5, 3.75, 4.0, 4.5, 5 mm) and length (6, 8, 10, 12, 14, 16, 18 mm) were included in our study to promote adaptability and suitability in IIP in esthetic zone.

--> These are great discussion points. Please add them to your manuscript. You should compare your study with these two recently published articles since these points are clinically relevant.

Answer related to the study limitation: In our study, to standardized the method, implant planning is limited to static predetermined angulation to anatomical relation and implant size. This could limited the probability as clinician can increase the depth of implant placement, modified implant angulation within restorable position. Future study is suggested to study the effect of probability associated with dynamic implant planning.

--> This answer needs to be added as the last paragraph of your Discussion.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-29819R2Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: A CBCT studyPLOS ONE

Dear Dr. Nakaparksin,

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 submit your revised manuscript by Jun 14 2024 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,

Johari Yap Abdullah, B.S. & I.T, GradDip ICT, M.Sc, Ph.D.

Academic Editor

PLOS ONE

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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 #3: (No Response)

Reviewer #4: (No Response)

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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 #3: No

Reviewer #4: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: No

Reviewer #4: Yes

**********

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 #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: (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 #3: Dear authors,

I am evaluating the R2 version of the article titled "Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: a CBCT study”. The purpose of this “cone-beam computed tomography (CBCT) study was to determine the probability of IIP in the esthetic zone, using four different implant directions.”

After reading the results session, I understood the study. No patient received dental implants.

There are biases in the study.

The probability depends on many factors which must be considered and were abandoned. Moreover, there was no statistical to prove the superiority of any type over another one.

SPECIFIC COMMENTS

ABSTRACT:

- “Statement of problem: What are the incidences of immediate implant placement (IIP) in the esthetic zone, using four different implant directions?” - It is wrongly developed.

- The methodology was weakly presented.

INTRODUCTION

- This session is long.

M&M

- there is a time problem in the study “The sample criteria for this study were patients who had CBCT scans of the anterior maxilla at the Oral and Maxillofacial Radiology clinic, Faculty of Dentistry, Mahidol University performed during January 2012 – August 2022. CBCT images were performed by 3D Accuitomo 170 (J. 91 Morita®, Japan) and randomly selected for evaluation on 9 June 2021.”

- Exclusion criteria is incomplete

- Statistics was poorly presented

RESULTS

- What was the foundation/parameter to support the probability suggested? “The distribution of SRP with probability of IIP are shown in Table 1."

CONCLUSION

- I suggest to rethink and adjust it after revision.

Reviewer #4: Thank you for the authors of this work. The study aim to determine the probability of IIP in the esthetic zone without perioperative complications, using four different implant placement directions. The study is considered Novel and of interest. However, some concerns were addressed in the Word file attached. Please correct them all and comment when needed.

To mention some of the comments here:

1. Title needs to be improved

2. Abstract: The problem statement is not clear and is almost the same as what is mentioned in the purpose.

3. Introduction: A. In my opinion, you can shorten your introduction by removing unnecessary details; B. Your introduction needs to be strengthened. You need to add a paragraph of other studies that used simulations like yours and describe their findings in a very short and meaningful way. C. Some references were missing; D. Add your study hypothesis.

4. Material: A. Please specify the population?, which ethnicity? Age (Mean age)? Gender? B. Figure 1 showed misaligned anterior central incisor. One of your exclusion criteria is misaligned teeth, so how come you have included this in your study. This is contradicting and may be translated into bias in your study. Please comment on this. C. In your figure 3, I noticed that there are some issues in your alignment of your Implant. It is clearly evident to the readers in this figure that you are not following exactly Point M or Point S when placing your implants. Even the incisal edge is not followed 100%.

The points mentioned in figure 2 are not exactly followed in figure 3

This can affect all your study results and can be considered invalid outcomes. Please comment on this.

Other comments and suggestions were mentioned in the word file. Please correct and comment on them all.

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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 #3: No

Reviewer #4: 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-23-29819-reviewer comments.docx

Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: A CBCT study

PONE-D-23-29819R3

Dear Dr. Nakaparksin,

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.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. 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.

Kind regards,

Johari Yap Abdullah, B.S. & I.T, GradDip ICT, M.Sc, Ph.D.

Academic Editor

PLOS ONE

Summary of Reviews

The manuscript received a total of four reviews. Two reviewers recommended acceptance, praising the paper for its originality and significant contribution to the field. They highlighted the following points:

• Reviewer 1 commended that the manuscript is well written, with few comments to improve the overall manuscript.

• Reviewer 3 emphasized the novelty of the study, which follows the trend toward digital investigation in dentistry. The reviewer commented on many things, however, after the revision, all the comments were addressed according to this reviewer’s feedback.

However, two reviewers recommended rejection. Their concerns were primarily focused on:

• Reviewer 2 pointed out perceived methodological flaws and suggested comparative statistical testing. The reviewer’s comments were reduced from the first revision to the second revision. However, still the reviewer insisted on the poor statistical analysis.

• Reviewer 4 commented on the statistical method followed by the authors as it is only descriptive analysis.

Evaluation and Justification

After a thorough evaluation of the manuscript and considering the reviewers' comments, I believe that the strengths of the paper justify its acceptance. Here are my reasons:

1. Originality and Contribution: The manuscript presents novel findings that offer significant insights into digital guided implantology. The originality of the research aligns with the high standards of PLOS ONE, contributing valuable knowledge that can advance the field.

2. Robust Methodology: While two reviewers raised concerns about the statistical analysis, the authors have provided a detailed explanation addressing these points. In the era of digital research, studies with only descriptive data are not abnormal incidence. I have encountered many studies published in very prestigious journals with only descriptive data. The novelty claims superiority over the strength of the statistical analysis.

3. Despite the fact that the authors have made the necessary corrections, one of the reviewers failed to take into account the fact that the authors had made the correction. This reviewer continued to point out that the correction is needed.

4. Clarifications and Revisions: In response to all reviewers’ comments, the authors have revised the manuscript to clarify their interpretations and enhance the readability of key sections. These revisions address the concerns raised and improve the manuscript's quality.

5. Positive Reviewer Feedback: The positive feedback from Reviewers 1 and 3 cannot be overlooked. Their endorsement of the paper's strengths and its potential impact underscores the value of this research.

Conclusion

Given the substantial revisions made by the authors and the manuscript's contribution to the field, I recommend accepting this paper for publication in PLOS ONE. I believe that the positive aspects of the research, as highlighted by the accepting reviewers, outweigh the concerns raised by the rejecting reviewers. I am confident that this manuscript will be a valuable addition to PLOS ONE.

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 #4: All comments have been addressed

Reviewer #5: (No Response)

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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 #4: Yes

Reviewer #5: No

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #4: Yes

Reviewer #5: No

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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 #4: Yes

Reviewer #5: Yes

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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 #4: Yes

Reviewer #5: No

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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 #4: Thank you to the authors. All the previous comments have addressed and the figures were replaced. No further comments from my side.

Reviewer #5: The manuscript is poorly designed and statistically analysis is very weak. Probability is mentioned and any other comparative statistics or advance tools have not been used. The Manuscript is not suitable for publication as per PLOS ONE journal standards.

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Reviewer #4: No

Reviewer #5: No

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