Prevalence of congenital missing permanent teeth and its association with side and gender in a Saudi subpopulation

Abdulrahman K. Alshammari; Muteb A. Algharbi; Freah L. Alshammary; Nabeel S. Almotairy; Hatem D. Alshammari; Ibrahim R. Altheban; Khalid A. Aljameel; Fahad M. Aldakheel; Ahmed A. Madfa

doi:10.1371/journal.pone.0332958

Peer Review History

Original SubmissionJanuary 22, 2025
16 May 2025 Decision Letter - Sompop Bencharit, Editor PONE-D-25-02469Prevalence of congenital missing permanent teeth and explore any correlation with side and gender in a sample from Saudi subpopulationPLOS ONE Dear Dr. Alshammari, 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 review and address concerns from the reviewers especially in the methodology and the high prevalent of third molar agenesis explanation. ============================== Please submit your revised manuscript by Jun 30 2025 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. 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Please include a copy of Tables 1, 2, and 3 which you refer to in your text on pages 7, 8, 9. Additional Editor Comment: The reviewers have diverse opinion of this work. Please carefully review and address their concerns. [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: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 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 ****** 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 ****** 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: I have read the manuscript entitle “Prevalence of congenital missing permanent teeth and explore any correlation with side and gender in a sample from Saudi subpopulation”. Although this is an interesting topic, the authors did not bring any new information to the literature. The written style and results presentation could also have been improved One of my main concerns is that the authors observed a prevalence of 13.2%, that is too high once third molar agenesis were not take into consideration. However, this could be explained by the included patients age, which ranged from 9 to 60 years old. To have a correct diagnosis of agenesis in these age is a difficult task. Reviewer #2: Thank you for your submission, and congratulations on your hard work. The title is awkwardly phrased. Suggest rewording for clarity: “Prevalence of Congenital Missing Permanent Teeth and Its Association with Side and Gender in a Saudi Subpopulation”. Abstract: The abstract contains multiple grammatical issues and lacks clarity in the conclusion. Consider stating a more definitive takeaway. The term “most congenital missing” is not standard. Consider using “most commonly missing”. Methodology: The methodology is sound, but the explanation of examiner calibration and statistical analysis is verbose and could be more concise. It would strengthen the paper to include inter- and intra-examiner reliability. Clarify how the classification of agenesis (mild/moderate/severe) was used in the analysis — this is mentioned but not utilized in the results or discussion meaningfully. Results: Results are described adequately, but tables and figures should be referenced more clearly within the text. There is unnecessary repetition in reporting gender and arch differences in multiple sections. Consider using more precise language in the interpretation of statistical results (e.g., “not statistically significant” rather than “do not statistically significantly correlate”). Discussion: The discussion is too long and would benefit from being more focused and structured (e.g., prevalence compared to regional and global studies, followed by implications, and then limitations). Some references are outdated or repeated. Update with more recent literature where available. The authors should more critically assess potential sources of bias and the retrospective design limitations. Figures & Tables: Ensure figures are high-resolution and labeled appropriately. The figure legends are too vague. Specify which findings each figure is illustrating and provide clearer visual comparisons where applicable. Replace terms like “congenital missing” with more standard terminology such as “congenitally missing teeth” or “tooth agenesis”. Consider using consistent terminology throughout (e.g., “hypodontia” vs. “agenesis”). ****** 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: No Reviewer #2: 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.0332958.r001
Revision 1
25 May 2025 Author Response Point- by- Point Reply to Review Comments Thank you for your encouraging remarks and for your suggestions, which have improved our manuscript. We were able to address all your suggestions as detailed in the point-by-point reply below: Journal Requirements: Comment Response 1 Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Done 2 Thank you for stating the following financial disclosure: [This research has been funded by Scientific Research Deanship at University of Ha’il - Saudi Arabia through project number <<RG-23 113>>]. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. This research has been funded by Scientific Research Deanship at University of Ha’il - Saudi Arabia through project number <<RG-23 113>>. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 3 When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. We agree to make the data available on acceptance. 4 Please include a copy of Tables 1, 2, and 3 which you refer to in your text on pages 7, 8, 9. We include the copy of Tables 1 and 2. It appears that Table 3 was mistakenly inserted in place of Table 2. I apologize for the oversight. We correct the error and ensure the appropriate table 2 is included in the revised version. Reviewer: 1 5 The written style and results presentation could also have been improved We appreciate your suggestion regarding the written style and results presentation. We carefully reviewed the manuscript to enhance the clarity and coherence of the writing. Additionally, we revised the presentation of the results to ensure they are more clearly structured and easier to interpret, possibly by refining tables, figures, and descriptive summaries. 6 One of my main concerns is that the authors observed a prevalence of 13.2%, that is too high once third molar agenesis were not take into consideration. However, this could be explained by the included patients age, which ranged from 9 to 60 years old. To have a correct diagnosis of agenesis in this age is a difficult task. We acknowledge that the reported prevalence of 13.2% may appear elevated, especially considering that third molar agenesis was not included. As you correctly pointed out, the wide age range of the included patients (9 to 60 years old) may have influenced the results, particularly in the younger subset where dental development is still ongoing. We recognize that diagnosing agenesis accurately in younger patients can be challenging due to variability in tooth development and eruption times. This limitation be more clearly addressed and discussed in the revised version of the manuscript to provide better context for the reported prevalence. Reviewer: 2 7 The title is awkwardly phrased. Suggest rewording for clarity: “Prevalence of Congenital Missing Permanent Teeth and Its Association with Side and Gender in a Saudi Subpopulation”. Corrected 8 Abstract: The abstract contains multiple grammatical issues and lacks clarity in the conclusion. Consider stating a more definitive takeaway. The term “most congenital missing” is not standard. Consider using “most commonly missing”. We have revised the abstract to correct the grammatical issues and improved the clarity of the conclusion by stating a more definitive takeaway. Additionally, the phrase “most congenital missing” has been replaced with the more appropriate term “most commonly missing.” 9 Methodology: The methodology is sound, but the explanation of examiner calibration and statistical analysis is verbose and could be more concise. It would strengthen the paper to include inter- and intra-examiner reliability. We have revised the section on examiner calibration and statistical analysis to make it more concise and focused. Additionally, we have included the inter- and intra-examiner reliability results. 10 Clarify how the classification of agenesis (mild/moderate/severe) was used in the analysis — this is mentioned but not utilized in the results or discussion meaningfully. Tooth agenesis was categorized based on literature into three groups: mild (one or two missing teeth), moderate (three to five missing teeth), and severe (six or more missing teeth). Additional explanations regarding these classifications were provided in the results section. 11 Results: Results are described adequately, but tables and figures should be referenced more clearly within the text. There is unnecessary repetition in reporting gender and arch differences in multiple sections. Consider using more precise language in the interpretation of statistical results (e.g., “not statistically significant” rather than “do not statistically significantly correlate”). Done 12 Discussion: The discussion is too long and would benefit from being more focused and structured (e.g., prevalence compared to regional and global studies, followed by implications, and then limitations). Done. We acknowledge that we streamlined the discussion with enhancing clarity and coherence. 13 Some references are outdated or repeated. Update with more recent literature where available. We checked the references and added more update one. The repeated references were removed. 14 The authors should more critically assess potential sources of bias and the retrospective design limitations. Corrected 15 Figures & Tables: Ensure figures are high-resolution and labeled appropriately. The figure legends are too vague. Specify which findings each figure is illustrating and provide clearer visual comparisons where applicable. Done 16 Replace terms like “congenital missing” with more standard terminology such as “congenitally missing teeth” or “tooth agenesis”. Consider using consistent terminology throughout (e.g., “hypodontia” vs. “agenesis”). We have revised the manuscript to replace non-standard terms like “congenital missing” with “congenitally missing teeth”.” We have also ensured consistent use of terminology throughout the text, by using “agenesis”. Attachments Attachment Submitted filename: Reply to Reviewers comments.docx https://doi.org/10.1371/journal.pone.0332958.r002
8 Sep 2025 Decision Letter - Mohmed Isaqali Karobari, Editor Prevalence of Congenital Missing Permanent Teeth and Its Association with Side and Gender in a Saudi Subpopulation PONE-D-25-02469R1 Dear Dr. Alshammari, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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The manuscript can be accepted for publication in its current form. I would like to congratulate the authors and wish them all the very best in their future endeavours. Best regards and keep well 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: All comments have been addressed Reviewer #4: 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 #3: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes 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: 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 #3: The authors conducted a all the corrections according to the reviewers comments. The paper was enhanced by these corrections and provides a good knowledge regarding this topic in our dental field. Reviewer #4: In this research, the authors studied the frequency of congenital tooth missing and evaluated the relationship between gender and side characteristics. The authors have addressed all comments. The manuscript can be accepted. ****** 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 ******** https://doi.org/10.1371/journal.pone.0332958.r003
Formally Accepted
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