Evaluation of morphological variations of mandibular bone in adult bruxers using CBCT: A cross-sectional study

Estelle Casazza; Benoit Ballester; Clémence Vernet; Camille Philip-Alliez; Anne Raskin

doi:10.1371/journal.pone.0342472

Peer Review History

Original SubmissionMay 12, 2025
6 Aug 2025 Decision Letter - Cristiano Miranda de Araujo, Editor Dear Dr. CASAZZA, 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 Sep 20 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 . 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. 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'. 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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: This manuscript presents a well-conducted cross-sectional study investigating morphological differences in the mandibles of bruxer and non-bruxer adults using CBCT. The use of both 3D Slicer® and Romexis® software for assessing bone density and mandibular angle measurements strengthens the methodological rigor. The statistical analyses appear appropriate, and the discussion is comprehensive, connecting the findings to relevant literature. However, before this manuscript is suitable for publication, I recommend the following revisions: 1. Introduction and Literature Review The introduction could benefit from a clearer identification of the gap in the literature. While panoramic radiographs have been used previously, the novelty and clinical relevance of employing CBCT in this specific context should be more explicitly stated. The definition of bruxism is accurate, but a brief clarification on the difference between awake and sleep bruxism—and whether this distinction was considered—would enhance the reader’s understanding. 2. Methodological Clarifications Diagnostic Criteria for Bruxism: One of the main limitations of the study is the absence of a standardized diagnostic protocol for identifying bruxers. Please clarify whether diagnosis was based solely on clinical records, self-report, clinical signs (e.g., tooth wear), or validated instruments. If diagnosis was retrospective and inconsistent, this should be clearly emphasized as a limitation. Sample Size Calculation: Although a sample size calculation is presented, it is unclear whether it was based on the primary outcome measures (bone density or mandibular angle). Please specify the statistical parameters and assumptions used. 3. Discussion and Interpretation Clinical implications of the findings—particularly regarding implant planning, orthodontics, or risk of mandibular changes—should be more explicitly discussed. The association between decreased mandibular angle and bruxism is noteworthy. Please elaborate on whether this may reflect muscular hyperactivity, skeletal remodeling, or growth-related factors. The lack of control for potential confounding variables (e.g., sex, occlusal classification, medication use, parafunctional habits) should be acknowledged more directly. Reviewer #2: 1. Sample size calculation: The sample size was calculated based on prevalence estimation (22%) and a 7% margin of error, which is not appropriate for a comparative study involving continuous variables. I recommend recalculating the sample size based on: -A clinically relevant minimum difference between groups; -An estimated standard deviation (from pilot data or literature); -A significance level of α = 0.05; -Statistical power of at least 80% (1-β ≥ 0.8). 2. Bruxism diagnosis: I suggest clarifying the criteria used to classify subjects as bruxers or non-bruxers, as recorded in the medical charts. The absence of standardized or validated diagnostic tools (such as STAB) introduces classification bias, which should be clearly acknowledged as a limitation. If possible, I encourage providing descriptive data on bruxism subtypes (sleep vs. awake, centric vs. eccentric), which could help strengthen the clinical interpretation. 3. Confounding factors: There are apparent age differences between groups, yet no statistical adjustment was performed. I recommend using multivariate models (e.g., linear regression) or stratified analysis to control for potential confounders such as age and sex. If not feasible, this limitation should be explicitly acknowledged in the discussion. 4. Excessive number of tables and data simplification: The manuscript includes a large number of tables, many of which present redundant or overly granular data. I suggest consolidating tables where possible, grouping by anatomical region (e.g., symphyseal, premolar, molar areas), and simplifying the presentation to improve clarity. 5. Clinical relevance of findings: Beyond statistical significance, I suggest discussing whether the observed differences (in HU and degrees) are clinically meaningful and how they might influence treatment planning in implantology or orthodontics. 6. Interpretation and speculation: The discussion raises interesting hypotheses regarding the relationship between bruxism type and anatomical site affected. However, these associations were not directly assessed in this study. I recommend clearly stating that these are hypothetical implications, to be explored in future prospective research. 7. Age stratification (≤45 vs. >45 years): If the division by age group was applied in the tables or analysis, I suggest justifying the rationale for this cutoff. If no statistical comparison was performed based on age, this stratification should be removed or explained as purely descriptive. The study addresses an important topic and employs a robust imaging methodology. With improvements in the methodological rigor, statistical analysis, and data presentation, I believe this manuscript may offer a valuable contribution to the field of dental imaging and bruxism research. ****** 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.0342472.r001
Revision 1
28 Aug 2025 Author Response Academic Editor Dear Editor, Thank you for your review of our manuscript. We have modified the items you mentioned in your feedback. You will find our responses to each of your suggestions in blue. Kind regards, The authors 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The requested checks have been carried out, and changes made to figure legends and supporting information. 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. In accordance with French regulations, single-center retrospective studies using pre-existing data for research purposes do not require written consent from patients, provided they have been informed in advance and do not object, and subject to a favorable opinion from an ethics committee. This indication has been added to the manuscript (lines 99-100). 3. We note that Figures 1 and 2 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. • Figure 1 is based on a screenshot from the 3D Slicer software, which is a free open source software distributed under a BSD style license. The license does not impose restrictions on the use of the software, as indicated on the software website at the following address: https://www.slicer.org/commercial-use.html This figure has therefore been retained in the manuscript. • Figure 2 has been removed from the manuscript. 4. We note that there is identifying data in the Supporting Information files S2_Table.csv, S3_Table.csv, S4_Table.csv, S5_Table.csv, and S6_Table.csv. Due to the inclusion of these potentially identifying data, we have removed this file from your file inventory. Prior to sharing human research participant data, authors should consult with an ethics committee to ensure data are shared in accordance with participant consent and all applicable local laws. Thank you for these clarifications. The necessary modifications have been made. Reviewers Dear Reviewers, Thank you for your careful review of the manuscript and your suggestions for improving its quality. We have considered every one of your comments to improve this article. You will find our responses to your feedback in blue. Kind regards, The authors Reviewer #1 1. Introduction and Literature Review The introduction could benefit from a clearer identification of the gap in the literature. While panoramic radiographs have been used previously, the novelty and clinical relevance of employing CBCT in this specific context should be more explicitly stated. Thank you for your comment. It has been added (lines 79–82). In addition, this is developed in the discussion (lines 256-260). The definition of bruxism is accurate, but a brief clarification on the difference between awake and sleep bruxism—and whether this distinction was considered—would enhance the reader’s understanding. We have taken your suggestion into account to complete the manuscript (lines 59-60). As this distinction could not be taken into account due to the absence of this data in a certain number of medical records, it could not be exploited in this study. This element has been added to the discussion (line 313). 2. Methodological Clarifications Diagnostic Criteria for Bruxism: One of the main limitations of the study is the absence of a standardized diagnostic protocol for identifying bruxers. Please clarify whether diagnosis was based solely on clinical records, self-report, clinical signs (e.g., tooth wear), or validated instruments. If diagnosis was retrospective and inconsistent, this should be clearly emphasized as a limitation. Thank you for your comment. This was clarified in the inclusion criteria (lines 106-108). Sample Size Calculation: Although a sample size calculation is presented, it is unclear whether it was based on the primary outcome measures (bone density or mandibular angle). Please specify the statistical parameters and assumptions used. Thank you for your comment. The requested information has been added (lines 125-129). 3. Discussion and Interpretation Clinical implications of the findings—particularly regarding implant planning, orthodontics, or risk of mandibular changes—should be more explicitly discussed. Your comments have been taken into account, and the clinical implications are detailed lines 283-292 and 326-329. The association between decreased mandibular angle and bruxism is noteworthy. Please elaborate on whether this may reflect muscular hyperactivity, skeletal remodeling, or growth-related factors. These elements have been mentioned lines 322-325. The lack of control for potential confounding variables (e.g., sex, occlusal classification, medication use, parafunctional habits) should be acknowledged more directly. Thank you for your comment. Details of confounding variables have been added line 336. Reviewer #2 1. Sample size calculation: The sample size was calculated based on prevalence estimation (22%) and a 7% margin of error, which is not appropriate for a comparative study involving continuous variables. I recommend recalculating the sample size based on: -A clinically relevant minimum difference between groups; -An estimated standard deviation (from pilot data or literature); -A significance level of α = 0.05; -Statistical power of at least 80% (1-β ≥ 0.8). Thank you for this comment and the associated information. The calculation of the number of subjects required has been corrected according to your indications. It is based on an expected difference between groups of 200HU, with a standard deviation of 250HU, an alpha risk of 0.05% and a power of 90% (lines 125-129). However, in order to anticipate the potential loss of data (missing teeth, missing mandibular angle), a number greater than the minimum size required was included, to guarantee sufficient statistical power for both parts of the study, particularly for the mandibular angle section. 2. Bruxism diagnosis: I suggest clarifying the criteria used to classify subjects as bruxers or non-bruxers, as recorded in the medical charts. The absence of standardized or validated diagnostic tools (such as STAB) introduces classification bias, which should be clearly acknowledged as a limitation. If possible, I encourage providing descriptive data on bruxism subtypes (sleep vs. awake, centric vs. eccentric), which could help strengthen the clinical interpretation. Thank you for your comment. Additional descriptive elements concerning the diagnosis of bruxism have been added lines 106-108. Unfortunately, data on bruxism subtypes were not sufficiently mentioned in the medical records to allow clinical interpretations. This was discussed at the end of the manuscript. 3. Confounding factors: There are apparent age differences between groups, yet no statistical adjustment was performed. I recommend using multivariate models (e.g., linear regression) or stratified analysis to control for potential confounders such as age and sex. If not feasible, this limitation should be explicitly acknowledged in the discussion. Thank you for your comment. The corresponding change has been added (line 337). 4. Excessive number of tables and data simplification: The manuscript includes a large number of tables, many of which present redundant or overly granular data. I suggest consolidating tables where possible, grouping by anatomical region (e.g., symphyseal, premolar, molar areas), and simplifying the presentation to improve clarity. Thank you for your comment. The presentation of the results has been modified (lines 198-209). To improve readability and avoid repetition, 2 tables have been removed from the manuscript, and are now part of the supporting information. We preferred to keep the values in a single table to give the reader an overview of the results. We hope the result is more in line with your expectations. 5. Clinical relevance of findings: Beyond statistical significance, I suggest discussing whether the observed differences (in HU and degrees) are clinically meaningful and how they might influence treatment planning in implantology or orthodontics. Thank you for your comment. Modifications has been added lines 282-292 and 326-329. 7. Age stratification (≤45 vs. >45 years): If the division by age group was applied in the tables or analysis, I suggest justifying the rationale for this cutoff. If no statistical comparison was performed based on age, this stratification should be removed or explained as purely descriptive. Thank you for your comment. The division by age group was purely descriptive. The cut-off of 45 years old was the median age of the patients included in the study. This clarification has been added to the manuscript (line 189). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0342472.r002
8 Oct 2025 Decision Letter - Cristiano Miranda de Araujo, Editor Dear Dr. CASAZZA, 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 Nov 22 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 . 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. 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 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, Cristiano Miranda de Araujo Academic Editor PLOS ONE Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> 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 Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: All comments are completely answered. Thank you for opportunity to review. This is a very good study. The authors are to be congratulated for their research and should feel encouraged to increase the sample size in future investigations Reviewer #2: Overall, the manuscript has been improved, and most of the limitations highlighted in the previous review have been adequately addressed or properly justified. The study presents relevant findings, but I suggest a few additional revisions before acceptance: -Review of references The citation Lumetti S. et al., 2016 [9] does not adequately support the statement in lines 57–58: “can weaken the teeth and the temporomandibular joints, and generate mastication myalgia [9]”. Please revise this reference and consider replacing it with a more appropriate source. -Study limitations Although the limitations are discussed, I recommend moving the content currently found in lines 316–329 into the Discussion as the final paragraph. Alternatively, a specific subsection entitled “Study limitations and recommendations for future research” could be created. -Conclusion Please ensure that the Conclusion is concise and directly answers the research question: whether differences exist between bruxers and non-bruxers, and in which variables these differences were found. ****** 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 https://doi.org/10.1371/journal.pone.0342472.r003
Revision 2
14 Oct 2025 Author Response Reviewer #1 Reviewer #1: All comments are completely answered. Thank you for opportunity to review. This is a very good study. The authors are to be congratulated for their research and should feel encouraged to increase the sample size in future investigations. We would like to thank you for your feedback and the valuable advice you gave us to improve the quality of the manuscript. Reviewer #2 Overall, the manuscript has been improved, and most of the limitations highlighted in the previous review have been adequately addressed or properly justified. The study presents relevant findings, but I suggest a few additional revisions before acceptance: -Review of references The citation Lumetti S. et al., 2016 [9] does not adequately support the statement in lines 57–58: “can weaken the teeth and the temporomandibular joints, and generate mastication myalgia [9]”. Please revise this reference and consider replacing it with a more appropriate source. Thank you for your comment. This citation has been replaced by a more appropriate reference. Matusz K, Maciejewska-Szaniec Z, Gredes T, Pobudek-Radzikowska M, Glapiński M, Górna N, Przystańska A. Common therapeutic approaches in sleep and awake bruxism - an overview. Neurol Neurochir Pol. 2022;56(6):455-463. doi: 10.5603/PJNNS.a2022.0073. Epub 2022 Nov 29. -Study limitations Although the limitations are discussed, I recommend moving the content currently found in lines 316–329 into the Discussion as the final paragraph. Alternatively, a specific subsection entitled “Study limitations and recommendations for future research” could be created. Thanks to your suggestion, a section “Study limitations and recommendations for future research” has been created at the end of the discussion (line 315). -Conclusion Please ensure that the Conclusion is concise and directly answers the research question: whether differences exist between bruxers and non-bruxers, and in which variables these differences were found. Thank you for your comment. The conclusion has been rewritten according to your instructions (lines 333-339). Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx https://doi.org/10.1371/journal.pone.0342472.r004
19 Jan 2026 Decision Letter - Sergio Luiz Mota-Junior, Editor Dear Dr. CASAZZA, 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. ============================== The manuscript has improved. A minor revision is still suggested by Reviewer 2, and we recommend that the authors carefully observe this suggestion. ============================== Please submit your revised manuscript by within Mar 05 2026 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. A 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 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, Sergio Luiz Mota-Junior, Ph.D. Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. Additional Editor Comments: The manuscript has improved. However, a minor revision is still suggested by Reviewer 2. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> 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 Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you for all corrections and good luck in your research. It’s a very complex and necessary research Reviewer #2: I congratulate the authors once again on the development of this work. All recommendations have been accepted and addressed. During the process of reviewing this article, an updated concept of bruxism was published. I simply recommend that the new concept be incorporated into your work. The reference is as follows: Verhoeff MC, Lobbezoo F, Ahlberg J, Bender S, Bracci A, Colonna A, Dal Fabbro C, Durham J, Glaros AG, Häggman-Henrikson B, Kato T, Koutris M, Lavigne GJ, Nykänen L, Raphael KG, Svensson P, Wieckiewicz M, Manfredini D. Updating the Bruxism Definitions: Report of an International Consensus Meeting. J Oral Rehabil. 2025 Sep;52(9):1335-1342. doi: 10.1111/joor.13985. Epub 2025 May 1. PMID: 40312776; PMCID: PMC12408978. ****** 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. 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Revision 3
19 Jan 2026 Author Response Reviewer #1: Thank you for all corrections and good luck in your research. It’s a very complex and necessary research We would like to thank you for your feedback to improve the quality of the manuscript. Reviewer #2: I congratulate the authors once again on the development of this work. All recommendations have been accepted and addressed. During the process of reviewing this article, an updated concept of bruxism was published. I simply recommend that the new concept be incorporated into your work. The reference is as follows: Verhoeff MC, Lobbezoo F, Ahlberg J, Bender S, Bracci A, Colonna A, Dal Fabbro C, Durham J, Glaros AG, Häggman-Henrikson B, Kato T, Koutris M, Lavigne GJ, Nykänen L, Raphael KG, Svensson P, Wieckiewicz M, Manfredini D. Updating the Bruxism Definitions: Report of an International Consensus Meeting. J Oral Rehabil. 2025 Sep;52(9):1335-1342. doi: 10.1111/joor.13985. Epub 2025 May 1. PMID: 40312776; PMCID: PMC12408978 Thank you for your comment and your interest in this work. This citation has been added to update the bibliography. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_3.docx https://doi.org/10.1371/journal.pone.0342472.r006
25 Jan 2026 Decision Letter - Sergio Luiz Mota-Junior, Editor Evaluation of morphological variations of mandibular bone in adult bruxers using CBCT: a cross-sectional study PONE-D-25-25414R3 Dear Dr. Casazza, 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. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . 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, Sergio Luiz Mota-Junior, Ph.D. Academic Editor PLOS One Additional Editor Comments (optional): Dear Authors, Thank you for submitting the revised version of your manuscript to PLOS ONE. We have now completed the evaluation of the revised manuscript and the responses to the reviewers’ comments. Based on this assessment, the manuscript is adequate for publication in PLOS One. https://doi.org/10.1371/journal.pone.0342472.r007
Formally Accepted
Acceptance Letter - Sergio Luiz Mota-Junior, Editor PONE-D-25-25414R3 PLOS One Dear Dr. CASAZZA, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Sergio Luiz Mota-Junior Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0342472.r008

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