Association between Maxillary Posterior Teeth Periapical Odontogenic Lesions and Maxillary Sinus Mucosal Thickening: A 3D Volumetric Computed Tomography Analysis

Round 1

Reviewer 1 Report

This is a nice paper that clearly explains some important aspects of the pathogenesis of odontogenic CRS. It definitely deserves publication, but the paper could appear much more attractive and comprehensive if the authors add some typical CT scans illustrating different scenarios of the relationship between periodontitis bone lesions and severity of the mucosal oedema in the maxillary sinus.

Author Response

Dear Reviewer,
We have added some typical CT scans in axial, sagittal and coronal views illustrating different scenarios relationship between periodontitis bone lesions and severity of the mucosa thickening in the maxillary sinus. Please see the Figure 6 in the attached file.

Thank you for Your comments.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear authors, Your study is interesting, however there are some point to be clarified. 

sample size. It is now clear how many maxillary sinuses You analyzed. 

Ethics. I have found the same protocol number in other two papers published by Your group. Please provide explenation also in the manuscript. 

the variable considered statistically significant such sex and type of teeth should be more discussed (why men? is the inflammatory processs in male different tha women etc)

Author Response

Dear Reviewer,

Thank you for Your comments. We have prepared some answers to your concerns:

1. Sample size: „It is not clear how many maxillary sinuses You analysed” – In Results section first part (Line 140) the first sentence is: „In total, 83 teeth with lesions and maxillary sinuses were analysed”. As stated in manuscript, we analysed in detail 83 teeth, periapical bone lesions around the roots of these teeth and 83 maxillary sinuses.
2. Ethics: „I have found the same protocol number in other two papers published by Your group. Please provide explanation also in the manuscript.” - The bioethics committee permission No. P2-86/2004 was given for the large research of upper airways diseases, which also includes exploration of odontogenic sinusitis using CT and other methods, testing surgical techniques and gathering patients’ clinical data. We have included this explanation in the manuscript.
3. Significant variables: „the variable considered statistically significant such sex and type of teeth should be more discussed (why men? is the inflammatory process in male different then women etc)” – we have added discussion insights according to the newest research in the spectrum of our study. Please see in the attached manuscript.

Reviewer 3 Report

Very intense and detailed manuscript whose intended audience would fall into the dental field.  adequate statistical analysis is displayed. However,
the study would not merit a significant interest to the rhinology specialty.  Although it it a well designed study, the intensity of results would likely overwhelm the average clinical otolaryngologist and not add to his significant knowledge base.  
A small suggestion to authors would be to separate inclusion and exclusion criteria in the Materials and Methods section.  

Author Response

Dear Reviewer,

Thank You for Your comments. This study is a part of a large research in order to analyse the importance of odontogenic maxillary sinusitis. In this study we focused on detailed, structured, reliable and standardised analysis of the relationship between apical periodontitis bone lesions around teeth roots and maxillary sinus mucosa thickening. This research is intended to provide reliable information by analysing objective variables on the maxillary sinus mucosa thickening in 3D. Otolaryngologists are very important part of this study and their knowledge were (and we think will be) broadened by standardised objective variables analysis.

Secondly, we have separated inclusion and exclusion criteria in Materials and Methods section, as You suggested.

Hope this answers Your questions.

Round 2

Reviewer 2 Report

Manuscript can be now accepted