Review Reports

Round 1

Reviewer 1 Report

I want to thank the authors for the opportunity to review this paper. It treats an interesting and clinically relevant topic. However, some extensive work on the manuscript, especially regarding the M&M section and the language, is needed before it can be considered for publication. 

See my comments below: 

TITLE: 

 

I would suggest some linguistic adaptation of the title. I would prefer "Area and volume of remaining cement and enamel  after removal and polishing of buccal or lingual multibracket appliances"

 

ABSTRACT: 

 

L.18-22: I would to suggest the first sentence into two sentences and would suggest to insert one (i.e. the recent null-hypothesis) or two hypotheses. 

 

L. 26: i would suggest "remaining cement" instead of "cement remaining", as remaining is  an adjective. This appears frequently in the manuscript.  

 

INTRODUCTION: 

 

L.41-45: I would suggest to split this sentence in two to make it easier for the reader to understand. 

L. 45-46: i suggest "has evidence for a higher risk" and a full stop before "however".

L. 50: replace "worst" by "worse".

L. 63: Reference 11 does not mention fiber glass burs and investigates only tungsten carbide burs. Please doublecheck the references. 

L.70-79: This entire section is one single sentence. PLease write in shorter sentences for more clarity. 

 

MATERIALS & METHODS: 

 

L.82: Please specify the kind of teeth in greater detail, as the lingual surface of an incisor is i.e. much more complex than of a premolar. Please provide Informations about the storage (duration, T°, substance) of the teeth. Have you performed some x-rays to exclude carious or fractured teeth? 

L.92-93: Please describe in greater detail, why you used "two experimental models of epoxy resin". 

L. 92, 95: I would recommend to name your randomization software (Epidat) just once in the mansucript to avoid  redundance.

L. 100: Please provide the resolution of the scan in terms of a minimum triangle size/diameter. 

L.100: Please remove the first bracket with STL.

L. 107: Please name the polymerization times whenever light-polymerization was used. 

L. 110: Please use the FDI-nomenclature for teeth (15 to 25).

L.111-112: How ahve you ensured, that you used the same amount of cement bucally and lingually? The baseline ampunt of cement seems to be a very important point for your later results. 

L.119: The  H379AGK is named "adhesive remover bur" in the Komet cataloque, which is less misleading compared to your version "composite bur", which suggests that the bur is made from polymer. Please use the term "adhesive remover bur" throughout the whole manuscript. Please provide information about the bur-speed in rpm. 

L.125-127: please correct the sentence grammatically. 

Figure 1: You should provide a scale bar or at least a more precise description of the exact meaning of the colors. At the moment, it is very descriptive. 

L.142-143: Please specify, what exactly was randomized here. 

Figure 2: Please rewrite the term tesella network excess. Especially "Tesella" cannot be found in a dictionary. Furthermore, it would be valuable to import the image in better quality. The read line e.g. can very hardly been found in the image. Addiionally, in the left picture the yellow area is not visible entirely. For that reason, it is in my opnion very questionable, if the volume and area calucation can be performed exactly. 

Figure 3: See my comment on Fig. 1: You need to provide a scale bar with a mm value for every color. 

L.165-168: You can shorten and clarify this sentence extensively, e.g by not redundantly writing "after cement polishing".

L.177-181: It is absolutely not clear, why you used parametrical statistics and later provide medians in the graphics. As the data seem to be not normally distributed, non-parametrical statistics as Mann Whitney U Test seem to be much more suitable. If you , against my advice, want to use t-tests, you should also provide tests of normality (e.g. kolmogorow-smirnow). 

 

RESULTS:

 

Fig. 5-7: These box-plots suffer from low image quality. Furthermore you should provide information about all depicted marks (not only medains, which are misleading, becuase you do only mention mean and SD in your statistic section).

Fig. 6: Please check the font sizes. 

 

DISCUSSION: 

Wide parts of your discussion are treating SBS values. Were SBS-tests performed in this study? In the first place, you discussed different materials and pretreatments.  You should discuss the variations between lingual and buccal surfaces in greater detail. Maybe the differences in residual cement between buccal and lingual surfaces are due to lower bond-strength and to more complex lingual surfaces?

L. 234-237: As pour measurement methods have limitations, it is not possible to accep a hypothesis. Rewirte the sentence in a form that states "the null-hypothesis could not be rejected...". And, as suggested above, i would suggest to split the hypothesis in two parts.

L. 239: replace "comparing" by "compared to".

L.242-244: Please rewrite this sentence grammatically. 

L. 255: replace "concern" by "concerns"

L.270: What does preacondition mean?

L.299: Please correct the Error with the bookmark.

L.307-308: Please correct the following sentence grammatically: "however, it did not influenced statistically on the debonding forces"

L.315: Your reference list says Eichenberger, your text says Eichemberger. Please check. 

 

Author Response

I’m pleased to resubmit the manuscript of the work entitled, “Comparative Analysis of the Area and Volume of Cement Remaining, Cement Polishing and Enamel Removed After Buccal and Lingual Multibracket Appliance Therapy Debonding.”.

 

Reviewer 1: English language and style are fine/minor spell check required

Response: In order to respond to the reviewer 1 comment, we have we have sent the manuscript to the English editing service of MDPI.

 

Reviewer 1: I would suggest some linguistic adaptation of the title. I would prefer "Area and volume of remaining cement and enamel after removal and polishing of buccal or lingual multibracket appliances"

Response: In order to respond to the reviewer 1 comment, we have changed the title.

 

ABSTRACT

Reviewer 1: L.18-22: I would suggest the first sentence into two sentences and would suggest to insert one (i.e. the recent null-hypothesis) or two hypotheses.

Response: In order to respond to the reviewer 1 comment, we have divided the first sentence into two sentences.

 

Reviewer 1: L. 26: I would suggest "remaining cement" instead of "cement remaining", as remaining is an adjective. This appears frequently in the manuscript.

Response: In order to respond to the reviewer 1 comment, we have changed the words.

 

INTRODUCTION

Reviewer 1: L.41-45: I would suggest to split this sentence in two to make it easier for the reader to understand.

Response: In order to respond to the reviewer 1 comment, we have splitted the sentence in two.

 

Reviewer 1: L. 45-46: I suggest "has evidence for a higher risk" and a full stop before "however".

Response: In order to respond to the reviewer 1 comment, we have made the changes suggested.

 

Reviewer 1: L. 50: replace "worst" by "worse".

Response: In order to respond to the reviewer 1 comment, we have changed the word.

 

Reviewer 1: L. 63: Reference 11 does not mention fiber glass burs and investigates only tungsten carbide burs. Please doublecheck the references.

Response: In order to respond to the reviewer 1 comment, we have changed the reference: Garg R, Dixit P, Khosla T, Gupta P, Kalra H, Kumar P. Enamel Surface Roughness after Debonding: A Comparative Study using Three Different Burs. J Contemp Dent Pract. 2018 May 1;19(5):521-526. 

 

Reviewer 1: L.70-79: This entire section is one single sentence. Please write in shorter sentences for more clarity.

Response: In order to respond to the reviewer 1 comment, we have clarified the sentence.

 

MATERIALS & METHODS

Reviewer 1: L.82: Please specify the kind of teeth in greater detail, as the lingual surface of an incisor is i.e. much more complex than of a premolar. Please provide information about the storage (duration, T°, substance) of the teeth. Have you performed some x-rays to exclude carious or fractured teeth?

Response: In order to respond to the reviewer 1 comment, we have clarified the kind of teeth and the storage conditions. No X-rays were performed because the caries and fractures could be directly visible on the extracted teeth.

 

Reviewer 1: L.92-93: Please describe in greater detail, why you used "two experimental models of epoxy resin".

Response: In order to respond to the reviewer 1 comment, we clarify that an intact surface (buccal or palatal) was necessary to align accurately the STL digital files in the engineer software Geomagic Wrap. If both surfaces suffer changes, the alignment procedure would be impossible.

 

Reviewer 1: L. 92, 95: I would recommend to name your randomization software (Epidat) just once in the manuscript to avoid redundancy.

Response: In order to respond to the reviewer 1 comment, we have removed the second appearance of the randomization software.

 

Reviewer 1: L. 100: Please provide the resolution of the scan in terms of a minimum triangle size/diameter.

Response: In order to respond to the reviewer 1 comment, we have added the resolution and a reference.

 

Reviewer 1: L.100: Please remove the first bracket with STL.

Response: In order to respond to the reviewer 1 comment, we have removed de first bracket with STL

 

Reviewer 1: L. 107: Please name the polymerization times whenever light-polymerization was used.

Response: In order to respond to the reviewer 1 comment, we have clarified the polymerization times

 

Reviewer 1: L. 110: Please use the FDI-nomenclature for teeth (15 to 25).

Response: In order to respond to the reviewer 1 comment, we have used FDI-nomenclature.

 

Reviewer 1: L.111-112: How have you ensured, that you used the same amount of cement bucally and lingually? The baseline amount of cement seems to be a very important point for your later results.

Response: In order to respond to the reviewer 1 comment, a unique operator cemented the brackets trying to use the same amount of cement.

 

Reviewer 1: L.119: The H379AGK is named "adhesive remover bur" in the Komet cataloque, which is less misleading compared to your version "composite bur", which suggests that the bur is made from polymer. Please use the term "adhesive remover bur" throughout the whole manuscript. Please provide information about the bur-speed in rpm.

Response: In order to respond to the reviewer 1 comment, we have changed the name of the bur and added the bur-speed

 

Reviewer 1: L.125-127: please correct the sentence grammatically.

Response: In order to respond to the reviewer 1 comment, we have rephrased the paragraph.

 

Reviewer 1: Figure 1: You should provide a scale bar or at least a more precise description of the exact meaning of the colors. At the moment, it is very descriptive.

Response: In order to respond to the reviewer 1 comment, we have added a scale bar.

 

Reviewer 1: L.142-143: Please specify, what exactly was randomized here.

Response: In order to respond to the reviewer 1 comment, we randomized the tooth from which the images of the procedure would be shown

 

Reviewer 1: Figure 2: Please rewrite the term tesella network excess. Especially "Tesella" cannot be found in a dictionary. Furthermore, it would be valuable to import the image in better quality. The read line e.g. can very hardly been found in the image. Additionally, in the left picture the yellow area is not visible entirely. For that reason, it is in my opinion very questionable, if the volume and area calculation can be performed exactly.

Response: In order to respond to the reviewer 1 comment, we have rewritten the word and improved the “Image A” of “Figure 2”.

 

Reviewer 1: Figure 3: See my comment on Fig. 1: You need to provide a scale bar with a mm value for every color.

Response: In order to respond to the reviewer 1 comment, we have added a scale bar.

 

Reviewer 1: L.165-168: You can shorten and clarify this sentence extensively, e.g by not redundantly writing "after cement polishing".

Response: In order to respond to the reviewer 1 comment, we have short the sentence.

 

Reviewer 1: L.177-181: It is absolutely not clear, why you used parametrical statistics and later provide medians in the graphics. As the data seem to be not normally distributed, non-parametrical statistics as Mann Whitney U Test seem to be much more suitable. If you , against my advice, want to use t-tests, you should also provide tests of normality (e.g. kolmogorow-smirnow).

Response: In order to respond to the reviewer 1 comment, we clarify the statistical analysis after confirming with the statistic: Bivariate analysis was done using Student's t-test or Mann-Whitney non-parametric test for non-normal distributions. The assumption of normality was verified using the Shapiro-Wilk test.

 

RESULTS

Reviewer 1: Fig. 5-7: These box-plots suffer from low image quality. Furthermore you should provide information about all depicted marks (not only medians, which are misleading, because you do only mention mean and SD in your statistic section).

Response: In order to respond to the reviewer 1 comment, we have changed the quality of the box plot and also changed the information provided in the statistic section.

 

Reviewer 1: Fig. 6: Please check the font sizes.

Response: In order to respond to the reviewer 1 comment, we have changed the font size

 

DISCUSSION

Reviewer 1: Wide parts of your discussion are treating SBS values. Were SBS-tests performed in this study? In the first place, you discussed different materials and pretreatments.  You should discuss the variations between lingual and buccal surfaces in greater detail. Maybe the differences in residual cement between buccal and lingual surfaces are due to lower bond-strength and to more complex lingual surfaces?

Response: In order to respond to the reviewer 1 comment, we clarify that the aim of the study was to compare the area and volume of cement remaining after lingual and buccal multibracket appliances debonding using digital morphometry; therefore, the SBS-tests were not performed in this study. However, we appreciate the Reviewer 1 contribution for future studies. In addition, we clarify that the morphometry of the dental surfaces influence on the SBS value (Brosh T, Strouthou S, Sarne O. Effects of buccal versus lingual surfaces, enamel conditioning procedures and storage duration on brackets debonding characteristics. J Dent. 2005 Feb;33(2):99-105.); however, the experimental models used in this study included central incisors, lateral incisors, canines, first and second premolars and premolars have evidenced similar buccal and palatal surfaces (Mati M, Amm E, Bouserhal J, Bassil-Nassif N. Effects of buccal and lingual enamel sandblasting on shear bond strength of orthodontic brackets bonded with a self-etching primer. Int Orthod. 2012 Dec;10(4):422-31.).

 

Reviewer 1: L. 234-237: As pour measurement methods have limitations, it is not possible to accept a hypothesis. Rewrite the sentence in a form that states "the null-hypothesis could not be rejected...". And, as suggested above, I would suggest to split the hypothesis in two parts.

Response: In order to respond to the reviewer 1 comment, we have splitted the hypothesis in two parts. However, we consider that the null hypothesis must be rejected because there are statistically significant differences in terms of the area and volume of remaining cement after lingual and buccal multibracket appliances debonding and also between the area and volume of remaining cement after cement polishing of the lingual and buccal multibracket appliances therapy.

 

Reviewer 1: L. 239: replace "comparing" by "compared to".

Response: In order to respond to the reviewer 1 comment, we have changed the word

 

Reviewer 1: L.242-244: Please rewrite this sentence grammatically.

Response: In order to respond to the reviewer 1 comment, we have rewritten the sentence

 

Reviewer 1: L. 255: replace "concern" by "concerns"

Response: In order to respond to the reviewer 1 comment, we have changed the word

 

Reviewer 1: L.270: What does preacondition mean?

Response: In order to respond to the reviewer 1 comment, we have changed the word

 

Reviewer 1: L.299: Please correct the Error with the bookmark.

Response: In order to respond to the reviewer 1 comment, we have corrected the Error with the bookmark

 

Reviewer 1: L.307-308: Please correct the following sentence grammatically: "however, it did not influence statistically on the debonding forces"

Response: In order to respond to the reviewer 1 comment, we have corrected the sentence

 

Reviewer 1: L.315: Your reference list says Eichenberger, your text says Eichemberger. Please check.

Response: In order to respond to the reviewer 1 comment, we have changed the the author's name

We take this opportunity to thank the recommendations and suggestions made by the reviewers to improve the document.

 

 

Yours sincerely,

 

Clara Guinot-Barona, DDS, PhD.

Department of Orthodontics, Faculty of Medicine and Dentistry, Catholic University of Valencia, 46001 Valencia, Spain

E-mail: clara.guinot@ucv.es

Reviewer 2 Report

This study deals with the amount of cement remaining on vestibular and lingual tooth surfaces after debonding of orthodontic brackets.

The study is interesting but present some limits.

1)In the abstract the authors should add the mean and the SD of the findings.

2)The introduction is good.

3) It is not clear if the operators performing the bonding and the cement polishing is one and is the same for both the procedures.

4)The study misses a power analysis

5)The data should be analyzed for normal distribution before to use parametric tests.

6) Why the authors preferred to bond only one bracket on each tooth instead of two brackets (one lingual and one vestibular) for tooth

6)The results are clear

7) In the discussion more citations should be included on the effects of different adhesive materials with different polymerization techinque (Valletta, Prisco De Santis Ambrosio Martina EJO 2007;29:571-577)

The images should be of higher resolution.

Author Response

I’m pleased to resubmit the manuscript of the work entitled, “Comparative Analysis of the Area and Volume of Cement Remaining, Cement Polishing and Enamel Removed After Buccal and Lingual Multibracket Appliance Therapy Debonding.”

 

Reviewer 2: 1) In the abstract the authors should add the mean and the SD of the findings.

Response: In order to respond to the reviewer 2 comment, we have added the mean and SD values.

 

Reviewer 2: 3) It is not clear if the operators performing the bonding and the cement polishing is one and is the same for both the procedures.

Response: In order to respond to the reviewer 2 comment, we clarify that the experimental procedures performed at both experimental models were performed by a unique operator.

 

Reviewer 2: 4) The study misses a power analysis

Response: In order to respond to the reviewer 2 comment, we clarify that we use the same sample size of a previous study: Zubizarreta-Macho Á, Triduo M, Alonso Pérez-Barquero J, Guinot Barona C, Albaladejo Martínez A. Novel Digital Technique to Quantify the Area and Volume of Cement Remaining and Enamel Removed after Fixed Multibracket Appliance Therapy Debonding: An In Vitro Study. J Clin Med. 2020 Apr 12;9(4):1098.

 

Reviewer 2: 5) The data should be analyzed for normal distribution before to use parametric tests.

Response: In order to respond to the reviewer 2 comment, we clarify the statistical analysis after confirming with the statistic: Bivariate analysis was done using Student's t-test or Mann-Whitney non-parametric test for non-normal distributions. The assumption of normality was verified using the Shapiro-Wilk test.

 

Reviewer 2: 6) Why the authors preferred to bond only one bracket on each tooth instead of two brackets (one lingual and one vestibular) for tooth

Response: In order to respond to the reviewer 2 comment, we clarify that an intact surface (buccal or palatal) was necessary to align accurately the STL digital files in the engineer software Geomagic Wrap. If both surfaces suffer changes, the alignment procedure would be not possible.

 

Reviewer 2: 7) In the discussion more citations should be included on the effects of different adhesive materials with different polymerization technique (Valletta, Prisco De Santis Ambrosio Martina EJO 2007;29:571-577)

Response: In order to respond to the reviewer 2 comment, we have included the article mentioned and another recent article.

 

Reviewer 2: The images should be of higher resolution.

Response: In order to respond to the reviewer 2 comment, we have changed all figures.

We take this opportunity to thank the recommendations and suggestions made by the reviewers to improve the document.

Yours sincerely,

 

Clara Guinot-Barona, DDS, PhD.

Department of Orthodontics, Faculty of Medicine and Dentistry, Catholic University of Valencia, 46001 Valencia, Spain

E-mail: clara.guinot@ucv.es

Round 2

Reviewer 1 Report

I want to thank the editor for the opportunity to make another review for this interesting paper. The quality of the publication, especially regarding the english language, has improved significantly. 

However, there are some minor points that need to be changed beforehand the publication. Especially the figures need some improvements. 

Fig. 1 and Fig. 3: A Scale bar was added, the reviewer assumes that the used unit is mm. Please add this (mm) in the legend or the scale itself. 

L. 149: I would suggest to replace "tessella network", which seems to be an inadequate term, e.g. by "triangulated surface"

Fig. 5+6: These Figures still suffers from very low quality un the legend. maybe you should add the information about "red" and "blue" diagrams in the legend.

 

Author Response

I’m pleased to resubmit the manuscript of the work entitled, “Area and Volume of Remaining Cement and Enamel After Removal and Polishing of Buccal or Lingual Multibracket Appliances.”.

Reviewer 1: Fig. 1 and Fig. 3: A Scale bar was added, the reviewer assumes that the used unit is mm. Please add this (mm) in the legend or the scale itself. 

Response: In order to respond to the reviewer 1 comment, we have we have clarified in the legends of the figures with the calorimetry that are expressed in mm. (Figures 1, 3 and 4)   

Reviewer 1: L. 149: I would suggest to replace "tessella network", which seems to be an inadequate term, e.g. by "triangulated surface"

Response: In order to respond to the reviewer 1 comment, we have we have changed “tessella network” by triangulated surface in L506

Reviewer 1: Fig. 5+6: These Figures still suffers from very low quality un the legend. maybe you should add the information about "red" and "blue" diagrams in the legend.

 Response: In order to respond to the reviewer 1 comment, we have we have added the information about the blue and red colour in the legends of the 5, 6 and 7 Figures.

Reviewer 1: English language and style are fine/minor spell check required

Response: In order to respond to the reviewer 1 comment, we have changed words like in L405 (no modified)

We take this opportunity to thank the recommendations and suggestions made by the reviewers to improve the document.

 

 

Yours sincerely,

 

 

 

Clara Guinot-Barona, DDS, PhD.

Department of Orthodontics, Faculty of Medicine and Dentistry, Catholic University of Valencia, 46001 Valencia, Spain

E-mail: clara.guinot@ucv.es