Evaluation of the Effectiveness on Dentin Hypersensitivity of Sodium Fluoride and a New Desensitizing Agent, Used Alone or in Combination with a Diode Laser: A Clinical Study

Round 1

Reviewer 1 Report

lines 58-60 the sentence is written in Italian

lines 79-83 need improvement in clarity, it's not that the vestibular surfaces came into the clinic.

lines 88-91 the sentences are repetitive, please correct

lines 93-106 need better English, it is not scientifically well explained  in this manner

Also, ET (evaporative test) needs to be explained when first mentioned, not at the end of the MM section. Please add "air" in the term also - evaporative (air) test

In the Results, in all tables there is a word Media, what does it mean and represent? Mean value? Please correct. 

There is no explanation for scoring VAS test in the Manuscript. 

line 181 There is missing a subtitle at the beginning of the Discussion section

Discussion should begin with the main results of this study, from line 191. 

Lines 191-241. Discussion repeats the Results, while it should explain obtained results and compare them with other research. 

The conclusion should be summarized better as is in the Summary section. 

Author Response

Dear Reviewer,
we thank you for your valuable opinion and analysis. We have made several changes and corrections to the text to improve it and make it even more suitable for publication. We hope that it will go well and that you consider it suitable for this objective. Please see the file attached.

Author Response File: Author Response.docx

Reviewer 2 Report

The paper presented for evaluation raises an important topic in dental practice, namely dentin hypersensitivity. The issue underlies many studies carried out by many authors. The study investigated the influence of 2 different preparations available on the market and the effect of these substances in combination with the operation of a diode laser. Today's dental offices in many cases have such equipment, which significantly increases the use of clinical effects presented for the evaluation of work. The authors represent a very good research technique. Patient qualification was carried out in three stages, which also proves the high ability to conduct research. The issues of statistical analysis, division into test groups and the presentation of results were presented in detail. However, despite the very high values ​​of labor statistics, after the first analysis it is difficult to clearly define in which of the studied groups the best results were achieved. In my opinion, the work, despite the issue that has been studied for a long time, has the value of innovation, represented by the use of diode laser light in conjunction with the methods used so far.

 Summing up, in my opinion, the work with minor editorial corrections should be published in your journal.

Author Response

Dear Reviewer,
we thank you for your valuable opinion and analysis. We have made several changes and corrections to the text to improve it and make it even more suitable for publication. We hope that it will go well and that you consider it suitable for this objective

Reviewer 3 Report

The layout could be improved. The font size varies in the paper at line 196. 

In the Abstract, state the laser parameters (e.g. wavelength, fluence, treatment time)

In the introduction, cite recent systematic reviews of laser therapy (photobiomodulation) and dental pain/analgesia which are relevant to the effect of the laser in the short term. 

Line 58 - convert this text to English: Altri meccanismi sono stati studiati per migliorare e controllare il dolore da DH, agenti a base di nitrato di potassio che causano miglioramento del dolore per effetto di maccanismi neuronali [11,12]. 

Line 69: Expand the text here to explain what past studies have tested in combination protocols with diode lasers, and explain clearly how this study differs from and extends past work.

Line 102. Revise the text "Only NNCLs. Only 102 patients..." so it is clear what is being described.

Line 113. What was the pH of the F gel? Was this product APF?

Line 118. Provide a power density calculation and an estimate of Joules per tooth.  

Line 120. Explain how the treatment time of 60 sec was chosen (e.g. 0.2 W fopr 60 secs gives an irradiance of 12 Joules). 

Line 124 and 219. State the active ingredients in VivaSens®.

Line 125, reword the text " so forming a film-like to varnish".

Line 153 and Table 1. What is media? median or mean?

Line 153. Explain whether the study groups were different at baseline forgener,age or baseline sensitivity.

Line 156. The Table has no values in bold. Instead, use asterisks to show differences from baseline, and letters to show differences between groups. It is unclear why a total(aggregate) has been calculated and shown. 

Explain if the analysis tracked responses in individual subjects (repeated measures) or looked at aggregated data across groups.  

Line 171. Explain the overall trends without just repeating information that is evident from the table. Make specific reference to whether the inclusion of laser therapy adds specific benefits at particular times.

Line 209. "at short and long temp" Why is temperature mentioned here?

Line 240 Explain and expand "to the action of the diode laser that could allow deeper penetration into the dentin tubules of NaF". How could such a mechanism work?

Line 241 The authors need to explain that one mechanism is that light at ~ 800-830nm enhances fluoride uptake which provides resistance against acid attack, as shown in 2007 in this paper PMID 17969284. 

Line 348. This is not an appropriate reference for the statement made in line 243 as it is a cell culture study; instead find an appropriate reference on 800-830 nm diode laser effects on dentine proteins.   

Mention limitations of the study, such as no sham laser irradiation control for the effect of the laser.

Author Response

Dear Reviewer,
we thank you for your valuable opinion and analysis. We have made several changes and corrections to the text to improve it and make it even more suitable for publication. We hope that it will go well and that you consider it suitable for this objective. Please see the file attached.

Author Response File: Author Response.docx

Reviewer 4 Report

It is a very interesting study, and I appreciate that the authors recognized the study's limits. The article is well structured and the research is conducted in accordance with scientific requirements. The large percentage of similarities, in my opinion, is the most serious problem. I recommend that the authors go through this part again and make any necessary changes. I've attached the report on similarities. I also have some questions/recommendations to clarify some of the authors' less-emphasized points.

In my perspective, there are a number of concerns that should be handled better.

1. You mentioned that all subjects received oral  professional hygiene and instructions for maintaining it. Besides each patient was researched and individuated the causative factors that led to DH from NCCLs and given  instructions to eliminate them ( row 134-136 ).How did you check that they understood and followed the instructions?
2. Did all of the patients finish the trial and cooperate to the end?
3. Why did you choose VivaSens® (Ivoclar, 124 Vivadent) over other options?
4. Please double-check the bibliographic references and correct any that do not follow the recommended format.

Author Response

Dear Reviewer,
we thank you for your valuable opinion and analysis. We have made several changes and corrections to the text to improve it and make it even more suitable for publication. We hope that it will go well and that you consider it suitable for this objective. Please see the file attached.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Nice research and nice improvement of the manuscript. 

Congratulations. 

Reviewer 3 Report

The revisions made have improved the paper,

Further checking for correct English language expression is needed, as some minor errors still persist, as well as minor issues with layout and line spacing that could be fixed by the journal production staff.

Reviewer 4 Report

Dear author,

Thank you for submitting the final form. I appreciate the effort made to increase the scientific soundness of your research.