Patient and Clinician Experiences When Using a CO₂ Laser for Cavity Preparations: Lessons learned from Prospective Clinical Research

Round 1

Reviewer 1 Report

1. You should write more sentences in the conclusion.
2. in the table 1, why Laser only, with anesthesia contain only n=2 and Laser and drill, with anes-thesia only n=5  that is very low population sampling.
3. in the method section, how can you select the human sample?

Author Response

1. You should write more sentences in the conclusion.  This has been addressed and additional sentences to clarify our conclusions can be found in lines 317-324.
2. In Table 1, why Laser only, with anesthesia contain only n=2 and Laser and drill, with anesthesia only n=5  that is very low population sampling.  Although 106 subjects were enrolled and completed the study, this table reflects the reported discomfort levels reported by each group. These were the reported numbers from each of the groups.
3. In the method section, how can you select the human sample?  This has been added and subject recruitment details can be found in lines 95-149.

Reviewer 2 Report

I congratulazioni with the Authors for their article.

I have few points to ask them to clarify.

Here my review:

Introduction:

• Add a small paragraph at the beginning of the introduction describing how minimal invasiveness treatments are continuously evolving in order to preserve the maximum quantity of sounded teeth. Check this article and improve this point with it doi: 10.3390/polym13173002. Then continue with the advantage properties of the lasers and their rational, lasers have been used in dentistry in the United States for caries removal and cavity  preparation since receiving FDA approval.....
• add the null hypothesis at the end of the introduction.

Materials and methods

• Specify the number of the approval by the Institutional Review Board
• Considering that multiple cavity preparations produced higher discomfort than single preparation, please specify if multiple cavity preparations were performed in a single or multiple appointments or in what case they were split in different appointments or in a single appointment. If you considered only procedures that can be performed in a single appointment, even if multiple cavities, add this point in the inclusion criteria. 
• line 148, ''When asked which treatment option they preferred for future cavity preparations, the majority (98%) would choose the laser over a conventional handpiece treatment: 94% would choose the laser with no anesthetic, and 4% laser with anesthetic.  Only 2% of participants would prefer a conventional handpiece treatment with anesthetic for future treatments.'' The Authors should specify if patients already had in their life other procedures with traditional handpiece in order to answer if they would prefer laser or handpiece. Considering the the study was not designed as split mouth study (half procedures with laser and half with handpieces in the same patients and then survey on what procedure they would like to receive in the future), this point should also be added as a limitation of the study.
• In figure 3, does the y-axis indicate the years of experience? please specify in the caption.

Discussion:

• Add in general the limitations of the lasers and the cases where they can not be used (amalgam, etc..)
• Improve the study limitations. 

Author Response

Introduction:

• Add a small paragraph at the beginning of the introduction describing how minimal invasiveness treatments are continuously evolving in order to preserve the maximum quantity of sounded teeth. Check this article and improve this point with it doi: 10.3390/polym13173002. Then continue with the advantage properties of the lasers and their rational, lasers have been used in dentistry in the United States for caries removal and cavity  preparation since receiving FDA approval. This has been addressed and can be found in lines 27-31 and 339-340.
• add the null hypothesis at the end of the introduction.  This has been added and can be found in lines 87-92. Additionally, new text to clarify the null hypotheses testing has been addressed and answered and can be found on lines 242-244, 258-259, and 281-283.

Materials and methods

• Specify the number of the approval by the Institutional Review Board.  This has been added and can be found in lines 94-95.
• Considering that multiple cavity preparations produced higher discomfort than single preparation, please specify if multiple cavity preparations were performed in a single or multiple appointments or in what case they were split in different appointments or in a single appointment. If you considered only procedures that can be performed in a single appointment, even if multiple cavities, add this point in the inclusion criteria. This has been addressed and can be found in lines 147-149.
• line 148, (Now lines 212-220) ''When asked which treatment option they preferred for future cavity preparations, the majority (98%) would choose the laser over a conventional handpiece treatment: 94% would choose the laser with no anesthetic, and 4% laser with anesthetic.  Only 2% of participants would prefer a conventional handpiece treatment with anesthetic for future treatments.'' The Authors should specify if patients already had in their life other procedures with traditional handpiece in order to answer if they would prefer laser or handpiece. Considering the the study was not designed as split mouth study (half procedures with laser and half with handpieces in the same patients and then survey on what procedure they would like to receive in the future), this point should also be added as a limitation of the study. This has been addressed and can be found in lines 147-149.
• In figure 3, does the y-axis indicate the years of experience? please specify in the caption. This has been addressed in the Figure 3 legend (lines 235-236).

Discussion:

• Add in general the limitations of the lasers and the cases where they cannot be used (amalgam, etc.)  This has been added and can be found in lines 293-296.
• Improve the study limitations.  Additional text has been added and can be found in lines 291-296.

 

Round 2

Reviewer 2 Report

Dear Authors,

 

Thank you for answering my points.