An Overview of Cone-Beam Computed Tomography and Dental Panoramic Radiography in Dentistry in the Community
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors1 As a review article, the authors only cited 29 references, which is insufficient, and there are significant issues with citation accuracy throughout the text.
2 The title "Tomography in Dentistry" is too broad. For such a title, the content should be more comprehensive. Therefore, the title needs to be more specific, focusing on dental panoramic radiographs (DPR) and cone-beam computed tomography (CBCT).
3 Abbreviations need to be clarified.
4 The Introduction is not specific enough; it does not clearly state the purpose of the paper, the progress in research, or the novel points of the review.
5 There is an abrupt transition from the Introduction to the discussion of DPR and CBCT without any proper segue.
6 The manuscript lacks a Discussion section. The Conclusion is too general and should be more detailed.
7 It is unclear how the DPR and CBCT images were obtained, whether IRB approval was granted, and if there are any HIPAA violations.
8 Figure 9 was taken from other literature. Reprint permissions from the respective journals are required for these images.
Comments on the Quality of English Language
Moderate editing of English language required
Author Response
1 As a review article, the authors only cited 29 references, which is insufficient, and there are significant issues with citation accuracy throughout the text.
Reply: As already stated, the original version of this paper which the reviewers reviewed had to be produced within a very short time frame set by Tomography. As already stated as a single-handed specialist during that time I had to address other priorities at work as they emerged. This was increased to 60 references even although I have removed at the EIC request some of my own references.
2 The title "Tomography in Dentistry" is too broad. For such a title, the content should be more comprehensive. Therefore, the title needs to be more specific, focusing on dental panoramic radiographs (DPR) and cone-beam computed tomography (CBCT).
Reply: The title has been changed. A more accurate one would be
“An overview CBCT and dental tomographic radiography in dentistry in the community.”
3 Abbreviations need to be clarified.
Reply: The abbreviations have all been rendered in their full expanded form.
4 The Introduction is not specific enough; it does not clearly state the purpose of the paper, the progress in research, or the novel points of the review.
Reply: The introduction gives and clear insight into the background upon which dental radiography still rests.
5 There is an abrupt transition from the Introduction to the discussion of DPR and CBCT without any proper segue.
Reply: This has been addressed.
6 The manuscript lacks a Discussion section. The Conclusion is too general and should be more detailed.
Reply: The overview format discussed each issue as it appears.
7 It is unclear how the DPR and CBCT images were obtained, whether IRB approval was granted, and if there are any HIPAA violations.
Reply: The use of all clinical images was secured with the appropriate consent.
8 Figure 9 was taken from other literature. Reprint permissions from the respective journals are required for these images.
Reply: The appropriate permission was acquired.
Comments on the Quality of English Language:
Moderate editing of English language required
Reply: Performed
Thank you for your kind attention
Reviewer 2 Report
Comments and Suggestions for AuthorsThe topic of the reviewed article is: Tomography in dentistry.
The aim of the study was to present and discuss the two most frequently used radiological examinations in dentistry: panoramic X-ray (DPR) and cone-beam computed tomography (CBCT).
In the introduction, the authors present the history of the development of the above-mentioned radiological examination methods and emphasize their contribution to the development of diagnostics in the field of dentistry.
The authors present the evolution of DPR, the advantages of digitalization and the convenience of easier diagnosis of various diseases.
They emphasize the importance of DPR in dialogue with the patient, presentation and better understanding of planned procedures by the patient.
The authors also discuss the aspect of bitewing photos, their advantages and the problems of using them in times of a pandemic in connection with aerosol-generating reflexes.
The authors emphasize the diagnostic importance of CBCT examination in endodontics.
They emphasize that despite the advantage of CBCT in some cases, such as imaging of the jaw and maxillary sinuses, DPR remains the most frequently chosen method by doctors.
The authors describe additional benefits of taking DPR images, such as "incidental findings", referring to carotid artery calcifications, which may indicate atherosclerosis and require further diagnostics.
They emphasize the importance of low radiation doses compared to other methods.
The article contains 9 figures with descriptions that significantly help the reader understand the article.
Grammatically, I have no major objections.
The article is rather simple, clear and understandable. It provides some, well-known knowledge about two key imaging technologies used in dentistry.
The authors discussed both the advantages and limitations of both methods, allowing for a better understanding of their use in clinical practice. To sum up, the article is generally well written, in quite simple language, it provides valuable information on radiological diagnostics, the benefits of using tomography in dentistry, while emphasizing the need for a conscious and responsible approach to imaging diagnostics.
However, there are several aspects of this work that the authors should address:
- The title does not correspond to the content of the article - the authors describe both DPR and CBCT, and not only tomography - as the current title suggests.
- Even though the article is written correctly, it is not very interesting because it presents generally known issues. Therefore, it is for informational purposes only. It has the nature of a literature review, but it does not meet the criteria of any type of review known to me. The authors do not provide inclusion and exclusion criteria for the articles they qualified for the review. They do not indicate what keywords they were looking for. They do not specify what databases have been searched. They do not indicate from which years the articles were taken into account. All this above mentioned issues significantly reduces the value of the manuscript.
- Having read the article, I don't know who it is mainly addressed to? In my opinion, almost every practicing dentist has the knowledge contained in this article.
- The authors do not actually define any conclusions from their work. Maybe the authors have any specific suggestions regarding cases in which CBCT should be performed and in which only DPR should be performed?
- The number of literature is much too small for a review. Moreover, it is completely incomprehensible why the literature contains almost exclusively less current items - only one article is from 2024 and only two from 2023, the rest are older.
minor editing
Author Response
The topic of the reviewed article is: Tomography in dentistry.
The aim of the study was to present and discuss the two most frequently used radiological examinations in dentistry: panoramic X-ray (DPR) and cone-beam computed tomography (CBCT).
In the introduction, the authors present the history of the development of the above-mentioned radiological examination methods and emphasize their contribution to the development of diagnostics in the field of dentistry.
The authors present the evolution of DPR, the advantages of digitalization and the convenience of easier diagnosis of various diseases.
They emphasize the importance of DPR in dialogue with the patient, presentation and better understanding of planned procedures by the patient.
The authors also discuss the aspect of bitewing photos, their advantages and the problems of using them in times of a pandemic in connection with aerosol-generating reflexes.
The authors emphasize the diagnostic importance of CBCT examination in endodontics.
They emphasize that despite the advantage of CBCT in some cases, such as imaging of the jaw and maxillary sinuses, DPR remains the most frequently chosen method by doctors.
The authors describe additional benefits of taking DPR images, such as "incidental findings", referring to carotid artery calcifications, which may indicate atherosclerosis and require further diagnostics.
They emphasize the importance of low radiation doses compared to other methods.
The article contains 9 figures with descriptions that significantly help the reader understand the article.
Grammatically, I have no major objections.
The article is rather simple, clear and understandable. It provides some, well-known knowledge about two key imaging technologies used in dentistry.
The authors discussed both the advantages and limitations of both methods, allowing for a better understanding of their use in clinical practice. To sum up, the article is generally well written, in quite simple language, it provides valuable information on radiological diagnostics, the benefits of using tomography in dentistry, while emphasizing the need for a conscious and responsible approach to imaging diagnostics.
Reply: Thank you for your comments, which generally indicate the overview is going in the correct direction.
However, there are several aspects of this work that the authors should address:
- The title does not correspond to the content of the article - the authors describe both DPR and CBCT, and not only tomography - as the current title suggests.
Reply: The title has been changed. A more accurate one would be
“An overview CBCT and dental tomographic radiography in dentistry in the community.”
- Even though the article is written correctly, it is not very interesting because it presents generally known issues. Therefore, it is for informational purposes only. It has the nature of a literature review, but it does not meet the criteria of any type of review known to me. The authors do not provide inclusion and exclusion criteria for the articles they qualified for the review. They do not indicate what keywords they were looking for. They do not specify what databases have been searched. They do not indicate from which years the articles were taken into account. All this above-mentioned issues significantly reduces the value of the manuscript.
Reply: Although some dentists might be aware of most if not all these issues, those serving the community generally are not. Instead many get their information from the trade and from “How CBCT improved my bottom line” presenters. I get it! Dentistry is a business (an important source of employment in the community) as well as a health profession and it is the function of the trade to sell their wares. I work successfully with both groups so that they can target better the needs of the communities (and/or particular parts of them). Good and correct information is key to that aim. These need to be frequently reiterated as wrong practice creeps back in! Ultimately, we are concerned with the patient’s best interest!
The ‘review’ you are suggesting I use is the systematic review’. This is another area in which I have unique expertise. I was the first in my global profession who first applied this successfully in diagnostic radiology (doi: 10.1038/sj/dmfr/4600586.). It has since grown from there! I have extended its use in implants (Int J Oral Maxillofac Implants. 2007;22 Suppl:117-39.) and Barrett’s esophagus (doi: 10.1038/ajg.2015.55.) etc.)
The review type I have employed here is now called an ‘overview,’
- Having read the article, I don't know who it is mainly addressed to? In my opinion, almost every practicing dentist has the knowledge contained in this article.
Reply: see above!
I have more clearly specified the readership in the revised version.
“this review will instead focus on their clinical applications in order to inform and inspire dentists, related medical specialities, medical physicists and engineers to understand better how these modalities could be further developed to improve health-care.“
- The authors do not actually define any conclusions from their work. Maybe the authors have any specific suggestions regarding cases in which CBCT should be performed and in which only DPR should be performed?
Reply: at suggester the new conclusion will be:-
First a complete history and a full clinical examination must be performed. From these indicates shape the subsequent radiography, if required. No findings on a routine check-up patient indicate no radiography unless the patient is new to the office with no access to previous radiographs. If the patient is young a DPR and BWs serve to reveal unerupted teeth that might need surgery and supplemented by CBCT. if the patient is a mature adult then this may reveal retained roots etc. that may impact treatment planning. It would also reveal CCAAs. BW may indicate caries and should prompt a re-examination. Symptoms and clinical findings direct appropriate radiography. Retreated endodontic cases should included small FOV CBCT. Any maxillary lesion if not a medical emergency should indicate CBCT. CBCT on children should be avoided in principal. Extraoral bitewings can be invaluable for these patients particularly when challenged by the lack of co-operation. Intra-oral radiography should be avoided when confronted by a potentially infective and lethal aerosol-borne virus. Finally, every DPR and CBCT database should be carefully reviewed to ensure that all findings are detected and reported.
- The number of literature is much too small for a review. Moreover, it is completely incomprehensible why the literature contains almost exclusively less current items - only one article is from 2024 and only two from 2023, the rest are older.
Reply: I agree! As I was initially only given a short time frame to develop the initial version you reviewed.
Comments on the Quality of English Language:
minor editing
Reply: I agree!
Thank you for your kind attention
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe author has addressed my concerns. Please conduct a final check of all grammar; thereafter, the manuscript can be accepted.
Comments on the Quality of English LanguageMinor editing of English language required
Author Response
Dear Reviewer. EiC and Jasen,
Thank you all for your industry and invaluable comments.
Thank you for inserting the new title and conclusions.
I have reviewed the whole document for grammar errors.
I have also exchanged a few of the earlier references with more recent ones which not only covered the same points, but also had dois, which meant they would be earlier for reader to find.
