Laser Doppler for Accurate Diagnosis of Oehler’s Type III Dens Invaginatus: A Case Report
Round 1
Reviewer 1 Report
An interesting case about the use of LDF in endodontics is presented. However, some issues have to be addressed before publication:
l52: Maybe you could insert a short note on propan-butan spray and CO2, which are also used for sensivity testing.
Please increase the size of the figures.
The Prisma Chart indicates the use of LDF during the Primary diagnostics while no such procedure or figures are given in the case report.
In the conclusion you say how LDF improved diagnostics and treatment while this ist not described in the case report.
The conclusion expands over the limitations of a case report. Please revise
The use of a new LDF device is mainly the Topic of the manuscript. Please give a bit more Information in the introcuction and discussion about the novelty of this device.
Minor Issues
l28:mm²
l144: wiht K-Files up to a size 80 apical master file
Author Response
We appreciate the time and effort you and each of the reviewers have dedicated to providing insightful feedback on ways to strengthen our paper. Thus, it is with great pleasure that we resubmit our article for further consideration. We have incorporated changes that reflect the detailed suggestions you have graciously provided. We also hope that our edits and the responses we provide below satisfactorily address all the issues and concerns you and the reviewers have noted.
Point 1: l52: Maybe you could insert a short note on propan-butan spray and CO2, which are also used for sensitivity testing.
Response 1:
Page2 Line52
The sentence has been revised as follows:
In vital pulp therapy, dental pulp testing aids the differential diagnosis and influences the treatment plan such as electric pulp testing, propan-butan spray and CO2
Point 2: Please increase the size of the figures.
Response 2:
The figures have been revised accordingly.
Point 3: The Prisma Chart indicates the use of LDF during the Primary diagnostics while no such procedure or figures are given in the case report.
Response 3:
Page8
The flow chart has been revised. Laser Doppler Blood Flow Monitor and Imager (MoorLDI-2λ) was only scheduled for follow-up assessment.
Point 4: In the conclusion you say how LDF improved diagnostics and treatment while this is not described in the case report.
Response 4:
Page7 Line197
“Since Laser Doppler have successfully enhanced the diagnostic accuracy, unnecessary interventions can be avoided.” The sentence was described in the case report as you suggest.
Point 5: The conclusion expands over the limitations of a case report. Please revise
Response 5:
Page10 Line277
We agreed with you and inserted a short note:“ The factor and motion artifact noise of the Laser Doppler technique motivate ongoing research. Further work is needed to resolve the limitations.”
Point 6: The use of a new LDF device is mainly the Topic of the manuscript. Please give a bit more Information in the introduction and discussion about the novelty of this device.
Response 6:
Page2 Line62
The manuscript text has been revised accordingly (Introduction, fourth paragraph).
Point 7: l28:mm²
Response 7:
Line 28
The sentence has been revised to “a peri-invagination lesion sized 8× 9 mm2”
Point 8: l144: wiht K-Files up to a size 80 apical master file
Response 8:
Page6 Line 151
The sentence has been revised from “with K-files of ISO size 80 (Master apical file).” to “with K-files up to a size 80 apical master file.”
Author Response File: Author Response.docx
Reviewer 2 Report
Dear authors, I was interested reading this article. The innovative idea is significant for litterature and I will suggest to the editor to accept your manuscript after this few modifications that I reccomend to you.
LINE 60-61:
I would write as follows and I would cite this article.
"Laser Doppler has proven to be reliable in previous studies for pulp 60 vitality evaluation and even to assess the healing process of bone lesion of the jaws."
Musu D, Shemesh H, Boccuzzi M, Dettori C, Cotti E. Correction to: The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review. Clin Oral Investig. 2020 Dec;24(12):4663. doi: 10.1007/s00784-020-03641-6. Erratum for: Clin Oral Investig. 2020 Nov;24(11):3739-3747.
LINE 65-67
Before the last sentence of the intruduction I suggest you to cite an other case report on this rare lesion such as this one:
Lee JK, Hwang JJ, Kim HC. Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report. BMC Oral Health. 2020 Jan 30;20(1):29. doi: 10.1186/s12903-020-1008-x.
FIG. 5c: You can improve the quality of this table
FIG. 6: You can improve the quality of this table
Author Response
We appreciate the time and effort you and each of the reviewers have dedicated to providing insightful feedback on ways to strengthen our paper. Thus, it is with great pleasure that we resubmit our article for further consideration. We have incorporated changes that reflect the detailed suggestions you have graciously provided. We also hope that our edits and the responses we provide below satisfactorily address all the issues and concerns you and the reviewers have noted.
Point 1:
LINE 60-61:
I would write as follows and I would cite this article.
"Laser Doppler has proven to be reliable in previous studies for pulp 60 vitality evaluation and even to assess the healing process of bone lesion of the jaws."
Musu D, Shemesh H, Boccuzzi M, Dettori C, Cotti E. Correction to: The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review. Clin Oral Investig. 2020 Dec;24(12):4663. doi: 10.1007/s00784-020-03641-6. Erratum for: Clin Oral Investig. 2020 Nov;24(11):3739-3747.
Response 1:
Page2 Line 62
We agree with you and have incorporated this suggestion.
Point 2:
LINE 65-67
Before the last sentence of the intruduction I suggest you to cite an other case report on this rare lesion such as this one:
Lee JK, Hwang JJ, Kim HC. Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report. BMC Oral Health. 2020 Jan 30;20(1):29. doi: 10.1186/s12903-020-1008-x.
Response 2:
Page2 Line 69
We agree with you and have incorporated this suggestion.
Point 3:
FIG. 5c: You can improve the quality of this table
FIG. 6: You can improve the quality of this table
Response 3:
Thank you for your suggestion.
However, Fig 5 is extracted from MoorLDI V6.0 software, and it’s hard to be adjusted.
We have tried our best to set the picture to 300 DPI.
Author Response File: Author Response.docx
Reviewer 3 Report
This is an interesting case report on sucsessful conservative treatment of dens invaginatus with preserving pulp vitality.
There are a few minor issues to be
ABSTRACT dens invaginatus instead of DI because it is the first mention of DI
Page 2 line 73 ''our department'' please replace this with the exact name of the Department
Description of Figure 1. (b) ''Incisal'' instead of ''occlusal'' view. Also, name the teeth on the picture.
Page 3 line 91 authors state that the pseudo canal is spreading towards CEJ and it ''forms an open apex, with a lesion at the root apex'' I suppose that the term apex is reserved for the main root. Perhaps ''the opening of the pseudo canal would be more suitable. Also, the lesion was associated with the invagination opening at it is not at the apex but at the mesiolateral part of the root.
Page 3 line 101 Could the following sentence be rephrased to be more clear: ''pseudo canal was not closed at the upper apex, and it was mixed with a well-defined unilocular peri-invagination radiolucent lesion''
What does it actually mean that the pseudo canal was mixed with the lesion? Also, maybe the term ''upper apex'' could be replaced with the opening of the invagination near CDJ.
Similarly, decription of Figure 3.
Author Response
We appreciate the time and effort you and each of the reviewers have dedicated to providing insightful feedback on ways to strengthen our paper. Thus, it is with great pleasure that we resubmit our article for further consideration. We have incorporated changes that reflect the detailed suggestions you have graciously provided. We also hope that our edits and the responses we provide below satisfactorily address all the issues and concerns you and the reviewers have noted.
Point 1: ABSTRACT dens invaginatus instead of DI because it is the first mention of DI
Response 1:
Line 27
The manuscript text has been revised accordingly
Point 2: Page 2 line 73 ''our department'' please replace this with the exact name of the Department.
Response 2:
Page 2 Line 78
The sentence was revised as follows.
she was referred to conservative department of Kaohsiung Medical University Chung-Ho Memorial Hospital.
Point 3: Description of Figure 1. (b) ''Incisal'' instead of ''occlusal'' view. Also, name the teeth on the picture.
Response 3:
Page 3 Line 87
The description was revised : Incisal view of tooth 12 showing a Peg-shaped clinical crown.
Point 4: Page 3 line 91 authors state that the pseudo canal is spreading towards CEJ and it ''forms an open apex, with a lesion at the root apex'' I suppose that the term apex is reserved for the main root. Perhaps ''the opening of the pseudo canal would be more suitable. Also, the lesion was associated with the invagination opening at it is not at the apex but at the mesiolateral part of the root.
Response 4:
Page 3 Line 94
A “pseudo-canal” was located near the mesial side and extended from the enamel invagination to approximately the cemento-enamel junction, spreading and forming the opening of the pseudo canal, with a lesion at the mesial and lateral part of the root.
Point 5: Page 3 line 101 Could the following sentence be rephrased to be more clear: ''pseudo canal was not closed at the upper apex, and it was mixed with a well-defined unilocular peri-invagination radiolucent lesion''
What does it actually mean that the pseudo canal was mixed with the lesion? Also, maybe the term ''upper apex'' could be replaced with the opening of the invagination near CDJ.
Similarly, decription of Figure 3.
Response 5:
We agree with you and have incorporated this suggestion throughout our paper..
The manuscript text has been revised accordingly.
Page 4 Line 113
The CBCT sagittal view showed that the buccal side of the pseudo canal with the opening of the invagination near the cemento-enamel junction, and it was adjacent with a well-defined unilocular peri-invagination radiolucent lesion measuring 8 mm (mesiodistal) x 9 mm (labiopalatal) x 12 mm (craniocaudal) (Figure 3)
Page5 Line 127
The CBCT sagittal view showing that the buccal side of the pseudo canal with the opening of the invagination near the cemento-enamel junction , and it was adjacent with a well-defined unilocular peri-invagination radiolucent lesion with a size of 8mm x 9 mmx 12mm.
Author Response File: Author Response.docx