Round 1

Reviewer 1 Report (New Reviewer)

Dear Authors,

thank you for the opportunity to review this paper. Here are some suggestions of mine how to improve it:

1. You should explaitn "RE" abbreviation, when used for the first time, also in abstract.

2. When you discuss the use of laser to take scans, you should write more details about it - the color, parameters (at least basic information)

3. Figure 1 - add the exact models of the presented devices. Is the photo made by the Author? Or do you have right to use it - if so, you should write it is used thanks to the eg. manufacturer and the information should also be added in acknowledgements

4. I think you should write more general "modern dentistry, including orthodontics". I could see the intention of Authors to focus on orthodontics, but generally those statements refer to dentistry and this would in my mind attract higher number of readers

5. When writing of "facially driven orthodontics" you should refer to prof. Ackerman, that was the leader of that trend and created a kind of cephalometric analysis to make it possible to use that in the "everyday life". Additionally, the trend is followed by bioesthetic dentistry and in orthodontics - FACE. Please, refer to that

6. Fig. 9 - I would suggest it is rather improvement in symmetry, not asymmetry?

7. Figure 11 - please explain what are the "dots" and "pink shapes" on the clin-check. Not everyone treats patients with Invisalign (BTW, it is reserved name, so the sererved sign should be used in that place). Was it the first or the last clin-check? How many was there? I could see you planned class II elastics. It should be described which forces were used etc. 

To be honest if it is the first clin-check, the outcome would be impressive, especially with a black dot meaning the limitation in tooth movement. 

8. I think you should maybe add some more information on the properties of the materials used in 3D-manufacturing, see that resins could be used for indirect bonding (in that case the resin should be more flexible), but also for orhodontic insertion of miniscrews (in this case even though it is possible to use "elastic" material, it is better to use a rigid one. Not many studies compare that fact, see:

Paradowska-Stolarz A, Malysa A, Mikulewicz M. Comparison of the Compression and Tensile Modulus of Two Chosen Resins Used in Dentistry for 3D Printing. Materials (Basel). 2022 Dec 15;15(24):8956. doi: 10.3390/ma15248956. PMID: 36556761;

9. When discussing TMJ splints, you should mention the possibilities of using the splints to treat OSA

To sum up, the paper is an "encyclopedic" review, with a lot of detailed information. Therefore, I am not surprised some errors and flaws occured. In general, it is really well prepared, deliberated and studied.

Author Response

Reply to Reviewer # 1

 

We thank the reviewer since his considerations/suggestions have significantly increased the quality of our manuscript.

 

Reviewer’s general consideration. Dear Authors, thank you for the opportunity to review this paper. Here are some suggestions of mine how to improve it:

 

Authors’ response. Thank you esteemed colleague for having appreciated our efforts. We strongly believe that with your suggestions the quality of our study has been increased. We hope that after this revision the reviewer is satisfied.

 

Reviewer’s concern 1. You should explaitn "RE" abbreviation, when used for the first time, also in abstract.

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

Reviewer’s concern 1. When you discuss the use of laser to take scans, you should write more details about it - the color, parameters (at least basic information)

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 3. Figure 1 - add the exact models of the presented devices. Is the photo made by the Author? Or do you have right to use it - if so, you should write it is used thanks to the eg. manufacturer and the information should also be added in acknowledgements

 

Authors’ response. Dear Reviewer, both intra-oral and facial scanner are available in our dental clinic. We made photos and assembled them. However, since the aim of figure 1 is to generically illustrate the data obtained from intra-oral and facial scans, we did not report the name of both appliances. We would like to avoid readers’ mis-interpretation for indirect publicity. If the reviewer agrees we would prefer to do not report the name of the products, otherwise we will do it of course.

 

 

Reviewer’s concern 4. I think you should write more general "modern dentistry, including orthodontics". I could see the intention of Authors to focus on orthodontics, but generally those statements refer to dentistry and this would in my mind attract higher number of readers

 

Authors’ response. We totally agree with the reviewer. Thank for the precious suggestion. In this regard, we’ve modified the title reporting “modern dentistry and orthodontics”. Also, in the introduction there is a paragraph that generically introduce the application of RE in different dental field and only after there is a paragraph for orthodontics. Finally, we have reformulated the phrase describing the aim of the study specifying that we discuss about RE applications in modern dentistry with also a detailed focused on orthodontics.

 

 

Reviewer’s concern 5. When writing of "facially driven orthodontics" you should refer to prof. Ackerman, that was the leader of that trend and created a kind of cephalometric analysis to make it possible to use that in the "everyday life". Additionally, the trend is followed by bioesthetic dentistry and in orthodontics - FACE. Please, refer to that

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 6. Fig. 9 - I would suggest it is rather improvement in symmetry, not asymmetry?

 

Authors’ response. We warmly thank the reviewer for the suggestion. The symmetry significantly improved. Unfortunately, it was a typo error. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 7. Figure 11 - please explain what are the "dots" and "pink shapes" on the clin-check. Not everyone treats patients with Invisalign (BTW, it is reserved name, so the sererved sign should be used in that place). Was it the first or the last clin-check? How many was there? I could see you planned class II elastics. It should be described which forces were used etc. To be honest if it is the first clin-check, the outcome would be impressive, especially with a black dot meaning the limitation in tooth movement.

 

Authors’ response. We warmly thank the reviewer for his/her concern. The reviewer is right, some of the information provided before could have been misleading for reader not familiar with aligners’ software. We’ve clearly explain in the text the procedure used and we’ve clearly explained in the figure legend what “dots”, “phin shape” and “blue lines” represent. This was the first clin-check and a second clin-check was required to complete the treatment. The refinement stage is ongoig so we have not the images of the final treatment. However, as reported below our goal is to show the importance of planning the treatment even showing a mistake we made, that is we did not properly set the over-correction of the deep-bite.

 

In the main text, we’ve specified that “Figure 11 shows the expected treatment outcomes (Treatment Plan 1) and the pre-refinement clinical outcomes, with complete correction of the class II malocclusion that was accomplished by setting in the system the usage of inter-maxillary elastics from a specific stage of the treatment. 3/16 intermaxillary elastics were worn 22 hours per day with different release of forces (2,5 once on the righ side and 4,5 once on the left side) since class II occlusal relationship was more severe on the right side. However, there was an incomplete correction of the deepbite that has required additional aligners.”

The meaning of our concept is not to show a “well-conducted orthodontic case” but rather the fact that we need to control the system a-priori. In this case, we obtained a good correction of the class II since we introduced the usage of class II elastics but we did not obtain a complete correction of the overbite because we did not introduce in the clin-check a greater amount of virtual correction of the overbite (over-correction).

 

 

 

Reviewer’s concern 8. I think you should maybe add some more information on the properties of the materials used in 3D-manufacturing, see that resins could be used for indirect bonding (in that case the resin should be more flexible), but also for orhodontic insertion of miniscrews (in this case even though it is possible to use "elastic" material, it is better to use a rigid one. Not many studies compare that fact, see: Paradowska-Stolarz A, Malysa A, Mikulewicz M. Comparison of the Compression and Tensile Modulus of Two Chosen Resins Used in Dentistry for 3D Printing. Materials (Basel). 2022 Dec 15;15(24):8956. doi: 10.3390/ma15248956. PMID: 36556761;

 

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes. In particular we’ve created a brief paragraph citing the suggested reference.

 

 

Reviewer’s concern 9. When discussing TMJ splints, you should mention the possibilities of using the splints to treat OSA.

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

Final Reviewer’s consideration. To sum up, the paper is an "encyclopedic" review, with a lot of detailed information. Therefore, I am not surprised some errors and flaws occured. In general, it is really well prepared, deliberated and studied.

 

Authors’ response. We warmly thank the reviewer for having appreciated our efforts and having deeply understood the main goal of the present paper. Concerning errors, we’ve submitted the paper for English syntax revision.

 

Reviewer 2 Report (New Reviewer)

From Reverse Engineering Software to CAD-CAM Systems: How Digital environment has influenced the clinical applica-tions in Orthodontics

 

This perspective article presents a narrative review of digital technologies that are currently applied in orthodontics and dento-facial orthopedics.

It offers a welcome synthesis regarding new technologies that can facilitate the work of orthodontists, dento-facial orthopedists and orthognatic surgeons, provided that such technologies are brought to their attention and that a proper learning curve takes place about their use. Digital reverse engineering technologies applied in orthodontics and dento-facial orthopedics also offer a significant potential for patient customization and therefore superior patient care, easier and more precise diagnosis, treatment planning and outcome prognosis.

This perspective article  is well-presented, in a logical sequence and structure, with many relevant illustrations. It also offers examples of freely available software that may be tried out by practitioners who contemplate a possible integration of these technologies in their practice.

The content of the manuscript and the use of English language are fine, overal, but a few improvements are needed, as highlighted in the attached file and suggested below:

Page 2 – consider replacing “free-radiation surface” with “radiation-free surface”;

Page 3 – consider replacing “moreover, is” with “moreover, it is”;

Page 4 – consider replacing “and is not possible” with “and it is not possible”;

Page 4 – consider replacing “but is usually possible” with “but it is usually possible”;

Page 4 – consider replacing “to record dataset” with “to record the dataset”;

Page 6 and subsequent pages – consider removing the underlign+bold text formatting;

Page 6 – consider replacing “and is possible” with “and it is possible”;

Page 7 and subsequent pages – Figures 6, 9, 10, 13, 14, 15, 16, 17, 18, 19, 20, 21, need to be re-aligned / resized, since they are only visible in part;

Page 19 – consider replacing “The are two main limitations” with “There are two main limitations”;

Page 19 – consider correcting “Copenaghen, Danimarca” to “Copenhagen, Denmark”;

Page 25 – consider replacing “it has been introduced the possibility to design” with “the possibility to design has been introduced”;

Page 25 – consider replacing “the possibility of produce” with “the possibility to produce”.

Comments for author File: Comments.pdf

Author Response

Reply to Reviewer # 2

 

 

We thank the reviewer since his considerations/suggestions have significantly increased the quality of our manuscript.

 

 

Reviewer’s general consideration. This perspective article presents a narrative review of digital technologies that are currently applied in orthodontics and dento-facial orthopedics. It offers a welcome synthesis regarding new technologies that can facilitate the work of orthodontists, dento-facial orthopedists and orthognatic surgeons, provided that such technologies are brought to their attention and that a proper learning curve takes place about their use. Digital reverse engineering technologies applied in orthodontics and dento-facial orthopedics also offer a significant potential for patient customization and therefore superior patient care, easier and more precise diagnosis, treatment planning and outcome prognosis. This perspective article is well-presented, in a logical sequence and structure, with many relevant illustrations. It also offers examples of freely available software that may be tried out by practitioners who contemplate a possible integration of these technologies in their practice.

The content of the manuscript and the use of English language are fine, overal, but a few improvements are needed, as highlighted in the attached file and suggested below:

 

Dear Authors, thank you for the opportunity to review this paper. Here are some suggestions of mine how to improve it:

 

Authors’ response. Thank you esteemed colleague for having appreciated our efforts. We strongly believe that with your suggestions the quality of our study has been increased. We hope that after this revision the reviewer is completely satisfied.

 

 

Reviewer’s concern 1. Page 2 – consider replacing “free-radiation surface” with “radiation-free surface”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 2. Page 3 – consider replacing “moreover, is” with “moreover, it is”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

 

 

 

 

 

 

Reviewer’s concern 3. Page 4 – consider replacing “and is not possible” with “and it is not possible”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 4. Page 4 – consider replacing “but is usually possible” with “but it is usually possible”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 5. Page 4 – consider replacing “to record dataset” with “to record the dataset”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 6. Page 6 and subsequent pages – consider removing the underlign+bold text formatting

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes. Underlign+blod text now is only for revised parts.

 

 

Reviewer’s concern 7. Page 6 – consider replacing “and is possible” with “and it is possible”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 8. Page 7 and subsequent pages – Figures 6, 9, 10, 13, 14, 15, 16, 17, 18, 19, 20, 21, need to be re-aligned / resized, since they are only visible in part.

 

Authors’ response. Dear and esteemed reviewer, the images were sized and aligned accordin to the journal’s style. Probably, the reviewer should set the wide field option view in word software (that with the “word icon”.

 

Reviewer’s concern 9. Page 19 – consider replacing “The are two main limitations” with “There are two main limitations”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

 

 

 

 

 

 

 

Reviewer’s concern 10. Page 19 – consider correcting “Copenaghen, Danimarca” to “Copenhagen, Denmark”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 11. Page 25 – consider replacing “it has been introduced the possibility to design” with “the possibility to design has been introduced”

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 12. Page 25 – consider replacing “it has been introduced the possibility to design” with “the possibility to design has been introduced”.

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

 

 

Reviewer’s concern 13. Page 25 – consider replacing “the possibility of produce” with “the possibility to produce”.

 

Authors’ response. According to the reviewer’s suggestion, we’ve made appropriate changes.

Reviewer 3 Report (New Reviewer)

Dear authors, thank you so much for your exhausting paper describing an actual and well know way of practicing nowadays. It can be considered a resume of all digital applications in orthodontics, all options that can be easily found on literature and that belong to an actual dental practice but nothing that contribute to the originality of the manuscript. Honestly the extensive processes explanation seems to be more adapt for a chapter on a book than for a research paper. 

Author Response

Reply to Reviewer # 3

 

 

We thank the reviewer since his considerations/suggestions have significantly increased the quality of our manuscript.

 

 

Reviewer’s general consideration. Dear authors, thank you so much for your exhausting paper describing an actual and well know way of practicing nowadays. It can be considered a resume of all digital applications in orthodontics, all options that can be easily found on literature and that belong to an actual dental practice but nothing that contribute to the originality of the manuscript. Honestly the extensive processes explanation seems to be more adapt for a chapter on a book than for a research paper.

 

Authors’ response. We warmly thank the reviewer for his honest consideration. We totally agree with him/her. All the applications documented can be found in literature, however our goal was to create a paper the comprehensively summarize the clinical applications of reverse engineering in orthodontics. Although we agree with the reviewer that the contents of the paper can be suitable for book chapter, we warmly believe that it is suitable for journal publication too, considering that online journals are much more easily available for clinicians. In this regard, some readers that may be interested in introducing orthodontic digital technologies in clinical practice, can easily get a comprehensive discussion on the topic addressed in the present paper.

Reviewer 4 Report (New Reviewer)

The article as review/guideline is well written.  Some parts in the current text were underlined which was difficult to read

Not many remarks can be made but revision is necessary to avoid 

Some plagiarism/(19%)auto plagiarism(4%) was detected : more than 4% of the current article was written in the article below

Comparison between Additive and Subtractive CAD-CAM Technique to Produce Orthognathic Surgical Splints: A Personalized Approach

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System

Author Response

Reply to Reviewer # 4

 

 

We thank the reviewer since his considerations/suggestions have significantly increased the quality of our manuscript.

 

 

Reviewer’s general consideration. The article as review/guideline is well written.  Some parts in the current text were underlined which was difficult to read. Not many remarks can be made but revision is necessary to avoid some plagiarism/(19%)auto plagiarism(4%) was detected : more than 4% of the current article was written in the article below:

Comparison between Additive and Subtractive CAD-CAM Technique to Produce Orthognathic Surgical Splints: A Personalized Approach

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System

 

Authors’ response. Thank you esteemed colleague for having appreciated our efforts. We strongly believe that with your suggestions the quality of our study has been increased. We’ve removed the underlined text and limited it only for the actual revised parts. Concerning plagiarism, we’ve modified the text as much as possible to reduce it. However, for transparency, the mentioned papers are from our research group and probably we’ve used the same style to discuss similar arguments.

We hope that after this revision the reviewer is completely satisfied. In case the reviewer will still find some amount of plagiarism, we will modify this part again.

 

 

Round 2

Reviewer 3 Report (New Reviewer)

Thank you for answering my comments. 

Author Response

Dear Reviewer,

 

thanks for your prestigious contribution.

Reviewer 4 Report (New Reviewer)

The underlined sections were not removed in the version that was sent

Author Response

Dear Reviewer,

 

thank you for your prestigious contribution. We've performed a revision for minor spelling corrections

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Dear Authors,

 

thank you for submitting this manuscript to MDPI Applied Sciences.

The authors aim to review current applications of reverse engineering in orthodontics with the purpose of giving interested parties a condensed overview of the topic.

Unfortunately, the paper does not meet the requirements of a review. A broader overview and more critical work on the topic should be performed.  Furthermore, original screenshots or own novel developments, can not be included in a review.

There are some sections which are still written in Italian including subheadings. It seems as if an “working version” of the article was accidentally submitted here instead of the final version.

The contents of the article are interesting, but should be elaborated in more detail and maybe submitted under another article type.

 

Good luck for your future submissions!

Reviewer 2 Report

 

The scientific paper "From Reverse Engineering Software to CAD-CAM Systems: How Digital environment has influenced the clinical and scientific applications in Orthodontics” provides a review of application of Reverse engineering and CAD/CAM technologies in the orthodontic/maxillofacial field. The present paper discusses and argues about its several applications from clinical and scientific perspectives.

 

In my opinion, the manuscript, overall, is missing the scientific contribution and weight.

 

The quality of the presentation is not very satisfactory. The organization of the paper was somewhat chaotic and not well structured. Too many paragraphs made the structure broken and hard to get the main idea from the text.

 

Reverse engineering field is much more than the described in this paper. It involves application of advanced 3D digitizing systems, advanced software tools for design, and also tools for geometry verification. Authors did not mention anything about the verification aspect (ie. dimensional analysis, CAD-Inspection, etc.).

 

The manuscript also suffers from weaknesses from the following points of view:

 

The Abstract is written in a way that it contains no new insight into the application of RE and CAD/CAM technologies.

Discussion in the manuscript about “gladius” sword is not relevant at all.

There are flaws regarding styles and formatting in the manuscript, for example:

“In this regard, RE satisfied the necessity of automation in the modern global commercialized society. [4]” (line 57 to 58) – citing number should be inside the sentence. There are more examples like this for both references and figures throughout entire manuscript.

Terminology regarding the application of CAD/CAM is not correct. For example, “CAD-CAM Appliances”

Terminology used in Reverse engineering applications is not correct, for example:

Sentence” These devices allow the acquisition of a map formed by a cloud of points of interest (POI)…” (line 92 to 93) – correct terminology is point cloud

 

The overview of the literature, especially regarding the application of RE is not state of the art. This is due to the large number of literature dedicated to Reverse Engineering and its application in the medical field over the years.

 

The manuscript is entangled with Italian language in certain areas, for example:

·         “15, 16 articolo seg denti” (line 182)

·         Realizzazione dei dispositivi (CAD-CAM) (line 331)

·         c) + efficienza, comunicazione con l’odontotecnico semplificata (visione immediata al pc dell’anatomia e delle caratteristiche che deve possedere il dispositivo, soprattutto possibilità dell’odontoiatra di vedere in tempo reale se il design va bene o no). (line 392 to 394)

 

Manuscript is full of English grammar errors and it is not understandable in some sections.

 

Literature is missing Journal information in some of the references (see references 4, 11, 29).

Reviewer 3 Report

Dear Authors,
You have an interesting and original viewpoint regarding the application of reverse engineering in Orthodontics. However, the presented manuscript has several shortcomings that need to be addressed prior to publication.

Please check the English style and language - there are several hard-to-read paragraphs and, in some instances, text in Italian. This is not acceptable and needs to be revised prior to publication.

There are multiple inaccuracies within the main body of the text. Here is a short list from the beginning of the manuscript:

"As for dentistry appliclation, IOSs work by projecting a structured beam of light onto the surface of the teeth and measuring the extent of the distortion which can..."

95 96

The information coloured in red depicts an inaccuracy - structured light, also known as "moire stripes", is not common in IOS devices. The only device using a structured light I am aware of presently is the R2 scanner by Megagen. This technology is common for tabletop (desktop) scanning systems. The same is true for most facial scanners that use continuous light and triangulation to obtain surface topography information.

"The main difference between IOS and FS data is the format of the	105
genereted file, the first (IOS) produce a Standard Tesselation language or Stereolithogra-	106
phy (.STL) or a Polygonial file (.PLY), the latter an Object Code file (.OBJ). "

The quoted information is misleading since, currently, most IOS systems allow export in all of the above-mentioned formats.

In the 2. point of your manuscript, you state that the process of refining the data is done within the same company's software. However, your example is from Meshmixer - a free program from Adobe (you should add information about the manufacturer after each mention of specific software or device in brackets) which is not in any way associated with any specific IOS or FS system. Furthermore, the software is not supported or developed for several years now, although it has been used routinely for dental applications. There are very few systems currently that have the ability to export point clouds. Usually, ready-to-use files are exported from the IOS or FS application.

Figures are not referenced appropriately - Are the images presented original? Since this is a review of the literature, they should be part of published studies. In that case, however, written reprint permission from the authors is required. The figures in the manuscript are not even referenced.

Please consult the Journal's requirements regarding the formatting of the references since there is heterogeneity in the format. Also, many current studies are being published regarding FS that can be added. This is not mandatory but might improve the quality of the manuscript.