Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth.  In Vitro study

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Research indicates that laser irradiation can enhance the uptake of fluoride into dental enamel, an effect that is particularly pronounced when used as an adjunct to topical fluoride treatments. The present study aimed to evaluate the impact of CO₂ laser irradiation on fluoride uptake in the enamel of permanent teeth. Methods Six human upper premolars, extracted for orthodontic reasons, were selected for this study. The roots were separated from the crowns, and each crown was then sectioned mesiodistally to create mesial and distal halves. These halves were randomly assigned to either an experimental or a control group (n = 6 per group). All specimens received an application of 5% sodium fluoride (NaF) varnish. Subsequently, the samples in the experimental group were subjected to irradiation with a 1 W CO2 laser for a duration of 15 seconds. To assess the effects of the treatments, fluoride uptake was measured and the topographic characteristics of the enamel surface were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Statistical analysis of the data was performed using SPSS software version 26 (IBM, USA). Results Energy-dispersive X-ray spectrometry analysis showed a significant increase in the percentage of fluoride with the application of the laser, The results of the mean ranks showed that the fluoride and CO₂ laser group recorded significantly higher ranks in the fluoride element (8.75 vs. 4.25), reflecting a higher concentration and confirmed statistical significance. Statistically, in the Mann-Whitney U test, a significant statistical difference in fluoride ratios appeared between the two groups (P value = 0.026) smaller than (0.05), which indicates the effectiveness of using CO₂ lasers in enhancing fluoride absorption within the tooth structure. Conclusion The results showed CO₂ laser irradiation of dental enamel resulted in increased fluoride uptake. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/15-588", "name": "Comparison between the protective effect of applying sodium fluoride..." } } ] } Home Browse Comparison between the protective effect of applying sodium fluoride... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Alkhateeb SMF, Kouchaji CN, Alkhaled AA and Hamadah O. Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.12688/f1000research.171971.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] Sham Mohamad Farouq Alkhateeb 1 , Chaza Nader Kouchaji 2 , Abdulrhman Ahmad Alkhaled https://orcid.org/0000-0002-5510-4339 2 , Omar Hamadah 1,3 Sham Mohamad Farouq Alkhateeb 1 , Chaza Nader Kouchaji 2 , Abdulrhman Ahmad Alkhaled https://orcid.org/0000-0002-5510-4339 2 , Omar Hamadah 1,3 PUBLISHED 19 Apr 2026 Author details Author details 1 Higher Institute of Laser Research and Applications, Damascus University, Damascus, Syria 2 Department of Pediatric Dentistry, Damascus University Faculty of Dentistry, Damascus, Syria 3 Oral Medicine Department, Damascus University Faculty of Dentistry, Damascus, Syria Sham Mohamad Farouq Alkhateeb Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Chaza Nader Kouchaji Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Abdulrhman Ahmad Alkhaled Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Omar Hamadah Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Fluoride administration plays a critical role in the management and prophylaxis of dental caries. Research indicates that laser irradiation can enhance the uptake of fluoride into dental enamel, an effect that is particularly pronounced when used as an adjunct to topical fluoride treatments. The present study aimed to evaluate the impact of CO₂ laser irradiation on fluoride uptake in the enamel of permanent teeth. Methods Six human upper premolars, extracted for orthodontic reasons, were selected for this study. The roots were separated from the crowns, and each crown was then sectioned mesiodistally to create mesial and distal halves. These halves were randomly assigned to either an experimental or a control group (n = 6 per group). All specimens received an application of 5% sodium fluoride (NaF) varnish. Subsequently, the samples in the experimental group were subjected to irradiation with a 1 W CO2 laser for a duration of 15 seconds. To assess the effects of the treatments, fluoride uptake was measured and the topographic characteristics of the enamel surface were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Statistical analysis of the data was performed using SPSS software version 26 (IBM, USA). Results Energy-dispersive X-ray spectrometry analysis showed a significant increase in the percentage of fluoride with the application of the laser, The results of the mean ranks showed that the fluoride and CO₂ laser group recorded significantly higher ranks in the fluoride element (8.75 vs. 4.25), reflecting a higher concentration and confirmed statistical significance. Statistically, in the Mann-Whitney U test, a significant statistical difference in fluoride ratios appeared between the two groups (P value = 0.026) smaller than (0.05), which indicates the effectiveness of using CO₂ lasers in enhancing fluoride absorption within the tooth structure. Conclusion The results showed CO₂ laser irradiation of dental enamel resulted in increased fluoride uptake. READ ALL READ LESS Keywords Laser; Gas; Dental Enamel; caries; Fluoride. Corresponding Author(s) Abdulrhman Ahmad Alkhaled ( [email protected] ) Close Corresponding author: Abdulrhman Ahmad Alkhaled Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Alkhateeb SMF et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Alkhateeb SMF, Kouchaji CN, Alkhaled AA and Hamadah O. Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.12688/f1000research.171971.1 ) First published: 19 Apr 2026, 15 :588 ( https://doi.org/10.12688/f1000research.171971.1 ) Latest published: 19 Apr 2026, 15 :588 ( https://doi.org/10.12688/f1000research.171971.1 ) Introduction Dental caries deserves attention because it has become a chronic disease affecting children worldwide. 1 , 2 Dental caries is a multifactorial disease caused by the simultaneous interaction of various factors— sugar and dental biofilms —in the oral cavity. The introduction of fluoride into dental practice over seventy years ago is widely regarded as the principal reason for the global decline in dental caries. Despite this public health success, the sole confirmed adverse effect of fluoride use in dentistry is dental fluorosis, a condition resulting from excessive fluoride ingestion during tooth development. Recent epidemiological trends indicate a concurrent rise in the prevalence of dental fluorosis and a decline in caries rates. 3 The most common varnish used in dentistry to prevent tooth caries is sodium fluoride (NaF). 4 Topical application of NaF on teeth mitigates enamel demineralization while enhancing the remineralization process. The primary antimicrobial mechanism of fluoride is not direct bacterial destruction, but rather an indirect action through the inhibition of bacterial acid production, which results in a higher pH at the tooth surface. 5 , 6 The combined use of laser irradiation and topical fluoride represents a novel approach to caries prevention by increasing the enamel’s affinity for and incorporation of fluoride. Zancope et al. were the first to report that CO2 lasers cause morphological changes on the surface of tooth enamel, such as fusion and dissolution. 7 On the other hand, studies were conducted to evaluate the effect of carbon dioxide laser on the structure of tooth enamel and dentin, and showed that its absorption by dental tissue was high. 8 The 10600 nm CO2 laser has an absorption coefficient in hydroxyapatite ten times lower than that of 9600 nm and this allows deeper penetration and higher flow by the 10600 nm CO2 laser to produce the desired thermal effects on caries inhibition compared to the CO2 laser at other wavelengths. 9 Calcium, phosphorus and fluoride ions play a crucial role in remineralizing tooth enamel. 8 A high level of calcium in the remineralization solution may enhance the rate of mineral deposition in the caries lesion and the calcium level greatly affects the defense mechanism of the hard tissues of the teeth and as the number of caries increases the calcium level decreases. 10 This study aimed to evaluate and compare the efficacy of CO 2 laser irradiation versus a CO 2 application in enhancing fluoride uptake by the surfaces of permanent teeth following treatment with NaF varnish. Materials and methods Source of teeth specimens The six human upper premolars were obtained from the Department of Oral and Maxillofacial Surgery in College of Dentistry, University of Damascus after routine extractions for orthodontic reasons and not specifically for this study. Teeth were stored in distilled water at 4 °C until use. Teeth were examined to ensure they were free of any caries, abrasions or fractures. They were divided into two sections, a mesial section and a distal section, so that each treatment was applied to a section of the tooth. The root was cut from the Cementoenamel junction and the crown were stored in distilled water to prevent dehydration ( Figure 1 ). Figure 1. A picture of the teeth used in the research before and after the section. Mesial section was used as the experimental specimen and the distal as the control. All specimens were first dried and treated with 5% NaF varnish (VOCO®, Germany). A distinction was then made between the groups: the experimental specimens were laser irradiated, while the control specimens were not. Sodium fluoride varnish (5% NaF varnish (VOCO, Germany, Product Code: [190/10]) was applied to the mesial section of the tooth with a carbon dioxide laser with a wavelength of 10600 nm (power 1 W – pulse duration 15 ms) while the control sample was in the distal section and sodium fluoride varnish alone was applied ( Figure 2 ). Figure 2. A picture of the sodium fluoride varnish used by VOCO and how it is applied. Table 1 : lists earlier research that used CO 2 laser irradiation with comparable settings. so that the parameters used in this investigation may be compared to those documented in the literature. With many research concentrating on 2 W power output, it is clear that the power parameter (1 W) employed in this study fits within the range documented in earlier investigations (0.4–10 W). The wavelength that is most frequently used in research assessing how CO2 lasers affect dental hard tissues is 10,600 nm. Table 1. The earlier research that used CO 2 laser irradiation with comparable settings. Authors Year Journal Wavelength Power Chin-Ying SH, Xiaoli G, Jisheng P, Wefel JS. 2004 Journal of Dentistry 10600 nm (model LX-20, Luxar Corp., Bothell, WA, USA) 2 W - 4 W Tepper SA, Zehnder M, Pajarola GF, Schmidlin PR. 2004 Journal of Dentistry 10600 nm (Sharplan 15F, Lumenis Inc., Santa Clara, CA, USA). 2 W Steiner-Oliveira C, Rodrigues LK, Soares LE, Martin AA, Zezell DM, Nobre-dos-Santos M. 2006 Dental Materials Journal 10600 nm (Model UM L30, Union Medical Engineering Co., Yangju-si, Gyeonggi-Do, Korea) 2 W, 4 W, 6 W, 8 W, and 10 W Souza-Gabriel AE, Colucci V, Turssi CP, Serra MC, Corona SA. 2010 Microscopy Research and Technique 10600 nm 2 W Lepri TP, Colucci V, Turssi CP, Corona SA. 2013 Lasers in Medical Science 10600 nm (Opus 20; Opus Dent, Tel Aviv, Israel) 2 W Bahrololoomi Z, Fotuhi Ardakani F, Sorouri M. 2015 Journal of Dentistry 10600 nm (Daeshin Enterprise Corp., Seoul, South Korea) 1 W Soltanimehr E, Bahrampour E, Yousefvand Z. 2019 BMC Oral Health. 10600 nm (Lasersat 15tm, Satelec, Merignac, France) 2 W Dehghan H, Mojarad F, Serajzadeh M, Fekrazad R. 2020 Oral Health & Preventive Dentistry 10600 nm (Smart US 20D, Deka: Florence, Italy) 2 W Zhao IS, Xue VW, Yin IX, Niu JY, Lo ECM, Chu CH. 2021 ScienceDirect 9300 nm (Model DL-500; Access Laser Co, Everett, WA, USA) 0.67 W Eissa NM, Elshourbagy EM, Gomaa NE. 2022 Heliyon Journal 10600 nm (DEKALaser Technologies, Florence, Italy) 0.4 W The varnish was applied using a small brush according to the manufacturer’s instructions by applying a thin layer over the entire occlusal surface of the tooth. The sample in the mesial section was exposed to CO2 laser radiation (10600 nm wavelength, 1 W power, pulsed mode, 15 ms pulse duration) with a wavelength of 10600 nm and a power of 1 W for 15 seconds with a pulsed mode and a pulse duration of 15 ms 11 at a distance of 1 cm. Irradiation was performed in a continuous scanning motion that allowed the entire surface to be irradiated and we re-preserved it with distilled water ( Figure 3 ). Figure 3. Image of the parameters used. The test of the effect of the laser on the varnish was by means of a SEM (scanning electron microscope) (T-Scan company VEGA II XMU, Czech Republic). The amount of fluoride, calcium, phosphorus and carbon remaining on the two samples was tested using spectral analysis of EDX (Energy-dispersive X-ray spectroscopy, Oxford Instruments, UK) of the scanning electron microscope located in the Atomic Energy Commission ( Figure 4 ). The sample was analyzed by SEM to observe the topographic properties of the enamel surface after different treatments and SEM images of the central region of the samples were taken using different reagents with two different detectors SE (Secondary Electrons Detector) and BSE (Backscattered Electrons Detector). EDX analysis can provide information on the chemical composition/distribution of elements over a non-destructively large surface area. 12 The response variable was mainly a change in fluoride concentration and a change in the concentration of carbonate, calcium and phosphorus that make up hydroxyapatite, which was analyzed by EDX. Figure 4. Image of the sample after preparation for entry into the scanning electron microscope. Ethical approval and informed consent This in vitro study utilized extracted human teeth collected from patients who underwent orthodontic treatment. This study was from 24/8/2025 to 27/9/2025 The study protocol was reviewed and approved by the Institutional Review Board (IRB) of College of Dentistry, University of Damascus On August 21, 2025 under reference number (DN-210-125-3-9-1/21/8/2025) “Not applicable as the study used discarded biological material”]. All participants (or their guardians) provided written informed consent for the use of their extracted teeth for research purposes, in accordance with the principles of the Declaration of Helsinki. Patient identifiers were removed to ensure confidentiality. Results The results were evaluated according to the surface shape in electron microscope images and according to the concentration of fluoride, calcium, phosphorus and carbon. In this study, SEM images showed that CO2 laser irradiation fuses the surface, creating a smooth, recrystallized side. Fusion between enamel surface crystals was also observed after carbon dioxide laser treatment ( Figure 5 , 6 ). Figure 5. A: Image of the mesial section (fluoride + laser) with SE detector (Secondary Electrons Detector), x1000 measurement magnification and 20 kV acceleration voltage. B: Image of the distal section (fluoride only) with SE detector, x1000 magnification and 20 kV acceleration voltage. C: Image of the mesial section (fluoride + laser) with SE detector, x500 magnification and 20 kV acceleration voltage. D: Image of the distal section (fluoride only) with SE detector, x500 magnification and 20 kV acceleration voltage. Figure 6. A: Image of the mesial section (fluoride + laser) with a BSE detector (Backscattered Electrons Detector), x200 magnification, and 20 kV acceleration voltage. B: Image of the lateral section (fluoride only) with a BSE detector, x200 magnification, and 20 kV acceleration voltage. C: Image of the medial section (fluoride + laser) with BSE detector, x500 magnification and 20 kV acceleration voltage. D: Image of the lateral section (fluoride only) with BSE detector, x500 magnification and 20 kV acceleration voltage. Comparing the apparent differences in the mean of the measured items between the two groups ( Table 2 ) and the descriptive statistics for fluoride, calcium, phosphorus, and carbon ratios in both study groups ( Table 3 , 4 , 5 , 6 ). Table 2. The comparison between elements using the mean. Element Fluoride group Fluoride + CO2 laser The difference between averages Comments Fluoride 0.35 1.73 +1.38 Obvious apparent increase in fluoride with laser application Calcium 1.62 3.72 +2.10 Significant apparent increase in calcium Phosphorus 0.99 0.65 −0.34 Slight decrease in phosphorus Carbon 72.89 67.30 −5.59 Slight carbon reduction Table 3. The descriptive statistics of fluoride ratios. Fluoride Fluoride group Fluoride + CO2 laser group Mean 0.4 1.7 Std. Deviation 0.3 1.4 Median 0.2 1.4 Minimum 0.1 0.2 Maximum 1.0 4.3 Table 4. The descriptive statistics of calcium ratios. Calcium Fluoride group Fluoride + CO2 laser group Mean 1.62 3.72 Std. Deviation 1.56 6.28 Median 1.10 1.28 Minimum 0.50 0.60 Maximum 4.65 16.50 Table 5. The descriptive statistics of phosphorus ratios. Phosphorus Fluoride group Fluoride + CO2 laser group Mean 0.99 0.65 Std. Deviation 1.13 0.92 Median 0.39 0.35 Minimum 0.11 0.00 Maximum 2.44 2.50 Table 6. The descriptive statistics of carbon ratios. Carbon Fluoride group Fluoride + CO2 laser group Mean 72.89 67.29 Std. Deviation 8.97 7.42 Median 74.24 68.75 Minimum 57.13 57.80 Maximum 84.12 77.56 The results of the Mann-Whitney U test showed a significant statistical difference in fluoride ratios between the two groups (P value = 0.026) smaller than 0.05, indicating the effectiveness of using CO 2 lasers in enhancing fluoride absorption within the tooth structure. In contrast, the remaining elements (calcium, phosphorus, carbon) did not show significant differences, although there were apparent changes in the arithmetic mean, in the rest of the descriptive statistics measures, and in the ranks of the averages ( Table 7 ). Table 7. Mann-Whitney U test results. Fluoride Calcium phosphorus Carbon Test value 4.5 15 17 11 P value 0.026 0.699 0.937 0.31 Comparison with significance level Less than 0.05 Greater than 0.05 Greater than 0.05 Greater than 0.05 Result There is a statistically significant difference between the two groups, indicating a clear effect of the laser in raising fluoride levels no statistically significant difference no statistically significant difference no statistically significant difference Discussion This study evaluated the efficacy of a CO 2 laser for enhancing fluoride uptake in dental enamel. The combined application of a CO 2 laser with fluoride varnishes or gels, which can quadruple fluoride absorption, may significantly improve caries prevention. This synergistic effect could potentially reduce the required fluoride dosage and frequency of clinical applications. The mechanism is attributed to an increased formation of fluorapatite within the enamel, thereby elevating its resistance to acid demineralization. 13 In order to obtain a protective effect, a laser was used to raise the temperature of the tooth enamel to the melting point of its inorganic components or to the decomposition point of its organic components. On the other hand, non-thermal laser radiation was used after tooth fluoridation to achieve a slow fluoride release effect. This type of reaction is called laser-activated fluoride treatment. 11 Carbon dioxide laser irradiation of tooth enamel, within certain parameters, results in a specific temperature increase above the irreversible pulpitis threshold of 5.5 °C, 14 which changes the chemical composition of the tooth enamel surface and the morphological structure 15 and the increase may lead to permanent damage to the tooth pulp. Excessive temperature elevation during laser application poses a risk of injury to the dental pulp. A study addressing this risk compared the thermal effects of two laser systems: a CO 2 laser (at 1 and 2 W) and a diode laser (at 5 and 7 W). The results indicated that the mean temperature rise remained below the 5.5 °C critical threshold for pulp damage. Based on this evidence, the authors determined that both lasers could be used safely without compromising pulp health. 16 The absorption depth of port and ivory is 12 μm, compared to the absorption depth of water of 15 μm. 17 The absorption effects of tooth enamel and dentin at these depths depend on how the laser energy affects them and the laser energy depends on laser parameters such as power, mode of operation (continuous or pulsed wave mode), flow (energy density) and dose. The continuous wave mode resulted in carbonization, dissolution and cracking of the enamel and the development of the pulse mode allowed variations by frequency and pulse duration in milliseconds (ms) and microseconds (μs). This improved the thermal control of the laser in tissue. The dose depends on the radiation method: spot radiation or sweeping motion, the number of repeated radiations. 9 Several hypotheses have been advanced to explain the mechanisms by which combined laser and fluoride treatment enhances resistance to enamel demineralization. A principal theory posits that laser irradiation creates micro-spaces within the enamel structure, which subsequently serve to retain fluoride ions more effectively. These structural alterations are also believed to contribute directly to reducing enamel solubility. The observed morphological changes on the enamel surface following the sequential application of topical fluoride and CO 2 laser irradiation provide a rationale for the superior protective effect compared to fluoride treatment alone. This synergistic effect is further attributed to the laser-induced conversion of hydroxyapatite to the more acid-resistant fluorapatite, a process accompanied by the melting and recrystallization of hydroxyapatite crystals. 18 The results of previous studies showed that treating the surface of tooth enamel using a carbon dioxide laser reduces demineralization of tooth enamel compared to the control group. Studies have shown that wavelengths from 9 to 11 micrometers of CO2 lasers are effectively absorbed by dental hydroxyapatite, causing loss of carbonate mineral, which in turn reduces acid reactivity. 19 , 20 The integration of lasers in preventive dentistry reflects a modern paradigm shift within the field, moving away from a traditional focus on restorative treatment and toward a philosophy of disease prevention. This approach is consistent with the recommendations of major professional bodies and is part of a wider scientific consensus advocating for less invasive caries management strategies, 21 Which aims to preserve tissues to the maximum extent, and in this new approach, prevention has acquired an important role that it has not played before in the past. 11 All experiments combining CO2 and fluoride laser radiation have shown better results in preventing tooth caries when compared to a single treatment. Therefore, this ‘combination therapy’ may be clinically effective, and at the same time, it may only involve moderate daily doses of fluoride and low levels of laser radiation energy, which is consistent with our current study. Conclusion • Irradiation of tooth enamel at specific wavelengths and CO2 laser energy densities alters hydroxyapatite crystals, making the surface more resistant. • Laser therapy can be an alternative or synergistic to topical fluoridation to prevent tooth enamel caries with a longer-lasting effect. • When a carbon dioxide laser is combined with fluoride, it is possible to reduce the laser energy density and reduce the number of times fluoride is applied. • If this CO2 laser technology becomes available at an affordable cost and the results can be applied in clinical practice, there will be a promising future for this laser in preventing tooth caries. Recommendations Although these results are very promising, more studies should be developed in order to test these radiation conditions under different challenges, and simulate other clinical variables and therefore, future clinical studies are recommended to confirm these results. Data availability The dataset includes raw EDX values for fluoride, calcium, phosphorus, and carbon, as well as the data used for statistical analyses and tables are It is available to the public at this link. Figshare: Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. https://doi.org/10.6084/m9.figshare.31333387.v2 22 The dataset includes: • Research Data • EDx images Data are available under the terms of the CC BY 4.0 Extended data Extended data associated with this study, including EDX spectra, and detailed statistical output tables, are available in the same repository as the underlying data under a CC BY 4.0 license . Acknowledgments None. References 1. Dadgar S, Heydarian A, Sobouti F, et al. : Effects of probiotic and fluoride mouthrinses on Streptococcus mutans in dental plaque around orthodontic brackets: A preliminary explorative randomized placebo controlled clinical trial. Dent Res J (Isfahan). 2021 2021/09/25; 18 : 74. 2. Valizadeh S, Kamangar S, Nekoofar M, et al. : Comparison of Dentin Caries Remineralization with Four Bioactive Cements. Eur. J. Prosthodont. Restor. Dent. 2022; 30 (3): 223–229. PubMed Abstract | Publisher Full Text 3. Clark DC: Trends in prevalence of dental fluorosis in North America. Community Dent. Oral Epidemiol. 1994; 22 : 148–155. Publisher Full Text 4. Magalhães AC, Romanelli AC, Rios D, et al. : Effect of single application of TiF4 and NaF varnish and solutions combined with Nd:YAG laser irradiation on enamel erosion in vitro. Photomed. Laser Surg. 2011; 29 : 537–544. 5. Ishiguro T, Mayanagi G, Azumi M, et al. : Sodium fluoride and silver diamine fluoride-coated tooth surfaces inhibit bacterial acid production at the bacteria/tooth interface. J. Dent. 2019; 84 : 30–35. PubMed Abstract | Publisher Full Text 6. Reddy N, Golob Deeb J, Kitten T, et al. : The in vitro Effect of Laser Irradiation (Er:YAG and CO2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria. Int. J. Mol. Sci. 2022; 23 : 15732. 7. Zancope BR, Dainezi VB, Nobre-dos-Santos M, et al. : Effects of CO2 laser irradiation on matrix-rich biofilm development formation – an in vitro study. PeerJ. 2016; 4 : e2458. 8. Somasundaram P, Vimala N, Mandke LG: Protective potential of casein phosphopeptide amorphous calcium phosphate containing paste on enamel surfaces. Journal of Conservative Dentistry: JCD. 2013; 16 (2): 152–156. PubMed Abstract | Publisher Full Text | Free Full Text 9. Luk K, Zhao IS, Gutknecht N, et al. : Use of carbon dioxide lasers in dentistry. Lasers Dent Sci. 2018; 9 : 1–9. 10. Soesilawati P, Rezkika Y, Ayunnisa N, et al. : Effectivity of Calcium, Phosphate and Vitamin D in Dental Caries Prevention. DENTA. 2023; 17 (2): 67–74. 11. Bahrololoomi Z, Fotuhi Ardakani F, Sorouri M: In Vitro Comparison of the Effects of Diode Laser and CO2 Laser on Topical Fluoride Uptake in Primary Teeth. J Dent (Tehran). 2015; 12 (8): 585–591. PubMed Abstract 12. Lopes FVV, Sanches RP, de Vasconcelos G : Enamel erosion prevention and mechanism: effect of 10.6-μm wavelength CO2 laser low power density irradiation studied by X-ray fluorescence and infrared spectroscopy and scanning electron microscopy. Res Biomed Eng. 2021; 37 : 351–359. Publisher Full Text 13. Pagano S, Lombardo G, Orso M: Lasers to prevent dental caries: a systematic review. BMJ Open. 2020; 10 : e038638. 14. Ramalho K, Eduardo C, Heussen N, et al. : Randomized in situ study on the efficacy of CO2 laser irradiation in increasing enamel erosion resistance. Clin. Oral Investig. 2019; 23 : 2103–2112. 15. Silva C, Mantilla T, Engel Y, et al. : The effect of CO2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without fluoride applications— a randomized, controlled in vitro study. Lasers Med. Sci. 2020; 35 : 1213–1222. Publisher Full Text 16. Lombardo G, Pagano S, Cianetti S, et al. : Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies. Eur. J. Paediatr. Dent. 2019; 20 (4): 295–301. PubMed Abstract | Publisher Full Text 17. Almarsomy D, al-Taee L: Different Effectiveness of 10,600 nm Carbon Dioxide Laser on Enamel Surface. Tikrit J Dent Sci. 2024; 12 : 103–112. 18. Vahid M, Reza Z, Mona S, et al. : Effect of CO2 Laser-Assisted Titanium Tetrafluoride on Demineralization of Enamel Around Orthodontic. J Lasers Med Sci. 2024; 17 (15): e9. 19. Moshkelgosha V, Zandian R, Sohrabi M, et al. : Effect of CO2 Laser-Assisted Titanium Tetra-fluoride on Demineralization of Enamel Around Orthodontic Brackets. J Lasers Med Sci. 2024 2024/04/17; 15 : e9. 20. Rechmann P, Fried D, Le CQ, et al. : Caries inhibition in vital teeth using 9.6 μm CO2-laser irradiation. J. Biomed. Opt. 2011; 16 (7): 071405. 21. Giacaman RA, Muñoz-Sandoval C, Neuhaus KW: Evidence-Based strategies for the minimally invasive treatment of carious lesions: review of the literature. Adv. Clin. Exp. Med. 2018; 27 : 1009–1016. 22. Alkhaled A: Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. Dataset. figshare. 2026. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 Higher Institute of Laser Research and Applications, Damascus University, Damascus, Syria 2 Department of Pediatric Dentistry, Damascus University Faculty of Dentistry, Damascus, Syria 3 Oral Medicine Department, Damascus University Faculty of Dentistry, Damascus, Syria Sham Mohamad Farouq Alkhateeb Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Chaza Nader Kouchaji Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Abdulrhman Ahmad Alkhaled Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Omar Hamadah Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 19 Apr 2026, 15:588 https://doi.org/10.12688/f1000research.171971.1 Copyright © 2026 Alkhateeb SMF et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Alkhateeb SMF, Kouchaji CN, Alkhaled AA and Hamadah O. Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.12688/f1000research.171971.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 19 Apr 2026 Views 0 Cite How to cite this report: Qasim AA. Reviewer Report For: Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.5256/f1000research.189644.r480471 ) The direct URL for this report is: https://f1000research.com/articles/15-588/v1#referee-response-480471 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 May 2026 Alhan Ahmed Qasim , University of Baghdad, Baghdad, Baghdad Governorate, Iraq Approved VIEWS 0 https://doi.org/10.5256/f1000research.189644.r480471 Greetings : 1. Introduction: It needs to highlight the important of enamel protection role against acid dissolution. paragraph 3 " Recent epidemiological trends indicate .............." the reference is old ; attention should be paid to this. 2. Discussion: ... Continue reading READ ALL Greetings : 1. Introduction: It needs to highlight the important of enamel protection role against acid dissolution. paragraph 3 " Recent epidemiological trends indicate .............." the reference is old ; attention should be paid to this. 2. Discussion: the results of this study need further clarification and comparison with other studies, and it is preferable recent. The authors did not mention the limitations of this study. 3. Conclusion: second point" Laser therapy can be an alternative or synergistic to topical fluoridation to prevent tooth enamel caries with a longer-lasting effect" according to the result of this study laser is synergistic to topical fluoride application to increase fluoride uptake by enamel surface. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Valério R, Rocha C, Galo R, Borsatto M, et al.: CO2 Laser and Topical Fluoride Therapy in the Control of Caries Lesions on Demineralized Primary Enamel. The Scientific World Journal . 2015; 2015 (1). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Preventive Dentistry I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Qasim AA. Reviewer Report For: Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.5256/f1000research.189644.r480471 ) The direct URL for this report is: https://f1000research.com/articles/15-588/v1#referee-response-480471 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Apr 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 19 Apr 26 read Alhan Ahmed Qasim , University of Baghdad, Baghdad, Iraq Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Qasim A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 May 2026 | for Version 1 Alhan Ahmed Qasim , University of Baghdad, Baghdad, Baghdad Governorate, Iraq 0 Views copyright © 2026 Qasim A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Greetings : 1. Introduction: It needs to highlight the important of enamel protection role against acid dissolution. paragraph 3 " Recent epidemiological trends indicate .............." the reference is old ; attention should be paid to this. 2. Discussion: the results of this study need further clarification and comparison with other studies, and it is preferable recent. The authors did not mention the limitations of this study. 3. Conclusion: second point" Laser therapy can be an alternative or synergistic to topical fluoridation to prevent tooth enamel caries with a longer-lasting effect" according to the result of this study laser is synergistic to topical fluoride application to increase fluoride uptake by enamel surface. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Valério R, Rocha C, Galo R, Borsatto M, et al.: CO2 Laser and Topical Fluoride Therapy in the Control of Caries Lesions on Demineralized Primary Enamel. The Scientific World Journal . 2015; 2015 (1). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Preventive Dentistry I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Qasim AA. Peer Review Report For: Comparison between the protective effect of applying sodium fluoride varnish alone and applying CO2 laser with it in permanent teeth. In Vitro study [version 1; peer review: 1 approved] . F1000Research 2026, 15 :588 ( https://doi.org/10.5256/f1000research.189644.r480471) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-588/v1#referee-response-480471 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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