Thank you for your comments on our article “Three-dimensional imaging for indirect-direct bonding.” Your interest in our research gives us the opportunity to provide more insight and to further clarify the intention of our article.

We all agree that the principle of nonmaleficence (do no harm)—the second ethical principle according to American Dental Association’s code of ethics and professional conduct—dictates that professionals have a duty to protect their patients from harm. This principle also dictates that harm should not come to patients as a result of their participation in a research project. Health of patients is our main concern, and every measure should be taken to ensure that.

Radiographic imaging should follow the ALARA principle: as low as reasonably achievable. It was proven that the radiation dose for standard resolution CBCT scans ranges between 64.7 and 69.2 μSv, which is about 2 to 3 times that of panoramic and lateral cephalometric radiographs combined. Yet, the added diagnostic information from CBCT images is sometimes irreplaceable by conventional imaging techniques, since the former allow a complete 3-dimensional visualization of the anatomic structures. Since the introduction of CBCT machines, a great enhancement toward reduced exposure parameters has been achieved, opening the way for future routine implementation of CBCT scans in dental practice.

Since tooth alignment should be in respect to the 3 planes, the teeth must be visualized in 3 dimensions during the bonding procedure. The presented technique in our article aimed at positioning the teeth ideally with respect to both the crowns and the roots, ensuring proper expression of bracket prescriptions as well as root parallelism at the end of treatment. The idea is a futuristic approach that could be implemented if acceptable CBCT exposure parameters can be attained in the future. The idea was presented as a Techno bytes article, not as a case report, and was based on CBCT scans obtained from the patient archives in the Department of Orthodontics and Dentofacial Orthopedics at Cairo University.

We agree that using this technique with the constraints of the available CBCT machines, especially on children, would be unjustifiable. But we hope that it could be an incentive encouraging further enhancements in contemporary CBCT machines.