Abstract
Dental wear analysis through the use of an intraoral scanner is a reality of modern dentistry. This study aimed to investigate the reliability of qualitative tooth wear evaluation through three-dimensional images captured with an intraoral scanner and compared to clinical and photographic examinations. Eighteen adult volunteers of both genders (18 to 55 years old) were submitted to clinical exams, intraoral photographs and intraoral scanning protocol using an optical scanner (TRIOS® Pod, 3Shape, Copenhagen, Denmark). Occlusal tooth wear, from second to second premolars, was measured by two evaluators and reevaluated after 30 days, according to a slight modification of the method described by Mockers et al. Weighted Kappa was used to measure intra and inter-examiner agreement. The Friedman test was used to verify the differences among methods. Random and systematic errors were assessed using Bland-Altman plots. All statistical analysis was performed with p<0.05. There was a substantive agreement for clinical (K = 0.75) and photographic exams (K = 0.79) and a moderate agreement for intraoral scanner analysis (K = 0.60) for inter-examiner evaluation. A substantial intra-examiner agreement was obtained for both evaluators. No significant difference between the methods was observed (p = 0.7343 for examiner 1 and 0.8007 for examiner 2). The Bland-Altman plot confirmed no systematic errors between the methods and a random error of 0.25 with the scanner method when compared to clinical assessment. All three methods showed reliability in qualitative occlusal tooth wear evaluation. Intraoral scanning seems to be a sound and reliable tool to evaluate tooth wear when compared to traditional methods, considering the lower inter-examiner agreement and the inherent limitations of this pilot study. Further research will be necessary in order to achieve more robust evidence.
Highlights
Tooth wear refers to diverse conditions that cause loss of mineralized tooth tissue without bacterial action or dental trauma [1]
Abfraction was added to this group of disorders causing dental hard tissue loss and it is characterized by microfractures and microstructural loss that culminates in cervical lesions, caused by a force application point outside the long tooth axis [11]
The results showed substantial agreement, with evaluator 1 obtaining Kappa values of K = 0.663 and K = 0.661 for the photography and the scanner, respectively, and evaluator 2 K = 0.684 for photography and K = 0.641 for the scanner analysis (Table 1)
Summary
Tooth wear refers to diverse conditions that cause loss of mineralized tooth tissue without bacterial action or dental trauma [1] These conditions have common characteristics, they show etiological and morphological differences, that are related to mechanical tooth-totooth contact on the occlusal surfaces, to tooth contact with food during the chewing process or no masticatory movements, and to the chemical dissolution of enamel through acid from diet or gastric sources [1,2]. This mechanism is associated with different non-carious tooth tissue loss, namely attrition, abrasion and erosion [3]. Abfraction was added to this group of disorders causing dental hard tissue loss and it is characterized by microfractures and microstructural loss that culminates in cervical lesions, caused by a force application point outside the long tooth axis [11]
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