ASSESSING 3D INTRAORAL SCANNING FOR THE DETECTION OF CARIES, FLUOROSIS, AND EROSIVE TOOTH WEAR ACROSS SMOOTH TOOTH SURFACES AND LOCATIONS.

OBJECTIVE

To evaluate the diagnostic agreement between a 3D intraoral scanner (IOS) and standard visual examinations for the assessment of dental hard-tissue conditions, including caries and erosive tooth wear (ETW) and enamel fluorosis

METHODS

A total of 4,620 surfaces assessments were performed using three indices, corresponding to 2,351, 1,280, and 989 surfaces, respectively. Assessments were conducted using full-mouth IOS scans and visual scoring using the International Caries Detection and Assessment System - ICDAS for caries; Basic Erosive Wear Examination - BEWE for ETW and Thylstrup-Fejerskov- TF index for enamel fluorosis. Agreement was examined overall and by tooth location (anterior/posterior) and surface (buccal, lingual, incisal). Statistical analyses included Cohen's κ, weighted κ, percent absolute agreement, and Spearman correlation coefficients for ordinal consistency.

RESULTS

For ICDAS, IOS demonstrated excellent agreement with visual examination (κ=0.82; weighted κ=0.89; 97% agreement; ρ=0.87). Anterior teeth (weighted κ=0.91) showed greater agreement than posterior teeth (weighted κ=0.86), with highest agreement on lingual surfaces. Discrepancies occurred mainly within intermediate lesion stages. For BEWE, agreement was substantial overall (κ=0.69; weighted κ=0.75; 79% agreement; ρ=0.78). Anterior and posterior surfaces exhibited similar agreement (81% and 78% agreement, respectively). For TFI, similar substantial agreement was observed (κ=0.67; weighted κ=0.74; 84% agreement; ρ=0.78). Anterior-lingual surfaces demonstrated the strongest performance (99% agreement), while posterior-buccal surfaces showed the lowest, though still acceptable, agreement.

CONCLUSION

The 3D IOS showed promising performance across all three dental conditions and surface types evaluated. Agreement with visual examination was consistently high, supporting IOS may serve as a useful adjunct tool for the assessment of dental hard-tissue conditions.

CLINICAL SIGNIFICANCE: IOS technology may enhance clinical decision-making, facilitate longitudinal monitoring, and improve standardization in research protocols involving enamel health.