Development of a clinically relevant index for tooth wear treatment needs

Background: This study aimed to develop a tooth wear classification system that combined the extent, severity, and aesthetic impact of tooth wear and correlated them with the most appropriate clinical management strategy.

Methods: Three hundred photographs were used to develop a classification tool that contained four levels of severity and aesthetic impact (0, 1, 2, and 3) in three age groups of patients. Ten examiners assessed and classified the cases using validated forms. Additionally, they selected the recommended treatment modality for each level. The analysis was conducted using a coefficient correlation test.

Results: The coefficient correlation for the severity was 0.81, 0.82 in the upper anterior and posterior segments, and 0.85 and 0.77 for the lower anterior and posterior segments, respectively. The aesthetic impact correlation coefficient was 0.84. Examiners had agreed that minor cases required monitoring or simple restorative interventions. The moderate-level cases had variety in the recommended management options depending on the aim of treatment. The severe level cases often required rehabilitation at an increased occlusal vertical dimension.

Conclusion: Within the limitations of this preliminary study, a good agreement between the examiners was found using the provided tools. More strict criteria in the classification part of the tool can further improve the examiners’ agreement.