Development of a new, clinically relevant ‘Index of Wear Treatment Needs’ for the management of tooth surface loss (TSL)

Abstract

Aim: this study aims to develop a tool to classify tooth surface loss (TSL) to different severity and aesthetic impact levels using photographs, and to categorize each level to the most appropriate modality of management. Then to use the classified cases to develop a photographic version of the index. An index of this type can be used by clinicians to determine the nature of treatment required based on the classification achieved. Methodology: Anonymous, unidentifiable, and untraceable photographs of mild, moderate, and sever toothwear cases were taken from the patients who are attended the Charles Clifford Dental hospital, Sheffield, UK and signed the hospital consent to use their photographs in research purpose. The classification tool has been developed using around 300 patient photographs. Additionally, it includes 4 levels of severity and 4 levels of aesthetic impact. Different management modalities for TSL have been added to the form. Out of the total photographs, 40 groups (240 photographs) were met the selection criteria. Five examiners assessed 60 patients’ photographs divided to 10 groups in pilot study and Ten examiners assessed and classified 120 cases photographs divided to 20 groups in the main study. Additionally, they recommended the treatment modality for each level. The analysis was conducted using a coefficient correlation test. The classified cases were then used to develop the photographic version of the classification system to be tested in a further study. Results: The coefficient correlation for the severity level was (.81, .82) upper anterior and upper posterior, and (.85, .77) for the lower anterior and lower posterior respectively. The aesthetic impact correlation between examiners was .84. The examiners have agreement that minor cases require monitoring or the simple addition of a resin-based composite. The moderate level cases had variety in the treatment options, which ranged from simple conforming intervention to extensive rehabilitation at centric relation. The severe level can be managed by aiming to rehabilitate the function and aesthetic of dentition with different fixed or removable options at increased OVD. Conclusion: The use of dental photographs can provide an acceptable agreement between clinicians to classify the severity and aesthetic component. Although there is agreement about the main approach for each level in this study, the suitable treatment option for each case requires further information, which cannot be investigated by the photographs and which is one of the study’s limitations.