Roehl Jakob C, Katzer Lukasz, Jakstat Holger A, Wetselaar Peter, Ahlers M Oliver
CMD-Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Oral Rehabil. 2025 Feb;52(2):125-136. doi: 10.1111/joor.13856. Epub 2024 Sep 27.
Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well-trained practitioners, rather than nonexperts.
The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale.
Forty-seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter-rater reliability) were calculated.
The agreements of the operators' ratings compared to the sample-solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces. Inter-rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter-rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously.
The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.
牙齿磨损是一个导致牙体硬组织丧失的多因素过程。为了对其进行评估，已发布了牙齿磨损评估系统（TWES）2.0。先前关于TWES的研究涉及训练有素的从业者，而非非专业人员。
本研究的首要目的是调查非专业人员使用TWES 2.0评估牙体硬组织牙齿磨损严重程度的可靠性。第二个目的是使用第三种量表调查评估牙齿修复体磨损严重程度的可靠性。
47名牙科学生对14个可能的患者病例中的至少9个进行了石膏模型和口内照片评估。计算了科恩kappa值（与样本解决方案的一致性）和弗莱iss kappa值（评分者间信度）。
与样本解决方案相比，操作者评分的一致性导致科恩kappa值在0.02至0.9之间。咬合面的一致性为0.34；前庭面为0.43；口腔面为0.57。评分者间信度（弗莱iss kappa值），咬合面为0.35，前庭面为0.17，口腔评估为0.24。有修复体的牙面评分的评分者间信度较低，咬合面为0.21，前庭面为0.14，口腔面为0.39。不同修复体的一致性差异极大。
个体检查者正确评估病例的能力差异很大。在本研究的范围内，与天然牙相比，修复体的评估略具挑战性，尤其是在咬合区域或修复材料为金时。后续研究应探讨加强培训和改进牙齿磨损等级定义是否会导致更高的信度分数。
