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. 2025 Feb;52(2):125-136.
doi: 10.1111/joor.13856. Epub 2024 Sep 27.

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts

Jakob C Roehl  1   2 , Lukasz Katzer  1 , Holger A Jakstat  3 , Peter Wetselaar  4 , M Oliver Ahlers  1   5
Affiliations

Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts

Jakob C Roehl et al. J Oral Rehabil. 2025 Feb.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: DC‐TW; clinical assessment tools; diagnostic criteria; reliability; tooth wear; tooth wear evaluation system.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Findings sheet for tooth wear quantification (Tooth Wear Evaluation System 2.0).
FIGURE 2
FIGURE 2
Graphical presentation of tooth wear severity assessment. (a) Presentation of occlusal/incisal assessment guidelines using the 5‐point scale. (b) Presentation of vestibular/oral assessment guidelines using the 5‐point scale. (c) Presentation of assessment guidelines on restorations using the 5‐point scale.
FIGURE 3
FIGURE 3
Box‐Whisker‐Plot for the Cohen's kappa results tooth wear assessment.
See this image and copyright information in PMC

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