title: Is a Basic Erosive Wear Examination (BEWE) reliable for recording erosive tooth wear on 3D models?
abstract: OBJECTIVE
  To assess the reliability of the BEWE index on 3D models and to compare 3D-assessed erosive tooth wear scores with clinically detected scores.
  
  
  METHODS
  In total, 1964 members of the Northern Finland Birth Cohort 1966 participated in a standardized clinical dental examination including the Basic Erosive Wear Examination (BEWE) and dental 3D modelling at the age of 45-46 years. Of those examined, 586 were randomly selected for this study. 3D models were assessed using the same BEWE criteria as in the clinical examination. Calculated kappa values as well as the prevalence and severity of erosive wear according to the clinical examination and 3D models were compared. Re-examinations were performed to calculate intra- and inter-method and -examiner agreements.
  
  
  RESULTS
  The BEWE index on 3D models was reproducible; the mean intra- and inter-examiner agreement were 0.89 and 0.87, respectively, for sextant level, and 0.64 and 1, respectively, for BEWE sum scores. Erosive tooth wear was recorded as more severe in 3D models than in the clinical examination, and inter-method agreement was 0.41 for severe erosive wear (BEWE sum>8). The biggest inter-method differences were found in upper posterior sextants.
  
  
  CONCLUSIONS
  The BEWE index is reliable for recording erosive tooth wear on 3D models. 3D models seem to be especially sensitive in detecting initial erosive wear. Additionally, it seems that erosive wear may be underscored in the upper posterior sextants when assessed clinically. Due to the nature of 3D models, the assessment of erosive wear clinically and on 3D models may not be entirely comparable.
  
  
  CONCLUSIONS
  3D models can serve as an additional tool to detect and document erosive wear, especially during the early stages of the condition and in assessing the progression of wear. When scoring erosive wear clinically, care must be taken especially when assessing upper posterior sextants.
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland. Electronic address: viivi.alaraudanjoki@oulu.fi.
authors.forename: Viivi
authors.initials: V
authors.lastname: Alaraudanjoki
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland. Electronic address: henna.saarela@student.oulu.fi.
authors.forename: Henna
authors.initials: H
authors.lastname: Saarela
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland. Electronic address: reetta.pesonen@student.oulu.fi.
authors.forename: Reetta
authors.initials: R
authors.lastname: Pesonen
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland. Electronic address: marja-liisa.laitala@oulu.fi.
authors.forename: Marja-Liisa
authors.initials: ML
authors.lastname: Laitala
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland. Electronic address: heikki.kiviahde@oulu.fi.
authors.forename: Heikki
authors.initials: H
authors.lastname: Kiviahde
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 54, 90029 Oulu, Finland; Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, Kasarmikatu 11-13, 00029 Helsinki, Finland. Electronic address: leo.tjaderhane@oulu.fi.
authors.forename: Leo
authors.initials: L
authors.lastname: Tjäderhane
authors.affiliation: Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, CH-3010 Bern, Switzerland. Electronic address: adrian.lussi@zmk.unibe.ch.
authors.forename: Adrian
authors.initials: A
authors.lastname: Lussi
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 54, 90029 Oulu, Finland. Electronic address: paula.pesonen@oulu.fi.
authors.forename: Paula
authors.initials: P
authors.lastname: Pesonen
authors.affiliation: Research Unit of Oral Health Sciences, University of Oulu, PO Box 5281, 90014, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Kajaanintie 54, 90029 Oulu, Finland. Electronic address: vuokko.anttonen@oulu.fi.
authors.forename: Vuokko
authors.initials: V
authors.lastname: Anttonen
mesh_terms: D017076:Computer-Aided Design / Q000295:instrumentation; D003945:Diagnosis, Oral / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005387:Finland; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014077:Tooth Erosion / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D057085:Tooth Wear / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology
keywords: 3D model; Assessment; BEWE; Detection; Erosive wear; Validation