Photographs as a means of assessing developmental defects of enamel

To evaluate the validity and reliability of photographic examinations for developmental defects of enamel (DDE) in maxillary and mandibular incisors and canines using a standardized process.

The anterior teeth of 257 children were examined 'wet', both clinically and photographically for DDE, using the modified Federation Dentaire Internationale (FDI) (DDE) Index. A series of five standardized photographs were taken for each child: a frontal view perpendicular to the four incisors; two lateral views, each showing the lateral incisors and canines on each side of the dental arch; and the superior and inferior views, retaking of the frontal view with the camera held at approximately 30 degrees above and below the horizontal plane. The photographs taken for each child were viewed as three different sets; the 'five-view' (frontal, two lateral views plus superior and inferior views), 'three-view' (frontal and two lateral views), and 'one-view' (frontal view only) slide sets.

Using 'one view' slides, 91.7% of teeth could be examined photographically. Whereas using multiple views 99.9% of teeth could be assessed. At the subject level, agreements between clinical diagnoses (gold standard) and photographic examinations were substantial to almost perfect (k = 0.73-0.86). At the tooth level, agreement was best for incisors (k = 0.71 or higher). The intra-examiner reproducibility was high for the photographic assessments at both subject and tooth levels (k = 0.71-0.95).

Multiple-view photographic slides of 'five-view' and 'three-view' are valid and reliable for assessing DDE on the 12 anterior teeth, while a 'one-view' (frontal) was acceptable to study only the incisors.