Methods for Assessing and Measuring Tooth Wear-Applications in Clinical Research and a Comparison of the Basic...

Tooth wear is an increasing concern, particularly among younger individuals, driven by lifestyle and dietary changes as well as by bruxism. This condition, including attrition, abrasion and erosion, can result in sensitivity, aesthetic decline and functional impairment. Although dental caries prevention has improved, tooth wear remains a complex, multifactorial problem requiring early detection and effective management.

This paper is a literature survey that provides an overview and compares three diagnostic systems for tooth wear assessment-the Smith and Knight Index (TWI), Basic Erosive Wear Examination (BEWE) and Tooth Wear Evaluation System (TWES 2.0)-as recommended by the European Consensus Statement (2017). BEWE is primarily designed to assess erosive tooth wear, whereas TWI and TWES 2.0 provide a more comprehensive evaluation that also encompasses attrition and abrasion. This paper evaluates the suitability of all three indices for both population-level screening and individual patient assessment, focusing on efficiency, detail and ease of use. All three indices can be applied for screening purposes and for detailed evaluation of patients, although their primary applications may differ: BEWE is primarily used for screening populations, whereas TWI and TWES 2.0 are more often employed for assessing individual patients requiring treatment. It should be noted, however, that the TWI is not a screening tool but a diagnostic index intended for detailed clinical evaluation. The article also examines limitations, especially regarding the assessment of wear on restorative materials, and explores emerging technologies.

A literature review was conducted to assess the clinical relevance, diagnostic performance and practical application of the TWI, BEWE and TWES 2.0, based on a literature search performed using PubMed, Embase, ScienceDirect and Web of Science databases. Key outcome parameters compared for each index included scoring system, focus area, simplicity, level of detail, sensitivity to early wear, inclusion of restorations, ease of standardisation, application, advantages and limitations. Emerging diagnostic technologies were also considered.

All three systems offer structured approaches to diagnosing tooth wear, but each has limitations. BEWE is efficient for population screening but lacks clinical detail. TWI is comprehensive but time-consuming. TWES 2.0 balances efficiency with detail. Importantly, TWES 2.0 is the first diagnostic tool designed to identify additional signs associated with pathological tooth wear. Unlike BEWE and TWI, TWES 2.0 includes features to assess wear on restorative materials, although full functionality for crowns and bridges is still under development.

No single system is universally suitable for all clinical or epidemiological purposes. BEWE is efficient for population-level screening but lacks detailed surface-specific information. The TWI, while providing comprehensive diagnostic detail, is not designed for screening purposes and is best suited for individual clinical evaluation. TWI provides comprehensive evaluation but is time-consuming and less practical for large-scale studies. TWES 2.0 balances efficiency with detail and includes features to assess wear on restorative materials, although full functionality is still under development. A tailored approach, selecting the most appropriate system based on study or clinical objectives, is recommended for accurate assessment and monitoring of tooth wear.