CARES-A New Three-Dimensional Coding System for Classifying Teeth With Dens Invaginatus

To establish a novel comprehensive three-dimensional coding system for the classification of teeth with dens invaginatus (DI) using cone beam computed tomography (CBCT) imaging.

An initial draft classification of teeth with DI was developed by the project directors and steering group based on the interpretation of CBCT images. A group of 26 global experts then provided their perspectives on the classification via a consensus-building online Delphi process. Following the achievement of consensus, six endodontists independently examined CBCT images of teeth with DI to evaluate the reliability of the draft classification. Inter-rater reliability was employed to ascertain the agreement among the six assessors and intra-rater reliability was assessed following the re-evaluation of the identical CBCT images 3 weeks later. The steering group then revised and finalized the classification.

The online Delphi process was completed in a single round with a 100% response rate. The inter-rater reliability score of 0.89 and the intra-rater reliability score of 0.88 revealed "almost perfect" agreement among and within the evaluators. The final CARES classification of teeth with DI includes five domains: Communication (C), cross-sectional Anatomy (A), Root formation (R), vertical Extent (E), and Supplementary features (S).

The three-dimensional CARES classification system provides stakeholders with a consistent and unambiguous method of categorizing teeth with DI. The system has the potential to enhance the precision of diagnosis and clinical decision-making during the management of DI and ensures clinicians can communicate more accurately with patients and other healthcare professionals.