Diagnosis and Dentists' Treatment Preferences for Vestibular Enamel Defects-A Cross-Sectional Survey

Vestibular enamel defects, including WSL, MIH, or fluorosis, can impair esthetics and patient well-being, making accurate diagnosis essential for selecting appropriate treatment strategies. However, distinguishing these based solely on clinical images-an increasingly common scenario in digital communication-can be challenging. This pilot study aimed to assess dentists' diagnosis accuracy and confidence in assessing clinical images of vestibular enamel defects, and how the diagnosis influenced treatment choices.

A cross-sectional survey was distributed primarily to dentists from Europe and South America. It included demographic questions and 10 clinical images (two showing WSL, three fluorosis, four MIH, and one MIH/enamel hypoplasia combined). Reference diagnoses were established based on consensus among three specialists. Participants were asked to diagnose each image, select their preferred treatment options, and rate their diagnostic and therapeutic confidence using a 5-point Likert scale.

A total of 168 dentists completed the survey. Overall, diagnostic accuracy was 52%, with the highest for fluorosis (66%) and the lowest for the mixed case (33%). Most participants correctly diagnosed 3-8 of 10 cases. Conservative treatment options were chosen primarily, with resin infiltration selected in 70% of responses regardless of diagnosis. Diagnostic confidence was reported in 72% of cases.

The diagnostic accuracy of vestibular enamel defects based on clinical images was limited, and overconfidence was frequent. Dentists preferred conservative treatment strategies, though their choices were influenced by diagnostic accuracy.