Methods for Assessing and Measuring Tooth Wear—Applications in Clinical Research and a Comparison of the Basic Erosive Wear Examination, Tooth Wear Index and Tooth Wear Evaluation System Version 2.0

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2025-11-17 DOI:10.1111/joor.70104

Maria Lorens, Iwona Tomaszewska

{"title":"Methods for Assessing and Measuring Tooth Wear—Applications in Clinical Research and a Comparison of the Basic Erosive Wear Examination, Tooth Wear Index and Tooth Wear Evaluation System Version 2.0","authors":"Maria Lorens, Iwona Tomaszewska","doi":"10.1111/joor.70104","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":16605,"journal":{"name":"Journal of oral rehabilitation","volume":"53 2","pages":"568-578"},"PeriodicalIF":4.0000,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of oral rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/joor.70104","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Abstract Image

查看原文本刊更多论文

牙齿磨损评估与测量方法——在临床研究中的应用及基本侵蚀磨损检查、牙齿磨损指数和牙齿磨损评价系统2.0版本的比较

背景：由于生活方式和饮食的改变以及磨牙症，牙齿磨损越来越受到关注，特别是在年轻人中。这种情况，包括磨损，磨损和侵蚀，可导致敏感性，审美下降和功能障碍。虽然龋齿的预防已经有所改善，但牙齿磨损仍然是一个复杂的多因素问题，需要早期发现和有效管理。目的：本文是一项文献调查，概述并比较了欧洲共识声明（2017）推荐的三种牙齿磨损评估诊断系统-史密斯和奈特指数（TWI），基本侵蚀磨损检查（BEWE）和牙齿磨损评估系统（TWES 2.0）。BEWE主要用于评估牙齿的侵蚀磨损，而TWI和TWES 2.0提供了更全面的评估，还包括磨损和磨损。本文评估了所有三个指标在人群水平筛查和个体患者评估中的适用性，重点是效率、细节和易用性。这三个指标都可以用于筛查目的和对患者的详细评估，尽管它们的主要应用可能有所不同：BEWE主要用于筛查人群，而TWI和TWES 2.0更常用于评估需要治疗的个体患者。然而，应该指出的是，TWI不是一种筛查工具，而是一种用于详细临床评估的诊断指标。文章还考察了局限性，特别是关于修复材料磨损的评估，并探讨了新兴技术。方法：通过PubMed、Embase、ScienceDirect和Web of Science数据库的文献检索，对TWI、BEWE和TWES 2.0的临床相关性、诊断性能和实际应用进行文献综述。各指标比较的主要结果参数包括评分体系、重点领域、简单性、细节水平、早期磨损敏感性、修复体纳入、标准化难易程度、应用、优势和局限性。还审议了新兴的诊断技术。结果：所有三种系统都提供了结构化的方法来诊断牙齿磨损，但每个系统都有局限性。BEWE对人群筛查是有效的，但缺乏临床细节。TWI是全面但耗时的。TWES 2.0平衡了效率和细节。重要的是，TWES 2.0是第一个用于识别与病理性牙齿磨损相关的其他体征的诊断工具。与BEWE和TWI不同，TWES 2.0包括评估修复材料磨损的功能，尽管冠和桥的完整功能仍在开发中。结论：没有一个单一的系统是普遍适用于所有临床或流行病学目的。BEWE对人群水平的筛查是有效的，但缺乏详细的表面特异性信息。TWI虽然提供了全面的诊断细节，但不是为筛查目的而设计的，最适合于个人临床评估。TWI提供了全面的评估，但对于大规模研究来说耗时且不太实用。TWES 2.0平衡了效率和细节，并包括评估修复材料磨损的功能，尽管完整的功能仍在开发中。建议根据研究或临床目标选择最合适的系统，以准确评估和监测牙齿磨损。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.