A Reliability Assessment of the Basic Erosive Wear Examination and the Tooth Wear Evaluation System 2.0 Utilizing Intraoral Scan Data

Objectives This study assessed the reliability and clinical applicability of two tooth wear screening indices—Basic Erosive Wear Examination (BEWE) and the Tooth Wear Screening module of the Tooth Wear Evaluation System 2.0 (TWES 2.0)—using intraoral scans. Materials and methods A total of 246 anonymized intraoral scans from adult patients were independently evaluated by two calibrated examiners. Examiners calibration was performed prior to the study using a representative set of intraoral scans and a reference standard. Calibration was repeated until a predefined level of agreement was achieved before formal data collection. Scores for all sextants were recorded for BEWE and TWES 2.0. Inter-rater agreement was assessed using Wilcoxon signed-rank tests to detect systematic differences between paired scores, intraclass correlation coefficients (ICCs) to assess inter-examiner consistency, Bland–Altman plots to evaluate agreement between examiners. Statistical significance was set at p < 0.05. Results BEWE demonstrated good reliability, with ICCs ranging from 0.761 to 0.852 across sextants. According to commonly used ICC interpretation thresholds (poor < 0.50, moderate 0.50–0.75, good 0.75–0.90, excellent > 0.90), the observed ICCs indicate good inter-examiner reliability. Bland–Altman analysis showed small differences between examiners and no systematic bias. TWES 2.0 exhibited moderate to good reliability, with ICCs between 0.543 and 0.761. Conclusions Both BEWE and TWES 2.0 are reliable and practical for screening noncarious tooth wear via intraoral scans. BEWE showed slightly higher inter-rater consistency, whereas TWES 2.0 allows more detailed evaluation of occlusal and palatal surfaces. These indices can support standardized monitoring, early detection, and clinical management of tooth wear. Examiner calibration remains essential, particularly for TWES 2.0. Clinical Significance: Tooth wear is an increasingly prevalent condition in modern dentistry, often progressing silently until advanced stages. The application of BEWE and TWES 2.0 to intraoral scans provides clinicians with a standardized, noninvasive, and reproducible method for detecting and monitoring tooth wear at an early stage. Integrating these indices into routine digital workflows supports timely diagnosis, preventive management, and long-term follow-up of patients affected by erosive and attritional tooth wear. Clinical trial registration This study did not involve an interventional clinical trial and therefore was not registered in a clinical trial registry. The study protocol was reviewed and approved by the Bioethics Committee at the District Medical Chamber in Kraków, Poland (approval number: L.dz.OIL/KBL/22/2025, issued on 27 May 2025)