Remote Assessment of Caries, MIH, and Plaque on Intraoral 3D Scan Images: Findings from the LIFE Child Study

Objectives To evaluate the diagnostic agreement between clinical examinations and time-delayed remote diagnostic assessments of intraoral 3D scans (IOS) for detecting oral diseases in children and adolescents, validating intraoral 3D scans as a tool in epidemiology studies. Material and Methods A total of 511 participants aged 7.5–20.5 years from the LIFE Child cohort received standardized chairside clinical diagnostics followed by intraoral 3D scanning (TRIOS 5, 3shape). Two calibrated examiners independently performed blinded remote review of digital scans after a predefined latency period. Diagnostic parameters comprised caries (ICDAS II), MIH classification, restorative status, sealant status, and plaque accumulation1 quantified using the Plaque Index (PI). Primary outcomes were diagnostic agreement and interrater reliability, analysed by weighted percent agreement, Cohen’s weighted Kappa and Bland-Altman plots. Results Very high agreement was observed between clinical and IOS-based assessments for caries experience (DMF-T: \(\:{pa}_{w}\)= 0.990, κ = 0.77; dmf-t: \(\:{pa}_{w}\)= 0.991, κ = 0.93) and for severity-graded caries lesions (ICDAS 3–4: \(\:{pa}_{w}\)= 0.998, κ = 0.69; ICDAS 5–6: \(\:{pa}_{w}\)= 1.000, κ = 0.87). Agreement for initial lesions (ICDAS 1–2) was slightly lower but remained high (\(\:{pa}_{w}\)= 0.979, κ = 0.29). Fissure sealants and fillings showed excellent agreement (\(\:{pa}_{w}\)= 0.997, κ = 0.84 and \(\:{pa}_{w}\)= 0.998, κ = 0.71). MIH detection on at least one tooth showed very good agreement (\(\:{pa}_{w}\) = 0.932, κ = 0.83), with consistently high agreement across severity codes. Plaque assessment showed good agreement overall (\(\:{pa}_{w}\) = 0.898), with slightly higher agreement in anterior regions. Interrater reliability was substantial to excellent across parameters. Conclusions Intraoral 3D scans enable reliable remote assessment of clinically relevant dental conditions in children and adolescents, particularly for advanced caries lesions and molar incisor hypomineralisation (MIH). Clinical Relevance Intraoral 3D scanning enables efficient remote evaluation in screening and epidemiological programs, prioritizing visually distinct or treatment-relevant findings, with slightly reduced alignment for early enamel findings.