Diagnosis of developmental defects of enamel made from photographs

Photographs offer an opportunity to remotely examine teeth for developmental defects of enamel. However, the flash on the camera can cause burn-out which obscures the surface. Therefore, multiple views may be necessary to overcome this problem. In this study we examined the validity and reliability of diagnosis of enamel defects made from photographs. A series of five intra-oral photographs (central, right lateral, left lateral, superior and inferior views) at 1 : 1 magnification were taken for 125 Chinese children aged 12 to 13 years. The maxillary incisor teeth of these children were examined both clinically and photographically for enamel defects which, if present, were recorded using the modified FDI (DDE) Index. One hundred sets of slides were then randomly selected from the subjects and were viewed by six professional and two lay observers for enamel defects. The slide sets of five views and three views (central and two lateral views) were studied separately. The Kappa coefficients which were in the range of “substantial” to “total agreement” (κ = 0.73–1.00) at the tooth level for agreement between the clinical and the five-view photographic assessments on indicated that photographs were a reliable alternative to the clinical examination to detect the presence of enamel defects. No apparent significant differences were noted between the assessments of the two slide sets. These findings suggest that a series of three slides is adequate to study enamel defects for the four maxillary incisors.