Smartphone Photography as a Teledentistry Method to Evaluate Anterior Composite Restorations

Table 1

The form used for the examinations. An example of filled one is demonstrated here.

Form is for: Patient A, upper left 2
Part A
A. Esthetic properties	1. Surface lustre	2. Staining; a. Surface; b. Margin	3. Color match and translucency	4. Esthetic anatomical form
1. Clinically excellent/very good	1.1. Lustre comparable to enamel	2a.1. No surface staining; 2b.1. No marginal staining	3.1. Good color match, no difference in shade, and/or translucency	4.1. Form is ideal
2. Clinically good; (after polishing probably very good)	1.2.1. Slightly dull, not noticeable from speaking distance; 1.2.2. Some isolated pores	2a.2. Minor surface staining, easily removable by polishing; 2b.2. Minor marginal staining, easily removable by polishing	3.2. Minor deviations in shade and/or translucency	4.2. Form is only slightly deviated from the normal
3. Clinically sufficient/satisfactory; (minor shorcomings,no unacceptable effects but not adjustable w/o damage to the tooth)	1.3.1. Dull surface but acceptable if covered with film of saliva; 1.3.2. Multiple pores on more than one third of the surface	2a.3. Moderate surface staining that may also present on other teeth, not esthetically unacceptable; 2b.3. Moderate marginal staining, not esthetically unacceptable	3.3. Distinct deviation but acceptable. Does not affect esthetics: 3.3.1. More opaque; 3.3.2. More translucent; 3.3.3. Darker; 3.3.4. Brighter	4.3. Form deviates from the normal but is esthetically acceptable
4. Clinically unsatisfactory; (but reparable)	1.4.1. Rough surface, cannot be masked by saliva film, simple polishing is not sufficient. Further intervention necessary; 1.4.2. Voids	2a.4. Unacceptable surface staining on the restoration and major intervention necessary for improvement; 2b.4. Pronounced marginal staining; major intervention necessary for improvement	3.4. Localized clinically deviation that can be corrected by repair: 3.4.1. Too opaque; 3.4.2. Too translucent; 3.4.3. Too dark; 3.4.4. Too bright	4.4. Form is affected and unacceptable esthetically. Intervention/correction is necessary
5. Clinicaly poor; (replacement necessary)	1.5. Very rough, unacceptable plaque retentive surface	2a.5. Severe surface staining and/or subsurface staining, generalized, or localized, not accessible for intervention.; 2b.5. Deep marginal staining, not accessible for intervention	3.5. Unacceptable replacement necessary	4.5. Form is unsatisfactory and/or lost. Repair not feasible/reasonable, replacement needed
Part B
B. Functional properties	5. Fracture of material and retention	6. Marginal adaptation	7. Occlusal contour and wear; (a) Qualitatively; (b) Quantitatively	8. Approximal anatomical form; (a) Contact point; (b) Contour
1. Clinically excellent/very good	5.1. No fractures/cracks	6.1. Harmonious outline, no gaps, no white, or discolored lines	7a.1. Physiological wear equivalent of enamel; 7b.1. Wear corresponding to 80%–120% of enamel	8a.1. Normal contact point (floss or 25 µm metal blade can pass); 8b.1. Normal contour
2. Clinically good	5.2. Small hairline crack	6.2.1. Marginal gap (<150 µm), white lines; 6.2.2. Small marginal fracture removable by polishing; 6.2.3. Slight ditching, slight step/flashes, minor irregularities	7a.2. Normal wear only slightly different from that to enamel; 7b.2. 50%–80% or 120%–150% wear compared to that of corresponding enamel	8a.2. Contact slightly too strong but no disadvantage (floss or 25 µm metal blade can only pass with pressure); 8b.2. Slightly deficient contour
3. Clinically sufficient/satisfactory; (minor shortcomings, no unacceptable effects but not adjustable w/o damage to the tooth)	5.3. Two or more or larger hairline cracks and/or material chip fracture not affecting the marginal integrity or approximal contact	6.3.1. Gap < 250 µm not removable; 6.3.2. Several small marginal fractures; 6.3.3. Major irregularities, ditching, or flash, steps	7a.3. Different wear rate than enamel but within the biological variation; 7b.3. < 50% or 150%–300% of corresponding enamel	8a.3. Somewhat weak contact, no indication of damage to tooth, gingiva or periodontal structures; 50 µm metal blade can pass; 8b.3. Visible deficient contour
4. Clinically unsatisfactory/(but reparable	5.4.1. Material chip fractures which damage marginal quality or approximal contacts; 5.4.2. Bulk fractures with partial loss (less than half of the restoration)	6.4.1. Gap >250 µm or dentin/base exposed; 6.4.2. Severe ditching or marginal fractures; 6.4.3. Larger irregularities or steps (repair necessary)	7a.4. Wear considerably exceeds normal enamel wear; or occlusal contact points are lost; 7b.4. Restoration >300% of enamel wear or antagonist >300%	8a.4. Too weak and possible damage due to food impaction; 100 µm metal blade can pass; 8b.4. Inadequate contour repair possible
5. Clinicaly Poor; (replacement necessary)	5.5. (Partial or complete) loss of restoration or multiple fractures	6.5.1. Restoration (complete or partial) is loose but in situ.; 6.5.2. Generalized major gaps or irregularities	7a.5. Wear is excessive; 7b.5. Restoration or antagonist >500% of corresponding enamel	8a.5. Too weak and/or clear damage due to food impaction and/or pain/gingivitis; 8b.5. Insufficient contour requires replacement
Part C
C. Biological properties	9. Recurrence of caries (CAR), erosion, abfraction	10. Tooth integrity (enamel cracks, tooth fractures)	11. Periodontal response (always compared to a reference tooth)	12. Adjacent mucosa
1. Clinically very good	9.1. No secondary or primary caries	10.1. Complete integrity	11.1. No plaque, no inflammation, no pockets	12.1. Healthy mucosa adjacent to restoration
2. Clinically good (after correction maybe very good) no treatment required	9.2. Small and localized; (1) Demineralization; (2) Erosion or; (3) Abfraction	10.2.1. Small marginal enamel fracture (<150 µm); 10.2.2. Hairline crack in enamel (<150 µm)	11.2. Little plaque, no inflammation (gingivitis), no pocket development; 11.2.1. Without; 11.2.2. With overhangs, gaps or inadequate anatomic form	12.2. Healthy after minor removal of mechanical irritations (plaque, calculus, sharp edges, etc.)
3. Clinically sufficient/satisfactory (minor shortcomings with no adverse effects but not adjustable without damage to the tooth)	9.3. Larger areas of; (1) Demineralisation,; (2) Erosion, or; (3) Abrasion/abfraction, dentin not exposed Only preventive measures necessary	10.3.1. Marginal enamel defect <250 µm; 10.3.2. Crack <250 µm; 10.3.3. Enamel chipping 13.3.4 multiple cracks	11.3. Difference up to one grade in severity of PBI compared to baseline and compared to control tooth; 11.3.1. Without; 11.3.2. With overhangs, gaps or inadequate anatomic form	12.3. Alteration of mucosa but no suspicion of causal relationship with restorative material
4. Clinically unsatisfactory (repair for prophylactic reasons)	9.4.1. Caries with cavitation and suspected undermining caries; 9.4.2. Erosion in dentin; 9.4.3. Abrasion/abfraction in dentin Localized and accessible can be repaired	10.4.1. Major marginal enamel defects; gap > 250 µm or dentin or base exposed 10.4.2. Large cracks >250 µm, probe penetrates; 10.4.3. Large enamel chipping or wall fracture	11.4. Difference of more than one grade of PBI in comparison to control tooth or increase in pocket depth >1 mm requiring intervention.; 11.4.1. Without; 11.4.2. With overhangs, gaps, or inadequate anatomic form	12.4. Suspected mild allergic, lichenoid, or toxic reaction
5. Clinically poor (replacement necessary)	9.5. Deep caries or exposed dentin that is not accessible for repair of restoration	10.5. Cusp or tooth fracture	11.5. Severe/acute gingivitis or periodontitis; 11.5.1. Without; 11.5.2. With overhangs, gaps, or inadequate anatomic form	12.5. Suspected severe allergic, lichenoid, or toxic reaction
Result:
Scores	Acceptable			Unacceptable
	1	2	3	4	5
Esthetic properties
Functional properties
Biological properties
Overall score

Italic values were the examples of filled form and were important.