Quality Assessment of Anterior Composite Restorations: Clinical Examination versus Three Digital Photographic Techniques

Quality Assessment of Anterior Composite Restorations: Clinical Examination versus Three Digital Photographic Techniques | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality Assessment of Anterior Composite Restorations: Clinical Examination versus Three Digital Photographic Techniques Specialist Aleyna Keskin, Gul Yildiz Telatar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8519690/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Clinical Oral Investigations → Version 1 posted 9 You are reading this latest preprint version Abstract Objective The aim of this study was for the first time to evaluate of intraoral digital photography in assessing anterior composite restorations using a smartphone (iPhone 14 Pro), a smartphone with a lens (2IN1 Phone Macro Lens), and a digital camera with a macro lens (Canon Rebel XTi), compared to clinical examination, based on World Dental Federation (FDI) criteria. Methods A total of 185 anterior composite restorations were evaluated by calibrated restorative dentistry specialists. Restorations were scored according to the FDI criteria as intact, requiring repair, or needing replacement. Clinical examination was considered the gold standard. Photographs were taken under standardized conditions, and inter-observer and inter-method agreement were analyzed using Cohen’s Kappa and intraclass correlation coefficient (ICC). Results High inter-observer agreement was observed across all methods (Kappa = 0.928–1.0). Good to excellent agreement was found between clinical examination and digital photography methods for FDI final scores (Kappa = 0.775–0.973, p < 0.001). Photographs taken with the lens-equipped smartphone and macro camera showed higher agreement with clinical examination (Kappa = 0.973). Conclusion Digital photography, particularly with a lens-equipped smartphone and macro camera, offers effectiveness comparable to clinical examination in evaluating anterior composite restorations. anterior composite restorations digital photography FDI criteria lens-equipped smartphone teledentistry Figures Figure 1 Clinical Relevance This study demonstrates that intraoral digital photography, particularly with a lens-equipped smartphone and macro camera, achieves diagnostic outcomes closely aligned with clinical examination using FDI criteria. While smartphones alone are practical, lens-assisted imaging enhances accuracy, supporting its use as a cost-effective alternative to professional macro cameras. Introduction The clinical success of dental restorations is a significant area of research concerning diagnosis, treatment, and restoration longevity [ 1 ]. The growing interest in evidence-based dentistry has increased the number of clinical studies on this topic [ 2 ]. Composite resins, like other restorative materials, have a limited lifespan [ 3 ]. It is estimated that 56% of restorations applied to treated teeth are used to replace existing restorations rather than to treat primary caries [ 4 ]. Among the reasons for the failure of intraoral composite restorations, secondary caries is the most common cause [ 5 ]. Following secondary caries, frequent reasons for replacing composite restorations include marginal fracture (18%), marginal discoloration (9%), complete fracture (7%), tooth fracture (7%), complete discoloration (6%), and pain (1%) [ 6 ]. In cases where there are no secondary caries beneath the restoration but deterioration is present at the margins, repair of the restoration may be preferred [ 7 ]. When making this decision, clinicians may rely on their clinical experience, leading to subjective judgments. For the evaluation of restorations, the World Dental Federation (FDI) criteria and the modified United States Public Health Service (USPHS)/Ryge criteria are widely used [ 8 , 9 ]. However, despite being well-defined, these criteria are often considered complex for routine clinical use and can lead to subjective evaluations, even among experienced clinicians [ 4 , 10 ]. The FDI criteria, which include functional, biological, and aesthetic categories with several subcategories. The final score was based on the worst subcategory score: intact (1–3), requiring repair (4, partial failure), or replacement (5, complete failure). The distinction between scores 4 and 5 depends on whether the defect can be repaired or necessitates full replacement [ 9 ]." Digital photography has emerged as an alternative that reduces bias in evaluating restoration quality. One of its primary uses is to allow clinicians to photograph restorations and send them to impartial researchers for assessment. Intraoral photography is recognized as a reliable diagnostic method for evaluating dental caries, trauma, and restorations [ 11 ]. Modern technology has found its place in the medical world, as in every aspect of our lives. These advancements have created a new field called teledentistry, where telecommunications and dentistry are used together [ 12 ]. Dental photography requires specific technical precision due to the challenging conditions of the intraoral environment. Today, to achieve ideal image quality, interchangeable-lens cameras equipped with macro lenses offering 1:1 magnification are used in combination with light sources such as macro ring flashes. However, these systems are both costly and bulky, presenting disadvantages [ 13 ]. In contrast, the widespread use of smartphones offers a low-cost and practical photography solution, although image quality may vary between devices [ 14 ]. Smartphone megapixels are not equivalent to those of Digital Single-Lens Reflex (DSLR) cameras because smartphones have smaller camera sensors [ 15 ]. However, the cost of a smartphone with a detachable telephoto lens setup is approximately half that of a DSLR. A telephoto lens enables zooming without reducing image resolution and increases focal length instead of cropping and enlarging the image. All iPhone models starting from the iPhone 11 Pro are equipped with a telephoto lens [ 16 ]. This study is the first to investigate the validity of intraoral digital photography in evaluating anterior composite restorations. Our hypothesis is that photographs taken with a smartphone, a lens-equipped smartphone, and a macro-lens camera will yield results comparable to clinical examination. Materials and Methods Study Design This study is a validation study examining the use of intraoral digital photography in evaluating anterior composite restorations. The study was deemed scientifically and ethically appropriate by the Non-Interventional Clinical Research Ethics Committee of XXX University Faculty of Medicine under decision number XXX. Participants signed an informed consent form explaining the study’s purpose, content, and methods. Participants and Sample The study included 185 anterior teeth with composite restorations from individuals aged 18–64 who applied to the Department of Restorative Dentistry at XXX University. Primary teeth, unrestored teeth, and teeth with amalgam, glass ionomer, or indirect restorations were excluded. Evaluation Methods Restorations were classified according to FDI criteria as intact (scores 1–3), requiring repair (score 4), or needing replacement (score 5) [ 5 ]. Clinical examination was considered the gold standard. Photographs were taken using an iPhone 14 Pro (48 MP main camera, 12 MP ultra-wide camera), an iPhone 14 Pro with a 2IN1 Phone Macro Lens, a Canon Rebel XTi (CMOS sensor, 3888x2592 pixels), and a Canon EF 100mm f/2.8 Macro IS USM lens. Photographs were captured under standardized lighting (28 Watt matte white LED) at a distance of 10 cm (smartphone) or 20 cm (macro camera), using lip-cheek retractors and positioning the camera perpendicular to the tooth surface. For the iPhone 14 Pro, focusing was done by tapping the screen; for macro lens photography, a ring flash was used. Macro photography settings included an aperture of f/22, ISO 200, exposure time of 1/160 second, and a Macro Ring Lite MR-14EX II flash. All images were saved in JPEG format (Fig. 1). Calibration and Evaluation Evaluations were conducted by two restorative dentistry specialists. Calibration was performed on 20 anterior teeth with restorations, which were not included in the study, using both clinical and digital methods. For clinical examination, a mirror, a rounded-tip probe, and a reflector light were used, and bite-wing and panoramic radiographs were reviewed. Photographs were taken by an experienced clinician. The captured photographs were scored by two different restorative dentistry specialists according to FDI criteria. Based on the FDI criteria, restorations were scored as follows: no intervention required (scores 1, 2, 3) with a final score of 1, repair required (score 4) with a final score of 2, and replacement required (score 5) with a final score of 3. Statistical Analysis The sample size was calculated using G*Power 3.1.9.2 with a 95% confidence interval, α = 0.05, and a theoretical power of 0.80, determining a minimum of 175 restorations [70]. Inter-observer and inter-method agreement were assessed using Cohen’s Kappa statistic and the Intraclass Correlation Coefficient (ICC). Kappa was used for categorical variables, and ICC for quantitative variables, with a significance level of p < 0.05. Analyses were performed using IBM SPSS V23. Results Interobserver Agreement The interobserver agreement for FDI final scores was found to be high across all imaging methods (Kappa = 0.928–1.0, p < 0.001). Interobserver agreement was evaluated for each criterion according to the imaging methods (Table 1 ). Within the smartphone method, a statistically significant good level of agreement was observed between the observers for the criteria of material fracture, proximal contact point, surface gloss and texture, marginal discoloration, and color match. A statistically significant moderate level of agreement was found for marginal adaptation and anatomical form and contour. In both the smartphone with lens method and the macro photography method, a statistically significant good level of agreement was obtained between the observers for all evaluated criteria. Table 1 Interobserver agreement by individual evaluation criteria Criterion ICC (95% CI) p Smartphone Material Fracture 0.796 (0.737–0.843) < 0.001 Marginal Adaptation 0.647 (0.554–0.723) < 0.001 Proximal Contact Point 0.76 (0.692–0.815) < 0.001 Form and Contour 0.665 (0.577–0.739) < 0.001 Surface Luster and Texture 0.763 (0.695–0.817) < 0.001 Marginal Discoloration 0.886 (0.85–0.913) < 0.001 Color Match 0.824 (0.771–0.865) < 0.001 Smartphone + Lens Material Fracture 0.85 (0.804–0.885) < 0.001 Marginal Adaptation 0.777 (0.713–0.829) < 0.001 Proximal Contact Point 0.82 (0.767–0.863) < 0.001 Form and Contour 0.82 (0.767–0.862) < 0.001 Surface Luster and Texture 0.813 (0.757–0.856) < 0.001 Marginal Discoloration 0.882 (0.845–0.91) < 0.001 Color Match 0.835 (0.786–0.874) < 0.001 Macro Photography Material Fracture 0.859 (0.815–0.892) < 0.001 Marginal Adaptation 0.76 (0.691–0.815) < 0.001 Proximal Contact Point 0.827 (0.775–0.867) < 0.001 Form and Contour 0.78 (0.716–0.83) < 0.001 Surface Luster and Texture 0.838 (0.79–0.876) < 0.001 Marginal Discoloration 0.895 (0.863–0.921) < 0.001 Color Match 0.852 (0.807–0.887) < 0.001 Comparison with Clinical Examination Inter-observer agreement was determined to be at a good level. The methods were compared with clinical examination using Observer 2 as the reference. Agreement between the methods was evaluated based on the final FDI scores. A good level of agreement was found between clinical examination and smartphone photography (Kappa = 0.775, p < 0.001), while very good agreement was observed with the smartphone plus lens and macro photography methods (Kappa = 0.973, p < 0.001) (Table 2 ). Table 2 Comparison of Clinical Examination with Other Methods Based on Final FDI Scores Clinical Kappa p Intact Repair Replacement Smartphone Intact 41 (91.1) 7 (17.1) 2 (2) 0.775 < 0.001 Repair 4 (8.9) 26 (63.4) 4 (4) Replacement 0 (0) 8 (19.5) 93 (93.9) Smartphone + Lens Intact 45 (100) 0 (0) 0 (0) 0.973 < 0.001 Repair 0 (0) 40 (97.6) 2 (2) Replacement 0 (0) 1 (2.4) 97 (98) Macro Photography Intact 45 (100) 0 (0) 0 (0) 0.973 < 0.001 Repair 0 (0) 40 (97.6) 2 (2) Replacement 0 (0) 1 (2.4) 97 (98) The agreement between clinical examination and other methods in terms of individual FDI criteria was evaluated (Table 3 ). A good level of agreement was found between clinical examination and the smartphone method for material fracture; moderate agreement was observed for marginal adaptation, proximal contact point, form and contour, caries at the restoration margin, surface gloss, surface texture, marginal staining, and color match; and low agreement was detected for hard tissue defects at the restoration margin. Between clinical examination and both the smartphone with lens and macro photography methods, good agreement was found for material fracture, caries at the restoration margin, and marginal staining; moderate agreement was observed for other criteria; and low agreement was found for hard tissue defects. Table 3 Agreement Between Clinical Examination and Other Methods Based on FDI Criteria (ICC with 95% Confidence Intervals) Criterion ICC (95% CI) p Clinical- Smartphone Material Fracture 0.822 (0.769–0.863) < 0.001 Marginal Adaptation 0.5 (0.383–0.6) < 0.001 Proximal Contact Point 0.591 (0.488–0.677) < 0.001 Form and Contour 0.519 (0.406–0.617) < 0.001 Caries at Restoration Margin 0.692 (0.608–0.76) < 0.001 Hard Tissue Defect at Restoration Margin 0.28 (0.141–0.407) < 0.001 Surface Luster and Texture 0.598 (0.497–0.683) < 0.001 Marginal Discoloration 0.737 (0.663–0.796) < 0.001 Color Match 0.633 (0.538–0.712) < 0.001 Clinical- Smartphone + Lens Material Fracture 0.86 (0.817–0.893) < 0.001 Marginal Adaptation 0.51 (0.395–0.609) < 0.001 Proximal Contact Point 0.622 (0.525–0.703) < 0.001 Form and Contour 0.605 (0.505–0.689) < 0.001 Caries at Restoration Margin 0.824 (0.772–0.865) < 0.001 Hard Tissue Defect at Restoration Margin 0.28 (0.141–0.407) < 0.001 Surface Luster and Texture 0.69 (0.607–0.759) < 0.001 Marginal Discoloration 0.765 (0.697–0.818) < 0.001 Color Match 0.691 (0.607–0.759) < 0.001 Clinical- Macro Photography Material Fracture 0.923 (0.898–0.942) < 0.001 Marginal Adaptation 0.542 (0.431–0.636) < 0.001 Proximal Contact Point 0.559 (0.451–0.651) < 0.001 Form and Contour 0.597 (0.496–0.682) < 0.001 Caries at Restoration Margin 0.824 (0.772–0.865) < 0.001 Hard Tissue Defect at Restoration Margin 0.28 (0.141–0.407) < 0.001 Surface Luster and Texture 0.705 (0.624–0.771) < 0.001 Marginal Discoloration 0.772 (0.706–0.824) < 0.001 Color Match 0.693 (0.61–0.761) < 0.001 ICC = Intraclass Correlation Coefficient Failure Detection The agreement between clinical examination and other methods was evaluated (Table 4 ). A binary scoring system was used to calculate the overall failure rate: 0 = no failure, 1 = failure (repair or replacement). For failure detection, the smartphone method demonstrated 93.57% sensitivity, 91.11% specificity, 97.04% positive predictive value (PPV), and 82% negative predictive value (NPV). Both the smartphone with lens and macro photography methods exhibited excellent diagnostic performance with 100% sensitivity, specificity, PPV, and NPV. Table 4 Evaluation of Agreement Between Clinical Examination and Other Methods Smartphone Smartphone + Lens Macro Photography No Failure Failure No Failure Failure No Failure Failure Clinical No Failure 41 (91.1) 4 (8.9) 45 (100) 0 (0) 45 (100) 0 (0) Failure 9 (6.4) 131 (93.6) 0 (0) 140 (100) 0 (0) 140 (100) Kappa 0.816 1 1 p < 0.001 < 0.001 < 0.001 Sensitivity %93.57 %100 %100 Specificity %91.11 %100 %100 PPV %97.04 %100 %100 NPV %82 %100 %100 Discussion This study aimed to evaluate the effectiveness of intraoral digital photography in assessing anterior composite restorations, compared to clinical examination, using FDI criteria. No similar study in the literature has evaluated restoration quality in the context of teledentistry using a smartphone (iPhone 14 Pro), a lens-equipped smartphone (2IN1 Phone Macro Lens), and a macro-lens digital camera (Canon Rebel XTi). Thus, this study provides an original contribution by comparing the effectiveness of these three methods. The results indicate high inter-observer agreement across all methods (Kappa = 0.928–1.0). The smartphone method showed slightly lower agreement compared to the lens-equipped smartphone and macro camera, likely due to the smartphone camera’s lower resolution and detail-capturing capacity [ 9 ]. Kohara et al. [ 9 ] used a smartphone and macro camera for occlusal caries detection, reporting Kappa values ranging from 0.60–0.66. In contrast, this study achieved higher Kappa values (0.775–0.973), which may be attributed to the technological superiority of the devices used (e.g., the iPhone 14 Pro’s 48 MP camera) and standardized imaging conditions. Signori et al. [ 11 ] reported low to moderate agreement (Kappa = 0.12–0.34) for anterior restorations evaluated with an intraoral camera. However, this study found good to excellent agreement for anterior restorations (Kappa = 0.775–0.973). This difference may stem from the superior resolution of the images used in this study (2268x4032–5472x3648 pixels) compared to the intraoral camera’s resolution (1024x768 pixels). Additionally, the accessibility of the anterior region likely enhanced image quality and diagnostic accuracy. Lower agreement was observed between methods for marginal adaptation, proximal contact points, and form/contour criteria. This may be due to the two-dimensional nature of digital photography, which lacks the perceptual capacity provided by tactile examination [ 17 , 18 ]. Valizadeh-Haghi et al. [ 18 ] reported that smartphone photographs were inadequate for detecting marginal adaptation. Clinical examination with a probe allows for more precise evaluation of marginal adaptation [ 17 ]. This suggests that digital methods may be limited in criteria requiring detailed assessment. Aesthetic criteria, particularly color match, were identified as a leading cause of restoration failure [ 19 ]. However, the evaluation of these criteria can vary based on clinicians’ experience and subjective perceptions. Simplifying the FDI criteria into three final scores (intact, repair, replacement) in this study may have increased inter-observer and inter-method agreement. This finding supports the idea that less complex scoring systems can provide more consistent results in clinical evaluations [ 20 ]. The smartphone method was effective in detecting obvious failures, such as material fractures, but limited in detailed assessments like marginal adaptation and proximal contact points. In contrast, the lens-equipped smartphone and macro camera provided results closely comparable to clinical examination, emerging as strong alternatives for teledentistry applications [ 16 , 21 ]. Notably, the lens-equipped smartphone, offering high-resolution images, may serve as a cost-effective alternative to the macro camera. A study in plastic surgery reported that a lens-equipped smartphone (iPhone 11 + Moment 58 mm telephoto lens) performed similarly to a macro-lens DSLR camera [ 16 ]. Similarly, this study observed that the lens-equipped smartphone yielded FDI scores nearly equivalent to those of the macro camera. The study’s limitations include the inadequacy of digital photography in criteria requiring tactile examination (e.g., marginal adaptation, hard tissue defects). Additionally, the subjective nature of aesthetic criteria may lead to inter-evaluator differences. To address this, comprehensive calibration of evaluators based on FDI criteria is recommended [ 20 ]. Finally, the study only covered anterior restorations, and the effectiveness of these methods for posterior restorations requires further investigation. Conclusion This study confirms that intraoral digital photography, particularly with a lens-equipped smartphone and macro-lens camera, offers effectiveness comparable to clinical examination in evaluating anterior composite restorations. While the iPhone 14 Pro stands out for its practicality and accessibility, its image quality is slightly inferior to that of the lens-equipped smartphone and macro camera. The lens-equipped smartphone holds high potential as a cost-effective alternative to the macro camera in teledentistry applications. Digital photography contributes to clinical practice as a rapid, effective, and cost-saving method for evaluating restorations based on FDI criteria. Technological advancements, particularly improvements in smartphone camera systems, suggest that this method will become more widespread and reliable in the future. Future studies focusing on posterior restorations and comparisons of different devices can further expand these findings. Declarations Ethics Approval and Consent to Participate The study was approved by the Non-Invasive Clinical Research Ethics Committee of Recep Tayyip Erdogan University Faculty of Medicine (project number for ethics approval: 2023/137). A signed and informed constent form was obtained from all volunteers for cooperation to use digital photographs taken. Author Disclosure Statement The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding Information None Data availability Datasets related to this article are available upon request to the corresponding author. Contributions Conceptualization: G.Y.T; Data curation: A.K., G.Y.T; Formal data analysis: A.K.; Funding acquisition: A.K.; Investigation: A.K., G.Y.T; Methodology: A.K., G.Y.T.; Resources: A.K.; Writing - Original draft: A.K., G.Y.T.; Writing - Review & editing: A.K., G.Y.T References Opdam NJM, Collares K, Hickel R et al (2018) Clinical studies in restorative dentistry: New directions and new demands. Dent Mater 34(1):1–12 Martin-Kerry JM, Lamont TJ, Keightley A et al (2015) Practical considerations for conducting dental clinical trials in primary care. Br Dent J 218(11):629–634 Turgut MD, Tekçiçek M, Olmez S (2004) Clinical evaluation of a polyacid-modified resin composite under different conditioning methods in primary teeth. Oper Dent 29(5):515–523 Wilson N, Lynch CD, Brunton PA et al (2016) Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section. 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Cite Share Download PDF Status: Published Journal Publication published 18 Apr, 2026 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 24 Jan, 2026 Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 06 Jan, 2026 Submission checks completed at journal 06 Jan, 2026 First submitted to journal 05 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8519690","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585424173,"identity":"da6161ad-5208-4edf-ac36-105f8bd61aa1","order_by":0,"name":"Specialist Aleyna Keskin","email":"","orcid":"","institution":"Bartın Oral and Dental Health Center","correspondingAuthor":false,"prefix":"","firstName":"Specialist","middleName":"Aleyna","lastName":"Keskin","suffix":""},{"id":585424174,"identity":"79866994-421c-4343-8083-9ee3a471d66c","order_by":1,"name":"Gul Yildiz Telatar","email":"data:image/png;base64,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","orcid":"","institution":"Burdur Mehmet Akif Ersoy University","correspondingAuthor":true,"prefix":"","firstName":"Gul","middleName":"Yildiz","lastName":"Telatar","suffix":""}],"badges":[],"createdAt":"2026-01-05 09:53:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8519690/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8519690/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00784-026-06870-3","type":"published","date":"2026-04-18T15:59:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":103607850,"identity":"2011cfa8-aa34-4ae0-8bd4-c6422856fa21","added_by":"auto","created_at":"2026-02-27 15:14:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55817,"visible":true,"origin":"","legend":"\u003cp\u003eImages of the same restoration taken with different devices. a; image taken using a macro-lens camera., b; image taken using a lens-equipped smartphone, c; image taken using a smartphone\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8519690/v1/ca9aceef5af523febd3bfb07.jpg"},{"id":107352325,"identity":"6b5bec14-5727-437b-929b-7b8f002e7b9f","added_by":"auto","created_at":"2026-04-20 16:13:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":484275,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8519690/v1/7c987db6-54fc-4e4a-8fc0-f5ba1c7e991c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality Assessment of Anterior Composite Restorations: Clinical Examination versus Three Digital Photographic Techniques","fulltext":[{"header":"Clinical Relevance","content":"\u003cp\u003eThis study demonstrates that intraoral digital photography, particularly with a lens-equipped smartphone and macro camera, achieves diagnostic outcomes closely aligned with clinical examination using FDI criteria. While smartphones alone are practical, lens-assisted imaging enhances accuracy, supporting its use as a cost-effective alternative to professional macro cameras.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe clinical success of dental restorations is a significant area of research concerning diagnosis, treatment, and restoration longevity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The growing interest in evidence-based dentistry has increased the number of clinical studies on this topic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComposite resins, like other restorative materials, have a limited lifespan [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is estimated that 56% of restorations applied to treated teeth are used to replace existing restorations rather than to treat primary caries [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among the reasons for the failure of intraoral composite restorations, secondary caries is the most common cause [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Following secondary caries, frequent reasons for replacing composite restorations include marginal fracture (18%), marginal discoloration (9%), complete fracture (7%), tooth fracture (7%), complete discoloration (6%), and pain (1%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn cases where there are no secondary caries beneath the restoration but deterioration is present at the margins, repair of the restoration may be preferred [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. When making this decision, clinicians may rely on their clinical experience, leading to subjective judgments.\u003c/p\u003e \u003cp\u003eFor the evaluation of restorations, the World Dental Federation (FDI) criteria and the modified United States Public Health Service (USPHS)/Ryge criteria are widely used [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, despite being well-defined, these criteria are often considered complex for routine clinical use and can lead to subjective evaluations, even among experienced clinicians [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe FDI criteria, which include functional, biological, and aesthetic categories with several subcategories. The final score was based on the worst subcategory score: intact (1\u0026ndash;3), requiring repair (4, partial failure), or replacement (5, complete failure). The distinction between scores 4 and 5 depends on whether the defect can be repaired or necessitates full replacement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\"\u003c/p\u003e \u003cp\u003eDigital photography has emerged as an alternative that reduces bias in evaluating restoration quality. One of its primary uses is to allow clinicians to photograph restorations and send them to impartial researchers for assessment. Intraoral photography is recognized as a reliable diagnostic method for evaluating dental caries, trauma, and restorations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eModern technology has found its place in the medical world, as in every aspect of our lives. These advancements have created a new field called teledentistry, where telecommunications and dentistry are used together [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Dental photography requires specific technical precision due to the challenging conditions of the intraoral environment. Today, to achieve ideal image quality, interchangeable-lens cameras equipped with macro lenses offering 1:1 magnification are used in combination with light sources such as macro ring flashes. However, these systems are both costly and bulky, presenting disadvantages [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, the widespread use of smartphones offers a low-cost and practical photography solution, although image quality may vary between devices [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Smartphone megapixels are not equivalent to those of Digital Single-Lens Reflex (DSLR) cameras because smartphones have smaller camera sensors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the cost of a smartphone with a detachable telephoto lens setup is approximately half that of a DSLR. A telephoto lens enables zooming without reducing image resolution and increases focal length instead of cropping and enlarging the image. All iPhone models starting from the iPhone 11 Pro are equipped with a telephoto lens [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study is the first to investigate the validity of intraoral digital photography in evaluating anterior composite restorations. Our hypothesis is that photographs taken with a smartphone, a lens-equipped smartphone, and a macro-lens camera will yield results comparable to clinical examination.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study is a validation study examining the use of intraoral digital photography in evaluating anterior composite restorations. The study was deemed scientifically and ethically appropriate by the Non-Interventional Clinical Research Ethics Committee of XXX University Faculty of Medicine under decision number XXX. Participants signed an informed consent form explaining the study\u0026rsquo;s purpose, content, and methods.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sample\u003c/h3\u003e\n\u003cp\u003eThe study included 185 anterior teeth with composite restorations from individuals aged 18\u0026ndash;64 who applied to the Department of Restorative Dentistry at XXX University. Primary teeth, unrestored teeth, and teeth with amalgam, glass ionomer, or indirect restorations were excluded.\u003c/p\u003e\n\u003ch3\u003eEvaluation Methods\u003c/h3\u003e\n\u003cp\u003eRestorations were classified according to FDI criteria as intact (scores 1\u0026ndash;3), requiring repair (score 4), or needing replacement (score 5) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Clinical examination was considered the gold standard. Photographs were taken using an iPhone 14 Pro (48 MP main camera, 12 MP ultra-wide camera), an iPhone 14 Pro with a 2IN1 Phone Macro Lens, a Canon Rebel XTi (CMOS sensor, 3888x2592 pixels), and a Canon EF 100mm f/2.8 Macro IS USM lens.\u003c/p\u003e \u003cp\u003ePhotographs were captured under standardized lighting (28 Watt matte white LED) at a distance of 10 cm (smartphone) or 20 cm (macro camera), using lip-cheek retractors and positioning the camera perpendicular to the tooth surface. For the iPhone 14 Pro, focusing was done by tapping the screen; for macro lens photography, a ring flash was used. Macro photography settings included an aperture of f/22, ISO 200, exposure time of 1/160 second, and a Macro Ring Lite MR-14EX II flash. All images were saved in JPEG format (Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003ch3\u003eCalibration and Evaluation\u003c/h3\u003e\n\u003cp\u003eEvaluations were conducted by two restorative dentistry specialists. Calibration was performed on 20 anterior teeth with restorations, which were not included in the study, using both clinical and digital methods.\u003c/p\u003e \u003cp\u003eFor clinical examination, a mirror, a rounded-tip probe, and a reflector light were used, and bite-wing and panoramic radiographs were reviewed. Photographs were taken by an experienced clinician. The captured photographs were scored by two different restorative dentistry specialists according to FDI criteria. Based on the FDI criteria, restorations were scored as follows: no intervention required (scores 1, 2, 3) with a final score of 1, repair required (score 4) with a final score of 2, and replacement required (score 5) with a final score of 3.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using G*Power 3.1.9.2 with a 95% confidence interval, α\u0026thinsp;=\u0026thinsp;0.05, and a theoretical power of 0.80, determining a minimum of 175 restorations [70]. Inter-observer and inter-method agreement were assessed using Cohen\u0026rsquo;s Kappa statistic and the Intraclass Correlation Coefficient (ICC). Kappa was used for categorical variables, and ICC for quantitative variables, with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Analyses were performed using IBM SPSS V23.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eInterobserver Agreement\u003c/h2\u003e \u003cp\u003eThe interobserver agreement for FDI final scores was found to be high across all imaging methods (Kappa\u0026thinsp;=\u0026thinsp;0.928\u0026ndash;1.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eInterobserver agreement was evaluated for each criterion according to the imaging methods (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Within the smartphone method, a statistically significant good level of agreement was observed between the observers for the criteria of material fracture, proximal contact point, surface gloss and texture, marginal discoloration, and color match. A statistically significant moderate level of agreement was found for marginal adaptation and anatomical form and contour. In both the smartphone with lens method and the macro photography method, a statistically significant good level of agreement was obtained between the observers for all evaluated criteria.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterobserver agreement by individual evaluation criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCriterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSmartphone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.796 (0.737\u0026ndash;0.843)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.647 (0.554\u0026ndash;0.723)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76 (0.692\u0026ndash;0.815)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.665 (0.577\u0026ndash;0.739)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.763 (0.695\u0026ndash;0.817)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.886 (0.85\u0026ndash;0.913)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.824 (0.771\u0026ndash;0.865)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eSmartphone\u0026thinsp;+\u0026thinsp;Lens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85 (0.804\u0026ndash;0.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.777 (0.713\u0026ndash;0.829)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82 (0.767\u0026ndash;0.863)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82 (0.767\u0026ndash;0.862)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.813 (0.757\u0026ndash;0.856)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.882 (0.845\u0026ndash;0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.835 (0.786\u0026ndash;0.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e \u003cp\u003e\u003cb\u003eMacro Photography\u003c/b\u003e\u003c/p\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.859 (0.815\u0026ndash;0.892)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76 (0.691\u0026ndash;0.815)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.827 (0.775\u0026ndash;0.867)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78 (0.716\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.838 (0.79\u0026ndash;0.876)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.895 (0.863\u0026ndash;0.921)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.852 (0.807\u0026ndash;0.887)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eComparison with Clinical Examination\u003c/h3\u003e\n\u003cp\u003eInter-observer agreement was determined to be at a good level. The methods were compared with clinical examination using Observer 2 as the reference.\u003c/p\u003e \u003cp\u003eAgreement between the methods was evaluated based on the final FDI scores. A good level of agreement was found between clinical examination and smartphone photography (Kappa\u0026thinsp;=\u0026thinsp;0.775, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while very good agreement was observed with the smartphone plus lens and macro photography methods (Kappa\u0026thinsp;=\u0026thinsp;0.973, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Clinical Examination with Other Methods Based on Final FDI Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eKappa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRepair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSmartphone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93 (93.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSmartphone\u0026thinsp;+\u0026thinsp;Lens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97 (98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMacro Photography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97 (98)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe agreement between clinical examination and other methods in terms of individual FDI criteria was evaluated (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A good level of agreement was found between clinical examination and the smartphone method for material fracture; moderate agreement was observed for marginal adaptation, proximal contact point, form and contour, caries at the restoration margin, surface gloss, surface texture, marginal staining, and color match; and low agreement was detected for hard tissue defects at the restoration margin. Between clinical examination and both the smartphone with lens and macro photography methods, good agreement was found for material fracture, caries at the restoration margin, and marginal staining; moderate agreement was observed for other criteria; and low agreement was found for hard tissue defects.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAgreement Between Clinical Examination and Other Methods Based on FDI Criteria (ICC with 95% Confidence Intervals)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCriterion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eClinical- Smartphone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.822 (0.769\u0026ndash;0.863)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5 (0.383\u0026ndash;0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.591 (0.488\u0026ndash;0.677)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.519 (0.406\u0026ndash;0.617)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaries at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.692 (0.608\u0026ndash;0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard Tissue Defect at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.28 (0.141\u0026ndash;0.407)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.598 (0.497\u0026ndash;0.683)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.737 (0.663\u0026ndash;0.796)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.633 (0.538\u0026ndash;0.712)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eClinical- Smartphone\u0026thinsp;+\u0026thinsp;Lens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86 (0.817\u0026ndash;0.893)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.51 (0.395\u0026ndash;0.609)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.622 (0.525\u0026ndash;0.703)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.605 (0.505\u0026ndash;0.689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaries at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.824 (0.772\u0026ndash;0.865)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard Tissue Defect at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.28 (0.141\u0026ndash;0.407)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69 (0.607\u0026ndash;0.759)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.765 (0.697\u0026ndash;0.818)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.691 (0.607\u0026ndash;0.759)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eClinical- Macro Photography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial Fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.923 (0.898\u0026ndash;0.942)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.542 (0.431\u0026ndash;0.636)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProximal Contact Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.559 (0.451\u0026ndash;0.651)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForm and Contour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.597 (0.496\u0026ndash;0.682)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaries at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.824 (0.772\u0026ndash;0.865)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHard Tissue Defect at Restoration Margin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.28 (0.141\u0026ndash;0.407)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurface Luster and Texture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.705 (0.624\u0026ndash;0.771)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarginal Discoloration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.772 (0.706\u0026ndash;0.824)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor Match\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.693 (0.61\u0026ndash;0.761)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eICC\u0026thinsp;=\u0026thinsp;Intraclass Correlation Coefficient\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFailure Detection\u003c/h2\u003e \u003cp\u003eThe agreement between clinical examination and other methods was evaluated (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A binary scoring system was used to calculate the overall failure rate: 0\u0026thinsp;=\u0026thinsp;no failure, 1\u0026thinsp;=\u0026thinsp;failure (repair or replacement). For failure detection, the smartphone method demonstrated 93.57% sensitivity, 91.11% specificity, 97.04% positive predictive value (PPV), and 82% negative predictive value (NPV). Both the smartphone with lens and macro photography methods exhibited excellent diagnostic performance with 100% sensitivity, specificity, PPV, and NPV.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of Agreement Between Clinical Examination and Other Methods\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSmartphone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSmartphone\u0026thinsp;+\u0026thinsp;Lens\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMacro Photography\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Failure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFailure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo Failure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFailure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo Failure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFailure\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eClinical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo Failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFailure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (93.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e140 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e140 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKappa\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSensitivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%93.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecificity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%91.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%97.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e%82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e%100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to evaluate the effectiveness of intraoral digital photography in assessing anterior composite restorations, compared to clinical examination, using FDI criteria. No similar study in the literature has evaluated restoration quality in the context of teledentistry using a smartphone (iPhone 14 Pro), a lens-equipped smartphone (2IN1 Phone Macro Lens), and a macro-lens digital camera (Canon Rebel XTi). Thus, this study provides an original contribution by comparing the effectiveness of these three methods.\u003c/p\u003e \u003cp\u003eThe results indicate high inter-observer agreement across all methods (Kappa\u0026thinsp;=\u0026thinsp;0.928\u0026ndash;1.0). The smartphone method showed slightly lower agreement compared to the lens-equipped smartphone and macro camera, likely due to the smartphone camera\u0026rsquo;s lower resolution and detail-capturing capacity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Kohara et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] used a smartphone and macro camera for occlusal caries detection, reporting Kappa values ranging from 0.60\u0026ndash;0.66. In contrast, this study achieved higher Kappa values (0.775\u0026ndash;0.973), which may be attributed to the technological superiority of the devices used (e.g., the iPhone 14 Pro\u0026rsquo;s 48 MP camera) and standardized imaging conditions.\u003c/p\u003e \u003cp\u003eSignori et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported low to moderate agreement (Kappa\u0026thinsp;=\u0026thinsp;0.12\u0026ndash;0.34) for anterior restorations evaluated with an intraoral camera. However, this study found good to excellent agreement for anterior restorations (Kappa\u0026thinsp;=\u0026thinsp;0.775\u0026ndash;0.973). This difference may stem from the superior resolution of the images used in this study (2268x4032\u0026ndash;5472x3648 pixels) compared to the intraoral camera\u0026rsquo;s resolution (1024x768 pixels). Additionally, the accessibility of the anterior region likely enhanced image quality and diagnostic accuracy.\u003c/p\u003e \u003cp\u003eLower agreement was observed between methods for marginal adaptation, proximal contact points, and form/contour criteria. This may be due to the two-dimensional nature of digital photography, which lacks the perceptual capacity provided by tactile examination [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Valizadeh-Haghi et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that smartphone photographs were inadequate for detecting marginal adaptation. Clinical examination with a probe allows for more precise evaluation of marginal adaptation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This suggests that digital methods may be limited in criteria requiring detailed assessment.\u003c/p\u003e \u003cp\u003eAesthetic criteria, particularly color match, were identified as a leading cause of restoration failure [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. However, the evaluation of these criteria can vary based on clinicians\u0026rsquo; experience and subjective perceptions. Simplifying the FDI criteria into three final scores (intact, repair, replacement) in this study may have increased inter-observer and inter-method agreement. This finding supports the idea that less complex scoring systems can provide more consistent results in clinical evaluations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe smartphone method was effective in detecting obvious failures, such as material fractures, but limited in detailed assessments like marginal adaptation and proximal contact points. In contrast, the lens-equipped smartphone and macro camera provided results closely comparable to clinical examination, emerging as strong alternatives for teledentistry applications [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Notably, the lens-equipped smartphone, offering high-resolution images, may serve as a cost-effective alternative to the macro camera. A study in plastic surgery reported that a lens-equipped smartphone (iPhone 11\u0026thinsp;+\u0026thinsp;Moment 58 mm telephoto lens) performed similarly to a macro-lens DSLR camera [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, this study observed that the lens-equipped smartphone yielded FDI scores nearly equivalent to those of the macro camera.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s limitations include the inadequacy of digital photography in criteria requiring tactile examination (e.g., marginal adaptation, hard tissue defects). Additionally, the subjective nature of aesthetic criteria may lead to inter-evaluator differences. To address this, comprehensive calibration of evaluators based on FDI criteria is recommended [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Finally, the study only covered anterior restorations, and the effectiveness of these methods for posterior restorations requires further investigation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms that intraoral digital photography, particularly with a lens-equipped smartphone and macro-lens camera, offers effectiveness comparable to clinical examination in evaluating anterior composite restorations. While the iPhone 14 Pro stands out for its practicality and accessibility, its image quality is slightly inferior to that of the lens-equipped smartphone and macro camera. The lens-equipped smartphone holds high potential as a cost-effective alternative to the macro camera in teledentistry applications.\u003c/p\u003e \u003cp\u003eDigital photography contributes to clinical practice as a rapid, effective, and cost-saving method for evaluating restorations based on FDI criteria. Technological advancements, particularly improvements in smartphone camera systems, suggest that this method will become more widespread and reliable in the future. Future studies focusing on posterior restorations and comparisons of different devices can further expand these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Non-Invasive Clinical Research Ethics Committee of Recep Tayyip Erdogan University Faculty of Medicine (project number for ethics approval: 2023/137). A signed and informed constent form was obtained from all volunteers for cooperation to use digital photographs taken.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Disclosure Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Information\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets related to this article are available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: G.Y.T; Data curation: A.K., G.Y.T; Formal data analysis: A.K.; Funding acquisition: A.K.; Investigation: A.K., G.Y.T; Methodology: A.K., G.Y.T.; Resources: A.K.; Writing - Original draft: A.K., G.Y.T.; Writing - Review \u0026amp; editing: A.K., G.Y.T\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOpdam NJM, Collares K, Hickel R et al (2018) Clinical studies in restorative dentistry: New directions and new demands. Dent Mater 34(1):1\u0026ndash;12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin-Kerry JM, Lamont TJ, Keightley A et al (2015) Practical considerations for conducting dental clinical trials in primary care. Br Dent J 218(11):629\u0026ndash;634\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurgut MD, Tek\u0026ccedil;i\u0026ccedil;ek M, Olmez S (2004) Clinical evaluation of a polyacid-modified resin composite under different conditioning methods in primary teeth. Oper Dent 29(5):515\u0026ndash;523\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson N, Lynch CD, Brunton PA et al (2016) Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section. Oper Dent 41:48\u0026ndash;57\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirsch J, Tchorz J, Hellwig E et al (2016) Decision criteria for replacement of fillings: a retrospective study. Clin Exp Dent Res 2(2):121\u0026ndash;128\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurke FJ, Wilson NH, Cheung SW et al (2001) Influence of patient factors on age of restorations at failure and reasons for their placement and replacement. J Dent 29(5):317\u0026ndash;324\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoack MJ, Treige B (1994) Der Therapieentscheid f\u0026uuml;r den Ersatz zahnbfarbener F\u0026uuml;llungen. Deutsche Zahn\u0026auml;rztliche Zeitschrift. :819\u0026ndash;822\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBayne SC, Schmalz G (2005) Reprinting the classic article on USPHS evaluation methods for measuring the clinical research performance of restorative materials. Clin Oral Investig 9(4):209\u0026ndash;214\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHickel R, Peschke A, Tyas M et al (2010) FDI World Dental Federation: Clinical criteria for the evaluation of direct and indirect restorations\u0026mdash;update and clinical examples. Clin Oral Investig 14(4):349\u0026ndash;366\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwendicke F, Opdam N (2018) Clinical studies in restorative dentistry: Design, conduct, analysis. Dent Mater 34(1):29\u0026ndash;39\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSignori C, Collares K, Cumerlato CBF et al (2018) Validation of assessment of intraoral digital photography for evaluation of dental restorations in clinical research. J Dent 71:54\u0026ndash;60\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMobile technologies for (2021) oral health: an implementation guide. World Health Organization\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmad I (2009) Digital dental photography. Part 4: Choosing a camera. Br Dent J 206(11):575\u0026ndash;581\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohara EK, Abdala CG, Novaes TF et al (2018) Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions? PLoS ONE 13(9):e0203287\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasquali P (2020) Photography in Clinical Medicine. Springer International Publishing\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeot N, Kiprovski A, Hatala A et al (2023) Evaluation of Mobile and Digital Single-Lens Reflex Photography for Facial Surgical Analysis. Laryngoscope 133(10):2590\u0026ndash;2596\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoncada G, Silva F, Angel P (2014) Evaluation of dental restorations: a comparative study between clinical and digital photographic assessments. Oper Dent 39(2):45\u0026ndash;56\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValizadeh-Haghi H, Valizadeh-Haghi S, Naslseraji N et al (2023) Smartphone Photography as a Teledentistry Method to Evaluate Anterior Composite Restorations. Int J Dent 2023:3171140\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaillet C, Decup F, Dantony E (2022) Selected and simplified FDI criteria for assessment of restorations. J Dent 122:104109\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim D, Ahn SY, Kim J et al (2017) Interrater and intrarater reliability of FDI criteria applied to photographs of posterior tooth-colored restorations. J Prosthet Dent 118(1):18\u0026ndash;25\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu CJ, Wu SY, Chen PC et al (2014) An innovative smartphone-based otorhinoendoscope and its application in mobile health and teleotolaryngology. J Med Internet Res 16(3):e71\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"anterior composite restorations, digital photography, FDI criteria, lens-equipped smartphone, teledentistry","lastPublishedDoi":"10.21203/rs.3.rs-8519690/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8519690/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe aim of this study was for the first time to evaluate of intraoral digital photography in assessing anterior composite restorations using a smartphone (iPhone 14 Pro), a smartphone with a lens (2IN1 Phone Macro Lens), and a digital camera with a macro lens (Canon Rebel XTi), compared to clinical examination, based on World Dental Federation (FDI) criteria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 185 anterior composite restorations were evaluated by calibrated restorative dentistry specialists. Restorations were scored according to the FDI criteria as intact, requiring repair, or needing replacement. Clinical examination was considered the gold standard. Photographs were taken under standardized conditions, and inter-observer and inter-method agreement were analyzed using Cohen\u0026rsquo;s Kappa and intraclass correlation coefficient (ICC).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHigh inter-observer agreement was observed across all methods (Kappa\u0026thinsp;=\u0026thinsp;0.928\u0026ndash;1.0). Good to excellent agreement was found between clinical examination and digital photography methods for FDI final scores (Kappa\u0026thinsp;=\u0026thinsp;0.775\u0026ndash;0.973, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Photographs taken with the lens-equipped smartphone and macro camera showed higher agreement with clinical examination (Kappa\u0026thinsp;=\u0026thinsp;0.973).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDigital photography, particularly with a lens-equipped smartphone and macro camera, offers effectiveness comparable to clinical examination in evaluating anterior composite restorations.\u003c/p\u003e","manuscriptTitle":"Quality Assessment of Anterior Composite Restorations: Clinical Examination versus Three Digital Photographic Techniques","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 15:14:22","doi":"10.21203/rs.3.rs-8519690/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-04T04:59:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T04:08:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74060247440602711513014519231224137782","date":"2026-01-24T10:27:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T15:50:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4707177643242566469153165892501988836","date":"2026-01-20T08:45:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T04:39:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-06T12:23:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T12:23:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2026-01-05T09:29:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"33e7dae6-b7a8-41d6-bfac-564361742391","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:11:46+00:00","versionOfRecord":{"articleIdentity":"rs-8519690","link":"https://doi.org/10.1007/s00784-026-06870-3","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2026-04-18 15:59:40","publishedOnDateReadable":"April 18th, 2026"},"versionCreatedAt":"2026-02-27 15:14:22","video":"","vorDoi":"10.1007/s00784-026-06870-3","vorDoiUrl":"https://doi.org/10.1007/s00784-026-06870-3","workflowStages":[]},"version":"v1","identity":"rs-8519690","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8519690","identity":"rs-8519690","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}