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

Remote Assessment of Caries, MIH, and Plaque on Intraoral 3D Scan Images: Findings from the LIFE Child Study | 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 Remote Assessment of Caries, MIH, and Plaque on Intraoral 3D Scan Images: Findings from the LIFE Child Study Nadja Stiller, Jana Schmidt, Christof Meigen, Anne Messerschmidt, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8553761/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Objectives To evaluate the diagnostic agreement between clinical examinations and time-delayed remote diagnostic assessments of intraoral 3D scans (IOS) for detecting oral diseases in children and adolescents, validating intraoral 3D scans as a tool in epidemiology studies. Material and Methods A total of 511 participants aged 7.5–20.5 years from the LIFE Child cohort received standardized chairside clinical diagnostics followed by intraoral 3D scanning (TRIOS 5, 3shape). Two calibrated examiners independently performed blinded remote review of digital scans after a predefined latency period. Diagnostic parameters comprised caries (ICDAS II), MIH classification, restorative status, sealant status, and plaque accumulation1 quantified using the Plaque Index (PI). Primary outcomes were diagnostic agreement and interrater reliability, analysed by weighted percent agreement, Cohen’s weighted Kappa and Bland-Altman plots. Results Very high agreement was observed between clinical and IOS-based assessments for caries experience (DMF-T: \(\:{pa}_{w}\) = 0.990, κ = 0.77; dmf-t: \(\:{pa}_{w}\) = 0.991, κ = 0.93) and for severity-graded caries lesions (ICDAS 3–4: \(\:{pa}_{w}\) = 0.998, κ = 0.69; ICDAS 5–6: \(\:{pa}_{w}\) = 1.000, κ = 0.87). Agreement for initial lesions (ICDAS 1–2) was slightly lower but remained high ( \(\:{pa}_{w}\) = 0.979, κ = 0.29). Fissure sealants and fillings showed excellent agreement ( \(\:{pa}_{w}\) = 0.997, κ = 0.84 and \(\:{pa}_{w}\) = 0.998, κ = 0.71). MIH detection on at least one tooth showed very good agreement ( \(\:{pa}_{w}\) = 0.932, κ = 0.83), with consistently high agreement across severity codes. Plaque assessment showed good agreement overall ( \(\:{pa}_{w}\) = 0.898), with slightly higher agreement in anterior regions. Interrater reliability was substantial to excellent across parameters. Conclusions Intraoral 3D scans enable reliable remote assessment of clinically relevant dental conditions in children and adolescents, particularly for advanced caries lesions and molar incisor hypomineralisation (MIH). Clinical Relevance Intraoral 3D scanning enables efficient remote evaluation in screening and epidemiological programs, prioritizing visually distinct or treatment-relevant findings, with slightly reduced alignment for early enamel findings. Dental Caries Molar-Incisor Hypomineralisation Child Adolescent Digital Dentistry Intraoral Scanner Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviews received at journal 30 Jan, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviewers agreed at journal 22 Jan, 2026 Reviewers invited by journal 22 Jan, 2026 Editor assigned by journal 09 Jan, 2026 Submission checks completed at journal 09 Jan, 2026 First submitted to journal 08 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-8553761","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578861881,"identity":"04cef795-d0d1-4a4d-967d-5e62236e550e","order_by":0,"name":"Nadja Stiller","email":"","orcid":"","institution":"University of Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Nadja","middleName":"","lastName":"Stiller","suffix":""},{"id":578861885,"identity":"553e97e5-ef77-4fc9-8068-8cf8cb7d4fbc","order_by":1,"name":"Jana 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Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Rainer","middleName":"","lastName":"Haak","suffix":""}],"badges":[],"createdAt":"2026-01-08 16:39:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8553761/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8553761/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101218025,"identity":"a94eb7ed-67d8-4762-97b2-ff6065895fdb","added_by":"auto","created_at":"2026-01-27 11:12:32","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":665564,"visible":true,"origin":"","legend":"","description":"","filename":"20251220ManuscriptNSJSCMMVRHfinal1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8553761/v1_covered_e1e44b8f-8b86-4c19-86dc-1cc5a1dcef45.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Remote Assessment of Caries, MIH, and Plaque on Intraoral 3D Scan Images: Findings from the LIFE Child Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"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":"Dental Caries, Molar-Incisor Hypomineralisation, Child, Adolescent, Digital Dentistry, Intraoral Scanner","lastPublishedDoi":"10.21203/rs.3.rs-8553761/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8553761/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo evaluate the diagnostic agreement between clinical examinations and time-delayed remote diagnostic assessments of intraoral 3D scans (IOS) for detecting oral diseases in children and adolescents, validating intraoral 3D scans as a tool in epidemiology studies.\u003c/p\u003e\u003ch2\u003eMaterial and Methods\u003c/h2\u003e \u003cp\u003eA total of 511 participants aged 7.5\u0026ndash;20.5 years from the LIFE Child cohort received standardized chairside clinical diagnostics followed by intraoral 3D scanning (TRIOS 5, 3shape). Two calibrated examiners independently performed blinded remote review of digital scans after a predefined latency period. Diagnostic parameters comprised caries (ICDAS II), MIH classification, restorative status, sealant status, and plaque accumulation1 quantified using the Plaque Index (PI). Primary outcomes were diagnostic agreement and interrater reliability, analysed by weighted percent agreement, Cohen\u0026rsquo;s weighted Kappa and Bland-Altman plots.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eVery high agreement was observed between clinical and IOS-based assessments for caries experience (DMF-T: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.990, κ\u0026thinsp;=\u0026thinsp;0.77; dmf-t: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.991, κ\u0026thinsp;=\u0026thinsp;0.93) and for severity-graded caries lesions (ICDAS 3\u0026ndash;4: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.998, κ\u0026thinsp;=\u0026thinsp;0.69; ICDAS 5\u0026ndash;6: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 1.000, κ\u0026thinsp;=\u0026thinsp;0.87). Agreement for initial lesions (ICDAS 1\u0026ndash;2) was slightly lower but remained high (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.979, κ\u0026thinsp;=\u0026thinsp;0.29). Fissure sealants and fillings showed excellent agreement (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.997, κ\u0026thinsp;=\u0026thinsp;0.84 and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e= 0.998, κ\u0026thinsp;=\u0026thinsp;0.71). MIH detection on at least one tooth showed very good agreement (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e = 0.932, κ\u0026thinsp;=\u0026thinsp;0.83), with consistently high agreement across severity codes. Plaque assessment showed good agreement overall (\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{pa}_{w}\\)\u003c/span\u003e\u003c/span\u003e = 0.898), with slightly higher agreement in anterior regions. Interrater reliability was substantial to excellent across parameters.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIntraoral 3D scans enable reliable remote assessment of clinically relevant dental conditions in children and adolescents, particularly for advanced caries lesions and molar incisor hypomineralisation (MIH).\u003c/p\u003e\u003ch2\u003eClinical Relevance\u003c/h2\u003e \u003cp\u003eIntraoral 3D scanning enables efficient remote evaluation in screening and epidemiological programs, prioritizing visually distinct or treatment-relevant findings, with slightly reduced alignment for early enamel findings.\u003c/p\u003e","manuscriptTitle":"Remote Assessment of Caries, MIH, and Plaque on Intraoral 3D Scan Images: Findings from the LIFE Child Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 11:10:09","doi":"10.21203/rs.3.rs-8553761/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T12:52:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T08:33:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-30T17:55:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336212642669724127229347149477223555919","date":"2026-01-28T14:20:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58481541780146016821603482208150267084","date":"2026-01-22T15:51:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303780615914608122209333744107046564079","date":"2026-01-22T12:32:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T11:24:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-09T08:41:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T08:40:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2026-01-08T16:29:00+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":"794e1bc5-7e01-4a47-8816-dcd8f7985b29","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-20T14:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 11:10:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8553761","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8553761","identity":"rs-8553761","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}