The Mucosal Scarring Index: reliability of a new composite index for assessing scarring following oral surgery

Retief Wessels, Sam De Roose, Thomas De Bruyckere, Aryan Eghbali, Wolfgang Jacquet, Tim De Rouck, Jan Cosyn

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Objectives: A critical and uniform assessment of mucosal scarring following oral surgery is needed to refine surgical decision-making. For that purpose, the Mucosal Scarring Index (MSI) was developed. Materials and methods: The MSI is a composite index based on five parameters: width, height/contour, color, suture marks, and overall appearance. Each parameter is assessed with a 0–1–2 score, yielding a MSI score ranging from 0 (no scar) to 10 (most extreme scar). Five periodontists, 5 prosthodontists, and 5 orthodontists assessed scarring using the new index on the basis of 30 clinical photographs of post-surgical sites. Cases had been carefully selected making sure that the complete spectrum of the index would be represented in the analysis. Duplicate evaluation was performed with a 2-h interval and in random order of cases. Results: On a total of 450 assessments, the mean MSI amounted to 4.91 (SD 3.087) with no significant differences between scores given by periodontists (mean 4.65; SD 3.054), orthodontists (mean 5.04; SD 3.301), or prosthodontists (mean 4.81; SD 2.842) (p = 0.548). The MSI appeared a highly reliable index given excellent inter- as well as intra-examiner agreement (ICC > 0.9; p < 0.001). Clinicians agreed most on ‘overall appearance’ (kappa = 0.582; p < 0.001) and least on ‘suture marks’ (kappa = 0.352; p < 0.001). Conclusion: The MSI is an effective, easy-to-use, and reliable composite index to assess mucosal scarring following oral surgical procedures. Clinical relevance: The MSI can be used as an adjunct to other indices in the esthetic evaluation of oral surgical procedures.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalClinical Oral Investigations
Issue number3
Early online date3 Jul 2018
Publication statusPublished - 8 Mar 2019


  • Dental implant
  • Index
  • Oral surgery
  • Scar
  • Scarring


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