The ICDAS II system enables standardized assessment of the entire spectrum of carious lesions; however, due to its multi-level classification, it requires thorough examiner calibration. Traditional clinical calibration is logistically demanding, prompting the adoption of alternative methods using standardized clinical photographs. In this study, eight examiners were calibrated using a combination of the ICCMS™
Core Training online program, clinical photograph assessment, and structured group discussion. Results demonstrated very high inter-examiner agreement in caries assessment (Gwet's AC2 = 0.827; Fleiss' k = 0.811; ICC = 0.816) and almost perfect agreement in assessing tooth surface status (Gwet's AC2 = 0.933). Intra-examiner reproducibility was nearly perfect (weighted k = 0.990). Non-clinical calibration using
photographs enables high reliability and represents an effective, feasible alternative to traditional clinical calibration in multicentre epidemiological studies.
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