Romero dental modification system from 2D diagrammatic representation to 3D digital models

The Romero Dental Modification System offers a standardised framework for classifying intentional dental modifications, with its theoretical and classificatory structure derived largely from Mesoamerican archaeological contexts. This study evaluated visual representations of the Romero dental modification system (1970) and proposed an updated contemporary illustration approach in the form of 3D digital models. Twenty-three studies applying the Romero classification system were reviewed. Modification types, frequency distributions, affected teeth, and visual documentation practices were extracted and synthesised. A total of 80 modification occurrences representing 35 distinct types (59.3% of the 59-type system) were identified. The class I contour modifications were most frequent (67.5%), followed by class II inlays (20.0%) and class III combined modifications (12.5%). Anatomically, modifications were strongly concentrated in anterior teeth, particularly upper incisors, with no molar modifications documented. Visual documentation practices were inconsistent: 26.1% of studies provided no imagery, and many relied on low-resolution or schematic representations, although recent studies increasingly used colour photography and combined imaging methods. This study provides the first comprehensive three-dimensional (3D) digital documentation of the Romero system (1970), with 67.8% coverage across all types and a complete representation of types A and E.