Abstract
AimThis systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail.Material and methodsPRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated.ResultsFrom 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81–0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited.ConclusionThe number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies.Clinical relevanceBWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.
Highlights
Many studies have indicated a decline in caries prevalence [1, 2]
Inclusion and exclusion criteria Studies eligible for inclusion were in vivo and in vitro caries diagnostic studies that tested the diagnostic performance of the following caries diagnostic methods: (1) visual examination (VE) with and without tactile examination, (2) conventional bitewing radiography
31 laboratory studies [35–65] and five clinical studies [66–70] were included in the meta-analysis
Summary
The occurrence of proximal caries lesions in posterior teeth is still very common in primary and permanent dentition and should not be underestimated [3]. For this reason, the detection, assessment, and diagnostics of proximal caries lesions is an important procedure for clinicians in daily dental practice and should enable well-justified preventive, non-operative, or operative caries management. When considering visual examination (VE) as a basic diagnostic method, it must be concluded that this technique is generally insufficient to estimate lesional characteristics in terms of detecting early lesions and determining the caries extent or activity at proximal sites [7–11]. To improve the repeatability of diagnostic examinations and provide X-ray–free diagnostics, several other photo-optical methods have been introduced over the last few decades, and these modalities, e.g. laser fluorescence (LF, DIAGNOdent, KaVo, Biberach, Germany)
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