Detection Of Secondary Caries Research Articles

An In Vitro Validation of DIAGNOdent Versus Radiography for the Detection of Caries Underneath Different Types of Restorations.

Objective This study aimed to assess the validity of DIAGNOdent as a diagnostic device for the detection of secondary dental caries underneath different types of restorations. Methods A total of 60 extracted human permanent molars were used in this experimental study (30 sound teeth and 30 teeth with proximal caries); 20 teeth (10 sound and 10 carious) were randomly allocated into one of three restorationgroups: composite, amalgam, or resin-modified glass ionomer (RMGI). All teeth were examined using both KaVo DIAGNOdent Classic and digital radiographic sensors. Results In the composite-restored teeth, DIAGNOdent showed excellent sensitivity (90%) and specificity (90%). On the other hand, digital radiography had high sensitivity (80%) and poor specificity (20%). In amalgam-restored teeth, DIAGNOdent showed low sensitivity (30%) and excellent specificity (100%), while radiographs showed good sensitivity (70%) and low specificity (30%). In the RMGI-restored teeth, DIAGNOdent had excellent sensitivity (100%) and 70% specificity, while digital radiography had poor sensitivity (30%)and excellent specificity (90%). Conclusions DIAGNOdent showed superior results in detecting secondary caries lesions underneathcomposite and RMGI restorations when compared to digital radiography. On the other hand, radiography emerged as a preferable method for the detection of secondary caries underneathamalgam restorations. Based on our findings, DIAGNOdent can be used in dental clinics for the early diagnosis of hidden secondary caries underneathcomposite and RMGI restorations.

Fluorescence and Near-Infrared Light for Detection of Secondary Caries: A Systematic Review.

Early detection of secondary caries near dental restorations is essential to prevent further complications. This systematic review seeks to evaluate the sensitivity of fluorescence and near-infrared (NIR) imaging techniques for detecting secondary caries and to provide insight into their clinical utility. A comprehensive search strategy was used to select studies from seven databases, emphasizing diagnostic accuracy studies of secondary caries detection using fluorescence and NIR imaging techniques. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) instrument assessed bias risk and practicality. Two evaluators performed data extraction, screening, and quality assessment independently. From 3110 initial recordings, nine studies were selected for full-text analysis. Wide variations in sensitivity (SE) and specificity (SP) values were reported across the studies. These studies exhibited variable SE and SP values, and the findings highlighted the importance of method selection based on clinical context. This systematic review underlines the potential for fluorescence and NIR imaging to detect secondary caries. However, results from different studies vary, indicating the need to consider additional variables such as restoration materials. Although these technologies exhibit potential for detecting caries, our research underscores the complex procedure of identifying secondary caries lesions. It is a continuous necessity for progress in dental diagnostics to promptly identify secondary caries lesions, particularly those in proximity to tooth-colored ones.

Radiopaque properties of polyetheretherketone crown at laboratory study

ObjectivesThere have been no reports on the radiopaque properties of new polyetheretherketone (PEEK) crowns for locating crowns during accidental ingestion or aspiration and detection of secondary caries, which is essential information for clinical application. This study aimed to investigate whether the radiopaque properties of PEEK crowns could be used to identify the site of accidental ingestion or aspiration and detect secondary caries. MethodsFour types of crowns were fabricated: three non-metal crowns (PEEK, hybrid resin, and zirconia) and one full metal cast crown (gold-silver-palladium alloy). Initially, the images for these crowns were compared using intraoral radiography, chest radiography, cone-beam computed tomography (CBCT), and multi-detector computed tomography (MDCT); computed tomography (CT) values were calculated. Subsequently, the images for the crowns placed on the secondary caries model with two artificial cavities were compared using intraoral radiography. ResultsThe PEEK crowns displayed the lowest radiopaque properties on radiography and very few artifacts were observed on CBCT and MDCT. On the other hand, the CT values of the PEEK crowns were a little lower than those of the hybrid resin crowns and considerably lower than the zirconia and full metal cast crowns. The cavity could be detected in the PEEK crown-placed secondary caries model through intraoral radiography. ConclusionsThis simulated study of radiopaque properties with four types of crowns suggested that a radiographic imaging system can be used to identify the site of accidental ingestion and aspiration of PEEK crowns and to detect secondary caries of the abutment tooth within a PEEK crown.

Secondary Caries Detection and Treatment Decision according to Two Criteria and the Impact of a Three-Dimensional Intraoral Scanner on Gap Evaluation

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were 7 days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman’s correlation coefficient (Rho) and 95% confidence intervals (95% CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system, and treatment decisions. Spearman’s correlation between the visual and scanner evaluation with the reference standard was performed. Spearman’s rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman’s correlation coefficients (Rho; 95% CI) between the following variables versus histology were the FDI presence of caries (0.65; 0.53–0.74); CARS scores (0.65; 0.52–0.74); FDI treatment decision (0.46; 0.31–0.59); and CARS treatment decision (0.62; 0.49–0.72). Rho (95% CI) between histology and the gap assessment by the visual inspection was 0.59 (0.45–0.70), the gap measurement by the visual inspection was 0.49 (0.33–0.62), and the gap measured by the scanner was 0.37 (0.18–0.53). Both visual criteria present similar performance in detecting caries. The correlation among treatment decisions is moderate for the FDI and CARS criteria, and both are moderately correlated with lesion depth, with a slight CARS superiority. However, visual examination presents better performance than the 3D intraoral scanner on gap size assessment.

Decision-making of general practitioners on interventions at restorations based on bitewing radiographs

ObjectiveThe aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry. MethodsThis practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen’s kappa statistic was used. ResultsFor the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision. ConclusionThe GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision. Clinical significanceThis study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.

In vivo assessment of clinical, radiographic and laser fluorescence examinations for the detection of secondary caries in Class I restorations

ABSTRAKTWstęp: Współczesna stomatologia zachowawcza oparta jest głównie na pracy z materiałami kompozytowymi. Jest to związane nie tylko z możliwością ich kompleksowego zastosowania, ale także z estetycznymi względami, które można osiągnąć dzięki szerokiej gamie tych materiałów. W przypadkach, w których nie jest możliwe prawidłowe wykonanie uzupełnień kompozytowych, należy rozważyć zastąpienie go alternatywnym materiałem, który zapewni bardziej stabilną rekonstrukcję tkanek zęba. Nieprawidłowo wykonane odbudowy kompozytowe w stosunkowo krótkim czasie mogą prowadzić do powstania nieszczelności brzeżnej, co przyczynia się do akumulacji płytki nazębnej i rozwoju próchnicy wtórnej.Celem pracy było dokonanie in vivo oceny przydatności trzech różnych metod diagnostycznych (badania klinicznego, fluorescencji laserowej oraz radiografii) w wykrywaniu próchnicy wtórnej w zębach posiadających wypełnienia amalgamatowe lub kompozytowe w klasie I wg Blacka.Materiały i metody: Badaniem objęto grupę 94 pacjentów w wieku 17–67 lat. Oceniono łącznie 200 wypełnień z materiałów złożonych i amalgamatu, w których stwierdzono obecność nieszczelności brzeżnej, przebarwienie brzegów wypełnienia lub przylegających tkanek zęba. Nie uwzględniano zębów z widocznymi ogniskami próchnicy wtórnej. Przeprowadzono badanie kliniczne, ocenę fluorescencji laserowej oraz badanie radiologiczne zębów zakwalifikowanych do oceny. Wyniki: Obecność próchnicy wtórnej stwierdzono w przypadku 137 spośród 200 badanych zębów. Metoda fluorescencji laserowej i badanie radiologiczne wykazały niską czułość wykrywania próchnicy wtórnej (odpowiednio 0,31 i 0,39). Obydwie metody wykazywały natomiast wyższą swoistość (odpowiednio 0,86 i 0,98) oraz dokładność (odpowiednio 0,49 i 0,58). Wnioski: Badanie kliniczne jest najskuteczniejszą metodą diagnozowania wtórnych ognisk próchnicy w uzupełnieniach klasy I wg Blacka. Fluorescencja laserowa oraz badania radiologiczne powinny być przeprowadzane wyłącznie w ramach uzupełnienia badania klinicznego.

Influence of Different Bioactive Tooth Colored Restorative Materials in Caries Detection Using Cone Beam Computed Tomography

Aim: To ensure the diagnostic ability of CBCT for caries detection under different types of tooth colored restorative materials. Material and Methods: In the present study a total of 80 extracted carious permanent molar teeth were selected. Caries was classified as grade 3 according to International Caries Detection and Assessment System (ICDAS) criteria. Half of carious lesions were removed from 40 molars as Control specimens. Carious teeth were randomly assigned into two groups and each group was divided into four subgroups including: two carious and two non-carious as controlled group and all the teeth were filled with different bioactive restorative materials, then all the specimens were scanned with cone beam computed tomography (CBCT) using a Promax® 3DMid CBCT device (Planmeca, Oy, Helsinki, Finland). Results: Caries was detected in all the carious specimens of all the groups except that group A2 was much less remarkable than other groups. In the control specimens (non-carious) of all the groups: No caries was detected .Conclusion: Although CBCT is an excellent tool for secondary caries detection under different types of restorative materials but it should not be used as a primary diagnostic tool on regular basis. If its use is a must, so, optimized low dose low resolution protocol is recommended.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations.

Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Diagnostic accuracy of cone-beam computed tomography in detecting secondary caries under composite fillings: an in vitro study.

The aim of this in vitro study was to assess the diagnostic performance of cone-beam computed tomography (CBCT) in the detection of secondary carious lesions under composite resin fillings applied to different types of cavities. Occlusal cavities (O) (n=18), occlusal cavities with mesial or distal component (MO/DO) (n=30), and mesial-occlusal-distal cavities (MOD) (n=30) were prepared in seventy eight extracted human posterior teeth. In half of the cavities in each group, artificial secondary caries lesions were simulated. All cavities were restored by using composite resin. All specimens were embedded in silicone and they were positioned to have approximal contacts. CBCT imaging was done and data were evaluated two times with two week interval by two observers, using a five-point confidence scale. Intra- and inter-observer agreements were calculated with Kappa statistics (κ). The area under (Az) the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy. Intra- (κ =0.89) and inter-observer (κ = 0.79) agreements were found to be excellent. Az values were highest for the O restorations which is followed by the MOD and DO/MO restorations. Az values for MOD and DO/MO restorations were very low and no statistically significant difference was found. Sensitivity for DO/MO restorations and specificity for MOD restorations were found to be the lowest values. Diagnostic performance of CBCT was higher in O composite restorations than MOD and DO/MO restorations for secondary caries detection. The use of alternative imaging methods rather than CBCT may be useful for evaluating secondary caries under composite MOD and DO/MO restorations.

In Vivo Diagnostic Accuracy of Digital Radiography in the Detection of Secondary Caries in Anterior Teeth

In Vivo Diagnostic Accuracy of Digital Radiography in the Detection of Secondary Caries in Anterior Teeth

Comparing the Diagnostic Accuracy of Two Different Resolutions of Radiographs Captured with PSP Digital Intraoral Receptors in Detection of Secondary Caries (In Vitro)

Comparing the Diagnostic Accuracy of Two Different Resolutions of Radiographs Captured with PSP Digital Intraoral Receptors in Detection of Secondary Caries (In Vitro)

Forenzic significance of composite restorations radiopacity: Assessment by dental students

In order to forensic use, dental materials should be sufficiently radiopaque to be detected against enamel/dentin, resulting in correct evaluation of restorations contours, detection of secondary caries, marginal defects, etc. Radiopacity of contemporary composites has been improved by inserting of filler-particles containing heavy metals: aluminum, barium, strontium, zirconium, ytterbium. Tetric composite group (Te-econom, Ceram, EvoCeram) has the most suitable radiopacity; T-econom has highest radiopacity (4.78mm aluminum when exposure-0.6'). The aim of this study was to comparison of MOD composite restorations (T-Econom, Ivoclar, Vivadent) radiographs in molar models and to assess their role in forensic identification, by dental students. Two sets of identical radiographs of molars models (that were previously filled with cement base and composite) were made by standardized technique (exposure-time 0.2ms, amperage-10mA, voltage-70kV). One of the sets consists a few radiographs that did not have their pairs in the second set. Equality of composite restorations on the 'ante-mortem' and 'post-mortem' radiographs were assessed by dental students. Statistical analysis was performed using the kappa test. Results showed (k.t.=0.82) that there is a high correlation of correct answers although estimates are made by students who have no experience in forensic identification and forensic evidence, neither enough knowledge in dental radiology. Although the forensic identification should not be based only on the appearance of the one restoration, or the assessment of non-professional forensic scientists, this study indicates that radiopacity of composites may have a major forensic importance, because 'ante-mortem' and 'post-mortem' radiographs were showed exactly match certain morphological characteristics of composite restorations.

Amalgam and Composite Restoration in Posterior Teeth

Basically most of the dentists choose amalgam for posterior restorations and they think amalgam is safe and poses no health risk to the patient. They also think that amalgam is the best material for posterior restoration as it can bear more masticatory stress, low price, easy to manipulate and also easy to handle/ place into the cavity. Moreover, their perception regarding amalgam is also very positive such as it is durable, the percentage of cusp fracture is less, no shrinkage and it has no toxic/harmful effect for oral health and general health also. But now a days controversy arises about this type of thinking in many clinical researches. Furthermore, composite became very popular to the dentist because of esthetic, two types of bonding (mechanical &amp; chemical), less sound tooth structure have to remove, no harmful effect like mercury of amalgam, marginal leakage is less, cusp fracture is less, secondary caries detection easier than amalgam by radiograph, composite takes good polish, etc. But composite resins also have some disadvantages. This article has been prepared to give a picture on merits, demerits and different aspects of comparison on amalgam and composite restorative materials after reviewing different articles and publications.DOI: http://dx.doi.org/10.3329/bjdre.v3i1.16593 Bangladesh Journal of Dental Research &amp; Education Vol.3(1) 2013: 30-35

Secondary caries detection

Secondary caries detection

Detection of proximal secondary caries at cervical class II-amalgam restoration margins in vitro

ObjectivesTo compare the performance of LFpen (DIAGNOdent pen) with two different wedge-shaped tips to conventional bitewing radiography (BW) for detecting proximal secondary caries at the cervical margin of amalgam restorations in vitro. MethodsSeventy-five molars with class II amalgam restorations were selected. Depending on the marginal filling extension, data was subdivided into a crown group (C), when the filling ended in enamel, and into a root group (R), when the filling ended beyond the cementum-enamel junction. Bayesian analysis including calculation of the area under the receiver operating curve (AUC) was performed. Furthermore, Spearman correlations between caries and cofactors, such as presence of plaque or stain, occlusal ditching, marginal gap size, filling overhangs, and shortfalls, were calculated. Additionally, for group R the correlation coefficient between LFpen measurements and lesion depth was calculated. Histology served as gold standard. ResultsIn group C both at the D1 and D3 levels, LFpen with two different tips showed a better performance than bitewing radiography (AUC at D1: 0.83/0.79 (LFpen) and 0.63 (BW); at D3: 0.66/0.66 (LFpen) and 0.53 (BW)). In group R, the respective AUC values were 0.53/0.56 (LF) and 0.59 (BW). A significant medium correlation was observed for occlusal ditching and proximal caries. Stain accumulation at the restoration margins especially in combination with filling overhangs interfered with LFpen readings, resulting in false positive measurements. ConclusionsCompared to BW, LFpen enhances the detection of secondary caries lesions at the cervical margin of amalgam restorations that do not extend below the cementum-enamel junction.

The visibility of secondary caries under bonding agents with two different imaging modalities

This study investigated the visibility of secondary caries lesions associated with two different adhesive systems of composite restorations (Optibond Solo Plus and Clearfil SE Bond) using a conventional dental x-ray film (Kodak D Speed) and a digital system (Digora) based on storage phosphor-plate technology for detection of secondary caries. For imaging techniques and adhesive systems, false positive scores were high. Intraobserver agreements ranged between 0.432 and 0.778, while interobserver agreements for the readings ranged 0.321-0.731 and 0.411-0.701, respectively. No statistical difference was found between the Az (area under curve) values obtained from PSP (photostimulable storage phosphor) and film images with the exception of the second observer's first reading for total etch adhesive system (Optibond Solo Plus) (p=0.0258). Furthermore, no statistical difference was found between both the bonding systems assessed (p>0.05). Adhesive materials should also have enough radiopacity to facilitate diagnosis of secondary caries.

Diagnostic performance of cone-beam computed tomography on detection of mechanically-created artificial secondary caries

PurposeThe aim of this study was to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) images and bitewing images in detection of secondary caries.Materials and MethodsOne hundred and twenty proximal slots of Class II cavities were randomly prepared on human premolar and molar teeth, and restored with amalgam (n=60) and composite resin (n=60). Then, artificial secondary caries lesions were randomly created using round steel No. 4 bur. The teeth were radiographed with a conventional bitewing technique and two CBCT systems; Pax-500ECT and Promax 3D. All images were evaluated by five observers. The area under the receiver operating characteristic (ROC) curve (Az) was used to evaluate the diagnostic accuracy. Significant difference was tested using the Friedman test (p value<0.05).ResultsThe mean Az values for bitewing, Pax-500ECT, and Promax 3D imaging systems were 0.882, 0.995, and 0.978, respectively. Significant differences were found between the two CBCT systems and film (p=0.007). For CBCT systems, the axial plane showed the greatest Az value.ConclusionBased on the design of this study, CBCT images were better than bitewing radiographs in detection of secondary caries.

In Vitro Detection of Secondary Caries Associated with Composite Restorations on Approximal Surfaces Using Laser Fluorescence

This study evaluated the performance of the DIAGNOdent pen laser fluorescence device (LFpen) in comparison with visual examination (VE), bitewing radiographs (BW) and visual examination combined with bitewing radiographs (VEBW) in detecting secondary approximal caries associated with composite restorations. In total, 60 approximal surfaces from 43 permanent molars with composite restorations were assessed twice by two examiners using the LFpen, VE, BW and VEBW. After histological preparation and hardness measurements, the sample was assigned to either a crown or root caries group, depending on the location of the lesions as the gold standard. For crown caries at D1, the highest values of specificity and sensitivity were observed for the LFpen at a cutoff value of 18 (1.00) and for the VEBW (0.89). At D3 (cutoff of 30), the LFpen showed the highest values of sensitivity and specificity. For root caries, the LFpen and VEBW showed the highest values of specificity (0.54), sensitivity (0.81) and accuracy (0.69). The Spearman rank correlation coefficients for crown/root caries with histology were 0.54/0.37 (LFpen), 0.29/0.10 (BW), 0.29/0.18 (VE) and 0.23/0.37 (VEBW). For the LFpen, the ICC varied from 0.80 (interexaminer) to 0.97 (intraexaminer B); the kappa value was 0.19 for BW and 0.35 for VE (interexaminer). Intraexaminer kappa values for BW were 0.25 (A) and 0.29 (B), and those for VE were 0.31 (A) and 0.32 (B). The LFpen device exhibited a performance comparable to that of conventional methods but with higher interexaminer reproducibility. Therefore, the LFpen should be considered an auxiliary method for the detection of secondary approximal caries associated with composite restorations.

Validity and reliability of methods for the detection of secondary caries around amalgam restorations in primary teeth

Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods--visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination--for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.

The eyes have it

Medline (1999-June 2004) provided the primary data source with references from one paper being reviewed for additional studies. The authors of one article were contacted for additional details. Articles, in English that assessed a commercially available caries detection device the DIAGNOdent (KaVo Dental GmbH Biberach), used human teeth with and without caries, and expressed diagnostic performance in terms of sensitivity and specificity of caries detection against a histological gold standard were included. Data were extracted to determine whether articles included: an appropriate study population; an adequate description of the test; an appropriate reference standard; a blinded comparison of test and reference samples and avoidance of verification bias. No quality score was assigned. Of the 25 studies identified, 16 assessed the in vitro performance of DIAGNOdent (DD) on occlusal surfaces of primary and permanent posterior teeth, four reported similar in vivo assessments, two examined DD performance on smooth surfaces and the final three addressed detection of secondary caries and residual caries in simulated cavities. DD sensitivity scores for in vitro detection of occlusal dentinal caries ranged from 0.19 to 1.0 (n=16) with 14 of the 16 results being >/=0.73. Specificity values ranged from 0.52 to 1.00. DD tended to show higher sensitivity but lower specificity than visual assessment methods. Only four studies considered DD in vivo performance and demonstrated sensitivity from 0.73 to 0.96 and specificity from 0.63 to 0.95. In the limited studies available DD demonstrated greater sensitivity but poorer specificity than visual caries diagnosis. Combined with the fact that little in vivo evidence is available for DD performance, the greater number of false-positive diagnoses suggest it should not be relied on as a clinician's primary diagnostic method.