A Systematic Review of the Performance of Methods for Identifying Carious Lesions

Abstract

This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessment of visual, visual/tactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to support generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.

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

“…This fact contributes to emphasize the lower reliability of the tested methods. 24 Hence, tactile examination and radiography would not be the most appropriate methods to detect secondary caries at the dentine threshold, which disagrees with previous findings related to radiographic examination, 7,11,25 but agrees with previous results related to tactile examination. 26 Despite the limitation of the visual index used in detecting early secondary caries due to the difficulty in distinguishing discolorations originated from the restoration or from demineralizations, 6 the visual inspection presented the highest sensitivity Table 1 -Sensitivity, specificity and accuracy of the laser fluorescence, visual inspection, radiography and tactile examination methods for detecting secondary caries lesions in primary teeth at enamel (D2) and dentine (D3) thresholds, and their performance expressed as the area under the ROC curve (Az).…”

“…11 The tactile examination generally presents high sensitivity and low specificity, resulting in a high number of false-positives. 24 Nevertheless, in our study the tactile examination presented a combination of high specificity and low sensitivity. The gentle use of the explorer probe may have caused that.…”

Surfing the spectrum – what is on the horizon?

“…Sensitivity of 14% and specificity of 95% for occlusal caries is reported, but proximal lesions result in 4% sensitivity and 100% specificity 38 from FOTI.…”

Caries diagnosis using light fluorescence devices: VistaProof and DIAGNOdent

“…While bitewing radiographs are considered to be of major importance for detecting proximal caries, they have a limited value to detect small carious lesions in occlusal surfaces because of the superposition of tooth's structure [11].…”