Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews

Abstract

Detection and diagnosis of caries—typically undertaken through a visual-tactile examination, often with supporting radiographic investigations—is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future “real world” context.

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis

“…The applicability of these five technologies was recently evaluated in a systematic review based on a great number of studies. By comparing them, broadly similar outcomes were observed in both cases with very wide 95% prediction intervals, indicating uncertainty in diagnostic accuracy for each [Walsh et al, 2022]. To evaluate the effect of CPP-ACP on the improvement of WSLs, our major limitation was to find randomized controlled trials which applied some of these methods for evaluation.…”

“…To evaluate the effect of CPP-ACP on the improvement of WSLs, our major limitation was to find randomized controlled trials which applied some of these methods for evaluation. In that respect, we found only applicable three evaluation systems [Drancourt et al, 2019;Macey et al, 2020;Walsh et al, 2022].…”

“…To evaluate enamel damage, theoretically multiple evaluation systems are available but their accuracy is still questionable and they are not equally used [Walsh et al, 2022]. The five major diagnostic test systems are fluorescence, visual or visual-tactile classification systems, radiographic imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies [Drancourt et al, 2019;Macey et al, 2020;Walsh et al, 2022]. The applicability of these five technologies was recently evaluated in a systematic review based on a great number of studies.…”

Dielectric Characterization of Healthy Human Teeth from 0.5 to 18 GHz with an Open-Ended Coaxial Probe

“…Caries detection is commonly assessed through subjective visual and tactile examination, often supported by X-rays [ 5 ]. These methods are effective at detecting caries in advanced states, where tooth restoration is necessary [ 6 ], but often show low sensitivity and may fail to detect early caries lesions [ 5 ]. In order to detect the initial signs of demineralization, complementary technologies have been developed over the past decades [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

Detection and localization of caries and hypomineralization on dental photographs with a vision transformer model

“…Both entities need to be reliably diagnosed by dental professionals. Here, a visual examination (VE) must be recognized as the method of choice for caries and MIH detection due to its simplicity, rapidness, and documented validity 4 – 9 . However, when considering the documented diagnostic variability between different dentists or work groups 5 , 6 , it can be argued that the reliability of VE can be improved and should optimally be as objective as possible.…”