Gap finder
Search review questions
Each row is one question a systematic review asked: who, what, compared with what, and which outcome, with the effect it found and how certain that is. Words match anywhere in the field.
555 questions in 21 reviews · intervention: Caries detection/diagnosis · outcome domain: Diagnostic accuracy
current versionsNo studies 19 · 3.4%Ungraded 489 · 88.1%Very low 17 · 3.1%Low 23 · 4.1%Moderate 7 · 1.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Intervention categories, outcome domains and clusters are a proposed key pending human validation. Clear all filters
| Question | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Fluorescence-based devices vs Visual classification Difference in specificity · Children or adults asymptomatic or suspected of enamel caries; extracted teeth · Analysis 1: fully within-person comparison Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. (2021) | Difference in specificity -0.03 [-0.09, 0.16] | 19 studies · 2849 participants | Ungraded |
Conventional bitewing radiography (D-speed film) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the caries detection level (D0 versus D1-D4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | Specificity 0.58 [0.42, 0.72] | 1 study | Ungraded |
COE with light-based detection (e.g. ViziLite Plus, Microlux/DL, VELscope, Identafi 3000) vs Reference standard: examination and clinical evaluation by a physician/clinician with specialist knowledge or training (long-term follow-up accepted for those screened negative) Outcome NR · Apparently healthy adults not reporting symptoms of OPMD or OSCC, attending an organised screening or surveillance… Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in… (2021) · Cochrane | There were no eligible studies evaluating light-based detection. | 0 studies | No studies |
Cone beam computed tomography (CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.81 [0.73, 0.88] | 7 studies | Ungraded |
Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), CBCT Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.76 [0.65, 0.85] | 6 studies | Ungraded |
Conventional bitewing radiography (E-speed film) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the caries detection level (D0 versus D1-D4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | Specificity 0.94 [0.46, 0.996] | 1 study | Ungraded |
Visual examination (VE) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the 1/3 dentin caries detection level (Ekstrand; D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | Sensitivity 0.72 [0.52, 0.86] | 3 studies | Ungraded |
Conventional bitewing radiography (E-speed film) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography) Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | AUC 0.75 | 2 studies | Ungraded |
Visual examination (VE) vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (1/3 dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · 1/3 dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.95 | 1 study | Ungraded |
Digital bitewing radiography, phosphor plate (PSP) vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.79 | 1 study | Ungraded |
Transillumination/OCT device used as an adjunct to a conventional visual examination vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography) Outcome NR · Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies);… · Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries (2021) · Cochrane | No studies formally reported the use of the illumination devices as an adjunct to a conventional visual examination, and therefore it has not been possible to make an assessment. | 0 studies | No studies |
Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Digital Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.47 [0.36, 0.59] | 15 studies | Ungraded |
Conventional bitewing radiography, F-speed film vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (1/3 dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · 1/3 dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | DOR 283.6 [16.1, 5010.0] | 1 study | Ungraded |
Visual or visual-tactile classification systems (any system: ICDAS, ERK, Nyvad, Downer, Lussi, UniViSS, or unspecified) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation) Sensitivity for detection of enamel caries · Asymptomatic children or adults presenting for clinical examination (in vivo studies), or extracted teeth of children… · Up to 3 months between index test and reference standard (in vivo studies), Medium prevalence of dentine caries (15% to 34%) Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane | Sensitivity 0.81 [0.72, 0.88] | NR | Ungraded |
CarieScan Pro device vs Reference standard: histology or enhanced visual examination (with or without radiographs) Specificity · Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or… · Up to 3 months between index test and reference standard (in vivo studies) Electrical conductance for the detection of dental caries (2021) · Cochrane | CarieScan Pro (3 studies, 244 tooth surfaces): specificity ranged from 0 to 1.00. | 3 studies | Ungraded |
Digital bitewing radiography, sensor-based (CCD/CMOS) vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (caries detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · Caries detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | Specificity 0.90 [0.85, 0.93] | 12 studies | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Sensitivity analysis: low risk of bias for index test Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.51 [0.43, 0.61] | NR | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Sensitivity analysis: excluding high/unclear risk of bias reference standard Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.51 [0.45, 0.57] | NR | Ungraded |
Conventional bitewing radiography (D-speed film) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the caries detection level (D0 versus D1-D4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | AUC 0.65 | 1 study | Ungraded |
Visual examination (VE) vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (caries detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · Caries detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.84 | 9 studies | Ungraded |
Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Digital Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.69 [0.57, 0.80] | 6 studies | Ungraded |
Visual examination (VE) vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.85 | 1 study | Ungraded |
Conventional bitewing radiography (E-speed film) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | Specificity 0.98 [0.79, 0.998] | 2 studies | Ungraded |
Visual examination (VE) vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | DOR 1.84 [0.03, 103.47] | 2 studies | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Occlusal surfaces (non-CBCT) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.88 [0.80, 0.93] | NR | Ungraded |
Other visual classification systems (unspecified or unique systems, e.g. Nyvad, Downer, Lussi, UniViSS) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation) Specificity for detection of enamel caries · Asymptomatic children or adults presenting for clinical examination (in vivo studies), or extracted teeth of children… · Up to 3 months between index test and reference standard (in vivo studies) Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane | Specificity 0.84 [0.73, 0.91] | 16 studies | Ungraded |
COE with vital rinsing (toluidine blue/tolonium chloride) vs Conventional oral examination (COE) alone Detection rate of oral pre-malignant and malignant lesions after referral (COE+vital rinsing vs COE alone) · OSCC or OPMD symptom-free individuals with tobacco habits Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in… (2021) · Cochrane | Rate ratio 1.05 [0.74, 1.41] | 1 study · 7975 participants | Moderate |
Combined index tests (e.g. vital staining plus light-based detection or cytology) vs Surgical or punch biopsy with histological assessment Specificity · Adults (aged 16 years or over) presenting to primary or secondary care with clinically evident suspicious or innocuous… Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically… (2021) · Cochrane | Specificity 0.71 [0.53, 0.84] | 9 studies | Very low |
Visual examination (VE) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the 1/3 dentin caries detection level (Ekstrand; D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | DOR 10.18 [3.94, 26.29] | 3 studies | Ungraded |
Digital bitewing radiography (phosphor plates) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography) Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | DOR 15.57 [0.47, 515.27] | 2 studies | Ungraded |
Conventional bitewing radiography, E-speed film vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | Sensitivity 0.35 [0.19, 0.51] | 1 study | Ungraded |
Conventional bitewing radiography, F-speed film vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.81 | 3 studies | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Sensitivity analysis: excluding high/unclear risk of bias reference standard Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.87 [0.83, 0.90] | NR | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Reference standard: excavation (non-CBCT) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.96 [0.80, 0.99] | 5 studies | Ungraded |
Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), CBCT Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.69 [0.35, 0.90] | 6 studies | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Dentine-caries (D3) prevalence medium 15-34% (non-CBCT) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.87 [0.78, 0.92] | NR | Ungraded |
Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination) Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.49 [0.42, 0.56] | 40 studies | Ungraded |
Digital bitewing radiography, phosphor plate (PSP) vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | DOR 7.5 [1.19, 47.13] | 1 study | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.88 [0.84, 0.92] | 77 studies | Low |
Digital bitewing radiography, sensor-based (CCD/CMOS) vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | Specificity 0.50 [0.02, 0.98] | 1 study | Ungraded |
Fluorescence-based devices vs Visual classification Difference in sensitivity · Children or adults asymptomatic or suspected of enamel caries; extracted teeth · Analysis 1: fully within-person comparison Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. (2021) | Difference in sensitivity -0.11 [-0.25, 0.03] | 19 studies · 2849 participants | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Diagnostic accuracy on surfaces with pit and fissure sealants · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Pit and fissure sealants Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Pre-specified heterogeneity investigation of surfaces with pit and fissure sealants: no study reported the inclusion of sealants that would allow evaluation of early caries lesions. | 0 studies | No studies |
Visual examination (VE) vs Direct visual examination after tooth separation or bioptical cavity preparation Diagnostic accuracy for proximal caries detection (dentin detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | AUC 0.53 | 2 studies | Ungraded |
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination) Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Setting: in vivo / clinical (non-CBCT) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.56 [0.43, 0.69] | 17 studies | Ungraded |
Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination Sensitivity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies), Analogue Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Sensitivity 0.41 [0.30, 0.53] | 15 studies | Ungraded |
Conventional bitewing radiography, D-speed film vs Histological validation of dental tissues (gold standard) Diagnostic accuracy for proximal caries detection (dentin detection level) · Extracted permanent posterior teeth with proximal surfaces (in vitro) · Dentin detection level Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021) | Sensitivity 0.17 [0.07, 0.40] | 1 study | Ungraded |
Near-infrared (NIR) transillumination vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography) Specificity for detection of enamel/early caries · Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies);… · Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries (2021) · Cochrane | Specificity 0.86 [0.80, 0.91] | 5 studies | Ungraded |
Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination) Specificity for detection and diagnosis of early (enamel) caries · Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted… · Up to 3 months between index test and reference standard (in vivo studies) Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane | Specificity 0.87 [0.82, 0.91] | 40 studies | Ungraded |
Fibre-optic transillumination (FOTI) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography) Diagnostic accuracy for occlusal caries detection at the caries detection level (D0 versus D1-D4) · Extracted human permanent posterior teeth (premolars and molars), occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | AUC 0.92 | 1 study | Ungraded |
Conventional bitewing radiography (D-speed film) vs Cavity preparation or biopsy (operative validation) Diagnostic accuracy for occlusal caries detection at the dentin caries detection level (D0-2 versus D3-4) · Human permanent posterior teeth (premolars and molars) in patients, occlusal (pit-and-fissure) surfaces Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. (2021) | AUC 0.77 | 2 studies | Ungraded |