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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.

Limit to evidence status or GRADE (optional)

515 questions in 19 reviews · cluster CL0076

current versions
No studies 19 · 3.7%Ungraded 449 · 87.2%Very low 17 · 3.3%Low 23 · 4.5%Moderate 7 · 1.4%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

QuestionEffectEvidenceStatus / GRADE
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)
DOR 127.56 [7.38, 2203.70]2 studiesUngraded
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)
Sensitivity 0.65 [0.57, 0.73]1 studyUngraded
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)
Sensitivity 0.35 [0.26, 0.45]12 studiesUngraded
Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) 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 0.87 [0.82, 0.92]23 studiesLow
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)
Sensitivity 0.80 [0.71, 0.87]1 studyUngraded
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)
Diagnostic accuracy (sensitivity/specificity) for enamel caries, not meta-analyzed · 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), Smooth surface
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Smooth surfaces reported by 2 datasets (Nakagawa 2013; Shi 2000) but excluded from the surface meta-analysis owing to sparsity; no summary sensitivity or specificity estimated.2 studiesUngraded
Visual examination (VE) vs Histological validation (serial sectioning, grinding, hemisection, or microradiography)
Diagnostic accuracy for occlusal caries detection at the 1/3 dentin caries detection level (Ekstrand; 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 16.6 [4.85, 56.79]2 studiesUngraded
Fibre-optic transillumination (FOTI) 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 37.77 [13.69, 104.19]2 studiesUngraded
Cone beam computed tomography (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)
Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane
Sensitivity 0.60 [0.51, 0.68]7 studiesUngraded
Digital bitewing radiography, phosphor plate (PSP) 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 0.922 studiesUngraded
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)
DOR 60.37 [3.31, 1100.70]1 studyUngraded
Digital bitewing radiography, sensor-based (CCD/CMOS) 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)
Specificity 0.95 [0.93, 0.97]4 studiesUngraded
Conventional bitewing radiography (F-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)
Specificity 0.97 [0.71, 0.998]2 studiesUngraded
Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)
Specificity (test accuracy for detecting enamel caries) · 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
SoF findings (HSROC; no summary operating point reported): 'ECM: specificity from 0.73 to 0.96 ... CarieScan Pro: specificity from 0 to 1.00'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites (no…7 studiesVery low
Conventional bitewing radiography (D-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)
Specificity 0.73 [0.53, 0.87]1 studyUngraded
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), Approximal surface
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Sensitivity 0.80 [0.60, 0.92]NRUngraded
Fibre-optic transillumination (FOTI) / digital fibre-optic transillumination (DIFOTI) 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 0.92 [0.86, 0.96]8 studiesUngraded
Visual examination (VE) 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 0.593 studiesUngraded
Other visual classification systems (unspecified or unique systems, e.g. Nyvad, Downer, Lussi, UniViSS) 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)
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Sensitivity 0.81 [0.65, 0.91]16 studiesUngraded
Visual classification: ICDAS (International Caries Detection and Assessment System) 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)
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Sensitivity 0.88 [0.81, 0.92]36 studiesUngraded
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)
DOR 10.69 [3.67, 31.15]2 studiesUngraded
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)
AUC 0.732 studiesUngraded
Visual examination (VE) 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)
Specificity 0.87 [0.72, 0.95]8 studiesUngraded
Digital bitewing radiography, sensor-based (CCD/CMOS) vs Direct visual examination after tooth separation or bioptical cavity preparation
Diagnostic accuracy for proximal caries detection (caries detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Caries detection level
Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021)
DOR 17.11 [3.73, 78.39]1 studyUngraded
Conventional bitewing radiography, E-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)
Specificity 0.94 [0.71, 0.99]5 studiesUngraded
Blood and saliva analysis (biomarker tests) vs Surgical or punch biopsy with histological assessment
Outcome NR · 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
No eligible studies assessed the diagnostic test accuracy of blood and saliva analysis; potentially eligible biomarker studies were excluded as case-control designs.0 studiesNo studies
Visual examination (VE) 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 5.93 [3.11, 11.31]8 studiesUngraded
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)
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), Primary/mixed dentition
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Specificity 0.79 [0.70, 0.85]NRUngraded
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)
Sensitivity 0.96 [0.91, 0.98]1 studyUngraded
Fibre-optic transillumination (FOTI) 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 0.922 studiesUngraded
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)
Diagnostic accuracy in previously restored teeth (secondary 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), Previously restored teeth (secondary caries)
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Only one study (Kim 2017) intentionally included restored teeth in its sample; the pre-specified secondary-caries subgroup analysis could not be performed, no summary estimate reported.1 studyUngraded
Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) 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
ECM (4 studies, 475 tooth surfaces): specificity ranged from 0.73 to 0.96.4 studiesUngraded
Digital bitewing radiography, phosphor plate (PSP) 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)
Sensitivity 0.41 [0.25, 0.61]11 studiesUngraded
Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)
Diagnostic odds ratio (overall test accuracy) · 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
Diagnostic odds ratio (DOR) 15.65 [1.43, 171.15]7 studiesVery low
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)
AUC 0.941 studyUngraded
Light-based detection and/or oral spectroscopy (e.g. ViziLite, VELscope, Microlux DL, Identafi 3000) 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 0.50 [0.32, 0.68]23 studiesVery low
Quantitative light-induced fluorescence (QLF) vs Histological validation (in vitro) or cavity preparation/biopsy (in vivo)
Diagnostic accuracy for occlusal caries detection (any threshold) · 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)
no estimate extracted0 studiesNo studies
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)
DOR 31.0 [3.3, 291.3]1 studyUngraded
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)
Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries (2021) · Cochrane
Sensitivity 0.86 [0.80, 0.90]67 studiesLow
Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination 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), Primary dentition
Electrical conductance for the detection of dental caries (2021) · Cochrane
Primary dentition (3 studies): specificity ranged from 0 to 0.92.3 studiesUngraded
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)
Specificity 0.996 [0.96, 1]1 studyUngraded
Vital staining (e.g. toluidine blue, tolonium chloride) 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 0.68 [0.58, 0.77]20 studiesVery low
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)
AUC 0.741 studyUngraded
Visual examination (VE) 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)
Specificity 0.83 [0.70, 0.92]3 studiesUngraded
Dental imaging (analog or digital radiographs) 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 0.06 [-0.04, 0.19]19 studies · 2849 participantsUngraded
Digital bitewing radiography, sensor-based (CCD/CMOS) vs Direct visual examination after tooth separation or bioptical cavity preparation
Diagnostic accuracy for proximal caries detection (caries detection level) · Patients with permanent posterior teeth, proximal surfaces assessed clinically (in vivo) · Caries detection level
Systematic review and meta-analysis of diagnostic studies of proximal surface caries. (2021)
Sensitivity 0.55 [0.42, 0.67]1 studyUngraded
Conventional bitewing radiography, E-speed film 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)
DOR 6.80 [4.58, 10.10]9 studiesUngraded
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)
Sensitivity 0.48 [0.24, 0.73]2 studiesUngraded
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), Primary dentition (non-CBCT)
Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane
Specificity 0.87 [0.77, 0.93]NRUngraded
Cone beam computed tomography (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), Proximal surfaces (CBCT)
Imaging modalities to inform the detection and diagnosis of early caries (2021) · Cochrane
Sensitivity 0.68 [0.42, 0.86]NRUngraded