Evidence Gaps

Imaging (analog or digital radiographs) vs Reference standard (histology, excavation, or enhanced visual examination)

Sensitivity for detection of enamel caries · Asymptomatic children or adults suspected of enamel caries (clinical studies); extracted teeth (in vitro studies)

In the fully within-person analysis, radiographic imaging had a summary sensitivity of 0.48 (95% CrI 0.35, 0.62); ungraded.

2 findings from 1 review

Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. 2022 All outcomes
General dental practice; in vitro (extracted teeth) and in vivo (clinical) studies · Analysis 1: fully within-person comparison (studies evaluating >=3 index tests)
Sensitivity 0.48 [0.35, 0.62]
19 studies · 2849 participants
GRADE not reported
Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews. 2022 All outcomes
General dental practice; in vitro (extracted teeth) and in vivo (clinical) studies · Analysis 2: network meta-analysis (all studies evaluating >=2 index tests)
Sensitivity 0.50 [0.40, 0.59]
64 studies · 24567 participants
Low

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 teeth of children or…

17 findings from 1 review

Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: enhanced visual (non-CBCT)
Sensitivity 0.47 [0.29, 0.66]
8 studies
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition (non-CBCT)
Sensitivity 0.44 [0.37, 0.51]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT)
Sensitivity 0.51 [0.40, 0.61]
Studies not reported
GRADE not reported

Show 14 more findings

Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence low <15% (non-CBCT)
Sensitivity 0.36 [0.25, 0.47]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: excavation (non-CBCT)
Sensitivity 0.51 [0.27, 0.74]
5 studies
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Analogue and digital combined (non-CBCT); 97 datasets
Sensitivity 0.46 [0.40, 0.51]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence high >=35% or unreported (non-CBCT)
Sensitivity 0.50 [0.40, 0.59]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low risk of bias for index test
Sensitivity 0.51 [0.43, 0.61]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: excluding high/unclear risk of bias reference standard
Sensitivity 0.51 [0.45, 0.57]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vivo / clinical (non-CBCT)
Sensitivity 0.56 [0.43, 0.69]
17 studies
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vitro (non-CBCT)
Sensitivity 0.44 [0.37, 0.50]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low dentine-caries prevalence <15%
Sensitivity 0.34 [0.25, 0.45]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: histology (non-CBCT)
Sensitivity 0.46 [0.39, 0.53]
64 studies
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies)
Sensitivity 0.47 [0.40, 0.53]
77 studies
Low
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (non-CBCT)
Sensitivity 0.45 [0.35, 0.54]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition (non-CBCT)
Sensitivity 0.52 [0.40, 0.63]
Studies not reported
GRADE not reported
Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes
Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (non-CBCT)
Sensitivity 0.47 [0.39, 0.55]
Studies not reported
GRADE not reported

What do systematic reviews say?

2 questions · 19 findings · 2 reviews

Imaging (analog or digital radiographs) vs Reference standard (histology, excavation, or enhanced visual examination)

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)