Evidence Gaps

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

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

Radiographic imaging had a summary specificity of 0.89 (95% CrI 0.83, 0.93) for detecting enamel caries; low certainty.

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 2: network meta-analysis (all studies evaluating >=2 index tests)
Specificity 0.89 [0.83, 0.93]
64 studies · 24567 participants
Low
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)
Specificity 0.92 [0.84, 0.96]
19 studies · 2849 participants
GRADE not reported

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 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) · Permanent dentition (non-CBCT)
Specificity 0.90 [0.85, 0.93]
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
Specificity 0.88 [0.82, 0.92]
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)
Specificity 0.89 [0.82, 0.93]
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) · Setting: in vitro (non-CBCT)
Specificity 0.89 [0.84, 0.92]
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)
Specificity 0.89 [0.84, 0.93]
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)
Specificity 0.87 [0.77, 0.93]
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) · Occlusal surfaces (non-CBCT)
Specificity 0.88 [0.80, 0.93]
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
Specificity 0.87 [0.83, 0.90]
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)
Specificity 0.96 [0.80, 0.99]
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) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT)
Specificity 0.87 [0.78, 0.92]
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)
Specificity 0.88 [0.84, 0.92]
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) · Analogue and digital combined (non-CBCT); 97 datasets
Specificity 0.89 [0.86, 0.92]
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%
Specificity 0.91 [0.87, 0.94]
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 low <15% (non-CBCT)
Specificity 0.91 [0.85, 0.95]
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)
Specificity 0.89 [0.78, 0.95]
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) · Reference standard: enhanced visual (non-CBCT)
Specificity 0.91 [0.77, 0.97]
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) · Reference standard: histology (non-CBCT)
Specificity 0.88 [0.83, 0.92]
64 studies
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)