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What do systematic reviews say?

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Evidence found and GRADE certainty

310 questions · 590 findings · 34 reviews

No studies found 12 · 2%GRADE not reported 470 · 79.7%Very low 23 · 3.9%Low 34 · 5.8%Moderate 51 · 8.6%High 0 · 0%

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)

Under in vitro conditions, conventional F-speed bitewing radiography had a pooled diagnostic odds ratio of 8.7 (95% CI 4.2, 18.1) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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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)

Under in vitro conditions, conventional D-speed bitewing radiography had a pooled specificity of 0.99 (95% CI 0.96, 0.999) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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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
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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)

Under in vitro conditions, sensor-based digital bitewing radiography had a pooled diagnostic odds ratio of 12.84 (95% CI 6.56, 25.13) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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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)

Under in vivo conditions, conventional E-speed bitewing radiography had a pooled specificity of 0.91 (95% CI 0.80, 0.96) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); 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…
2 findings from 1 review

Analogue (conventional) 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 teeth of children or…
1 finding from 1 review

Fibre-optic transillumination (FOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

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…
1 finding from 1 review

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)

Under in vitro conditions, conventional F-speed bitewing radiography had a summary ROC AUC of 0.98 for proximal caries detection at the 1/3 dentin detection level; ungraded.

4 findings from 1 review
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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)

Under in vitro conditions, visual examination had a pooled specificity of 0.84 (95% CI 0.76, 0.89) for proximal caries detection at the 1/3 dentin detection level; ungraded.

4 findings from 1 review
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Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

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…
1 finding from 1 review

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, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

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 teeth of children or…
3 findings from 1 review

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)

Under in vitro conditions, phosphor-plate digital bitewing radiography had a summary ROC AUC of 0.92 for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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Fibre-optic transillumination (FOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

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…
1 finding from 1 review

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, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review

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)

Under in vivo conditions, sensor-based digital bitewing radiography had a pooled sensitivity of 0.96 (95% CI 0.91, 0.98) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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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, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or…
1 finding from 1 review
  • Visual or visual‐tactile examination to detect and inform the diagnosis of enamel caries 2021 · Cochrane All outcomes
    Up to 3 months between index test and reference standard (in vivo studies) · Previously restored teeth (secondary caries)
    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 study
    GRADE not reported

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 teeth of children or…
2 findings from 1 review

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)

Under in vivo conditions, visual examination had a pooled specificity of 0.76 (95% CI 0.11, 0.99) for proximal caries detection at the dentin detection level; ungraded.

4 findings from 1 review
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