What do systematic reviews say?

Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology

• 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) · CBCT
  Sensitivity 0.76 [0.65, 0.85]
  6 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) · Digital
  Sensitivity 0.69 [0.57, 0.80]
  6 studies
  GRADE not reported

Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination

• 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) · Digital
  Sensitivity 0.47 [0.36, 0.59]
  15 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
  Sensitivity 0.41 [0.30, 0.53]
  15 studies
  GRADE not reported

Visual examination (VE) vs Histological validation of dental tissues (gold standard)

Under in vitro conditions, visual examination had a summary ROC AUC of 0.85 for proximal caries detection at the dentin detection level; ungraded.

• Systematic review and meta-analysis of diagnostic studies of proximal surface caries. 2021 All outcomes

  In vitro (laboratory; extracted teeth); permanent posterior teeth, proximal surfaces · Dentin detection level
  AUC 0.85
  1 study
  GRADE not reported
• Systematic review and meta-analysis of diagnostic studies of proximal surface caries. 2021 All outcomes

  In vitro (laboratory; extracted teeth); permanent posterior teeth, proximal surfaces · Dentin detection level
  DOR 13.26 [1.44, 122.51]
  1 study
  GRADE not reported
• Systematic review and meta-analysis of diagnostic studies of proximal surface caries. 2021 All outcomes

  In vitro (laboratory; extracted teeth); permanent posterior teeth, proximal surfaces · Dentin detection level
  Specificity 0.99 [0.94, 0.999]
  1 study
  GRADE not reported

Other visual classification systems (unspecified or unique systems, e.g. Nyvad, Downer, Lussi, UniViSS) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• 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)
  Specificity 0.84 [0.73, 0.91]
  16 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• 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 0.49 [0.42, 0.56]
  40 studies
  GRADE not reported

Near-infrared (NIR) transillumination vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.86 [0.80, 0.91]
  5 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• 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 0.87 [0.82, 0.91]
  40 studies
  GRADE not reported

Visual classification: ERK (Ekstrand-Ricketts-Kidd system) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• 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)
  Specificity 0.72 [0.61, 0.81]
  15 studies
  GRADE not reported

Optical coherence tomography (OCT) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.94 [0.88, 0.97]
  10 studies
  GRADE not reported

Optical coherence tomography (OCT) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.83 [0.68, 0.91]
  10 studies
  GRADE not reported

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

The review found no eligible studies for this question.

• 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) · Restorations (secondary caries)
  Pre-specified heterogeneity investigation of teeth with previously applied restorations (secondary caries): no study intentionally included restored teeth in its sample. Studies evaluating secondary caries were…
  0 studies
  No studies found

Visual classification: ERK (Ekstrand-Ricketts-Kidd system) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• 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)
  Sensitivity 0.85 [0.74, 0.92]
  15 studies
  GRADE not reported

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)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.75 [0.62, 0.85]
  23 studies
  Low

VistaProof (Durr Dental; blue fluorescence, 405 nm) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Analysed as a separate index test (coupled forest plot and SROC plot, Figure 24 / Figure 25; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 18 datasets, 2402 tooth sites.
  17 studies
  GRADE not reported

Laser fluorescence (DIAGNOdent 2190/pen) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 34 datasets, 6842 tooth sites.
  32 studies
  GRADE not reported

Laser fluorescence (LF; DIAGNOdent) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 46 datasets, 7316 tooth sites.
  45 studies
  GRADE not reported

Red fluorescence devices (DIAGNOdent, DIAGNOdent pen, MidWest; excitation wavelength >655 nm) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  DOR 12.75 [9.74, 16.68]
  68 studies
  GRADE not reported

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Histology or excavation reference standard
  DOR 13.49 [10.25, 17.76]
  Studies not reported
  GRADE not reported

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent/mixed dentition
  DOR 15.21 [11.35, 20.37]
  Studies not reported
  GRADE not reported

All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard (histology, excavation, or enhanced visual examination)

• Fluorescence devices for the detection of dental caries 2020 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.60 [0.54, 0.65]
  79 studies
  Low