What do systematic reviews say?

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) · Analogue
  Specificity 0.91 [0.86, 0.94]
  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) · Digital
  Specificity 0.88 [0.83, 0.92]
  15 studies
  GRADE not reported

Analogue (conventional) 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 0.90 [0.86, 0.93]
  51 studies
  GRADE not reported

Cone beam computed tomography (CBCT) 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 0.60 [0.51, 0.68]
  7 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) · Proximal surfaces (CBCT)
  Sensitivity 0.68 [0.42, 0.86]
  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 (CBCT)
  Sensitivity 0.76 [0.55, 0.89]
  Studies not reported
  GRADE not reported

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) · Digital
  Specificity 0.76 [0.43, 0.93]
  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) · CBCT
  Specificity 0.69 [0.35, 0.90]
  6 studies
  GRADE not reported

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

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

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

Fluoride varnish vs No fluoride treatment

In one trial, professionally applied sodium fluoride varnish significantly reduced the size of early enamel caries lesions compared with no fluoride treatment; ungraded.

• Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic… 2016 All outcomes

  Children in clinical dental settings
  One clinical trial (Du 2012) evaluating dimensional change reported that the average size of early enamel caries in children receiving professional NaF therapy was significantly smaller than in those with no fluoride…
  1 study
  GRADE not reported

6% sodium fluoride with 6% calcium fluoride varnish vs no treatment

One trial found 6% sodium fluoride plus 6% calcium fluoride varnish significantly reversed early enamel caries versus no treatment; ungraded and not meta-analysed.

• Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic… 2016 All outcomes

  Children in clinical dental settings
  One study (Xhemnica 2008) reported a significant reversal of early enamel caries using 6% NaF with 6% calcium fluoride compared with no treatment; this study was excluded from the meta-analysis.
  1 study
  GRADE not reported

Early loading of mini-screw implant vs Delayed loading of mini-screw implant

Early loading of mini-screw implant showed no clear difference in success of the anchorage device compared with delayed loading of mini-screw implant; GRADE not reported.

• Reinforcement of anchorage during orthodontic brace treatment with implants or other surgical methods 2014 · Cochrane All outcomes
  RR 1.00 [0.83, 1.20]
  2 studies · 36 participants
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Fluoride mouthrinse

Fluoride mouthrinse combined with fluoride toothpaste showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride mouthrinse alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 0.88 [0.67, 1.17]
  3 studies · 1697 participants
  GRADE not reported

Fluoride gel combined with fluoride mouthrinse vs Fluoride gel

Fluoride gel combined with fluoride mouthrinse showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride gel alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 1.00 [0.72, 1.40]
  1 study · 344 participants
  GRADE not reported

Fluoride varnish combined with fluoride toothpaste vs Fluoride varnish

Fluoride varnish combined with fluoride toothpaste showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride varnish alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 0.75 [0.22, 2.59]
  1 study · 196 participants
  GRADE not reported

Fluoride varnish combined with fluoride toothpaste vs Fluoride toothpaste alone

Fluoride varnish combined with fluoride toothpaste showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride toothpaste alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 1.29 [0.61, 2.71]
  2 studies · 294 participants
  GRADE not reported

Fluoride mouthrinse, gel or varnish combined with fluoride toothpaste (any combined regimen) vs Fluoride toothpaste alone

Fluoride mouthrinse, gel or varnish combined with fluoride… showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride toothpaste alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 1.06 [0.93, 1.22]
  5 studies · 1998 participants
  GRADE not reported

Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Fluoride toothpaste alone

Fluoride mouthrinse combined with fluoride toothpaste showed no clear difference in unacceptability of treatment (drop-outs / leaving study early) compared with fluoride toothpaste alone; GRADE not reported.

• Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for… 2004 · Cochrane All outcomes
  RR 1.03 [0.84, 1.26]
  3 studies · 1704 participants
  GRADE not reported

Patient-used 5000 ppm F toothpaste, daily vs 1450 to 1500 ppm F toothpaste

Patient-used 5000 ppm F toothpaste, daily throughout treatment showed no clear difference in number of participants with new demineralised lesions (DLs) compared with 1450 ppm F (conventional) toothpaste, daily (low certainty).

• Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment 2019 · Cochrane All outcomes

  At debond; follow-up 1.8 years
  RR 0.68 [0.46, 1.00]
  1 study · 380 participants
  Low

Fluoride varnish vs Untreated lesions (single-arm before vs after proportion)

Professionally applied 5% sodium fluoride varnish remineralised about two-thirds of early enamel caries lesions in children (pooled proportion 63.6%, 95% CI 36.0% to 91.2%; 4 studies); certainty was not GRADE-rated and heterogeneity was very high (I2=96%).

• Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic… 2016 All outcomes

  Children in clinical dental settings
  Proportion 0.636 [0.360, 0.912]
  4 studies
  GRADE not reported

1.23% APF gel vs Not specified

One trial found acidulated phosphate fluoride gel did not remineralise early enamel caries; ungraded.

• Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic… 2016 All outcomes

  Children in clinical dental settings
  One double-blind randomised trial found acidulated phosphate fluoride gel was not effective to remineralise early enamel caries.
  1 study
  GRADE not reported