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

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. All included studies assessed occlusal surfaces only; smooth surfaces were a planned surface subgroup with no data.
  0 studies
  No studies found

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition
  Permanent dentition (4 studies): specificity ranged from 0.73 to 1.00.
  4 studies
  GRADE not reported
• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition
  Primary dentition (3 studies): specificity ranged from 0 to 0.92.
  3 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  SoF findings (HSROC; no summary operating point reported): 'ECM: sensitivity from 0.61 to 0.98 ... CarieScan Pro: sensitivity from 0.55 to 0.91'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites…
  7 studies
  Very low

Analogue (conventional) radiographs vs Cone beam computed tomography (CBCT) (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)
  Direct comparison analogue vs CBCT (within-person): 6 datasets from 3 studies (737 tooth sites or surfaces) provided data, but the results could not be pooled; only individual study results are shown (Figure 21). No…
  3 studies
  GRADE not reported

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  ECM (4 studies, 475 tooth surfaces): sensitivity ranged from 0.61 to 0.98 (0.61-0.65 in three studies; 0.98 in the most recent ECM IV study). No evidence of a difference in accuracy by device type (Chi2=0.05, df=1,…
  4 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

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  SoF findings (HSROC; no summary operating point reported): 'ECM: specificity from 0.73 to 0.96 ... CarieScan Pro: specificity from 0 to 1.00'. Across all 7 studies (8 datasets), covering 719 tooth surfaces or sites (no…
  7 studies
  Very low

Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  ECM (4 studies, 475 tooth surfaces): specificity ranged from 0.73 to 0.96.
  4 studies
  GRADE not reported

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Diagnostic odds ratio (DOR) 15.65 [1.43, 171.15]
  7 studies
  Very low

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

CarieScan Pro device vs Reference standard (histology, excavation, or enhanced visual examination)

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  CarieScan Pro (3 studies, 244 tooth surfaces): specificity ranged from 0 to 1.00.
  3 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

Electrical conductance devices (electronic caries monitor (ECM) and/or CarieScan Pro), used as an adjunct to clinical oral examination vs Reference standard: histology or enhanced visual examination (with or without radiographs)

The review found no eligible studies for this question.

• Electrical conductance for the detection of dental caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  No eligible studies. All included studies assessed occlusal surfaces only ('All studies assessed the use of the electrical conductance devices on occlusal surfaces.'); proximal surfaces were a planned surface subgroup…
  0 studies
  No studies found

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

Radiographic examination (bitewing radiographs) vs Reference standard: histology

• Tests to detect and inform the diagnosis of root caries 2020 · Cochrane All outcomes
  2 in vitro studies (59 root surfaces) using extracted, restored teeth and a histological reference standard investigated the accuracy of radiographs. Reported estimates of sensitivity ranged from 0.40 to 0.63 and…
  2 studies
  Very low