Cochrane · DTA · CD013855
Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries
Macey, R, Walsh, T, Riley, P, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
9
current version
GRADE rated
2
No studies
1
Included studies
23
as reported
No studies 1 · 11.1%Ungraded 6 · 66.7%Very low 0 · 0%Low 2 · 22.2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants asymptomatic for dental caries who may have early, undetected caries at recruitment; children, adolescents, and adults were all eligible (primary, mixed, and permanent dentition). Excluded: participants explicitly recruited with caries into dentine or frank cavitation, and those referred to secondary care for restorative treatment | 16,702 tooth sites or surfaces from 23 studies (24 datasets); enamel-caries prevalence 3% to 83% (median 15%). Three studies primary dentition, 18 permanent, one mixed primary/permanent, two not reported. Countries: United States, Japan, Germany, UK, Brazil, Sweden, Switzerland, Finland, France, Australia, China, Malaysia; one unreported |
| Intervention | Transillumination and optical coherence tomography (OCT) devices using white light scattering and near-infrared (NIR) to detect or diagnose coronal caries, completed on intact teeth and used as an adjunct or replacement for aspects of the general dental examination. Four index-test categories: fibre-optic transillumination (FOTI); digital fibre-optic transillumination (DIFOTI); near-infrared (NIR) transillumination; optical coherence tomography (OCT) | Fibre-optic transillumination FOTI (n=6 studies); Digital fibre-optic transillumination DIFOTI (n=2 studies); Optical coherence tomography OCT (n=10 studies/datasets); Near-infrared NIR transillumination (n=5 studies, 6 datasets) |
| Comparison | Reference standards: histology (optimum); operative exploration/excavation; enhanced visual examination with or without radiographs; tooth separation using orthodontic bands (for approximal surfaces) | Histology (n=13 datasets); Radiographs (n=4); Visual examination with tooth separation (n=3); Microcomputed tomography/microCT (n=1); Visual examination alone (n=1); Visual examination plus radiograph (n=1); Visual examination plus operative excavation (n=1) |
| Outcomes | Diagnostic test accuracy: sensitivity and specificity (with 95% CI) and diagnostic odds ratio for detection/diagnosis of enamel (initial/non-cavitated) caries at the sound-vs-enamel-caries threshold; methodological quality assessed with QUADAS-2 | Diagnostic accuracy (sensitivity and specificity, plus diagnostic odds ratio) for detection of enamel/early caries (n=24 datasets); single overall GRADE certainty rated Low; device-subgroup estimates presented without separate GRADE ratings |
| Study designs | Diagnostic accuracy study designs: prospective studies of a single index test and studies directly comparing two or more index tests; randomised controlled trials of diagnostic test accuracy; case-control type accuracy studies (not in the primary analysis). In vitro and in vivo studies. Excluded: artificially created carious lesions; index test used during excavation | Diagnostic test accuracy studies only: 13 in vitro (previously extracted teeth) and 11 in vivo datasets (n=24 datasets from 23 studies); no eligible case-control or randomised controlled trial DTA designs were identified |
| Timing | Up to 3 months between index test and reference standard (in vivo); in vitro no time limit if teeth stored appropriately | Interval up to 3 months between index test and reference standard; in vitro studies used stored extracted teeth |
Search date: 2019-02-15. Databases: MEDLINE Ovid;Embase Ovid;US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov;World Health Organization International Clinical Trials Registry Platform
Questions and results
Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography)
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity for detection of enamel/early caries Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) | Specificity 0.87 [0.82, 0.92] 56 [34, 77] false positives per 1000 tooth surfaces at 57% pre-test probability | 23 studies | Low Downgraded: risk of bias, imprecision, indirectness |
Sensitivity for detection of enamel/early caries 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] 142 [86, 271] false negatives (missed early enamel caries) per 1000 tooth surfaces at 57% pre-test probability | 23 studies | Low Downgraded: risk of bias, imprecision, indirectness |
Near-infrared (NIR) transillumination vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography)
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection of enamel/early caries Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) | Sensitivity 0.58 [0.46, 0.68] | 5 studies | Ungraded |
Specificity for detection of enamel/early caries 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 | Ungraded |
Optical coherence tomography (OCT) vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography)
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection of enamel/early caries 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 | Ungraded |
Specificity for detection of enamel/early caries 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 | Ungraded |
Fibre-optic transillumination (FOTI) / digital fibre-optic transillumination (DIFOTI) vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography)
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection of enamel/early caries Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) | Sensitivity 0.47 [0.35, 0.59] | 8 studies | Ungraded |
Specificity for detection of enamel/early caries Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) | Specificity 0.92 [0.86, 0.96] | 8 studies | Ungraded |
Transillumination/OCT device used as an adjunct to a conventional visual examination vs Reference standard: histology, or enhanced visual examination with or without radiographs (also operative excavation, tooth separation, or microcomputed tomography)
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (clinical/in vivo studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately) | No studies formally reported the use of the illumination devices as an adjunct to a conventional visual examination, and therefore it has not been possible to make an assessment. | 0 studies | No studies |