Cochrane · DTA · CD014545
Imaging modalities to inform the detection and diagnosis of early caries
Walsh, T, Macey, R, 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
55
current version
GRADE rated
2
No studies
2
Included studies
77
as reported
No studies 2 · 3.6%Ungraded 51 · 92.7%Very low 0 · 0%Low 2 · 3.6%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 | Asymptomatic children, adolescents, and adults who may have early undetected caries; primary, mixed, and permanent dentition; extracted teeth (in vitro) or teeth in the oral cavity (in vivo); participants with advanced caries into dentine or frank cavitation, or referred to secondary care for restorative treatment, excluded. Target condition: early (non-cavitated enamel-only) coronal caries on occlusal, approximal, or smooth surfaces | 15,518 tooth sites or surfaces from 77 studies (104 datasets), median enamel-caries prevalence ~63%; studies published 1986-2019; permanent dentition (n=55 studies, 78 datasets); primary dentition (n=20 studies, 22 datasets); both dentitions (n=2 studies, 4 datasets) |
| Intervention | Analogue (conventional) radiographs; Digital radiographs; Cone beam computed tomography (CBCT) | Analogue radiographs (n=51 studies, 55 datasets); Digital radiographs (n=40 studies, 42 datasets); CBCT (n=7 studies, 7 datasets) |
| Comparison | Reference standard: histology, excavation (operative exploration), or enhanced visual examination; comparative accuracy across radiographic methods (indirect and direct within-person comparisons) | Histology (n=64 studies); excavation (n=5 studies); enhanced visual examination with separation (n=8 studies) |
| Outcomes | Sensitivity; Specificity (summary points with 95% confidence regions from bivariate hierarchical meta-analysis) | Sensitivity (n=104 datasets): overall 0.47 (0.40 to 0.53); Specificity (n=104 datasets): overall 0.88 (0.84 to 0.92) |
| Study designs | Diagnostic test accuracy studies (single-gate cross-sectional/cohort); case-control type accuracy studies; RCTs of test accuracy; in vivo and in vitro; primary analysis restricted to tooth-surface-level reporting | In vitro / extracted teeth (n=60 studies, 87 datasets); in vivo / clinical (n=17 studies, 17 datasets) |
| Timing | Index test conducted and interpreted before the reference standard; in vivo interval between index test and reference standard < 3 months | Not specified |
Search date: 2018-12. Databases: MEDLINE Ovid; Embase Ovid; US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov); WHO International Clinical Trials Registry Platform
Questions and results
Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT) | Sensitivity 0.51 [0.40, 0.61] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence low <15% (non-CBCT) | Sensitivity 0.36 [0.25, 0.47] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low risk of bias for index test | Specificity 0.88 [0.82, 0.92] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Analogue and digital combined (non-CBCT); 97 datasets | Sensitivity 0.46 [0.40, 0.51] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vitro (non-CBCT) | Specificity 0.89 [0.84, 0.92] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence high >=35% or unreported (non-CBCT) | Sensitivity 0.50 [0.40, 0.59] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (non-CBCT) | Specificity 0.89 [0.84, 0.93] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low risk of bias for index test | Sensitivity 0.51 [0.43, 0.61] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: excluding high/unclear risk of bias reference standard | Sensitivity 0.51 [0.45, 0.57] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: enhanced visual (non-CBCT) | Sensitivity 0.47 [0.29, 0.66] | 8 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT) | Specificity 0.87 [0.78, 0.92] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition (non-CBCT) | Sensitivity 0.44 [0.37, 0.51] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Specificity 0.88 [0.84, 0.92] | 77 studies | Low Downgraded: risk of bias, inconsistency, indirectness |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition (non-CBCT) | Specificity 0.90 [0.85, 0.93] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence high >=35% or unreported (non-CBCT) | Specificity 0.89 [0.82, 0.93] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition (non-CBCT) | Specificity 0.87 [0.77, 0.93] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: excavation (non-CBCT) | Sensitivity 0.51 [0.27, 0.74] | 5 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: excluding high/unclear risk of bias reference standard | Specificity 0.87 [0.83, 0.90] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (non-CBCT) | Specificity 0.88 [0.80, 0.93] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: excavation (non-CBCT) | Specificity 0.96 [0.80, 0.99] | 5 studies | Ungraded |
Diagnostic accuracy on surfaces with pit and fissure sealants Up to 3 months between index test and reference standard (in vivo studies) · Pit and fissure sealants | Pre-specified heterogeneity investigation of surfaces with pit and fissure sealants: no study reported the inclusion of sealants that would allow evaluation of early caries lesions. | 0 studies | No studies |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vivo / clinical (non-CBCT) | Sensitivity 0.56 [0.43, 0.69] | 17 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Analogue and digital combined (non-CBCT); 97 datasets | Specificity 0.89 [0.86, 0.92] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low dentine-caries prevalence <15% | Specificity 0.91 [0.87, 0.94] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence low <15% (non-CBCT) | Specificity 0.91 [0.85, 0.95] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vitro (non-CBCT) | Sensitivity 0.44 [0.37, 0.50] | NR | Ungraded |
Diagnostic accuracy on restored teeth (secondary caries) 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 |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low dentine-caries prevalence <15% | Sensitivity 0.34 [0.25, 0.45] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: histology (non-CBCT) | Sensitivity 0.46 [0.39, 0.53] | 64 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.47 [0.40, 0.53] | 77 studies | Low Downgraded: risk of bias, inconsistency, indirectness |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Setting: in vivo / clinical (non-CBCT) | Specificity 0.89 [0.78, 0.95] | 17 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition (non-CBCT) | Sensitivity 0.52 [0.40, 0.63] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: histology (non-CBCT) | Specificity 0.88 [0.83, 0.92] | 64 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (non-CBCT) | Sensitivity 0.47 [0.39, 0.55] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: enhanced visual (non-CBCT) | Specificity 0.91 [0.77, 0.97] | 8 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (non-CBCT) | Sensitivity 0.45 [0.35, 0.54] | NR | Ungraded |
Analogue (conventional) radiographs vs Reference standard (histology, excavation, or enhanced visual examination)
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Specificity 0.90 [0.86, 0.93] | 51 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.44 [0.38, 0.50] | 51 studies | Ungraded |
Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.49 [0.42, 0.56] | 40 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Specificity 0.87 [0.82, 0.91] | 40 studies | Ungraded |
Cone beam computed tomography (CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (CBCT) | Specificity 0.90 [0.77, 0.96] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Specificity 0.81 [0.73, 0.88] | 7 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.60 [0.51, 0.68] | 7 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (CBCT) | Sensitivity 0.68 [0.42, 0.86] | NR | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (CBCT) | Sensitivity 0.76 [0.55, 0.89] | NR | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (CBCT) | Specificity 0.54 [0.31, 0.75] | NR | Ungraded |
Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Digital | Sensitivity 0.47 [0.36, 0.59] | 15 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Digital | Specificity 0.88 [0.83, 0.92] | 15 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Analogue | Specificity 0.91 [0.86, 0.94] | 15 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Analogue | Sensitivity 0.41 [0.30, 0.53] | 15 studies | Ungraded |
Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Digital | Specificity 0.76 [0.43, 0.93] | 6 studies | Ungraded |
Specificity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · CBCT | Specificity 0.69 [0.35, 0.90] | 6 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · CBCT | Sensitivity 0.76 [0.65, 0.85] | 6 studies | Ungraded |
Sensitivity for detection and diagnosis of early (enamel) caries Up to 3 months between index test and reference standard (in vivo studies) · Digital | Sensitivity 0.69 [0.57, 0.80] | 6 studies | Ungraded |
Analogue (conventional) radiographs vs Cone beam computed tomography (CBCT) (direct within-person / paired comparison); reference standard: histology
Population: Asymptomatic children, adolescents, or adults presenting for clinical examination (in vivo studies), or extracted teeth of children or adults (in vitro studies); teeth apparently healthy or with suspected early caries. Studies intentionally including caries obviously into dentine or frank cavitation, or participants referred to secondary care for restorative treatment, were excluded. Target condition: early (non-cavitated enamel-only) coronal dental caries on occlusal, approximal, or smooth surfaces
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy: analogue versus CBCT (within-person, not pooled) 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 | Ungraded |