Cochrane · DTA · CD014547
Electrical conductance for the detection of dental 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
15
current version
GRADE rated
3
No studies
4
Included studies
7
as reported
No studies 4 · 26.7%Ungraded 8 · 53.3%Very low 3 · 20%Low 0 · 0%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 | Children; Adolescents (immature permanent dentition); Adults (mature permanent dentition); Asymptomatic patients presenting for routine examination; Suspected early/enamel caries; Extracted teeth (in vitro); Advanced dentine/cavitated lesions excluded | Primary dentition/children (n=3 studies); Permanent dentition/adults (n=4 studies); In vitro extracted teeth (n=3); In vivo clinical setting (n=4); countries Brazil/UK/Denmark/Turkey |
| Intervention | Electrical conductance devices (alone, as adjunct to visual examination, or in combination); Electronic caries monitor (ECM); CarieScan Pro; Vanguard electronic caries detector | Electronic caries monitor (ECM) (n=4 studies, 475 tooth surfaces; ECM II/III/IV); CarieScan Pro (n=3 studies, 244 tooth surfaces) |
| Comparison | Reference standards: histology; enhanced visual examination; radiographic examination; operative exploration/excavation; composite reference standard; and comparisons between the electrical conductance devices | Histology (n=6 studies); Enhanced visual examination (n=1 study) |
| Outcomes | Sensitivity; Specificity; Diagnostic odds ratio (DOR); SROC/HSROC summary curve | Sensitivity (n=7 studies, range 0.55-0.98); Specificity (n=7 studies, range 0-1.00); Diagnostic odds ratio (n=7 studies pooled, DOR 15.65, 95% CI 1.43-171.15) |
| Study designs | Diagnostic test accuracy studies (prospective; single index test or direct comparison); RCTs of test accuracy; case-control accuracy studies (excluded from primary analysis); in vitro and in vivo | Diagnostic test accuracy studies (n=7; 8 datasets); in vitro (n=3); in vivo (n=4) |
| Timing | Up to 3 months between index test and reference standard (in vivo) | Not specified |
Search date: 2019-04. Databases: MEDLINE Ovid; Embase Ovid; US NIH Ongoing Trials Register (ClinicalTrials.gov); WHO International Clinical Trials Registry Platform; reference lists of included papers and previous systematic reviews
Questions and results
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)
Population: Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or extracted teeth of children/adults (in vitro); target condition = non-cavitated coronal caries at the enamel threshold on occlusal surfaces. Studies intentionally including caries into dentine or frank cavitations were excluded.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity (test accuracy for detecting enamel caries) 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 Downgraded: risk of bias, imprecision, inconsistency |
Specificity 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 | Ungraded |
Sensitivity Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition | Permanent dentition (4 studies): sensitivity ranged from 0.55 to 0.65. | 4 studies | Ungraded |
Specificity (test accuracy for detecting enamel caries) 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 Downgraded: risk of bias, imprecision, inconsistency |
Specificity 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 | Ungraded |
Diagnostic odds ratio (overall test accuracy) 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 Downgraded: risk of bias, imprecision, inconsistency |
Sensitivity Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition | Primary dentition (3 studies): sensitivity ranged from 0.91 to 0.93. No evidence of a difference in accuracy by dentition (removing accuracy covariate: Chi2=3.15, df=1, P=0.08). | 3 studies | Ungraded |
Electronic caries monitor (ECM) device (ECM II / ECM III / ECM IV) vs Reference standard: histology or enhanced visual examination (with or without radiographs)
Population: Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or extracted teeth of children/adults (in vitro); target condition = non-cavitated coronal caries at the enamel threshold on occlusal surfaces. Studies intentionally including caries into dentine or frank cavitations were excluded.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity 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 | Ungraded |
Specificity 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 | Ungraded |
CarieScan Pro device vs Reference standard: histology or enhanced visual examination (with or without radiographs)
Population: Children, adolescents, or adults presenting asymptomatically or suspected of early enamel caries (in vivo), or extracted teeth of children/adults (in vitro); target condition = non-cavitated coronal caries at the enamel threshold on occlusal surfaces. Studies intentionally including caries into dentine or frank cavitations were excluded.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity Up to 3 months between index test and reference standard (in vivo studies) | CarieScan Pro (3 studies, 244 tooth surfaces): sensitivity ranged from 0.55 to 0.91. No evidence of a difference in accuracy by device type (Chi2=0.05, df=1, P=0.82). | 3 studies | Ungraded |
Specificity 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 | Ungraded |
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)
Population: Children/adolescents/adults or extracted teeth; target condition = non-cavitated enamel caries on PROXIMAL (approximal) tooth surfaces.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 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 |
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)
Population: Children/adolescents/adults or extracted teeth; target condition = non-cavitated enamel caries on SMOOTH tooth surfaces.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR 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 |
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)
Population: Teeth with previously applied restorations (secondary caries) or pit and fissure sealants; target condition = non-cavitated enamel caries.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Up to 3 months between index test and reference standard (in vivo studies) | No eligible studies. 'No included studies reported inclusion criteria of previously applied restorations or pit and fissure sealants' (a planned subgroup). | 0 studies | No studies |
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)
Population: Samples with a low (<15%) prevalence of caries into dentine (d3/D3); target condition = non-cavitated enamel caries.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Up to 3 months between index test and reference standard (in vivo studies) | No eligible studies. 'No studies reported the inclusion of a low prevalence (0% to 14%) of d3/D3 of tooth surfaces'; all included studies reported d3/D3 prevalence of 15% or above, so the planned low-prevalence… | 0 studies | No studies |