Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity

Abstract

Background: Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits.

Objective: We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions.

Data source: Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND DIAGNOSTIC METHODS: The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods.

Study appraisal and synthesis methods: A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated.

Results: Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias.

Conclusions: Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed.

Figure 1. Search strategy.

Chart containing the search strategy for electronic databases.

Figure 2. Flow diagram for selection of studies.

Figure 3. QUADAS graphic.

Analysis of study quality considering the Quality assessment of studies of diagnostic performance included in systematic reviews (QUADAS) checklist.

Figure 4. Paired forest plot of the results at initial caries lesions threshold.

Figure 5. Paired forest plot of the results at more advanced caries lesions threshold.

Figure 6. sROC curves of accuracy performed on occlusal surfaces of permanent teeth.

Summary Receiver-operating characteristics (sROC) curves and synthesis of the results obtained with studies of accuracy performed on occlusal surfaces of permanent teeth. LF = Laser fluorescence method; LFpen = pen-type LF; FC = Fluorescence camera.

Figure 7. sROC curves of accuracy performed on occlusal surfaces of primary teeth.

Summary Receiver-operating characteristics (sROC) curves and synthesis of the results obtained with studies of accuracy performed on occlusal surfaces of primary teeth. LF = Laser fluorescence method; LFpen = pen-type LF; FC = Fluorescence camera.

Figure 8. sROC curves of accuracy performed on approximal surfaces.

Summary Receiver-operating characteristics (sROC) curves and synthesis of the results obtained with studies about accuracy performed on approximal surfaces. LFpen = pen-type Laser fluorescence method.

Figure 9. Funnel plots to evaluate evidences of publication bias.

Funnel plots plotted to evaluate possibility of publication bias of studies using laser fluorescence method (A), pen-type laser fluorescence (LFpen) method (B) and Fluorescence camera (C) in detecting occlusal caries lesions and LFpen for approximal caries lesions (D).