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Meta-Analysis
. 2020 Dec 8;12(12):CD013811.
doi: 10.1002/14651858.CD013811.

Fluorescence devices for the detection of dental caries

Richard Macey  1 , Tanya Walsh  1 , Philip Riley  2 , Anne-Marie Glenny  1 , Helen V Worthington  2 , Patrick A Fee  3 , Janet E Clarkson  4 , David Ricketts  3
Affiliations
Meta-Analysis

Fluorescence devices for the detection of dental caries

Richard Macey et al. Cochrane Database Syst Rev. .

Abstract
in English, Spanish

Background: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non-invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence-based devices. There are three categories of fluorescence-based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay.

Objectives: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence-based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine.

Search methods: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles.

Selection criteria: We included diagnostic accuracy study designs that compared a fluorescence-based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded.

Data collection and analysis: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity-specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90).

Main results: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta-analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta-analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non-generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta-regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi2 = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results.

Authors' conclusions: There is considerable variation in the performance of these fluorescence-based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence-based devices appeared to outperform red fluorescence-based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta-analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies.

Antecedentes: La caries es una de las afecciones más frecuentes y prevenibles en todo el mundo. Si se identifican con suficiente antelación, se pueden aplicar técnicas no invasivas y, por lo tanto, esta revisión se centra en las caries tempranas que afectan la superficie del esmalte del diente. La piedra angular de la detección de la caries es una exploración dental visual y táctil; sin embargo, existen métodos alternativos de detección, entre los que se incluyen los dispositivos basados en la fluorescencia. Hay tres categorías de dispositivos basados en la fluorescencia, cada una de ellas definida principalmente por las diferentes longitudes de onda que utilizan; estos grupos se han llamado fluorescencia roja, azul y verde. Estos dispositivos podrían apoyar la exploración visual para la detección y el diagnóstico de la caries en una etapa temprana de descomposición.

Objetivos: Los objetivos principales fueron determinar la exactitud de la prueba diagnóstica de dispositivos basados en la fluorescencia para la detección y el diagnóstico de la caries del esmalte en niños o adultos. Se planificó investigar las siguientes fuentes potenciales de heterogeneidad: superficie dental (oclusal, proximal, superficie lisa o adyacente a una restauración); dispositivos de medición de punto único frente a dispositivos de imagen o de evaluación de superficie; y la prevalencia de enfermedades más graves en cada muestra de estudio, a nivel de caries en la dentina. MÉTODOS DE BÚSQUEDA: El documentalista del Grupo Cochrane de Salud Oral (Cochrane Oral Health Group) realizó una búsqueda en las siguientes bases de datos: MEDLINE Ovid (1946 al 30 de mayo de 2019); Embase Ovid (1980 al 30 de mayo de 2019); Registro de ensayos en curso de los Institutos Nacionales de Salud de los Estados Unidos (ClinicalTrials.gov, hasta el 30 de mayo de 2019); y la Plataforma de Registro Internacional de Ensayos Clínicos de la Organización Mundial de la Salud (hasta el 30 de mayo de 2019). Se estudiaron las listas de referencias y las revisiones sistemáticas publicadas. CRITERIOS DE SELECCIÓN: Se incluyeron diseños de estudios de exactitud diagnóstica que compararon un dispositivo basado en la fluorescencia con un estándar de referencia. Esto incluyó estudios prospectivos que evaluaron la exactitud diagnóstica de una única prueba índice y estudios que compararon directamente dos o más pruebas índice. Se excluyeron los estudios que reclutaron explícitamente a participantes con caries en la dentina o en la cavitación franca. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión extrajeron los datos de forma independiente mediante un formulario de extracción de datos de estudios piloto basado en la Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). De cada estudio se informaron la sensibilidad y la especificidad con intervalos de confianza (IC) del 95%. Esta información se ha presentado en forma de diagramas de bosque (forest plot) emparejados y gráficos de curva resumen de rendimiento diagnóstico (SROC), que muestran los puntos de sensibilidad‐especificidad de cada estudio. La exactitud diagnóstica se calculó mediante métodos de modelo jerárquico de curva resumen de rendimiento diagnóstico (HSROC). Se informaron sensibilidades a valores fijos de especificidad (mediana 0,78, cuartil superior 0,90).

Resultados principales: Se incluyeron un total de 133 estudios, 55 no informaron los datos en el formato 2 x 2 y no se pudieron incluir en el metanálisis. En el metanálisis se incluyeron 79 estudios que proporcionaron 114 conjuntos de datos y evaluaron 21 283 superficies dentales. Hubo alto riesgo de sesgo en el dominio de selección de los participantes. La prueba índice, el estándar de referencia y los dominios de flujo y tiempo mostraron que una alta proporción de los estudios tenían un bajo riesgo de sesgo. Las preocupaciones relacionadas con la aplicabilidad de la evidencia fueron altas o poco claras en todos los dominios, y la mayor proporción se observó en la selección de los participantes. El reclutamiento selectivo de los participantes, los umbrales diagnósticos mal definidos y el hecho de que los estudios in vitro no se puedan generalizar al escenario clínico de una exploración dental de rutina fueron las principales razones de estos hallazgos. El predominio de los estudios in vitro también hizo que la información sobre la forma en que se utilizan los resultados de esos dispositivos para apoyar el diagnóstico, en contraposición con la detección pura, fuera muy limitada. Hubo una variabilidad significativa en los resultados que no se pudo explicar por los diferentes dispositivos o dentición u otras fuentes de heterogeneidad que se investigaron. El odds ratio diagnóstico (ORD) fue 14,12 (IC del 95%: 11,17 a 17,84). La sensibilidad estimada, con una especificidad media fija de 0,78, fue 0,70 (IC del 95%: 0,64 a 0,75). En una cohorte hipotética de 1000 puntos o superficies dentales, con una prevalencia de caries del esmalte del 57%, obtenida de los estudios incluidos, la sensibilidad estimada de 0,70 y la especificidad de 0,78 daría lugar a 171 puntos o superficies dentales con caries del esmalte no detectados (falsos negativos) y 95 incorrectamente considerados con caries temprana (falsos positivos). Se utilizó la metarregresión para comparar la exactitud de los diferentes dispositivos para la fluorescencia roja (84 conjuntos de datos, 14 514 puntos dentales), la fluorescencia azul (21 conjuntos de datos, 3429 puntos dentales), y la fluorescencia verde (nueve conjuntos de datos, 3340 puntos dentales). Inicialmente, se permitió que el umbral, la forma y la exactitud variaran según el tipo de dispositivo, incluyendo covariables en el modelo. Permitiendo la homogeneidad de la forma, la eliminación de las covariables para la exactitud tuvo sólo un efecto insignificante (Ji2 = 3,91; grados de libertad [gl] = 2; p = 0,14). A pesar del volumen relativamente grande de evidencia, la certeza de las mismas se consideró baja, disminuyendo dos niveles en total, por el riesgo de sesgo debido a las limitaciones en el diseño y la realización de los estudios incluidos, los hallazgos indirectos derivados del elevado número de estudios in vitro y la incoherencia debida a la considerable variabilidad de los resultados.

Conclusiones de los autores: Existe una considerable variación en la ejecución de estos dispositivos basados en la fluorescencia que no se pudo explicar por las diferentes longitudes de onda de los dispositivos evaluados, los participantes ni las características de los estudios. Los dispositivos basados en la fluorescencia azul y verde parecieron superar a los basados en la fluorescencia roja, pero esta diferencia no estuvo respaldada por los resultados de una comparación estadística formal. La base de evidencia fue considerable, pero sólo fue posible incluir 79 estudios de 133 en el metanálisis, ya que no se pudieron extraer o derivar las estimaciones de los valores de sensibilidad o especificidad o ambos. En cuanto a la aplicabilidad, todo estudio futuro se debería realizar en un ámbito clínico, en el que las dificultades de la evaluación de la caries dentro de la cavidad oral incluyen la placa, la tinción y las restauraciones. Otras consideraciones son el potencial de los dispositivos de fluorescencia para ser utilizados en combinación con otras tecnologías y estudios comparativos de exactitud diagnóstica.

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Conflict of interest statement

Richard Macey: none known. Tanya Walsh: none known. I am Statistical Editor with Cochrane Oral Health. Philip Riley: none known. I am Deputy Co‐ordinating Editor of Cochrane Oral Health. Anne‐Marie Glenny: none known. I am Co‐ordinating Editor of Cochrane Oral Health. Helen V Worthington: none known. I am an Editor with Cochrane Oral Health. Patrick A Fee: none known. Janet E Clarkson: none known. I am Co‐ordinating Editor of Cochrane Oral Health. David Ricketts: none known.

Figures

1
1
Keystones of the International Caries Classification and Management System (ICCMS™).
Copyright© 2018 Ismail AI, Pitts NB, Tellez M. The International Caries Classification and Management System (ICCMS™) an example of a caries management pathway. BMC Oral Health 2015;15(Suppl 1):S9. Reproduced with permission.
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Review flow diagram.
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Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
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Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
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Studies included in the meta‐analysis ‐ Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
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Forest plot of all included fluorescence devices with the target condition of early/enamel caries (n = 114), ordered by sensitivity (highest to lowest).
7
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Summary receiver operating characteristic (SROC) plot of all fluorescence devices with the target condition of early/enamel caries (n = 114).
8
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Forest plot of tests of fluorescence devices with the target condition of early/enamel caries, categorised into: red fluorescence (n = 84), blue fluorescence (n = 21), and green fluorescence (n = 9) (each group ordered by sensitivity highest to lowest).
9
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Summary receiver operating characteristic (SROC) plot of tests: red fluorescence (n = 84 datasets), blue fluorescence (n = 21 datasets), and green fluorescence (n = 9 datasets).
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Forest plot of datasets categorised by dentition (permanent or mixed n = 74; or primary teeth n = 40) and ordered by sensitivity.
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Summary receiver operating characteristic (SROC) plot presented according to type of dentition (permanent or mixed n = 74; or primary teeth n = 40).
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Forest plot of subgroups according to prevalence of dentine caries (low < 0.15, medium 0.15 to 0.34, high ≥ 0.35).
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Summary receiver operating characteristic (SROC) plot according to prevalence of dentine caries (low < 0.15, medium 0.15 to 0.34, high ≥ 0.35).
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Forest plot of fluorescence devices according to tooth surface investigated.
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Summary receiver operating characteristic (SROC) plot presented according to tooth surface (proximal n = 18, occlusal n = 89, smooth/secondary caries n = 7).
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Forest plot of datasets categorised by reference standard (excavation n = 5, histology n = 78, radiograph n = 6, visual n = 25) and ordered by sensitivity.
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Summary receiver operating characteristic (SROC) plot presented according to reference standard (histology or excavation n = 83, radiograph n = 6, enhanced visual examination n = 25).
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Forest plot of all studies investigating the effect of multiple sites per tooth.
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Summary receiver operating characteristic (SROC) plot presented according to multiple or single site (multiple sites per tooth n = 24 and single sites n = 90).
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Summary receiver operating characteristic (SROC) plot of all datasets with risk of bias for participant selection domain identified.
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Sensitivity analysis of datasets reporting low risk of bias for participant selection domain.
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Forest plot of tests investigating laser fluorescence devices: DIAGNOdent, DIAGNOdent pen, and MidWest.
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Summary receiver operating characteristic (SROC) plot of fluorescence tests investigating differences between DIAGNOdent, DIAGNOdent pen, and MidWest.
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Forest plot of tests of red fluorescence devices: VistaProof and SoproLife.
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Summary receiver operating characteristic (SROC) plot of fluorescence tests investigating differences between red fluorescence devices VistaProof and SoproLife.
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Forest plot of fluorescence tests investigating differences between green fluorescence devices with image and function.
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Summary receiver operating characteristic (SROC) plot of fluorescence tests investigating differences between green fluorescence devices with image and function.
1
1. Test
All
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2. Test
Red fluorescence
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3. Test
Blue fluorescence
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4. Test
Green fluorescence
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5. Test
DIAGNOdent
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6. Test
DIAGNOdent pen
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7. Test
VistaProof
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8. Test
SoproLife
9
9. Test
QLF
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10. Test
MidWest
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11. Test
Combined visual/radiograph/DIAGNOdent
See this image and copyright information in PMC

References

References to studies included in this review

Achilleos 2013 {published data only}
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Alomari 2015 {published data only}
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Alwas‐Danowska 2002 {published data only}
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Angnes 2005 {published data only}
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Anttonen 2003 {published data only}
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Apostolopoulou 2009 {published data only}
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Arslan 2014 {published data only}
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Attrill 2001 {published data only}
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Bahrololoomi 2015 {published data only}
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Bamzahim 2002 {published data only}
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Bamzahim 2004 {published data only}
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Barberia 2008 {published data only}
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Baseren 2003 {published data only}
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Bengtson 2005 {published data only}
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Bittar 2012 {published data only}
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Bizhang 2016 {published data only}
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Boston 2003 {published data only}
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Bozdemir 2013 {published data only}
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Braga 2006 {published data only}
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Braga 2007 {published data only}
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Braga 2008 {published data only}
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Braga 2009 {published data only}
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Burin 2005 {published data only}
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Bussaneli 2015 {published data only}
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Bussaneli 2015a {published data only}
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Castilho 2016 {published data only}
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Chawla 2012 {published data only}
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Chen 2012 {published data only}
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Chong 2003 {published data only}
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Cinar 2013 {published data only}
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Costa 2002 {published data only}
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Costa 2007 {published data only}
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Diniz 2009 {published data only}
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Diniz 2011 {published data only}
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Diniz 2012 {published data only}
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Diniz 2019 {published data only}
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Duruturk 2011 {published data only}
    1. Duruturk L, Ciftci A, Baharoglu S, Oztuna D. Clinical evaluation of DIAGNOdent in detection of occlusal caries in newly erupted noncavitated first permanent molars in caries-active children. Operative Dentistry 2011;36:348-55. - PubMed
El‐Housseiny 2001 {published data only}
    1. El-Housseiny AA, Jamjoum H. Evaluation of visual, explorer, and a laser device for detection of early occlusal caries. Journal of Clinical Pediatric Dentistry 2001;26:41-8. - PubMed
Feng 2005 {published data only}
    1. Feng Y, Yin W, Zhang YY, Zhang B, Hu DY. Comparison of primary caries detection on smooth surface in the maxillary anterior teeth using QLF, digital photo and visual diagnosis. Shanghai Kou Qiang Yi Xue [Shanghai Journal of Stomatology] 2005;14(6):565-8. - PubMed
Ferreira 1998 {published data only}
    1. Ferreira Zandona AG, Analoui M, Beiswanger BB, Isaacs RL, Kafrawy AH, Eckert GJ, et al. An in vitro comparison between laser fluorescence and visual examination for detection of demineralization in occlusal pits and fissures. Caries Research 1998;32:210-8. - PubMed
Ferreira 2008 {published data only}
    1. Ferreira JM, Silva MF, Oliveira AF, Sampaio FC. Evaluation of different methods for monitoring incipient carious lesions in smooth surfaces under fluoride varnish therapy. International Journal of Paediatric Dentistry 2008;18:300-5. - PubMed
Francescut 2003 {published data only}
    1. Francescut P, Lussi A. Correlation between fissure discoloration, Diagnodent measurements, and caries depth: an in vitro study. Pediatric Dentistry 2003;25:559-64. - PubMed
Fung 2004 {published data only}
    1. Fung L, Smales R, Ngo H, Mount G. Diagnostic comparison of three groups of examiners using visual and laser fluorescence methods to detect occlusal caries in vitro. Australian Dental Journal 2004;49:67-71. - PubMed
Ghaname 2010 {published data only}
    1. Ghaname ES, Ritter AV, Heymann HO, Vann WF Jr, Shugars DA, Bader JD. Correlation between laser fluorescence readings and volume of tooth preparation in incipient occlusal caries in vitro. Journal of Esthetic & Restorative Dentistry 2010;22:31-9. - PubMed
Goel 2009 {published data only}
    1. Goel A, Chawla HS, Gauba K, Goyal A. Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal caries in primary molars using the histological gold standard: an in vivo study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2009;27(4):227-34. - PubMed
Graye 2012 {published data only}
    1. Graye M, Markowitz K, Strickland M, Guzy G, Burke M, Houpt M. In vitro evaluation of the Spectra early caries detection system. Journal of Clinical Dentistry 2012;23:1-6. - PubMed
Heinrich‐Weltzien 2003 {published data only}
    1. Heinrich-Weltzien R, Kuhnisch J, Oehme T, Ziehe A, Stosser L, Garcia-Godoy F. Comparison of different DIAGNOdent cut-off limits for in vivo detection of occlusal caries. Operative Dentistry 2003;28(6):672-80. - PubMed
Hibst 2001 {published data only}
    1. Hibst R, Paulus R, Lussi A. Detection of occlusal caries by laser fluorescence: basic and clinical investigations. Medical Laser Application 2001;16(3):205-13.
Huth 2008 {published data only}
    1. Huth KC, Neuhaus KW, Gygax M, Bucher K, Crispin A, Paschos E, et al. Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars. Journal of Dentistry 2008;36(12):1033-40. - PubMed
Huth 2010 {published data only}
    1. Huth KC, Lussi A, Gygax M, Thum M, Crispin A, Paschos E, et al. In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars. Journal of Dentistry 2010;38(12):1019-26. - PubMed
Iranzo‐Cortes 2017 {published data only}
    1. Iranzo-Cortes JE, Terzic S, Montiel-Company JM, Almerich-Silla JM. Diagnostic validity of ICDAS and DIAGNOdent combined: an in vitro study in pre-cavitated lesions. Lasers in Medical Science 2017;32(3):543-8. - PubMed
Jablonski‐Momeni 2011 {published data only}
    1. Jablonski-Momeni A, Schipper HM, Rosen SM, Heinzel-Gutenbrunner M, Roggendorf MJ, Stoll R, et al. Performance of a fluorescence camera for detection of occlusal caries in vitro. Odontology 2011;99(1):55-61. - PubMed
Jablonski‐Momeni 2012 {published data only}
    1. Jablonski-Momeni A, Rosen SM, Schipper HM, Stoll R, Roggendorf MJ, Heinzel-Gutenbrunner M, et al. Impact of measuring multiple or single occlusal lesions on estimates of diagnostic accuracy using fluorescence methods. Lasers in Medical Science 2012;27(2):343-52. - PubMed
Jablonski‐Momeni 2012a {published data only}
    1. Jablonski-Momeni A, Stucke J, Steinberg T, Heinzel-Gutenbrunner M. Use of ICDAS-II, fluorescence-based methods, and radiography in detection and treatment decision of occlusal caries lesions: an in vitro study. International Journal of Dentistry 2012;2012:371595. - PMC - PubMed
Jablonski‐Momeni 2014 {published data only}
    1. Jablonski-Momeni A, Heinzel-Gutenbrunner M, Klein SM. In vivo performance of the VistaProof fluorescence-based camera for detection of occlusal lesions. Clinical Oral Investigations 2014;18(7):1757-62. - PubMed
Jablonski‐Momeni 2016 {published data only}
    1. Jablonski-Momeni A, Heinzel-Gutenbrunner M, Vill G. Use of a fluorescence-based camera for monitoring occlusal surfaces of primary and permanent teeth. International Journal of Paediatric Dentistry 2016;26(6):448-56. - PubMed
Jeon 2004 {published data only}
    1. Jeon RJ, Han C, Mandelis A, Sanchez V, Abrams SH. Diagnosis of pit and fissure caries using frequency-domain infrared photothermal radiometry and modulated laser luminescence. Caries Research 2004;38(6):497-513. - PubMed
Jung 2018 {published data only}
    1. Jung EH, Lee ES, Jung HI, Kang SM, Josselin de Jong E, Kim BI. Development of a fluorescence-image scoring system for assessing noncavitated occlusal caries. Photodiagnosis and Photodynamic Therapy 2018;21:36-42. - PubMed
Kavvadia 2008 {published data only}
    1. Kavvadia K, Lagouvardos P. Clinical performance of a diode laser fluorescence device for the detection of occlusal caries in primary teeth. International Journal of Paediatric Dentistry 2008;18(3):197-204. - PubMed
Kavvadia 2012 {published data only}
    1. Kavvadia K, Lagouvardos P, Apostolopoulou D. Combined validity of DIAGNOdentTM and visual examination for in vitro detection of occlusal caries in primary molars. Lasers in Medical Science 2012;27(2):313-9. - PubMed
Kesler 2003 {published data only}
    1. Kesler G, Masychev V, Sokolovsky A, Alexandrov M, Kesler A, Koren R. Photon undulatory non-linear conversion diagnostic method for caries detection: a pilot study. Journal of Clinical Laser Medicine & Surgery 2003;21(4):209-17. - PubMed
Kim 2017 {published data only}
    1. Kim ES, Lee ES, Kang SM, Jung EH, Josselin de Jong E, Jung HI, et al. A new screening method to detect proximal dental caries using fluorescence imaging. Photodiagnosis and Photodynamic Therapy 2017;20:257-62. - PubMed
Ko 2015 {published data only}
    1. Ko HY, Kang SM, Kim HE, Kwon HK, Kim BI. Validation of quantitative light-induced fluorescence-digital (QLF-D) for the detection of approximal caries in vitro. Journal of Dentistry 2015;43(5):568-75. - PubMed
Kockanat 2017 {published data only}
    1. Kockanat A, Unal M. In vivo and in vitro comparison of ICDAS II, DIAGNOdent pen, CarieScan PRO and SoproLife camera for occlusal caries detection in primary molar teeth. European Journal of Paediatric Dentistry 2017;18(2):99-104. - PubMed
Kouchaji 2012 {published data only}
    1. Kouchaji C. Comparison between a laser fluorescence device and visual examination in the detection of occlusal caries in children. Saudi Dental Journal 2012;24(3-4):169-74. - PMC - PubMed
Krause 2007 {published data only}
    1. Krause F, Jepsen S, Braun A. Comparison of two laser fluorescence devices for the detection of occlusal caries in vivo. European Journal of Oral Sciences 2007;115(4):252-6. - PubMed
Kucukyilmaz 2015 {published data only}
    1. Kucukyilmaz E, Sener Y, Botsali MS. In vivo and in vitro performance of conventional methods, DIAGNOdent, and an electronic caries monitor for occlusal caries detection in primary teeth. Pediatric Dentistry 2015;37(4):E14-22. - PubMed
Kuhnisch 2006 {published data only}
    1. Kuhnisch J, Ifland S, Tranaeus S, Angmar-Mansson B, Hickel R, Stosser L, et al. Establishing quantitative light-induced fluorescence cut-offs for the detection of occlusal dentine lesions. European Journal of Oral Sciences 2006;114(6):483-8. - PubMed
Kuhnisch 2007 {published data only}
    1. Kuhnisch J, Ifland S, Tranaeus S, Hickel R, Stosser L, Heinrich-Weltzien R. In vivo detection of non-cavitated caries lesions on occlusal surfaces by visual inspection and quantitative light-induced fluorescence. Acta Odontologica Scandinavica 2007;65(3):183-8. - PubMed
Kuhnisch 2008 {published data only}
    1. Kuhnisch J, Berger S, Goddon I, Senkel H, Pitts N, Heinrich-Weltzien R. Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements. Community Dentistry and Oral Epidemiology 2008;36(6):475-84. - PubMed
Lee 2018 {published data only}
    1. Lee HS, Kim SK, Park SW, Jong E de Josselin de, Kwon HK, Jeong SH, et al. Caries detection and quantification around stained pits and fissures in occlusal tooth surfaces with fluorescence. Journal of Biomedical Optics 2018;23(9):1-7. - PubMed
Li 2006 {published data only}
    1. Li X, Fan X, Jia SH, Hu DY. Clinical study of use of laser fluorescence for detecting occlusal caries in deciduous teeth. Hua Xi Kou Qiang Yi Xue Za Zhi [West China Journal of Stomatology] 2006;24(1):36-8. - PubMed
Lussi 1999 {published data only}
    1. Lussi A, Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Research 1999;33(4):261-6. - PubMed
Lussi 2001 {published data only}
    1. Lussi A, Megert B, Longbottom C, Reich E, Francescut P. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. European Journal of Oral Sciences 2001;109(1):14-9. - PubMed
Lussi 2003 {published data only}
    1. Lussi A, Francescut P. Performance of conventional and new methods for the detection of occlusal caries in deciduous teeth. Caries Research 2003;37(1):2-7. - PubMed
Lussi 2005 {published data only}
    1. Lussi A, Longbottom C, Gygax M, Braig F. Influence of professional cleaning and drying of occlusal surfaces on laser fluorescence in vivo. Caries Research 2005;39(4):284-6. - PubMed
Lussi 2006 {published data only}
    1. Lussi A, Hack A, Hug I, Heckenberger H, Megert B, Stich H. Detection of approximal caries with a new laser fluorescence device. Caries Research 2006;40(2):97-103. - PubMed
Lussi 2006a {published data only}
    1. Lussi A, Hellwig E. Performance of a new laser fluorescence device for the detection of occlusal caries in vitro. Journal of Dentistry 2006;34(7):467-71. - PubMed
Mansour 2016 {published data only}
    1. Mansour S, Ajdaharian J, Nabelsi T, Chan G, Wilder-Smith P. Comparison of caries diagnostic modalities: a clinical study in 40 subjects. Lasers in Surgery and Medicine 2016;48(10):924-8. - PMC - PubMed
Manton 2007 {published data only}
    1. Manton DJ, Messer LB. The effect of pit and fissure sealants on the detection of occlusal caries in vitro. European Archives of Paediatric Dentistry 2007;8(1):43-8. - PubMed
Markowitz 2013 {published data only}
    1. Markowitz K, Rosenfeld D, Peikes D, Guzy G, Rosivack G. Effect of pit and fissure sealants on caries detection by a fluorescent camera system. Journal of Dentistry 2013;41(7):590-9. - PubMed
Markowitz 2015 {published data only}
    1. Markowitz K, Gutta A, Merdad H E, Guzy G, Rosivack G. In vitro study of the diagnostic performance of the Spectra Caries Detection Aid. Journal of Clinical Dentistry 2015;26(1):17-22. - PubMed
Matos 2011 {published data only}
    1. Matos R, Novaes TF, Braga MM, Siqueira WL, Duarte DA, Mendes FM. Clinical performance of two fluorescence-based methods in detecting occlusal caries lesions in primary teeth. Caries Research 2011;45(3):294-302. - PubMed
Mendes 2005 {published data only}
    1. Mendes FM, Siqueira WL, Mazzitelli JF, Pinheiro SL, Bengtson AL. Performance of DIAGNOdent for detection and quantification of smooth-surface caries in primary teeth. Journal of Dentistry 2005;33(1):79-84. - PubMed
Mendes 2006 {published data only}
    1. Mendes FM, Ganzerla E, Nunes AF, Puig AV, Imparato JC. Use of high-powered magnification to detect occlusal caries in primary teeth. American Journal of Dentistry 2006;19(1):19-22. - PubMed
Mendes 2012 {published data only}
    1. Mendes FM, Novaes TF, Matos R, Bittar DG, Piovesan C, Gimenez T, et al. Radiographic and laser fluorescence methods have no benefits for detecting caries in primary teeth. Caries Research 2012;46(6):536-43. - PubMed
Mepparambath 2014 {published data only}
    1. Mepparambath R, S Bhat S, K Hegde S, Anjana G, Sunil M, Mathew S. Comparison of proximal caries detection in primary teeth between laser fluorescence and bitewing radiography: an in vivo study. Jaypees International Journal of Clinical Pediatric Dentistry 2014;7(3):163-7. - PMC - PubMed
Mortensen 2018 {published data only}
    1. Mortensen D, Hessing-Olsen I, Ekstrand KR, Twetman S. In-vivo performance of impedance spectroscopy, laser fluorescence, and bitewing radiographs for occlusal caries detection. Quintessence International 2018;49(4):293-9. - PubMed
Muller‐Bolla 2017 {published data only}
    1. Muller-Bolla M, Joseph C, Pisapia M, Tramini P, Velly AM, Tassery H. Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents. European Archives of Paediatric Dentistry 2017;18(3):187-95. - PubMed
Neuhaus 2011 {published data only}
    1. Neuhaus KW, Rodrigues JA, Hug I, Stich H, Lussi A. Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars. Clinical Oral Investigations 2011;15(5):635-41. - PubMed
Novaes 2009 {published data only}
    1. Novaes TF, Matos R, Braga MM, Imparato JC, Raggio DP, Mendes FM. Performance of a pen-type laser fluorescence device and conventional methods in detecting approximal caries lesions in primary teeth - in vivo study. Caries Research 2009;43(1):36-42. - PubMed
Novaes 2010 {published data only}
    1. Novaes TF, Matos R, Raggio DP, Imparato JC, Braga MM, Mendes FM. Influence of the discomfort reported by children on the performance of approximal caries detection methods. Caries Research 2010;44(5):465-71. - PubMed
Novaes 2012 {published data only}
    1. Novaes TF, Matos R, Celiberti P, Braga MM, Mendes FM. The influence of interdental spacing on the detection of proximal caries lesions in primary teeth. Brazilian Oral Research 2012;26(4):293-9. - PubMed
Novaes 2012a {published data only}
    1. Novaes TF, Matos R, Gimenez T, Braga MM, DE Benedetto MS, Mendes FM. Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study. International Journal of Paediatric Dentistry 2012;22(6):459-66. - PubMed
Novaes 2016 {published data only}
    1. Novaes TF, Moriyama CM, De Benedetto MS, Kohara EK, Braga MM, Mendes FM. Performance of fluorescence-based methods for detecting and quantifying smooth-surface caries lesions in primary teeth: an in vitro study. International Journal of Paediatric Dentistry 2016;26(1):13-9. - PubMed
Ouellet 2002 {published data only}
    1. Ouellet A, Hondrum SO, Pietz DM. Detection of occlusal carious lesions. General Dentistry 2002;50(4):346-50. - PubMed
Ozsevik 2015 {published data only}
    1. Ozsevik AS, Kararslan ES, Aktan AM, Bozdemir E, Cebe F, Sari F. Effect of different contact materials on approximal caries detection by laser fluorescence and light-emitting diode devices. Photomedicine and Laser Surgery 2015;33(10):492-7. - PubMed
Ozturk 2015 {published data only}
    1. Ozturk E, Sinanoglu A. Histological validation of cone-beam computed tomography versus laser fluorescence and conventional diagnostic methods for occlusal caries detection. Photomedicine and Laser Surgery 2015;33(2):61-8. - PubMed
Paula 2011 {published data only}
    1. De Paula AB, Campos JADB, Diniz MB, Hebling J, Rodrigues JA. In situ and in vitro comparison of laser fluorescence with visual inspection in detecting occlusal caries lesions. Lasers in Medical Science 2011;26:1-5. - PubMed
Pereira 2011 {published data only}
    1. Pereira AC, Eggertsson H, González-Cabezas C, Zero DT, Eckert GJ, Mialhe FL. Quantitative light-induced fluorescence (QLF) in relation to other technologies and conventional methods for detecting occlusal caries in permanent teeth. Brazilian Journal of Oral Sciences 2011;10(1):27-32.
Pinelli 2002 {published data only}
    1. Pinelli C, Campos Serra M, Castro Monteiro Loffredo L. Validity and reproducibility of a laser fluorescence system for detecting the activity of white-spot lesions on free smooth surfaces in vivo. Caries Research 2002;36(1):19-24. - PubMed
Pourhashemi 2009 {published data only}
    1. Pourhashemi SJ, Jafari A, Motahhari P, Panjnoosh M, Kharrazi Fard MJ, Sanati I, et al. An in-vitro comparison of visual inspection, bite-wing radiography, and laser fluorescence methods for the diagnosis of occlusal caries. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2009;27(2):90-3. - PubMed
Presoto 2017 {published data only}
    1. Presoto CD, Trevisan TC, Andrade MC, Dantas AA, Campos JADB, Oliveira-Junior OB. Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries. Revista de Odontologia da UNESP 2017;46(2):109-15.
Rando‐Meirelles 2011 {published data only}
    1. Rando-Meirelles MP, Sousa Mda L. Using laser fluorescence (DIAGNOdent) in surveys for the detection of noncavitated occlusal dentine caries. Community Dental Health 2011;28(1):17-21. - PubMed
Reis 2004 {published data only}
    1. Reis A, Zach VL Jr, Lima AC, Lima Navarro MF, Grande RH. Occlusal caries detection: a comparison of DIAGNOdent and two conventional diagnostic methods. Journal of Clinical Dentistry 2004;15(3):76-82. - PubMed
Reis 2006 {published data only}
    1. Reis A, Mendes FM, Angnes V, Angnes G, Grande RH, Loguercio AD. Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions. Journal of Dentistry 2006;34(2):89-96. - PubMed
Ribeiro 2015 {published data only}
    1. Ribeiro AA, Purger F, Rodrigues JA, Oliveira PR, Lussi A, Monteiro AH, et al. Influence of contact points on the performance of caries detection methods in approximal surfaces of primary molars: an in vivo study. Caries Research 2015;49(2):99-108. - PubMed
Rocha 2003 {published data only}
    1. Rocha RO, Ardenghi TM, Oliveira LB, Rodrigues CR, Ciamponi AL. In vivo effectiveness of laser fluorescence compared to visual inspection and radiography for the detection of occlusal caries in primary teeth. Caries Research 2003;37(6):437-41. - PubMed
Rocha‐Cabral 2008 {published data only}
    1. Rocha-Cabral RM, Mendes FM, Miura F, Ribeiro Ada C, Braga MM, Zezell DM. Autoclaving and battery capacity influence on laser fluorescence measurements. Acta Odontologica Scandinavica 2008;66(2):122-7. - PubMed
Rodrigues 2008 {published data only}
    1. Rodrigues JA, Hug I, Diniz MB, Lussi A. Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Research 2008;42(4):297-304. - PubMed
Rodrigues 2009 {published data only}
    1. Rodrigues JA, Diniz MB, Josgrilberg EB, Cordeiro RC. In vitro comparison of laser fluorescence performance with visual examination for detection of occlusal caries in permanent and primary molars. Lasers in Medical Science 2009;24(4):501-6. - PubMed
Rodrigues 2011 {published data only}
    1. Rodrigues JA, Hug I, Neuhaus KW, Lussi A. Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries. Journal of Biomedical Optics 2011;16(10):107003. - PubMed
Seremidi 2012 {published data only}
    1. Seremidi K, Lagouvardos P, Kavvadia K. Comparative in vitro validation of VistaProof and DIAGNOdent pen for occlusal caries detection in permanent teeth. Operative Dentistry 2012;37(3):234-45. - PubMed
Sheehy 2001 {published data only}
    1. Sheehy EC, Brailsford SR, Kidd EA, Beighton D, Zoitopoulos L. Comparison between visual examination and a laser fluorescence system for in vivo diagnosis of occlusal caries. Caries Research 2001;35:421-6. - PubMed
Shi 2000 {published data only}
    1. Shi XQ, Welander U, Angmar-Mansson B. Occlusal caries detection with KaVo DIAGNOdent and radiography: an in vitro comparison. Caries Research 2000;34:151-8. - PubMed
Shwetha 2017 {published data only}
    1. Shwetha G, Chandra P, Anandakrishna L, Dhananjaya G, Shetty AK, Kamath PS. Validation of different diagnostic aids in detection of occlusal caries in primary molars: an in vitro study. Journal of the Indian Society of Pedodontics and Preventive Dentistry 2017;35(4):301-6. - PubMed
Sinanoglu 2014 {published data only}
    1. Sinanoglu A, Ozturk E, Ozel E. Diagnosis of occlusal caries using laser fluorescence versus conventional methods in permanent posterior teeth: a clinical study. Photomedicine and Laser Surgery 2014;32(3):130-7. - PubMed
Souza 2013 {published data only}
    1. Souza JF, Boldieri T, Diniz MB, Rodrigues JA, Lussi A, Cordeiro RC. Traditional and novel methods for occlusal caries detection: performance on primary teeth. Lasers in Medical Science 2013;28:287-95. - PubMed
Souza 2014 {published data only}
    1. Souza JF, Diniz MB, Boldieri T, Rodrigues JA, Lussi A, Cassia Loiola Cordeiro R. In vitro performance of a pen-type laser fluorescence device and bitewing radiographs for approximal caries detection in permanent and primary teeth. Indian Journal of Dental Research 2014;25(6):702-10. - PubMed
Souza 2018 {published data only}
    1. Souza LA, Cancio V, Tostes MA. Accuracy of pen-type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth - an in vivo study. International Journal of Paediatric Dentistry 2018;28(5):472-80. - PubMed
Sridhar 2009 {published data only}
    1. Sridhar N, Tandon S, Rao N. A comparative evaluation of DIAGNOdent with visual and radiography for detection of occlusal caries: an in vitro study. Indian Journal of Dental Research 2009;20:326-31. - PubMed
Teo 2014 {published data only}
    1. Teo TK, Ashley PF, Louca C. An in vivo and in vitro investigation of the use of ICDAS, DIAGNOdent pen and CarieScan PRO for the detection and assessment of occlusal caries in primary molar teeth. Clinical Oral Investigations 2014;18(3):737-44. - PubMed
Tonioli 2002 {published data only}
    1. Tonioli MB, Bouschlicher MR, Hillis SL. Laser fluorescence detection of occlusal caries. American Journal of Dentistry 2002;15:268-73. - PubMed
Tonkaboni 2018 {published data only}
    1. Tonkaboni A, Saffarpour A, Aghapourzangeneh F, Fard MJK. Comparison of diagnostic effects of infrared imaging and bitewing radiography in proximal caries of permanent teeth. Lasers in Medical Science 2018;34(5):873-9. - PubMed
Umemori 2010 {published data only}
    1. Umemori S, Tonami K, Nitta H, Mataki S, Araki K. The possibility of digital imaging in the diagnosis of occlusal caries. International Journal of Dentistry 2010;2010:860515. - PMC - PubMed
Valera 2008 {published data only}
    1. Valera FB, Pessan JP, Valera R, Mondelli J, Percinoto C. Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces. American Journal of Dentistry 2008;21:25-9. - PubMed
Van Hilsen 2013 {published data only}
    1. Van Hilsen Z, Jones RS. Comparing potential early caries assessment methods for teledentistry. BMC Oral Health 2013;13:16. - PMC - PubMed
Virajsilp 2005 {published data only}
    1. Virajsilp V, Thearmontree A, Aryatawong S, Paiboonwarachat D. Comparison of proximal caries detection in primary teeth between laser fluorescence and bitewing radiography. Pediatric Dentistry 2005;27:493-9. - PubMed
Yoon 2017 {published data only}
    1. Yoon HI, Yoo MJ, Park EJ. Detection of proximal caries using quantitative light-induced fluorescence-digital and laser fluorescence: a comparative study. Journal of Advanced Prosthodontics 2017;9(6):432-8. - PMC - PubMed
Zeitouny 2014 {published data only}
    1. Zeitouny M, Feghali M, Nasr A, Abou-Samra P, Saleh N, Bourgeois D, et al. SOPROLIFE system: an accurate diagnostic enhancer. Scientific World Journal 2014;2014:924741. - PMC - PubMed

References to studies excluded from this review

Abalos 2009 {published data only}
    1. Abalos C, Herrera M, Jimenez-Planas A, Llamas R. Performance of laser fluorescence for detection of occlusal dentinal caries lesions in permanent molars: an in vivo study with total validation of the sample. Caries Research 2009;43:137-41. - PubMed
Abalos 2012 {published data only}
    1. Abalos C, Mendoza A, Jimenez-Planas A, Guerrero E, Chaparro A, Garcia-Godoy F. Performance of laser fluorescence for the detection of enamel caries in non-cavitated occlusal surfaces: clinical study with total validation of the sample. American Journal of Dentistry 2012;25:44-8. - PubMed
Abou 2016 {published data only}
    1. Abou Nader C, Pellen F, Loutfi H, Mansour R, Le Jeune B, Le Brun G, et al. Early diagnosis of teeth erosion using polarized laser speckle imaging. Journal of Biomedical Optics 2016;21:71103. - PubMed
Abrams 2017 {published data only}
    1. Abrams TE, Abrams SH, Sivagurunathan KS, Silvertown JD, Hellen WMP, Elman GI, et al. In vitro detection of caries around amalgam restorations using four different modalities. Open Dentistry Journal 2017;11:609. - PMC - PubMed
Amaechi 2013 {published data only}
    1. Amaechi BT, Chedjieu I, Lozano-Pineda J. Clinical evaluation of an enhanced white light and fluorescence device for early detection of caries lesions. Journal of Clinical Dentistry 2013;24:43-8. - PubMed
Anttonen 2004 {published data only}
    1. Anttonen V, Seppa L, Hausen H. A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children. Community Dentistry and Oral Epidemiology 2004;32:312-8. - PubMed
Askaroglou 2011 {published data only}
    1. Askaroglou E, Kavvadia K, Lagouvardos P, Papagiannoulis L. Effect of sealants on laser fluorescence caries detection in primary teeth. Lasers in Medical Science 2011;26:29-34. - PubMed
Betrisey 2014 {published data only}
    1. Betrisey E, Rizcalla N, Krejci I, Ardu S. Caries diagnosis using light fluorescence devices: vistaProof and DIAGNOdent. Odontology 2014;102(2):330-5. - PubMed
Blazejewska 2016 {published data only}
    1. Blazejewska A, Dacyna N, Niesiobedzki P, Trzaska M, Gozdowski D, Turska-Szybka A, et al. Comparison of the detection of proximal caries in children and youth using DIAGNOcam and bitewing radiovisiography. Dental and Medical Problems 2016;53:468-75.
Diniz 2016 {published data only}
    1. Diniz MB, Cordeiro RC, Ferreira-Zandona AG. Detection of caries around amalgam restorations on approximal surfaces. Operative Dentistry 2016;41:34-43. - PubMed
Gomez 2013 {published data only}
    1. Gomez J, Zakian C, Salsone S, Pinto SC, Taylor A, Pretty IA, et al. In vitro performance of different methods in detecting occlusal caries lesions. Journal of Dentistry 2013;41(2):180-6. - PubMed
Heinrich‐Weltzien 2005 {published data only}
    1. Heinrich-Weltzien R, Kuhnisch J, Ifland S, Tranaeus S, Angmar-Mansson B, Stosser L. Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: an in vivo comparison. European Journal of Oral Sciences 2005;113(6):494-8. - PubMed
Holtzman 2014 {published data only}
    1. Holtzman JS, Ballantine J, Fontana M, Wang A, Calantog A, Benavides E, et al. Assessment of early occlusal caries pre- and post-sealant application - an imaging approach. Lasers in Surgery and Medicine 2014;46(6):499-507. - PMC - PubMed
Jablonski‐Momeni 2011a {published data only}
    1. Jablonski-Momeni A, Ricketts DN, Rolfsen S, Stoll R, Heinzel-Gutenbrunner M, Stachniss V, et al. Performance of laser fluorescence at tooth surface and histological section. Lasers in Medical Science 2011;26:171-8. - PubMed
Jablonski‐Momeni 2013 {published data only}
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