Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Aug;25(8):4801-4815.
doi: 10.1007/s00784-021-04024-1. Epub 2021 Jun 14.

Systematic review and meta-analysis of diagnostic methods for occlusal surface caries

Svetlana Kapor  1 , Mila Janjic Rankovic  2 , Yegane Khazaei  1   3 , Alexander Crispin  3 , Ina Schüler  4 , Felix Krause  5 , Adrian Lussi  6   7 , Klaus Neuhaus  8   9 , Florin Eggmann  8 , Stavroula Michou  10 , Kim Ekstrand  10 , Marie-Charlotte Huysmans  11 , Jan Kühnisch  12   13
Affiliations
Meta-Analysis

Systematic review and meta-analysis of diagnostic methods for occlusal surface caries

Svetlana Kapor et al. Clin Oral Investig. 2021 Aug.

Abstract

Aim: This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions.

Materials and methods: A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed.

Results: SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo.

Conclusion: The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds.

Clinical relevance: VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

Keywords: Accuracy; Bitewing radiography; Caries detection; Caries diagnostics; Diagnostic performance; Fibre-optic transillumination; Laser fluorescence measurements; Meta-analysis; Occlusal caries; Pit and fissure caries; Sensitivity; Specificity; Systematic review; Visual examination.

PubMed Disclaimer

Conflict of interest statement

Svetlana Kapor declares that she has no conflicts of interest. Mila Janic Rankovic declares that she has no conflicts of interest. Alexander Crispin declares that he has no conflicts of interest. Yegane Khazaei declares that she has no conflicts of interest. Ina Schüler declares that she has no conflicts of interest. Felix Krause declares that he has no conflicts of interest. Kim Ekstrand declares that he has no conflicts of interest. Stavroula Michou declares that she has no conflicts of interest. Klaus Neuhaus declares that he has no conflicts of interest. Florin Eggmann declares that he has no conflicts of interest. Adrian Lussi declares that he has no conflicts of interest. Marie-Charlotte Huysmans declares that she has no conflicts of interest. Jan Kühnisch declares that he has no conflicts of interest. All applicable international, national and/or institutional recommendations for conducting systematic revisions were followed.

Figures

Fig. 1
Fig. 1
Flow diagram detailing our search and study selection process applied during the systematic literature search (1st step) and study quality assessment (2nd step)
Fig. 2
Fig. 2
RoB graph across included in vivo (A) and in vitro (B) caries diagnostic studies for occlusal surfaces. Item no 1 (patient selection bias) is only available for clinical diagnostic studies
See this image and copyright information in PMC

References

    1. Weerheijm KL, Groen HJ, Bast AJJ, Kieft JA, Eijkman MAJ, Van Amerongen WE. Clinically undetected occlusal dentine caries: a radiographic comparison. Caries Res. 1992;26(4):305–309. doi: 10.1159/000261457. - DOI - PubMed
    1. Weerheijm KL, Kidd EAM, Groen HJ. The effect of fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces. Caries Res. 1997;31(1):30–34. doi: 10.1159/000262370. - DOI - PubMed
    1. Ricketts D, Kidd E, Weerheijm K, de Soet H. Hidden caries: what is it? Does it exist? Does it matter? Int Dent J. 1997;47(5):259–265. doi: 10.1002/j.1875-595x.1997.tb00786.x. - DOI - PubMed
    1. Zadik Y, Bechor R. Hidden Occlusal Caries. NY State Dent J. 2008;74(4):46–50. - PubMed
    1. Kühnisch J, Galler M, Seitz M, Stich H, Lussi A, Hickel R, Bücher K. Irregularities below the enamel-dentin junction may predispose for fissure caries. J Dent Res. 2012;91(11):1066–1070. doi: 10.1177/0022034512458688. - DOI - PubMed