Emerging Technologies for Dentin Caries Detection-A Systematic Review and Meta-Analysis

Abstract

This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination, light-emitting diode devices, optical coherence tomography (OCT), alternating current impedance spectroscopy, fluorescence cameras (FC), photo-thermal radiometry, and modulated luminescence technology. In vivo and in vitro results of such non-ionizing, non-invasive, and non-destructive methods' effectiveness in non-cavitated dentin caries detection are sometimes ambiguous. Following the PRISMA guidelines, 34 relevant research articles published between 2011-2021 were selected. The risk of bias was assessed with a tool tailored for caries diagnostic studies, and subsequent quantitative uni- and bi-variate meta-analysis was carried out in separate sub-groups according to the investigated surface (occlusal/proximal) and study setting (in vivo/in vitro). In spite of the high heterogeneity across the review groups, in vitro studies on LF and FC proved a good diagnostic ability for the occlusal surface, with area under the curve (AUC) of 0.803 (11 studies) and 0.845 (five studies), respectively. OCT studies reported an outstanding performance with an overall AUC = 0.945 (four studies). Promising technologies, such as OCT or FC VistaProof, still need well-designed and well-powered studies to accrue experimental and clinical data for conclusive medical evidence, especially for the proximal surface. Registration: INPLASY202210097.

Keywords: dental caries; diagnosis; laser fluorescence; non-cavitated dentin caries; occlusal caries; optical coherence tomography (OCT); permanent teeth; proximal caries; sensitivity; specificity.

Figure 1

Flow diagram of the study selection process.

Figure 2

Risk of bias assessment for the studies include in meta-analysis: (a) in vivo studies; (b) in vitro studies.

Figure 2

Risk of bias assessment for the studies include in meta-analysis: (a) in vivo studies; (b) in vitro studies.

Figure 3

Univariate summary plots for the three groups of index tests included in the comprehensive bivariate meta-analysis: LF DD pen occlusal, in vitro; FC VistaProof using optimal cut-off, in vitro; OCT overall. (a) Log DOR forest plots and random effects aggregate estimates. (b) Log DOR funnel plots to illustrate the publication bias as patterns of individual studies clustering around the mean effect.

Figure 4

Bivariate summary ROC (sROC) curves for the three groups of index tests included in the comprehensive bivariate meta-analysis: LF DD pen occlusal, in vitro; FC VistaProof using optimal cut-off, in vitro; OCT overall. They also integrate the individual studies’ data in a summary bi-dimensional estimate and show its 95% prediction region.