Radiographic caries detection: A systematic review and meta-analysis

Area of Science:

• Dental Radiology
• Caries Detection
• Diagnostic Accuracy

Background:

• Accurate detection of dental caries is crucial for timely intervention and treatment planning.
• Radiographic methods are commonly used for caries diagnosis, but their accuracy varies by lesion type and location.
• A systematic review is needed to synthesize existing evidence on the diagnostic performance of radiographic caries detection.

Purpose of the Study:

• To systematically evaluate the accuracy of radiographic caries detection for different types of lesions (initial, dentine, cavitated) at various locations (occlusal, proximal).
• To assess the sensitivity, specificity, and diagnostic odds ratios (DORs) of radiographic methods for caries detection.

Main Methods:

• Systematic literature search of electronic databases (Medline, Embase, Cochrane Central) and grey literature.
• Inclusion of studies reporting accuracy (sensitivity/specificity) of radiographic detection of natural primary caries lesions.
• Meta-analysis of pooled sensitivity, specificity, and DORs using random-effects models, with subgroup analyses for lesion type and location.

Main Results:

• Low pooled sensitivities (0.24-0.42) but moderate to high specificities (0.70-0.97) for detecting any caries lesions (including initial).
• Higher sensitivities (0.36-0.56) and specificities (0.87-0.95) for detecting dentine lesions.
• High accuracy (sensitivity >0.60, specificity >0.90) for detecting cavitated proximal lesions; no studies reported on cavitated occlusal lesions.

Conclusions:

• Radiographic caries detection is highly accurate for cavitated proximal lesions and suitable for detecting dentine caries.
• For initial lesions, particularly in high-caries-risk populations, alternative, more sensitive detection methods may be warranted.
• Radiographic methods offer a low risk of false positive diagnoses, especially for advanced caries lesions.