Detection Methods for Early Caries Diagnosis: A Systematic Review and Meta-Analysis

Area of Science:

• Dentistry
• Diagnostic Accuracy
• Caries Detection

Background:

• Early detection of incipient caries is crucial for effective dental treatment.
• Various diagnostic tools exist, but their comparative performance in vivo requires thorough appraisal.

Approach:

• A systematic review and meta-analysis was conducted, searching five databases for diagnostic test accuracy studies on early caries detection from January 2000 to October 2019.
• Inclusion criteria focused on studies of permanent and primary teeth, with risk-of-bias assessment using the QUADAS-2 tool.
• Data extraction and study selection were performed in duplicate, and the review protocol was registered a priori.

Key Points:

• For permanent teeth, occlusal caries detection showed high sensitivity for DIAGNOdent Pen (DD Pen) (0.81-0.89) and ICDAS-II (0.62-1) when histology was the reference.
• For approximal surfaces in permanent teeth, bitewing radiography (BW) demonstrated good sensitivity (0.75-0.83) and specificity (0.6-0.9).
• In primary teeth, DD Pen showed potential for detecting caries across all surfaces, with varying sensitivity and specificity depending on the surface and reference standard.

Conclusions:

• No single diagnostic method is perfect; combining methods with clinical examination is recommended.
• For permanent teeth, visual examination can be enhanced by DIAGNOdent (DD) for occlusal surfaces and BW for approximal surfaces.
• DIAGNOdent Pen (DD Pen) may serve as a valuable supplementary tool for detecting caries in primary teeth on all surfaces.