David Ricketts1. 1. Department of Restorative Dentistry, Dundee Dental Hospital, Dundee, UK.
Abstract
DATA SOURCES: Medline (1999-June 2004) provided the primary data source with references from one paper being reviewed for additional studies. The authors of one article were contacted for additional details. STUDY SELECTION: Articles, in English that assessed a commercially available caries detection device the DIAGNOdent (KaVo Dental GmbH Biberach), used human teeth with and without caries, and expressed diagnostic performance in terms of sensitivity and specificity of caries detection against a histological gold standard were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted to determine whether articles included: an appropriate study population; an adequate description of the test; an appropriate reference standard; a blinded comparison of test and reference samples and avoidance of verification bias. No quality score was assigned. RESULTS: Of the 25 studies identified, 16 assessed the in vitro performance of DIAGNOdent (DD) on occlusal surfaces of primary and permanent posterior teeth, four reported similar in vivo assessments, two examined DD performance on smooth surfaces and the final three addressed detection of secondary caries and residual caries in simulated cavities. DD sensitivity scores for in vitro detection of occlusal dentinal caries ranged from 0.19 to 1.0 (n=16) with 14 of the 16 results being >/=0.73. Specificity values ranged from 0.52 to 1.00. DD tended to show higher sensitivity but lower specificity than visual assessment methods. Only four studies considered DD in vivo performance and demonstrated sensitivity from 0.73 to 0.96 and specificity from 0.63 to 0.95. CONCLUSIONS: In the limited studies available DD demonstrated greater sensitivity but poorer specificity than visual caries diagnosis. Combined with the fact that little in vivo evidence is available for DD performance, the greater number of false-positive diagnoses suggest it should not be relied on as a clinician's primary diagnostic method.
DATA SOURCES: Medline (1999-June 2004) provided the primary data source with references from one paper being reviewed for additional studies. The authors of one article were contacted for additional details. STUDY SELECTION: Articles, in English that assessed a commercially available caries detection device the DIAGNOdent (KaVo Dental GmbH Biberach), used human teeth with and without caries, and expressed diagnostic performance in terms of sensitivity and specificity of caries detection against a histological gold standard were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted to determine whether articles included: an appropriate study population; an adequate description of the test; an appropriate reference standard; a blinded comparison of test and reference samples and avoidance of verification bias. No quality score was assigned. RESULTS: Of the 25 studies identified, 16 assessed the in vitro performance of DIAGNOdent (DD) on occlusal surfaces of primary and permanent posterior teeth, four reported similar in vivo assessments, two examined DD performance on smooth surfaces and the final three addressed detection of secondary caries and residual caries in simulated cavities. DD sensitivity scores for in vitro detection of occlusal dentinal caries ranged from 0.19 to 1.0 (n=16) with 14 of the 16 results being >/=0.73. Specificity values ranged from 0.52 to 1.00. DD tended to show higher sensitivity but lower specificity than visual assessment methods. Only four studies considered DD in vivo performance and demonstrated sensitivity from 0.73 to 0.96 and specificity from 0.63 to 0.95. CONCLUSIONS: In the limited studies available DD demonstrated greater sensitivity but poorer specificity than visual caries diagnosis. Combined with the fact that little in vivo evidence is available for DD performance, the greater number of false-positive diagnoses suggest it should not be relied on as a clinician's primary diagnostic method.