Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care

Author

Year,  

reference

Country

Type of 

study

Blin-

ding

Num-

ber of 

obser-

vers

Observer 

reliability

Popu-

lation

Caries 

preval-

ence and 

type of 

lesions

Number 

of indi-

viduals

Number 

of teeth  

Drop-

out/

missing 

data

Met-

hod or 

tech-

nique

Com-

parison 

method

Out-

come 

measure

Results 

enamel 

caries

Results  

dentine  

caries

Study 

quality and 

relevance

Comments

Grossman 

et al

2002 [1]

South 

Africa

Validity

Yes

4

Repeated

diagnoses, 

but relia-

bility not 

reported

Extrac-

ted 

teeth

59 (42%)

sound

36 (26%)

enamel 

44 (32%)

dentine

139 teeth/ 

surfaces

Not 

repor-

ted

FOTI

Histology

Kappa: 

82%

Se, Sp

Se: 39%

Sp: 92%

Se: 54%

Sp: 90%

Low

No relia-

bility test

Insufficient

description 

of material 

and methods

Tranæus 

et al

2004 [7]

Sweden

Validity,

relia-

bility

Yes

2

Spearman

Inter

mean: 

0.79

Intra

mean: 

0.86

Adult 

patients 

at a 

dental 

school

0 (0%)

sound

7 (13%)

enamel

16 (31%)

D2

29 (56%)

D3–D4

30 indivi-

duals, 52 

lesions

None

DD, 2

instru-

ments

Clinical 

exca-

vation, 

consen-

sus of 2 

obser-

vers

ANOVA,

correct 

diagnoses, 

Spearman 

correla-

tion

–

Spearman cor-

relation: <0.15

Low

Insuffi-

cient data 

reporting

Tranæus

2004 [7]

Sweden

Validity,

relia-

bility

Yes

2

Spearman

Inter

mean: 

0.83

Intra

mean: 

0.94

Adoles-

cent 

patients 

at a 

public 

dental 

clinic

30 enamel 

smooth 

surface 

caries 

lesions

30 indivi-

duals, 30 

lesions

None

DD, 2

instru-

ments

QLF

Spearman 

correla-

tion

Spear-

man cor-

relation 

mean: 

0.64

–

Low

Not valid-

ated to 

histology

Verdons-

chot et al

1993 [12]

The 

Nether-

lands

Validity

Not 

repor-

ted

4

Not 

reported

Molars

from 

Danish

recruits, 

18–20

yrs

27 (33%)

no sign of 

caries

26 (32%)

small 

lesions in 

dentine

28 (35%)

large 

lesions 

in inner 

dentine

81 teeth

Not 

repor-

ted

ECM

Histo-

logy

Se, Sp, 

AUC

–

Se: 67%

Sp: 82%

Low

No relia-  

bility test

AUC = Area under the curve; D2 = Caries to the enamel-dentine junction;  

D3 = Caries reaching not more than half of the dentine; D4 = Caries reaching more than

half of the dentine; DD = DIAGNOdent; ECM = Electronic caries measurement, electri-

cal conductance measurements; FOTI = Fibre optic transillumination; QLF = Quantitative

light-induced fluorescence; Se = Sensitivity; Sp = Specificity

187

K A P I T E L   4   •   d I A g n o s T I K

Author

Year,  

reference

Country

Type of 

study

Blin-

ding

Num-

ber of 

obser-

vers

Observer 

reliability

Popu-

lation

Caries 

preval-

ence and 

type of 

lesions

Number 

of indi-

viduals

Number 

of teeth  

Drop-

out/

missing 

data

Met-

hod or 

tech-

nique

Com-

parison 

method

Out-

come 

measure

Results 

enamel 

caries

Results  

dentine  

caries

Study 

quality and 

relevance

Comments

Grossman 

et al

2002 [1]

South 

Africa

Validity

Yes

4

Repeated

diagnoses, 

but relia-

bility not 

reported

Extrac-

ted 

teeth

59 (42%)

sound

36 (26%)

enamel 

44 (32%)

dentine

139 teeth/ 

surfaces

Not 

repor-

ted

FOTI

Histology

Kappa: 

82%

Se, Sp

Se: 39%

Sp: 92%

Se: 54%

Sp: 90%

Low

No relia-

bility test

Insufficient

description 

of material 

and methods

Tranæus 

et al

2004 [7]

Sweden

Validity,

relia-

bility

Yes

2

Spearman

Inter

mean: 

0.79

Intra

mean: 

0.86

Adult 

patients 

at a 

dental 

school

0 (0%)

sound

7 (13%)

enamel

16 (31%)

D2

29 (56%)

D3–D4

30 indivi-

duals, 52 

lesions

None

DD, 2

instru-

ments

Clinical 

exca-

vation, 

consen-

sus of 2 

obser-

vers

ANOVA,

correct 

diagnoses, 

Spearman 

correla-

tion

–

Spearman cor-

relation: <0.15

Low

Insuffi-

cient data 

reporting

Tranæus

2004 [7]

Sweden

Validity,

relia-

bility

Yes

2

Spearman

Inter

mean: 

0.83

Intra

mean: 

0.94

Adoles-

cent 

patients 

at a 

public 

dental 

clinic

30 enamel 

smooth 

surface 

caries 

lesions

30 indivi-

duals, 30 

lesions

None

DD, 2

instru-

ments

QLF

Spearman 

correla-

tion

Spear-

man cor-

relation 

mean: 

0.64

–

Low

Not valid-

ated to 

histology

Verdons-

chot et al

1993 [12]

The 

Nether-

lands

Validity

Not 

repor-

ted

4

Not 

reported

Molars

from 

Danish

recruits, 

18–20

yrs

27 (33%)

no sign of 

caries

26 (32%)

small 

lesions in 

dentine

28 (35%)

large 

lesions 

in inner 

dentine

81 teeth

Not 

repor-

ted

ECM

Histo-

logy

Se, Sp, 

AUC

–

Se: 67%

Sp: 82%

Low

No relia-  

bility test

K A R I E S   –   d I A G N O S T I K ,   R I S K B E d ö M N I N G   O C H   I C K E - I N vA S I v   B E H A N d L I N G

188

Table 4.3.7 Excluded studies.

Author, year, reference

Diagnostic 

methods

Caries, type 

Main reason

for exclusion

Aljehani et al, 2004 [15]

LF, QLF

Smooth

Artificial lesions

Alwas-Danowska et al, 2002 [16]

VI, LF

Occlusal

Not validated

Ando et al, 2000 [17]

VI, LF ECM,

QLF

Occlusal

Small sample

Ando et al, 2004 [18]

VI, LF, QLF

Smooth, proximal

Small sample

Anttonen et al, 2003 [59]

VI, LF

Occlusal

1 examiner,  

not validated

Anttonen et al, 2004 [60]

VI, LF

Occlusal

1 examiner

Anttonen et al, 2005 [61]

VI, LF

Occlusal

1 examiner

Ashley et al, 1998 [19]

VI, FOTI,

BW, ECM

Occlusal

<3 examiners

Ashley, 2000 [20]

VI, ECM

Occlusal, primary

<3 examiners

Ástvaldsdóttir et al, 2004 [62]

LF

Occlusal

Small sample

Attrill et al, 2001 [21]

VI, LF BW

Occlusal, primary

<3 examiners

Baysan et al, 2004 [22]

ECM

Root

<3 examiners

Braun et al, 2005 [23]

LF

Occlusal

<3 examiners

Caliskan Yanikoglu et al, 2000 [24]

Ultrasound

Smooth, WSL

Small sample

Chesters et al, 2002 [63]

CE, BW, 

FOTI

All

1 examiner

Chong et al, 2003 [25]

VI, BW, LF

Occlusal

<3 examiners

Cleaton-Jones et al, 2001 [64]

VI, VIP, FOTI Primary

Not validated

Côrtes et al, 2000 [26]

VI, FOTI

Occlusal

Small sample

Côrtes et al, 2003 [27]

VI, FOTI,  

LF, ECM

Occlusal

<3 examiners

Deery et al, 2000 [65]

CE, FOTI,

ECM, TS

All

1 examiner

Fennis-Ie et al, 1998 [66]

VI, FOTI,

ECM

Occlusal

1 examiner

Ferreira Zandoná et al, 1998 [28]

VI, LF

Occlusal

<3 examiners

Gonzáles-Cabezas et al, 2003 [29]

QLF

Secondary

Artificial lesions

Hall et al, 1997 [30]

LF

Smooth

Artificial lesions

Heinrich-Weltzien, 2002 [67]

VI, LF, BW

Occlusal

1 examiner

Heinrich-Weltzien, 2003 [68]

VI, LF

Occlusal

1 examiner

Huysmans et al, 1998 [31]

ECM

Occlusal

<3 examiners

The table continues on the next page

189

K A P I T E L   4   •   d I A g n o s T I K

Author, year, reference

Diagnostic 

methods

Caries, type 

Main reason

for exclusion

Aljehani et al, 2004 [15]

LF, QLF

Smooth

Artificial lesions

Alwas-Danowska et al, 2002 [16]

VI, LF

Occlusal

Not validated

Ando et al, 2000 [17]

VI, LF ECM,

QLF

Occlusal

Small sample

Ando et al, 2004 [18]

VI, LF, QLF

Smooth, proximal

Small sample

Anttonen et al, 2003 [59]

VI, LF

Occlusal

1 examiner,  

not validated

Anttonen et al, 2004 [60]

VI, LF

Occlusal

1 examiner

Anttonen et al, 2005 [61]

VI, LF

Occlusal

1 examiner

Ashley et al, 1998 [19]

VI, FOTI,

BW, ECM

Occlusal

<3 examiners

Ashley, 2000 [20]

VI, ECM

Occlusal, primary

<3 examiners

Ástvaldsdóttir et al, 2004 [62]

LF

Occlusal

Small sample

Attrill et al, 2001 [21]

VI, LF BW

Occlusal, primary

<3 examiners

Baysan et al, 2004 [22]

ECM

Root

<3 examiners

Braun et al, 2005 [23]

LF

Occlusal

<3 examiners

Caliskan Yanikoglu et al, 2000 [24]

Ultrasound

Smooth, WSL

Small sample

Chesters et al, 2002 [63]

CE, BW, 

FOTI

All

1 examiner

Chong et al, 2003 [25]

VI, BW, LF

Occlusal

<3 examiners

Cleaton-Jones et al, 2001 [64]

VI, VIP, FOTI Primary

Not validated

Côrtes et al, 2000 [26]

VI, FOTI

Occlusal

Small sample

Côrtes et al, 2003 [27]

VI, FOTI,  

LF, ECM

Occlusal

<3 examiners

Deery et al, 2000 [65]

CE, FOTI,

ECM, TS

All

1 examiner

Fennis-Ie et al, 1998 [66]

VI, FOTI,

ECM

Occlusal

1 examiner

Ferreira Zandoná et al, 1998 [28]

VI, LF

Occlusal

<3 examiners

Gonzáles-Cabezas et al, 2003 [29]

QLF

Secondary

Artificial lesions

Hall et al, 1997 [30]

LF

Smooth

Artificial lesions

Heinrich-Weltzien, 2002 [67]

VI, LF, BW

Occlusal

1 examiner

Heinrich-Weltzien, 2003 [68]

VI, LF

Occlusal

1 examiner

Huysmans et al, 1998 [31]

ECM

Occlusal

<3 examiners

The table continues on the next page

Author, year, reference

Diagnostic 

methods

Caries, type 

Main reason

for exclusion

Iwami et al, 2003 [32]

LF

Dentine

Small sample

Jeon et al, 2004 [33]

VI, LF, BW

Occlusal

Small sample

Katz et al, 2004 [69]

CE, FOTI,

ECM

All

Not adequate 

for the question

Kordic et al, 2003 [3]

ECM

Occlusal

<3 examiners

Kühnisch et al, 2004 [34]

LF

Occlusal

Not validated

Longbottom et al, 1990 [70]

VI, endo-

scope

Posterior

Small sample, 

one examiner

Lussi et al, 1999 [35]

LF, ECM

Occlusal

<3 examiners

Lussi et al, 2003 [36]

LF

Occlusal, primary

<3 examiners

Lussi et al, 2005 [37]

LF

Occlusal

Small sample

Lussi et al, 2006 [38]

LF

Proximal

<3 examiners

Lussi et al, 1995 [71]

ECM

Occlusal

Small sample

Lussi et al, 2001 [72]

VI, BW, LF

Occlusal

Different  

examiners

Lussi et al, 2005 [73]

LF

Occlusal

3 x 1 examiner

Mialhe et al, 2003 [74]

VI, FOTI,

BW, TS

Proximal

1 examiner

Mendes et al, 2004 [39]

LF

Occlusal, primary

<3 examiners

Mendes et al, 2005 [40]

LF

Occlusal, primary

<3 examiners

Mendes et al, 2006 [41]

VI, VIM,  

LF, BW

Occlusal, primary

<3 examiners

Ouellet et al, 2002 [42]

LF

Occlusal

<3 examiners

Peers et al, 1993 [43]

VI, FOTI,

BW

Proximal

<3 examiners

Pereira et al, 2001 [44]

VI, LF, ECM

Occlusal

<3 examiners

Pinelli et al, 2002 [75]

LF

Smooth

Activity not 

validated

Pretty et al, 2002 [45]

QLF

Occlusal, primary

Artificial lesions

Ricketts et al, 1996 [46]

ECM

Occlusal

Small sample

Ricketts et al, 1997 [47]

VI, ECM

Occlusal

<3 examiners

Ricketts et al, 1997 [48]

ECM

Occlusal

<3 examiners

Ricketts et al, 1997 [49]

ECM

Occlusal

<3 examiners

Table 4.3.7 continued

The table continues on the next page

K A R I E S   –   d I A G N O S T I K ,   R I S K B E d ö M N I N G   O C H   I C K E - I N vA S I v   B E H A N d L I N G

190

Table 4.3.7 continued

Author, year, reference

Diagnostic 

methods

Caries, type 

Main reason

for exclusion

Ricketts et al, 1995 [76]

CE, BW, 

ECM

Occlusal

1 examiner

Ricketts et al, 1995 [77]

VI, BW, ECM Occlusal

1 examiner

Rocha et al, 2003 [4]

VI, BW, LF

Occlusal

Small sample

Rock et al, 1988 [50]

ECM

Occlusal

<3 examiners

Sheehy et al, 2001 [78]

VI, LF

Occlusal

1 examiner

Song et al, 2005 [51]

UVL

All

Endpoint not 

relevant

Souza-Zaroni et al, 2006 [52]

VI, LF, BW

Occlusal

Small sample

Takamori et al, 2001 [53]

LF

Occlusal

<3 examiners

Tetuan et al, 2005 [79]

VI, LF

All

Endpoint not 

applicable

Tonioli et al, 2002 [54]

VI, BW, LF,

CDD

Occlusal

Small sample

Tranæus et al, 2002 [8]

QLF

Smooth

Not validated

Waly, 1995 [80]

CE, FOTI,

BW

Proximal,  

primary

1 examnier

Wenzel et al, 1992 [55]

VI, FOTI,

BW

Occlusal

See Verdonschot

et al 1993 [12]

Versdonschot et al, 1991 [56]

FOTI

Proximal

No original 

study

Wicht et al, 2002 [57]

LF

Root

Incomplete

endpoint  

measure

Virajsilp et al, 2005 [58]

LF, VI

Proximal

<3 examiners

BW = Bitewing radiographs; CDD = Caries detection dye; CE = Clinical examination;  

ECM = Electronic caries measurement; FOTI = Fibre optic transillumination; LF = Laser

fluorescence; QLF = Quantitative light-induced fluorescence; Smooth = Smooth surfaces  

TS = Tooth separation; UVL = Ultraviolet light; VI = Visual inspection; VIP = Visual 

inspection and probing

191

K A P I T E L   4   •   d I A g n o s T I K

1. Grossman ES, Cleaton-Jones PE, Cortes 

DF, Daya NP, Parak RB, Fatti LP, et al. 

Accurate diagnosis of occlusal carious 

lesions – a stereo microscope evaluation of 

clinical diagnosis. SADJ 2002;57:215-20.

2. Hintze H, Wenzel A, Danielsen B, 

Nyvad B. Reliability of visual examination, 

fibre-optic transillumination, and bite-

wing radiography, and reproducibility of 

direct visual examination following tooth 

separation for the identification of cavitated 

carious lesions in contacting approximal 

surfaces. Caries Res 1998;32:204-9.

3. Kordic A, Lussi A, Luder HU. Per-

formance of visual inspection, electrical 

conductance and laser fluorescence in 

detecting occlusal caries in vitro. Schweiz 

Monatsschr Zahnmed 2003;113:852-9.

4. Rocha RO, Ardenghi TM, Oliveira LB, 

Rodrigues CR, Ciamponi AL. In vivo ef-

fectiveness of laser fluorescence compared 

to visual inspection and radiography for 

the detection of occlusal caries in primary 

teeth. Caries Res 2003;37:437-41.

5. Angnes V, Angnes G, Batisttella M, 

Grande RH, Loguercio AD, Reis A. Clinical 

effectiveness of laser fluorescence, visual 

inspection and radiography in the detection 

of occlusal caries. Caries Res 2005;39:490-5.

6. Reis A, Mendes FM, Angnes V, Angnes 

G, Grande RH, Loguercio AD. Perform-

ance of methods of occlusal caries detection 

in permanent teeth under clinical and labo-

ratory conditions. J Dent 2006;34:89-96.

7. Tranaeus S, Lindgren LE, Karlsson L, 

Angmar-Månsson B. In vivo validity and 

reliability of IR fluorescence measurements 

for caries detection and quantification. 

Swed Dent J 2004;28:173-82.

8. Tranaeus S, Shi XQ, Lindgren LE, 

Trollsås K, Angmar-Månsson B. In vivo 

repeatability and reproducibility of the 

quantitative light-induced fluorescence 

method. Caries Res 2002;36:3-9.

9. Ekstrand KR, Ricketts DN, Kidd EA. 

Reproducibility and accuracy of three 

methods for assessment of demineralization 

depth of the occlusal surface: an in vitro 

examination. Caries Res 1997;31:224-31.

10. Ie YL, Verdonschot EH, Schaeken MJ, 

van ’t Hof MA. Electrical conductance of 

fissure enamel in recently erupted molar 

teeth as related to caries status. Caries Res 

1995;29:94-9.

11. Kühnisch J, Heinrich-Weltzien R, 

Tabatabaie M, Stösser L, Huysmans MC. 

An in vitro comparison between two met-

hods of electrical resistance measurement 

for occlusal caries detection. Caries Res 

2006;40:104-11.

12. Verdonschot EH, Wenzel A, Truin 

GJ, Konig KG. Performance of electrical 

resistance measurements adjunct to visual 

inspection in the early diagnosis of occlusal 

caries. J Dent 1993;21:332-7.

13. Longbottom C, Huysmans MC, Pitts 

NB, Los P, Bruce PG. Detection of dental 

decay and its extent using a.c. impedance 

spectroscopy. Nat Med 1996;2:235-7.

14. Fried D, Xie J, Shafi S, Featherstone 

JD, Breunig TM, Le C. Imaging caries 

lesions and lesion progression with polari-

zation sensitive optical coherence tomo-

graphy. J Biomed Opt 2002;7:618-27.

15. Aljehani A, Tranaeus S, Forsberg CM, 

Angmar-Månsson B, Shi XQ. In vitro 

quantification of white spot enamel lesions