Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care
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Author Year, reference Country Type of study Blinding Num- ber of obser- vers Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions No of indivi- duals Number of teeth Drop- out/ missing data Method or tech- nique Com- parison method Out- come meas- ure Results enamel caries Results dentine caries Study quality and relevance Comments Approximal Haak et al 2002 [9] Germany
Validity Yes
14, (7 dentists and 7 dental
stu- dents)
Kappa mean:
0.46 Molars
and pre- molars
33% sound 30%
enamel 37% den-
tine 20 mouth models with 160 teeth, 320 sur-
faces Not
reported VI VIM 4.5 x magni- fication
VI+prism loupe
2 obser- vers,
con- sensus
histology Se, Sp
Se VI: 71%
1 VIM: 63%
VI+prism loupe: 69% Sp VI: 75%
2 VIM: 72%
VI+prism loupe: 70% Se VI: 40%
3 VIM: 35%
VI+prism loupe: 36% Sp VI: 92%
4 VIM: 92%
VI+prism loupe: 92% High Based on 2 x 2 tables in the paper: 1 Se: 85%
(95% CI 80–89)
2 Sp: 83%
(95% CI 74–90)
3 Se: 88%
(95% CI 80–93)
4 Sp: 86%
(95% CI 81–91)
D1 = Enamel caries; 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; DSTM = Dundee selectable threshold method for caries diagnosis; LR = Likelihood ratio; NPV = Negative predictive value; PPV = Positive predictive value; ROC = Receiver operating characteristic; Se = Sensitivity; SEM = Scanning electron microscope; Sp = Specificity; VI = Visual inspection; VIC = Visual inspection camera; VIM = Visual inspection with magnification; VIV = Visual inspection video
99 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 Blinding Num- ber of obser- vers Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions No of indivi- duals Number of teeth Drop- out/ missing data Method or tech- nique Com- parison method Out- come meas- ure Results enamel caries Results dentine caries Study quality and relevance Comments Approximal Haak et al 2002 [9] Germany
Validity Yes
14, (7 dentists and 7 dental
stu- dents)
Kappa mean:
0.46 Molars
and pre- molars
33% sound 30%
enamel 37% den-
tine 20 mouth models with 160 teeth, 320 sur-
faces Not
reported VI VIM 4.5 x magni- fication
VI+prism loupe
2 obser- vers,
con- sensus
histology Se, Sp
Se VI: 71%
1 VIM: 63%
VI+prism loupe: 69% Sp VI: 75%
2 VIM: 72%
VI+prism loupe: 70% Se VI: 40%
3 VIM: 35%
VI+prism loupe: 36% Sp VI: 92%
4 VIM: 92%
VI+prism loupe: 92% High Based on 2 x 2 tables in the paper: 1 Se: 85%
(95% CI 80–89)
2 Sp: 83%
(95% CI 74–90)
3 Se: 88%
(95% CI 80–93)
4 Sp: 86%
(95% CI 81–91)
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 100
Table 4.1.5 Visual inspection, list of included clinical studies of permanent teeth. Studies with high or medium quality and relevance. Author Year, reference Country Type of study Blin- ding Num- ber of obser- vers Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions Num- ber of indivi- duals Num- ber of teeth Drop- out/ missing data Method or tech- nique Com- parison method Outcome measure Results enamel caries Results dentine caries (CI) Study quality and rele- vance Com- ments Clinical studies Occlusal Angnes
et al 2005 [13] Brazil Validity
Partly 2
Inter: 0.67
Adult volun-
teers, 3rd
molars for
extrac- tion
20 (18%) sound
24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 38 subjects, 57 teeth, 110 sites Not reported
VI Hemi-
section, histology Se, Sp, area under the ROC curve – Se: 72% Sp: 84% Medium
Limited to 3rd molars Ie et al 1995 [15] The Nether-
lands Validity
Not repor-
ted 2
Inter: 0.57
5–15 yrs,
patients at a
depart- ment of
paedia- tric den- tistry Not
reported 50 sub-
jects 2 subjects VI Clinical exca-
vation, sound/
enamel, dentine
ROC, Se, Sp, A
z – Se: 4% Sp: 97% Medium
Reis et al 2006 [14] Brazil Validity
Partly 2 Kappa: 0.72 In vivo/ in vitro Intra:
0.56 Inter:
0.51 Adult
volun- teers,
3rd molars
for extrac-
tion 20 (18%) sound 24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 38 subjects, 57 teeth, 110 sites Not reported
VI Hemi-
section, histology Se, Sp, accuracy
Se: 75% Sp: 58%
Accuracy: 0.68
Se: 72% Sp: 84%
Accuracy: 0.72
Medium Same
material as Angnes et al 2005 [13] Approximal Hintze et al 1998 [17] Denmark
Validity Yes
4 Kappa Inter:
0.4–0.5 Dentist
students, hygienist students 7% cavita- ted lesions 53
subjects, 338 sur-
faces 52 sur-
faces VI Separa- tion Se, Sp, PPV, NPV – Se: 34% (20–62) Sp: 98%
(96–99) PPV: 0.56 NPV: 0.96 Medium
Se varied between
12 and 50% A z = Area under a ROC curve; CI = Confidence interval; D1 = Enamel caries; 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;
101 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 Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions Num- ber of indivi- duals Num- ber of teeth Drop- out/ missing data Method or tech- nique Com- parison method Outcome measure Results enamel caries Results dentine caries (CI) Study quality and rele- vance Com- ments Clinical studies Occlusal Angnes
et al 2005 [13] Brazil Validity
Partly 2
Inter: 0.67
Adult volun-
teers, 3rd
molars for
extrac- tion
20 (18%) sound
24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 38 subjects, 57 teeth, 110 sites Not reported
VI Hemi-
section, histology Se, Sp, area under the ROC curve – Se: 72% Sp: 84% Medium
Limited to 3rd molars Ie et al 1995 [15] The Nether-
lands Validity
Not repor-
ted 2
Inter: 0.57
5–15 yrs,
patients at a
depart- ment of
paedia- tric den- tistry Not
reported 50 sub-
jects 2 subjects VI Clinical exca-
vation, sound/
enamel, dentine
ROC, Se, Sp, A
z – Se: 4% Sp: 97% Medium
Reis et al 2006 [14] Brazil Validity
Partly 2 Kappa: 0.72 In vivo/ in vitro Intra:
0.56 Inter:
0.51 Adult
volun- teers,
3rd molars
for extrac-
tion 20 (18%) sound 24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 38 subjects, 57 teeth, 110 sites Not reported
VI Hemi-
section, histology Se, Sp, accuracy
Se: 75% Sp: 58%
Accuracy: 0.68
Se: 72% Sp: 84%
Accuracy: 0.72
Medium Same
material as Angnes et al 2005 [13] Approximal Hintze et al 1998 [17] Denmark
Validity Yes
4 Kappa Inter:
0.4–0.5 Dentist
students, hygienist students 7% cavita- ted lesions 53
subjects, 338 sur-
faces 52 sur-
faces VI Separa- tion Se, Sp, PPV, NPV – Se: 34% (20–62) Sp: 98%
(96–99) PPV: 0.56 NPV: 0.96 Medium
Se varied between
12 and 50% NPV = Negative predictive value; PPV = Positive predictive value; Se = Sensitivity; Sp = Specificity; VI = Visual inspection; VIP = Visual inspection and probing
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 102
Table 4.1.6 Studies with low quality and relevance. Author Year, ref- erence Country Type of study Blin- ding Num- ber of obser- vers Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions Num- ber of indivi- duals Num- ber of teeth Drop- out/ missing data Method or tech- nique Com- parison method Out- come measure Results enamel caries Results dentine caries Study quality and rele- vance Com- ments Grossman et al 2002 [23]
South Africa
Valid- ity
yes 4 Repeated diagno- sis, but reliabi- lity not reported Extracted teeth 59 (42%) sound 36 (26%) enamel 44 (32%) dentine 139
teeth/ surfaces
Not repor-
ted VI Histology Se, Sp, NPV, PPV
Se: 35% Sp: 95%
NPV: 0.58 PPV: 0.90 Se: 48% Sp: 93%
NPV: 0.79 PPV: 0.77 Low Insuf-
ficient descrip-
tion of material and met- hods
Mejàre et al 1985 [16] Sweden Valid-
ity Yes
3 No Premolars, extracted for ortho- dontic reasons, mean age 14 yrs
265 (44%) sound
305 (51%) enamel
28 (5%) dentine
63 subjects, 598 sur- faces
Not repor-
ted VIP
VI (con- sensus
after extrac-
tion) PPV
Se: 32% Sp: 96%
PPV: ~0.43 Se: 36%
Sp: 98% PPV:
~0.50–0.57 Low
No relia- bility test. Clinical evaluation Ouellet et al
2002 [5] Canada
Valid- ity
Not repor-
ted 3 No 3rd molars from a
pool Not
reported 100
teeth Not
repor- ted
VI (2.6 x magnifi-
cation), and
probe Histology and dying by 1 ope- rator Se, Sp
Se: 40% Se: 79%
Low No relia- bility test, insuffi-
cient data reporting Penning et al
1992 [24] The
Nether- lands
Valid- ity
Not repor-
ted 3 No 100 molars from a
pool 1 140
surfaces 992 (87%) sound 148 (13%) >D2 100
teeth Not
repor- ted
VIP Bitewing, consensus by 3 ope- rators on D2-level
Number of: True positive, false posi- tive, true negative, false negative, PPV – Se: 24% Sp: 99% PPV: 0.88 NPV: 0.90 Low
No relia- bility test The table continues on the next page 103 K A P I T E L 4 • d I A g n o s T I K Author Year, ref- erence Country Type of study Blin- ding Num- ber of obser- vers Obser- ver relia- bility Popu- lation Caries preval- ence and type of lesions Num- ber of indivi- duals Num- ber of teeth Drop- out/ missing data Method or tech- nique Com- parison method Out- come measure Results enamel caries Results dentine caries Study quality and rele- vance Com- ments Grossman et al 2002 [23]
South Africa
Valid- ity
yes 4 Repeated diagno- sis, but reliabi- lity not reported Extracted teeth 59 (42%) sound 36 (26%) enamel 44 (32%) dentine 139
teeth/ surfaces
Not repor-
ted VI Histology Se, Sp, NPV, PPV
Se: 35% Sp: 95%
NPV: 0.58 PPV: 0.90 Se: 48% Sp: 93%
NPV: 0.79 PPV: 0.77 Low Insuf-
ficient descrip-
tion of material and met- hods
Mejàre et al 1985 [16] Sweden Valid-
ity Yes
3 No Premolars, extracted for ortho- dontic reasons, mean age 14 yrs
265 (44%) sound
305 (51%) enamel
28 (5%) dentine
63 subjects, 598 sur- faces
Not repor-
ted VIP
VI (con- sensus
after extrac-
tion) PPV
Se: 32% Sp: 96%
PPV: ~0.43 Se: 36%
Sp: 98% PPV:
~0.50–0.57 Low
No relia- bility test. Clinical evaluation Ouellet et al
2002 [5] Canada
Valid- ity
Not repor-
ted 3 No 3rd molars from a
pool Not
reported 100
teeth Not
repor- ted
VI (2.6 x magnifi-
cation), and
probe Histology and dying by 1 ope- rator Se, Sp
Se: 40% Se: 79%
Low No relia- bility test, insuffi-
cient data reporting Penning et al
1992 [24] The
Nether- lands
Valid- ity
Not repor-
ted 3 No 100 molars from a
pool 1 140
surfaces 992 (87%) sound 148 (13%) >D2 100
teeth Not
repor- ted
VIP Bitewing, consensus by 3 ope- rators on D2-level
Number of: True positive, false posi- tive, true negative, false negative, PPV – Se: 24% Sp: 99% PPV: 0.88 NPV: 0.90 Low
No relia- bility test 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 104
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; NPV = Negative predictive value; PPV = Positive predictive value; Se = Sensitivity; Sp = Specificity; VI = Visual inspection; VIP = Visual inspection and probing Table 4.1.6 continued Yüklə 4,3 Mb. Dostları ilə paylaş:
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