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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

Verdon- 


schot et al

1993 [25]

The 

Nether-


lands

Valid-


ity, 

relia-


bility

Yes


4

Not 


reported

Molars


from 

Danish


recruits, 

18–20 yrs

27 (33%)

sound +


enamel

26 (32%)

D3

28 (35%)



D4

81 teeth


Not 

repor-


ted

VI

Histology, 



(1 obser-

ver?)


Se, Sp, 

PPV, NPV


Se: 48%


Sp: 89%

At a 67% 

caries pre-

valence

PPV: 0.90

NPV: 0.46

At a 20% 

caries pre-

valence

PPV: 0.53

NPV: 0.46

Low


Wenzel 

et al


1991 [26]

Denmark


Valid-

ity, 


relia-

bility


Yes

8

Not 



reported

Molars and

premolars 

from a 


pool

84 (51%)

sound +

enamel


55 (33%)

D3

27 (16%)



D4

166 


teeth, 

145 


molars, 

21 pre-


molars

Not 


repor-

ted


VI

Histo-


logy, 1 

observer 

validated 

25 of the 

specimens 

twice


PPV, NPV,

LR



PPV mean:

0.85


NPV mean:

0.56


LR mean:

6.50


Low

105

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

Verdon- 


schot et al

1993 [25]

The 

Nether-


lands

Valid-


ity, 

relia-


bility

Yes


4

Not 


reported

Molars


from 

Danish


recruits, 

18–20 yrs

27 (33%)

sound +


enamel

26 (32%)

D3

28 (35%)



D4

81 teeth


Not 

repor-


ted

VI

Histology, 



(1 obser-

ver?)


Se, Sp, 

PPV, NPV


Se: 48%


Sp: 89%

At a 67% 

caries pre-

valence

PPV: 0.90

NPV: 0.46

At a 20% 

caries pre-

valence

PPV: 0.53

NPV: 0.46

Low


Wenzel 

et al


1991 [26]

Denmark


Valid-

ity, 


relia-

bility


Yes

8

Not 



reported

Molars and

premolars 

from a 


pool

84 (51%)

sound +

enamel


55 (33%)

D3

27 (16%)



D4

166 


teeth, 

145 


molars, 

21 pre-


molars

Not 


repor-

ted


VI

Histo-


logy, 1 

observer 

validated 

25 of the 

specimens 

twice


PPV, NPV,

LR



PPV mean:

0.85


NPV mean:

0.56


LR mean:

6.50


Low

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

106


Table 4.1.7 Excluded studies.

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Extracted teeth

Alwas-Danowska et al, 2002 [27] VI, LF

Occlusal

Not validated

Ando et al, 2000 [28]

VI, LF ECM, QLF

Occlusal

Small sample

Ando et al, 2004 [10]

VI, LF, QLF

Smooth 

surfaces, 



proximal

Small sample

Ashley et al, 1998 [29]

VI, FOTI, BW,

ECM

Occlusal


<3 examiners

Ashley, 2000 [30]

VI, ECM

Occlusal, 



primary

<3 examiners

Attrill et al, 2001 [31]

VI, LF, BW

Occlusal, 

primary

<3 examiners

Cayley et al, 1997 [32]

VI+BW

Molars


VI can not be  

separated

Chong et al, 2003 [33]

VI, BW, LF

Occlusal

<3 examiners

Côrtes et al, 2000 [34]

VI, FOTI

Occlusal


Small sample        

Côrtes et al, 2003 [35]

VI, FOTI, LF, ECM

Occlusal


<3 examiners

Ekstrand et al, 1995 [36]

VI

Occlusal


<3 examiners

El-Housseiny et al, 2001 [37]

VI, VIP

Occlusal


Small sample

Erten et al, 2006 [38]

VI, VIM, VI

Camera


Occlusal

Incomplete end-

point measure

Espelid et al, 1991 [11]

VI, BW

Secondary, 



proximal

VI cannot be  

separated  

from BW


Ferreira Zandoná et al, 1998 [39] VI, LF

Occlusal


<3 examiners

Hintze et al, 2003 [40]

VI, BW

Occlusal, 



proximal

<3 examiners

Jeon et al, 2004 [41]

VI, LF, BW

Occlusal


Small sample

Ketley et al, 1993 [42]

VI, BW

Occlusal


<3 examiners

Kidd et al, 2003 [43]

VI

Occlusal, 



proximal

<3 examiners

Mendes et al, 2006 [44]

VI, VIM, LF, BW

Occlusal, 

primary

<3 examiners

The table continues on the next page


107

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



Table 4.1.7 continued

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Peers et al, 1993 [45]

VI, BW, FOTI

Proximal


<3 examiners

Pereira et al, 2001 [46]

VI, LF, ECM

Occlusal


<3 examiners

Reis et al, 2004 [47]

VI

Occlusal


Small sample

Ricketts et al, 1995 [48]

VI

Occlusal


Small sample

Ricketts et al, 1997 [49]

VI, ECM

Occlusal


<3 examiners

Sikri et al, 1991 [50]

VI, BW

Root


<3 examiners

Souza-Zaroni et al, 2006 [51]

VI, LF, BW

Occlusal


Small sample

Thomas et al, 2000 [52]

VIP, VI + dying

Occlusal


Incomplete end-

point measure

Tonioli et al, 2002 [53]

VI, BW, LF, CDD

Occlusal

Small sample

Tveit et al, 1992 [12]

VI

Proximal



Not answering  

the question

Wenzel et al, 1992 [54]

VI, FOTI, BW

Occlusal

See Verdonschot  

et al 1993 [25]

Verdonschot et al, 1991 [55]

VI, BW

Proximal


Small sample

Wicht et al, 2002 [56]

VI

Root


<3 examiners

Virajsilp et al, 2005 [57]

VI, LF

Proximal


<3 examiners

Clinical studies

Amerise et al, 2001 [58]

VI, BW

Occlusal


Not validated

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

Assaf et al, 2004 [62]

CE

All



1 examiner

Banerjee et al, 2000 [63]



Not adequate  



for the question

Bauer et al, 1988 [64]

CE

Root


Not adequate  

for the question

Bjarnason et al, 1996 [65]

CE, BW


Smooth 

surfaces, 

proximal

1 examiner

Chesters et al, 2002 [66]

CE, BW, FOTI

All

1 examiner



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

108


The table continues on the next page

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Cleaton-Jones et al, 2001 [67]

VI, VIP, FOTI

Primary


Not validated

Deery et al, 2000 [68]

CE, FOTI, ECM, TS All

1 examiner

Disney et al, 1992 [69]

CE

All



Not adequate  

for the question

Ekstrand et al, 1998 [70]

CE

Occlusal



Activity not  

validated

Ekstrand et al, 2005 [71]

VI, VIT


Initials

Small sample,  

pilot study

Fennis-Ie et al, 1998 [72]

VI, FOTI, ECM

Occlusal


1 examiner

Fracaro et al, 2001 [73]

CE, BW

Occlusal


Different examiners

Fyffe et al, 2000 [74]

VI

All


Not validated

Galal et al, 1985 [75]

CE, VIP, BW

All


1 examiner

Heinrich-Weltzien, 2002 [76]

VI, LF, BW

Occlusal


1 examiner

Heinrich-Weltzien, 2003 [77]

VI, LF

Occlusal


1 examiner

Katz et al, 2004 [78]

CE, FOTI, ECM

All


Not adequate  

for the question

Longbottom et al, 1990 [79]

VI, endoscope

Posterior

Small sample,  

one examiner

Lunder et al, 1996 [80]

BW

Proximal


1 examiner

Lussi et al, 2001 [81]

VI, BW, LF

Occlusal


Different examiners

Machiulskiene et al, 1999 [82]

CE, BW

Proximal


1 examiner,  

not validated

Machiulskiene et al, 2004 [83]

CE, BW


All

1 examiner,  

not validated

Mialhe et al, 2003 [84]

VI, FOTI, BW, TS

Proximal


1 examiner

Mojon et al, 1995 [85]

CE

Root, crown Not validated



Nyvad et al, 2003 [86]

VI

All   



Does not fulfill

inclusion criteria

Pitts et al, 1992 [87]

CE

Proximal,  



posterior

1 examiner



Table 4.1.7 continued

109

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



Table 4.1.7 continued

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Ratledge et al, 2001 [88]

CE, BW

Proximal


1 examiner

Richardson et al, 1996 [89]

CE, BW

Occlusal,  



proximal

Not validated

Ricketts et al, 1995 [90]

CE, BW, ECM

Occlusal

1 examiner

Ricketts et al, 1995 [91]

VI, BW, ECM

Occlusal

1 examiner

Ricketts et al, 2002 [92]

VI, BW


Occlusal

1 examiner

Rosén et al, 1996 [93]

CE

Crown, root Small sample,  



not validated

Sheehy et al, 2001 [94]

VI, LF

Occlusal


1 examiner

Tetuan et al, 2005 [95]

VI, LF

All


Endpoint not  

applicable

Thompson et al, 2006 [96]

VI

All



1 examiner

Waly, 1995 [97]

CE, FOTI, BW

Proximal,  

primary

1 examiner



Wenzel et al, 1990 [98]

VI, BW, dBW

Occlusal, 

3rd molar

1 examiner for  

each method

Wolwacz et al, 2004 [99]

VI, BW


Occlusal,  

primary


1 examiner

de Vries et al, 1990 [100]

VI, BW

Proximal


Not validated

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

dBW = Digital bitewing radiographs; ECM = Electronic caries measurement, electrical

conductance measurements; FOTI = Fibre optic transillumination; LF = Laser fluores-

cence; QLF = Quantitative light-induced fluorescence; TS = Tooth separation; VI = Visual

inspection; VI Camera = Visual inspection with camera; VIM = Visual inspection with

magnification; 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

110


Tabell 4.1.8 Fördelning av inkluderade studier  

med avseende på typ av studier och tandyta.

Yta/kariestyp

Primära tänder

Extraherade    I munnen

Permanenta tänder

Extraherade       I munnen

På tuggytan

1

1

14



3*

Approximalt



3



2

Aktivitet/progression





Rotytekaries





Sekundärkaries





  

Tabell 4.1.9 Medelvärde (± standardavvikelse) och spridning av redovisade 



utfallsmått vid diagnostik av emalj- och dentinkaries på de bakre tändernas 

tuggytor med hjälp av visuell-taktil undersökning. ”n” anger antalet inkluderade 

undersökningar som ligger till grund för beräkningarna.

Utfallsmått

n

Emaljkaries

n

Dentinkaries

Sensitivitet

6

0,64±0,26 (0,43–1,0)



12

0,44±0,29 (0,10–0,95)

Specificitet

5

0,65±0,21 (0,38–0,92)



11

0,91*±0,09 (0,68–0,99)

PPV

3

0,64± 0,34 (0,29–0,97)



6

0,74±0,22 (0,31–0,97)

NPV

3

0,54±0,48 (0,04–1,0)



6

0,69±0,21 (0,46–0,96)

* Dessa studier baseras på ett och samma material.

* Statistiskt säkerställd skillnad mellan emalj- och dentinkaries (p<0,01, Student’s  

two-tailed t-test; skillnad i medelvärde 0,26, 95% konfidensintervall 0,10–0,42).

NPV = Negativt prediktionsvärde; PPV = Positivt prediktionsvärde

 


111

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



Yta/kariestyp

Primära tänder

Extraherade    I munnen

Permanenta tänder

Extraherade       I munnen

På tuggytan

1

1

14



3*

Approximalt



3



2

Aktivitet/progression





Rotytekaries





Sekundärkaries





  

1. Rocha RO, Ardenghi TM, Oliveira LB, 



Rodrigues CR, Ciamponi AL. In vivo  

effectiveness of laser fluorescence compared 

to visual inspection and radiography for 

the detection of occlusal caries in primary 

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

2. Lussi A, Francescut P. Performance of 

conventional and new methods for the 

detection of occlusal caries in deciduous 

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3. Ekstrand KR, Ricketts DN, Kidd EA. 

Reproducibility and accuracy of three 

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9. Haak R, Wicht MJ, Hellmich M, 

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10. Ando M, González-Cabezas C, Isaacs 

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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

112


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Suliborski S, Verdonschot EH. Reliability 

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Analoui M, Stookey GK. Comparative 

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29. Ashley PF, Blinkhorn AS, Davies RM. 

Occlusal caries diagnosis: an in vitro 

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J Dent 1998;26:83-8.

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ies in primary teeth. Int J Paediatr Dent 

2000;10:166-71.

31. Attrill DC, Ashley PF. Occlusal caries 

detection in primary teeth: a comparison of 

DIAGNOdent with conventional methods. 

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audit on the diagnosis of occlusal caries. 

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113

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

tion compared with conventional  

radiography, digital radiography, and  

Diagnodent in the diagnosis of occlusal 

occult caries in extracted premolars.  

Pediatr Dent 2003;25:341-9.

34. Côrtes DF, Ekstrand KR, Elias- 

Boneta AR, Ellwood RP. An in vitro 

comparison of the ability of fibre-optic 

transillumination, visual inspection and 

radiographs to detect occlusal caries 

and evaluate lesion depth. Caries Res 

2000;34:443-7.

35. Côrtes DF, Ellwood RP, Ekstrand KR. 

An in vitro comparison of a combined 

FOTI/visual examination of occlusal car-

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performance. Caries Res 2003;37:8-16.

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Thylstrup A. Relationship between exter-

nal and histologic features of progressive 

stages of caries in the occlusal fossa. Caries 

Res 1995;29:243-50.

37. El-Housseiny AA, Jamjoum H.  

Evaluation of visual, explorer, and a laser 

device for detection of early occlusal caries. 

J Clin Pediatr Dent 2001;26:41-8.

38. Erten H, Üctasli MB, Akarslan ZZ, 

Uzun O, Semiz M. Restorative treatment 

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