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

Num-

ber of

obser-

vers

Observer

reliability

Popu-

lation

Type of

lesion and

prevalence

Number of

teeth and

surfaces

Method Com-

parison

method

Outcome

measure

Results

enamel

caries

Results

dentine

caries

Study quality

and relevance

Comments

Bamzahim

et al

2004 [45]

Sweden

In vitro 5

No infor-

mation

Extrac-

ted teeth

with

restora-

tions

Secondary

caries,

amalgam

with caries

24/48 (50%),

tooth-

coloured

restorations

with caries

10/18 (56%)

66 teeth, 48

with amalgam

(32 molars, 16

premolars; 28

class I restora-

tions, 11 class II

restorations).

18 with tooth-

coloured

restorations

(13 molars, 5

premolars; 7

class I restora-

tions, 11 class II

restorations)

Clinical

inspection

after remo-

val of the

restoration,

joint deci-

sion by 2

observers

Se, Sp,

AUC,

logistic

regression

BW

Se: 65%

Sp: 81%

Low

No reliability

test. Insuf-

ficient descrip-

tion of material

and methods

No comment

of the possible

“hiding” of the

lesion by the

restorations

Bamzahim

et al

2005 [46]

Sweden

In vivo

majo-

rity

scores

Posterior

teeth

with

amalgam

resto-

rations,

preval-

ence

according

to gold

standard

25/51

(49%)

Secondary

caries

21 patients

(19–45 yrs), 51

restorations.

Location of

caries not spe-

cified and that

is crucial point

Clinical

inspection

after remo-

val of the

restoration,

joint deci-

sion by 2

observers

Se, Sp

Radiography

(gold standard:

caries visually

and tactile

consistency)

Se: 56%

Sp: 92%

Low

Few subjects/

teeth. No relia-

bility test

No comment

of “hiding” of

the lesion by

radiopaque

restoration

(amalgam)

Grossman

et al

2002 [47]

South

Africa,

Brazil,

Canada

In vitro 4

Repeated

diagnosis,

but no

informa-

tion about

reliability

Extrac-

ted teeth

Occlusal

caries,

36/139 (26%)

in enamel,

44 (32%) in

dentine

139 occlusal

surfaces

Histology,

kappa 0.82

Se, Sp,

PPV, NPV

Enamel

diagnosis

Se: 26%

Sp: 93%

PPV: 0.82

NPV: 0.53

Dentine

diagnosis

Se: 38%

Sp: 93%

PPV: 0.76

NPV: 0.74

Low

No reliability

test. Insuf-

ficient descrip-

tion of material

and methods

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

146

Haak et al

2003 [48]

Germany

In vitro 5

Extrac-

ted teeth

Approxi-

mal caries,

94/320

(29%) in

enamel, 119

(37%) in

dentine

160 teeth

320 surfaces

dBW

Histology

AUC,

Se, Sp

All caries

Se: 38%

Sp: 93%

Se: 33%

Sp: 95%

Low

No reliability

test. Insufficient

description of

material and

methods

Huysmans

et al

1997 [49]

The

Nether-

lands,

Denmark

In vitro 3

Extrac-

ted

teeth,

cuspids,

premo-

lars and

molars

(mainly

3rd

molars)

Occlusal

caries 20/189

(11%) outer

1/2 enamel,

32 (17%)

inner 1/2, 64

(34%) outer

1/2 dentine,

40 (21%)

inner 1/2

189 occlusal

surfaces

dBW

Histology

Se, Sp,

AUC and

others

All caries. Values from set V

(highest exposure)

Se: 90%

Sp: 94%

Low

No reliability

test. Not

representative

teeth (eg 3rd

molars)

Huysmans

et al

1997 [49]

The

Nether-

lands,

Denmark

In vitro 3

Extrac-

ted

teeth,

cuspids,

premo-

lars and

molars

(mainly

3rd

molars)

Approximal

caries 74/410

(18%) outer

1/2 enamel,

35 (9%)

inner 1/2, 37

(9%) outer

1/2 dentine,

3 (1%) inner

1/2

220 teeth

410 approximal

surfaces

dBW

Histology

Se, Sp,

AUC and

others

All caries

Se: 33%

Sp: 95%

Low

No reliability

test. Not

representative

teeth (eg 3rd

molars)

Lazarchik

et al

1995 [50]*

USA,

Switzerland

In vitro 44 (3

groups:

fresh-

man

dental

stu-

dents,

senior

dental

stu-

dents

and 15

faculty)

Kappa

inter-obs

(?) 0.24,

0.38, 0,53

respect-

ively for

the 3

groups

Extrac-

ted

premo-

lars and

molars

Occlusal

caries, 79%

with caries,

67% with

dentine

caries

100 teeth

Histology

Se, Sp,

kappa,

accuracy

Freshman

Se: 68%

Sp: 57%

Senior

Se: 69%

Sp: 58%

Faculty

Se: 58%

Sp: 79%

Low

Some obser-

vers were

unexperienced

(students).

Insufficient

description

of material

and methods

Table 4.2.3 continued

147

K A P I T E L 4 • d I A g n o s T I K

Haak et al

2003 [48]

Germany

In vitro 5

Extrac-

ted teeth

Approxi-

mal caries,

94/320

(29%) in

enamel, 119

(37%) in

dentine

160 teeth

320 surfaces

dBW

Histology

AUC,

Se, Sp

All caries

Se: 38%

Sp: 93%

Se: 33%

Sp: 95%

Low

No reliability

test. Insufficient

description of

material and

methods

Huysmans

et al

1997 [49]

The

Nether-

lands,

Denmark

In vitro 3

Extrac-

ted

teeth,

cuspids,

premo-

lars and

molars

(mainly

3rd

molars)

Occlusal

caries 20/189

(11%) outer

1/2 enamel,

32 (17%)

inner 1/2, 64

(34%) outer

1/2 dentine,

40 (21%)

inner 1/2

189 occlusal

surfaces

dBW

Histology

Se, Sp,

AUC and

others

All caries. Values from set V

(highest exposure)

Se: 90%

Sp: 94%

Low

No reliability

test. Not

representative

teeth (eg 3rd

molars)

Huysmans

et al

1997 [49]

The

Nether-

lands,

Denmark

In vitro 3

Extrac-

ted

teeth,

cuspids,

premo-

lars and

molars

(mainly

3rd

molars)

Approximal

caries 74/410

(18%) outer

1/2 enamel,

35 (9%)

inner 1/2, 37

(9%) outer

1/2 dentine,

3 (1%) inner

1/2

220 teeth

410 approximal

surfaces

dBW

Histology

Se, Sp,

AUC and

others

All caries

Se: 33%

Sp: 95%

Low

No reliability

test. Not

representative

teeth (eg 3rd

molars)

Lazarchik

et al

1995 [50]*

USA,

Switzerland

In vitro 44 (3

groups:

fresh-

man

dental

stu-

dents,

senior

dental

stu-

dents

and 15

faculty)

Kappa

inter-obs

(?) 0.24,

0.38, 0,53

respect-

ively for

the 3

groups

Extrac-

ted

premo-

lars and

molars

Occlusal

caries, 79%

with caries,

67% with

dentine

caries

100 teeth

Histology

Se, Sp,

kappa,

accuracy

Freshman

Se: 68%

Sp: 57%

Senior

Se: 69%

Sp: 58%

Faculty

Se: 58%

Sp: 79%

Low

Some obser-

vers were

unexperienced

(students).

Insufficient

description

of material

and methods

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

148

Lussi et al

2003 [51]

Switzerland

In vitro 3

Extrac-

ted

primary

teeth

Occlusal

caries, den-

tine caries

17/95 (18%)

95 teeth and

correspon-

ding occlusal

surfaces

Histology

Se, Sp

Dentine caries

Se: 88%

Sp: 71%

Low

No reliability

test

Lussi et al

2006 [52]

Switzer-

land,

Germany

In vitro 5

No infor-

mation

regarding

From a

pool of

extrac-

ted

human

molars

Approximal

caries, pre-

valence not

given nor can

be calculated

75 molars

150 surfaces

(20 (13%) d1,

32 (21%) d2, 37

(25%) d3+d4)

Grinding

procedure

(“histo-

logy”)

Se, Sp,

LR+

d1

Se: 68%

Sp: 67%

d2

Se: 46%

Sp: 81%

d3

Se: 45%

Sp: 89%

Low

No reliability

test

Mejàre et al

1985 [53]*

Sweden

In vivo

Teen-

agers,

mean age

15 yrs,

with one

or more

premo-

lars to be

extracted

Approximal

caries, inci-

pient lesion

(no cavity)

305/598,

manifest

lesion (with

cavity) 28

63 individu-

als with 598

approximal

surfaces

Direct

inspec-

tion after

extraction

2 x 2 table,

ROC

curves

Visually

judged

incipient

Se: 32%

Sp: 96%

Visually judged

manifest

Se: 36%

Sp: 98%

Low

No reliability

test. Uncer-

tain validation.

Results not

separated be-

tween enamel

and dentine

Schulze

et al

2004 [54]

Germany

In vitro 10

Extrac-

ted teeth

Approxi-

mal caries,

78/240

(33%) with

caries. Depth

of caries

in mm. No

distinction

between

enamel/den-

tine caries

120 teeth

(10 molars,

9 premolars,

15 canines,

86 incisors)

240 approximal

surfaces

Histology

(hemisec-

tions)

Se/Sp,

AUC,

LR+, LR–

All caries (all

films pooled)

Se: 47%

Sp: 78%

Low

No results

given for

enamel lesions

only. No relia-

bility test

Svanaes

et al

2000 [28]

Norway

In vitro 9

Extrac-

ted teeth

Approxi-

mal caries,

54/223

(24%) outer

1/2 enamel,

27 (12%)

inner 1/2, 38

(17%) outer

1/2 dentine,

18 (8%)

inner 1/2

120 teeth

(59 premolars,

61 molars)

223 surfaces

BW,

dBW

Histology

Se, Sp,

AUC

All caries BW

Se: 48%

Sp: 94%

All caries

dBW

Se: 61%

Sp: 86%

Low

No reliability

test. Results

not separa-

ted between

enamel and

dentine

Table 4.2.3 continued

149

K A P I T E L 4 • d I A g n o s T I K

Lussi et al

2003 [51]

Switzerland

In vitro 3

Extrac-

ted

primary

teeth

Occlusal

caries, den-

tine caries

17/95 (18%)

95 teeth and

correspon-

ding occlusal

surfaces

Histology

Se, Sp

Dentine caries

Se: 88%

Sp: 71%

Low

No reliability

test

Lussi et al

2006 [52]

Switzer-

land,

Germany

In vitro 5

No infor-

mation

regarding

From a

pool of

extrac-

ted

human

molars

Approximal

caries, pre-

valence not

given nor can

be calculated

75 molars

150 surfaces

(20 (13%) d1,

32 (21%) d2, 37

(25%) d3+d4)

Grinding

procedure

(“histo-

logy”)

Se, Sp,

LR+

d1

Se: 68%

Sp: 67%

d2

Se: 46%

Sp: 81%

d3

Se: 45%

Sp: 89%

Low

No reliability

test

Mejàre et al

1985 [53]*

Sweden

In vivo

Teen-

agers,

mean age

15 yrs,

with one

or more

premo-

lars to be

extracted

Approximal

caries, inci-

pient lesion

(no cavity)

305/598,

manifest

lesion (with

cavity) 28

63 individu-

als with 598

approximal

surfaces

Direct

inspec-

tion after

extraction

2 x 2 table,

ROC

curves

Visually

judged

incipient

Se: 32%

Sp: 96%

Visually judged

manifest

Se: 36%

Sp: 98%

Low

No reliability

test. Uncer-

tain validation.

Results not

separated be-

tween enamel

and dentine

Schulze

et al

2004 [54]

Germany

In vitro 10

Extrac-

ted teeth

Approxi-

mal caries,

78/240

(33%) with

caries. Depth

of caries

in mm. No

distinction

between

enamel/den-

tine caries

120 teeth

(10 molars,

9 premolars,

15 canines,

86 incisors)

240 approximal

surfaces

Histology

(hemisec-

tions)

Se/Sp,

AUC,

LR+, LR–

All caries (all

films pooled)

Se: 47%

Sp: 78%

Low

No results

given for

enamel lesions

only. No relia-

bility test

Svanaes

et al

2000 [28]

Norway

In vitro 9

Extrac-

ted teeth

Approxi-

mal caries,

54/223

(24%) outer

1/2 enamel,

27 (12%)

inner 1/2, 38

(17%) outer

1/2 dentine,

18 (8%)

inner 1/2

120 teeth

(59 premolars,

61 molars)

223 surfaces

BW,

dBW

Histology

Se, Sp,

AUC

All caries BW

Se: 48%

Sp: 94%

All caries

dBW

Se: 61%

Sp: 86%

Low

No reliability

test. Results

not separa-

ted between

enamel and

dentine

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

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