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
Verdon-
schot et al
1993 [55]*
The
Nether-
lands,
Denmark
In vitro 4
No infor-
mation
Extrac-
ted 3
molars
from
soldiers
aged
18–20
yrs
Occlusal
caries, 27/81
(27%) no sign
of caries, 26
(32%) small
lesions in
dentine, 28
(35%) large
lesions in
inner dentine
81 teeth
BW
Histology
Se, Sp,
AUC
Se: 61%
Sp: 79%
Low
No reliability
test
Wenzel
et al
1991 [36]*
Denmark,
France
In vitro 4
Extrac-
ted 3rd
molars
without
visible
macro-
scopic
cavitation
from
18–20 yr
old men
Occlusal
caries,
cariesfree
or caries
in enamel
27/81,
dentine
caries 54
81 teeth
dBW &
BW
Histology
True posi-
tive, false
positive,
PPV, NPV,
LR+
CR
Se: 62%
Sp: 85%
PPV: 0.84
NPV: 0.51
DR (RVG,
Trophy)
Se: 66%
Sp: 83%
PPV: 0.83
NPV: 0.51
Low
No reliability
test. Not
representative
teeth (3rd
molars)
Wenzel
et al
2002 [56]
Denmark
In vitro 4
Extrac-
ted teeth
Approxi-
mal caries,
82/363
(23%)
enamel
caries, 55
(15%) den-
tine caries
190 teeth
(146 molars,
31 premolars,
13 canines)
363 approximal
surfaces
dBW
Histology
Se, Sp,
PPV, NPV
All caries
Se: 27%
Sp: 94%
PPV: 0.77
NPV: 0.68
Se: 37%
Sp: 96%
PPV: 0.65
NPV: 0.90
Low
No reliability
test
White et al
1997 [29]*
USA
In vitro 16
Extrac-
ted teeth
Approxi-
mal caries
84/320
(26%) outer
1/2 enamel,
76 (24%)
inner 1/2, 80
(25%) outer
1/2 dentine
80 molars,
80 premolars,
80 canines,
80 incisors
320 surfaces
BW
Histology
(hemisec-
tions)
Se, Sp,
accuracy.
PPV and
NPV for
different
prevalence
examples
Se: 46%
Sp: 76%
Se: 58%
Sp: 94%
Low
No reliability
test
Table 4.2.3 continued
151
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
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
Verdon-
schot et al
1993 [55]*
The
Nether-
lands,
Denmark
In vitro 4
No infor-
mation
Extrac-
ted 3
molars
from
soldiers
aged
18–20
yrs
Occlusal
caries, 27/81
(27%) no sign
of caries, 26
(32%) small
lesions in
dentine, 28
(35%) large
lesions in
inner dentine
81 teeth
BW
Histology
Se, Sp,
AUC
Se: 61%
Sp: 79%
Low
No reliability
test
Wenzel
et al
1991 [36]*
Denmark,
France
In vitro 4
Extrac-
ted 3rd
molars
without
visible
macro-
scopic
cavitation
from
18–20 yr
old men
Occlusal
caries,
cariesfree
or caries
in enamel
27/81,
dentine
caries 54
81 teeth
dBW &
BW
Histology
True posi-
tive, false
positive,
PPV, NPV,
LR+
CR
Se: 62%
Sp: 85%
PPV: 0.84
NPV: 0.51
DR (RVG,
Trophy)
Se: 66%
Sp: 83%
PPV: 0.83
NPV: 0.51
Low
No reliability
test. Not
representative
teeth (3rd
molars)
Wenzel
et al
2002 [56]
Denmark
In vitro 4
Extrac-
ted teeth
Approxi-
mal caries,
82/363
(23%)
enamel
caries, 55
(15%) den-
tine caries
190 teeth
(146 molars,
31 premolars,
13 canines)
363 approximal
surfaces
dBW
Histology
Se, Sp,
PPV, NPV
All caries
Se: 27%
Sp: 94%
PPV: 0.77
NPV: 0.68
Se: 37%
Sp: 96%
PPV: 0.65
NPV: 0.90
Low
No reliability
test
White et al
1997 [29]*
USA
In vitro 16
Extrac-
ted teeth
Approxi-
mal caries
84/320
(26%) outer
1/2 enamel,
76 (24%)
inner 1/2, 80
(25%) outer
1/2 dentine
80 molars,
80 premolars,
80 canines,
80 incisors
320 surfaces
BW
Histology
(hemisec-
tions)
Se, Sp,
accuracy.
PPV and
NPV for
different
prevalence
examples
Se: 46%
Sp: 76%
Se: 58%
Sp: 94%
Low
No reliability
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
152
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
White et al
1997 [29]*
USA
In vitro 16
Extrac-
ted teeth
Approxi-
mal caries
84/320
(26%) outer
1/2 enamel,
76 (24%)
inner 1/2, 80
(25%) outer
1/2 dentine
80 molars,
80 premolars,
80 canines and
80 incisors
320 surfaces
dBW
Histology
(hemisec-
tions)
Se, Sp,
accuracy
PPV
NPV for
different
prevalence
examples
Se: 35%
Sp: 80%
Se: 52%
Sp: 95%
Low
No reliability
test
White et al
2000 [57]
USA
In vitro 12
No
Extrac-
ted teeth
Approximal
caries, 19/80
in outer 1/2
enamel, 21
inner 1/2,
20 outer
1/2 dentine
40 premolars
and 40 molars
80 surfaces
BW
Histology
Se, Sp,
accuracy,
AUC
Se: 40%
Sp: 75%
Se: 61%
Sp: 91%
Low
Wojtowicz
et al
2003 [58]
USA
In vitro 94 stu-
dents
(40
senior
dental
stu-
dents,
54
dental
hygiene
stu-
dents)
Extrac-
ted,
human
premo-
lar and
molar
teeth
Approxi-
mal caries,
10/140
enamel
caries, 3 to
DEJ, 26 in
dentine
96 extracted,
human premo-
lar and molar
teeth, of 140
surfaces
BW
Histology,
scored by 2
observers
indepen-
dently,
consensus
reached
when dis-
agreement
Se, Sp
All caries
(all students
pooled):
Se: 65%
Sp: 81%
Low
Inexperienced
observers
(students). No
results given
for enamel
lesions only.
Few lesions in
enamel. No
reliability test
Table 4.2.3 continued
* Study selected because the paper was included in the review by [23].
AUC = Area under the curve; BW = Bitewing radiographs; d1 = Caries in outer half of
enamel; d2 = Caries in inner half of enamel; d3 = Dentine caries; dBW = Digital bitewing
radiographs; DEJ = Dentine-enamel junction; LR = Likelihood ratio; NPV = Negative
predictive value; PPV = Positive predictive value; ROC = Receiver operating
characteristic; Se = Sensitivity; Sp = Specificity
153
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
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
White et al
1997 [29]*
USA
In vitro 16
Extrac-
ted teeth
Approxi-
mal caries
84/320
(26%) outer
1/2 enamel,
76 (24%)
inner 1/2, 80
(25%) outer
1/2 dentine
80 molars,
80 premolars,
80 canines and
80 incisors
320 surfaces
dBW
Histology
(hemisec-
tions)
Se, Sp,
accuracy
PPV
NPV for
different
prevalence
examples
Se: 35%
Sp: 80%
Se: 52%
Sp: 95%
Low
No reliability
test
White et al
2000 [57]
USA
In vitro 12
No
Extrac-
ted teeth
Approximal
caries, 19/80
in outer 1/2
enamel, 21
inner 1/2,
20 outer
1/2 dentine
40 premolars
and 40 molars
80 surfaces
BW
Histology
Se, Sp,
accuracy,
AUC
Se: 40%
Sp: 75%
Se: 61%
Sp: 91%
Low
Wojtowicz
et al
2003 [58]
USA
In vitro 94 stu-
dents
(40
senior
dental
stu-
dents,
54
dental
hygiene
stu-
dents)
Extrac-
ted,
human
premo-
lar and
molar
teeth
Approxi-
mal caries,
10/140
enamel
caries, 3 to
DEJ, 26 in
dentine
96 extracted,
human premo-
lar and molar
teeth, of 140
surfaces
BW
Histology,
scored by 2
observers
indepen-
dently,
consensus
reached
when dis-
agreement
Se, Sp
All caries
(all students
pooled):
Se: 65%
Sp: 81%
Low
Inexperienced
observers
(students). No
results given
for enamel
lesions only.
Few lesions in
enamel. No
reliability 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
154
Table 4.2.4 Excluded studies in vivo or in vitro, conventional radiography (BW),
digital radiography (dBW), fibre-optic transillumination.
Author, year,
reference
Diagnostic
method
Caries,
dentition
Main reason
for exclusion
Abreu et al, 2001 [59]
BW, dBW
Approximal,
permanent
Outcome measure
not applicable
Anttonen et al, 2003 [60]
BW
Occlusal, both
dentitions
Not validated
Ashley et al, 1998 [42]*
BW, dBW,
ECM, FOTI
Occlusal,
permanent
Less than 3 examiners
Ástvaldsdóttir et al, 2004 [61]
BW
Occlusal,
permanent
Biased selection
Bader et al, 2001 [62]
Not adequate
Bader et al, 2002 [63]
Not adequate
Baysan et al, 2004 [64]
ECM
Root,
permanent
Less than 3 examiners
Burin et al, 2005 [65]
BW
Occlusal,
permanent
Small sample
Caliskan Yanikoglu et al,
2000 [66]
Ultrasound
Approximal
Not validated
Choksi et al, 1994 [67]
BW
Secondary
Not validated
Chong et al, 2003 [68]
BW, dBW
Occlusal
Not validated
Côrtes et al, 2000 [69]
BW, FOTI
Occlusal,
permanent
Small sample
Costa et al, 2002 [70]
BW
Occlusal
Small sample
Dove, 2001 [71]
Not adequate
Erten et al, 2005 [72]
BW, dBW
Approximal,
permanent
Small sample
Espelid et al, 1986 [73]*
BW
Approximal,
permanent
Small sample
Espelid et al, 1991 [74]
BW
Secondary
Pooled diagnoses
for crown and root
Feldens et al, 2003 [75]
BW
Approximal,
primary
Less than 3 examiners
Firestone et al, 1998 [76]*
BW
Approximal,
permanent
Not validated
Fyffe et al, 2000 [77]
BW
Approximal,
permanent
Not validated
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155
K A P I T E L 4 • d I A g n o s T I K
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Author, year,
reference
Diagnostic
method
Caries,
dentition
Main reason
for exclusion
Güngör et al, 2005 [78]
BW
Approximal,
permanent
Small sample
Haak et al, 2001 [79]
BW, dBW
Approximal,
permanent
Not validated
Haak et al, 2005 [80]
dBW
Approximal,
permanent
Outcome measure
not applicable
Heaven et al, 1992 [81]*
BW
Approximal,
permanent
Small sample
Heinrich-Weltzien et al,
2002 [82]
BW
Occlusal,
permanent
Not validated
Hewlett et al, 1993 [83]
BW
Secondary
Not validated
Hintze et al, 1998 [44]*
BW, FOTI
Approximal,
permanent
Uncertain validation
Hintze et al, 2002 [84]
BW, dBW
Combinations
Outcome measure
not applicable
Hintze et al, 2002 [85]
BW, dBW
Combinations
Outcome measure
not applicable
Huysmans et al, 1998 [86]*
BW, ECM
Occlusal,
permanent
Less than 3 examiners
Jacobsen et al, 2004 [87]
dBW
Approximal
Biased selection
Janhom et al, 2002 [88]
dBW
Approximal
Outcome measure
not applicable
Ketley et al, 1993 [89]*
BW
Occlusal,
primary
Less than 3 examiners
Khan et al, 2005 [90]
BW
Approximal,
permanent
Outcome measure
not applicable
Khan et al, 2004 [91]
BW, dBW
Approximal,
permanent
Outcome measure
not applicable
Kidd et al, 1994 [92]
BW
Secondary
Less than 3 examiners
Li et al, 2002 [93]
dBW
Approximal
Outcome measure
not applicable
Ludlow et al, 2001 [94]
BW
Approximal,
permanent
Outcome measure
not applicable
Ludlow et al, 1999 [95]
BW, dBW
Approximal
Outcome measure
not applicable
Table 4.2.4 continued
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156
Table 4.2.4 continued
Author, year,
reference
Diagnostic
method
Caries,
dentition
Main reason
for exclusion
Lussi et al, 1995 [96]*
BW, ECM
Occlusal,
permanent
Small sample, less
than 3 examiners
Matalon et al, 2003 [97]
BW
Approximal,
permanent
Small sample
McGuire et al, 1993 [98]
BW
Secondary
Not validated
Mialhe et al, 2003 [99]
BW
Approximal
Less than 3 examiners
Mileman et al, 2002 [16]
BW
Approximal,
permanent
Reported in another
publication
Mileman et al, 2003 [100]
BW
Approximal
Not adequate
Møystad et al, 2003 [11]
dBW
Approximal
Outcome measure
not applicable
Nair et al, 2001 [101]
BW, dBW
Approximal,
permanent
Small sample
Nytun et al, 1992 [102]*
Combined
VI and BW
Occlusal,
permanent
Small sample
Pabla et al, 2003 [103]
dBW
Approximal,
permanent
Outcome measure
not applicable
Pitts et al, 1992 [104]*
BW
Approximal
Less than 3 examiners
Pretty et al, 2004 [105]
All available
methods
Not adequate
Ramesh et al, 2001 [106]
BW, dBW
Combinations
Not validated
Ratledge et al, 2001 [107]
BW
Approximal,
permanent
Biased selection
Reis et al, 2004 [108]
BW
Occlusal,
permanent
Small sample
Ricketts et al, 1994 [109]*
BW
Occlusal,
permanent
Small sample
Ricketts et al, 1996 [110]*
ECM
Occlusal,
permanent
Small sample
Ricketts et al, 1997 [111]*
ECM
Occlusal,
permanent
Less than 3 examiners
Ricketts et al, 1997 [112]*
ECM
Occlusal,
permanent
Less than 3 examiners
Ricketts et al, 1997 [113]*
ECM
Occlusal,
permanent
Less than 3 examiners
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157
K A P I T E L 4 • d I A g n o s T I K
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