Radiographic caries detection: A systematic review and meta-analysis.
OBJECTIVE
This systematic review aimed at evaluating the accuracy of radiographic caries detection for different lesions at different locations.


METHODS
Studies reporting on the accuracy (sensitivity/specificity) of radiographic detection of natural primary caries lesions under clinical or in vitro conditions were included. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity and diagnostic odds ratios (DORs) were calculated using random-effects meta-analysis. Analyses were performed separately for occlusal and proximal lesions, with further discrimination between any kind of lesions, dentine lesions, and cavitated lesions.


METHODS
Electronic databases (Medline, Embase, Cochrane Central) and grey literature were systematically searched, complemented by cross-referencing from bibliographies.


METHODS
From 947 identified articles, 442 were analyzed full-text. 117 studies (13,375 teeth, 19,108 surfaces) were included, the majority of them reporting on permanent teeth and having high risk of bias. The detection of any kind (i.e. also initial) lesions had low sensitivities (pooled DOR [95% CI]: 0.24 [0.21/0.26] to 0.42 [0.31/0.34]), but moderate to high specificities (0.70 [0.76/0.84] to 0.97 [0.95/0.98]). For dentine lesions, sensitivities were higher (from 0.36 [0.24/0.49] for proximal to 0.56 [0.53/0.59] for occlusal lesions), and specificities ranged between 0.87 [0.85/0.89] and 0.95 [0.94/0.96]. No studies reported on cavitated occlusal lesions, whilst for cavitated proximal lesions, sensitivities increased above 0.60, whilst sensitivities remained high (above 0.90).


CONCLUSIONS
Radiographic caries detection is highly accurate for cavitated proximal lesions, and seems also suitable to detect dentine caries lesions. For detecting initial lesions, more sensitive methods could be considered in population with high caries risk and prevalence.


CONCLUSIONS
Radiographic caries detection is especially suitable for detecting more advanced caries lesions, and has limited risks for false positive diagnoses. For groups with high caries risk and prevalence, alternative detection methods with higher sensitivity for initial lesions might be considered.
Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany. Electronic address: falk.schwendicke@charite.de.
Falk
F
Schwendicke
Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany. Electronic address: markus.tzschoppe@charite.de.
Markus
M
Tzschoppe
Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany. Electronic address: sebastian.paris@charite.de.
Sebastian
S
Paris
D003731:Dental Caries / Q000000981:diagnostic imaging*; D006801:Humans; D011861:Radiography, Dental / Q000379:methods*; D012680:Sensitivity and Specificity
Bitewing; Caries; Dental; Radiography