Accuracy of detection methods for secondary caries around direct restorations: a systematic review and meta-analysis

Objective: To evaluate and compare the accuracy of detection methods for the diagnosis of secondary caries around direct restorations in posterior teeth.

Data: Accuracy parameters including sensitivity, specificity, diagnostic odds ratio (DOR), area under curve (AUC), and partial AUC (pAUC) are generated from studies assessing the accuracy of detection methods for secondary caries.

Sources: Publications from PubMed, Web of Science, Scopus, Medline, EMBASE and Cochrane Library databases.

Study selection/results: This review included 25 studies evaluating visual examination (V; n=9), tactile examination (T; n=3), intra-oral radiography (IR; n=14), cone-beam computed tomography (CBCT; n=4), quantitative light-induced fluorescence (QLF; n=4), laser fluorescence (LF; n=8) and digital imaging fiber-optic transillumination (DIFOTI; n=1), and clinical visual examination(V(clinical); n = 2). The pooled sensitivity [95% Confidence Interval, CI] and specificity [95% CI] of laboratory detection methods for secondary caries were 0.60[0.45-0.73] and 0.67[0.53-0.78] for V; 0.31[0.25-0.39] and 0.95[0.78-0.99] for T; 0.59[0.52-0.66] and 0.82[0.75-0.88] for IR; 0.61[0.48-0.73] and 0.82[0.64-0.92] for CBCT; 0.71[0.64-0.78] and 0.51[0.40-0.62] for QLF; 0.57[0.43-0.71] and 0.81[0.76-0.85] for LF; 0.63[0.47-0.76] and 0.95[0.90-0.98] for DIFOTI; and 0.82[0.23-0.99] and 0.77[0.15-0.98] for V(clinical). DOR values [95% CI] of the secondary caries detection methods were V-2.88[2.18-3.80]; T-6.36[1.12-36.28]; IR-6.55[3.44-12.46]; CBCT-6.18[1.42-26.91]; QLF-2.25[1.39-3.63]; LF-4.86[2.40-9.82]; DIFOTI-30.00[11.94-75.36]; V(clinical)-16.66[3.84-72.28], respectively. Respective AUC (pAUC) were V-0.645(0.535); T-0.379(0.315); IR-0.767(0.693); CBCT-0.887(0.820); QLF-0.581(0.633) and LF-0.828(0.590). AUC values were not available for DIFOTI and V(clinical).

Conclusions: Among the seven types of detection method for secondary caries diagnosis, none of the detection methods demonstrate satisfactory accuracy in detecting secondary caries around direct restorations in posterior teeth.

Clinical significance: This systematic review provides insights for the clinician and researcher in selecting the clinical detection method for secondary caries diagnosis and facilitates clinical decision making.