Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Sao Paulo, Brazil.
Graduate Program in Dentistry, Ibirapuera University, Sao Paulo, Brazil.
Community Dent Oral Epidemiol. 2021 Jun;49(3):216-224. doi: 10.1111/cdoe.12641. Epub 2021 Apr 12.
To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface.
Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken.
Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings.
Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.
对不同方法检测恒牙和乳牙龋损的性能进行系统评价和荟萃分析，考虑所有类型的牙面。
两名评审员检索了 PubMed、Embase、Scopus 等数据库，截至 2020 年 11 月，以查找英文发表和未发表的研究。我们主要关注三种龋病检测方法：肉眼检查（VI）、放射线照相（RX）和荧光检测（LF）。我们纳入了至少评估以下方法之一的研究：（a）评估该方法检测龋损的准确性；（b）考虑乳牙或恒牙的咬合面、近中面或自由光滑面；（c）使用除三种方法之一以外的参考标准；（d）报告样本量和准确性数据。进行了多水平分析、meta 回归和双变量汇总受试者工作特征曲线的比较。
从最初确定的 14129 篇文章中筛选出 240 篇符合纳入标准的文章。VI 在所有龋损阈值下对咬合面，以及仅在实验室环境下所有病变阈值下对恒牙近中面的检测均优于 RX。LF 在临床环境下对恒牙咬合面的进展性病变，以及在实验室环境下对所有恒牙近中面病变的检测，均略优于 VI。尽管 LF 在实验室环境下对恒牙的进展性咬合面病变的表现略优于 VI，但在所有情况下，后者的特异性均明显高于其他方法。
在日常临床实践中，无论牙齿类型或表面如何，单独使用肉眼龋病检测就足以满足大多数患者的需求。
