Detection and diagnosis of caries—typically undertaken through a visual-tactile examination, often with supporting radiographic investigations—is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future “real world” context.

龋齿的检测和诊断——通常通过视觉-触觉检查进行，通常辅以放射线检查——通常被认为可以广泛有效地检测已经发展为牙本质并达到需要修复的阈值的龋齿。通过早期检测，有机会稳定疾病甚至使牙齿表面再矿化，最大限度地保留牙齿组织并防止终身修复。我们对不同技术的诊断准确性进行了正式比较分析，以使用已发表的 Cochrane 系统评价来检测和告知早期龋齿的诊断。构成我们比较分析基础的是 5 篇评估荧光的 Cochrane 诊断测试准确性系统评价，视觉或视觉触觉分类系统、成像、透照和光学相干断层扫描以及电导或阻抗技术。可接受的参考标准包括适当的组织学、手术探查或增强的视觉评估（有或没有牙齿分离）。我们根据研究设计进行了 2 项分析：完全研究内、个人内部分析和基于直接和间接比较的网络荟萃分析。19 项研究为完全个人内部分析提供了数据，64 项研究为网络荟萃分析提供了数据。在评估的 5 种技术中，最大的成对差异出现在成像和所有其他技术的汇总灵敏度点中，但汇总特异性点大致相似。对于这两种分析，95% 的宽预测区间表明所有技术未来诊断准确性的不确定性。证据的质量很低，由于研究的局限性、不一致和间接性而被降级。对大多数技术的诊断准确性的总结估计表明，使用此类设备可以提高就疾病存在与否做出决定的可信度。然而，鉴于广泛的预测区间，预测它们在任何未来“现实世界”环境中的准确性具有挑战性。对大多数技术的诊断准确性的总结估计表明，使用此类设备可以提高就疾病存在与否做出决定的可信度。然而，鉴于广泛的预测区间，预测它们在任何未来“现实世界”环境中的准确性具有挑战性。对大多数技术的诊断准确性的总结估计表明，使用此类设备可以提高就疾病存在与否做出决定的可信度。然而，鉴于广泛的预测区间，预测它们在任何未来“现实世界”环境中的准确性具有挑战性。