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Table 4.3.4 List of included studies with DIAGNOdent. Author Year, reference Country Type of study Blinding Number of observers Observer reliability Population Caries prevalence and type of lesions Clinical studies Primary teeth Rocha et al 2003 [4] Brazil Occlusal Angnes et al 2005 [5] Brazil Reis et al 2006 [6] Brazil Validity, reliability Yes 2 Kappa Intra mean: 66% Inter mean: 61% 10–11 yrs, molars under exfoliation or extracted for orthodontic reasons Validity Partly 2 Kappa: 53% Adult volunteers, 3rd molars for extraction Validity Partly 2 Kappa: 57% In vivo/ in vitro Intra: 0.28 Inter: 0.28 Adult volunteers, 3rd molars for extraction 21 (42%) sound 16 (32%) D1 6 (12%) D2 5 (10%) D3 2 (4%) D4 20 (18%) sound 24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 20 (18%) sound 24 (22%) D1 50 (45%) D2 14 (13%) D3 2 (2%) D4 Studies on extracted teeth Occlusal Kordic et al 2003 [3] Switzerland Validity Yes 4 Kappa: 60–75% 10–38 yrs, premolars and molars 21% sound 61% enamel 18% dentine CI = Confidence interval; D1 = Enamel caries; D2 = Caries to the enamel-dentine junction; D3 = Caries reaching not more than half of the dentine; D4 = Caries reaching more than half of the dentine; NPV = Negative predictive value; PPV = Positive predictive value; ROC = Receiver operating characteristic; SEM = Scanning electron microscope; Se = Sensitivity; Sp = Specificity 182 Karies – diagnostik, riskbedömning och icke-invasiv behandling
Number of individuals Number of teeth Dropout/ missing data Comparison method Outcome measure Results enamel caries (CI) Results dentine caries Study quality and relevance Comments 29 subjects 30 teeth 50 sites Not reported Histology Se, Sp, accuracy Se: 60% (45–74) Sp: 90% (78–96) Accuracy: 0.73 Se: 73% Sp: 95% Accuracy: 0.90 Medium 38 individuals, 57 teeth, 110 sites Not reported Hemisection, histology Se, Sp – Se: 75% Sp: 55% Medium Limited to 3rd molars 38 individuals, 57 teeth, 110 sites Not reported Hemisection, histology Se, Sp, accuracy Se: 80% Sp: 43% Accuracy: 0.65 Se: 75% Sp: 52% Accuracy: 0.82 Medium Same material as Angnes et al, 2005 [5] 61 teeth Not reported SEM, quantitative image analysis Se, Sp, ROC, accuracy, PPV, NPV Se: 95% Sp: 52% PPV: 0.33 NPV: 0.98 Se: 91% Sp: 76% PPV: 0.40 NPV: 0.98 High KAPITEL 4 • Diagnostik 183
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Karies - diagnostik, riskbedömning
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Karies - diagnostik, riskbedömning
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Primärt urval av studier 63 Bedöm
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Resultat 176 FOTI 176 DiFOTI 176 DI
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Metodik 356 Litteratursökning 356
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SBU:s sammanfattning och slutsatser
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Bakgrund Karies är en kronisk sjuk
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Gradering av slutsatsernas evidenss
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Visuell-taktil diagnostik Studier s
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Hur kan kariesskador predikteras me
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Barn (1-3 år) som borstar tändern
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Kostnadseffektivitet för diagnosti
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undersöks. Frekvensen röntgenunde
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sönderfall av tanden, då patiente
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av tandhälsan och har inga symtom.
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ning. Riskbedömning görs rutinmä
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Betydelsen av effektiv tidig behand
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Validitet och reliabilitet Validite
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negativa prediktionsvärdet (NPV) b
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ytterligare i Faktaruta 1.6. Exempe
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Samhällsnivå Sociodemografi och v
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Faktaruta 1.1 Olika aspekter på va
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Faktaruta 1.3 Fyrfältstabell med k
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Faktaruta 1.4 Diagram som illustrer
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Faktaruta 1.6 Beräkning av likelih
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Faktaruta 1.7 Nomogram som visar hu
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Referenser 1. Fiske J, Davis DM, Fr
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2. Metodik för sökning och utvär
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Primärt urval av studier För att
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laget för slutsatserna. En metod s
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• Förklarat/analyserat bortfall
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Otillräckligt vetenskapligt underl
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3. Praxisundersökning avseende bit
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svenska och norska tonåringar unde
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Totalt antal undersökta Stockholm
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Østfold Totalt antal undersökta %
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4. Diagnostik 4.1 Visuell-taktil di
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Bakgrund Den primära metoden för
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undersökare och bedömdes ha ett m
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diagnostik av emaljkaries på tuggy
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Aktiv (pågående) och inaktiv (kro
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Tabell 4.1.1 Inklusionskriterier f
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Dropout/ missing data Method or tec
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Table 4.1.7 continued Author, year,
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Table 4.1.7 continued Author, year,
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Referenser 1. Rocha RO, Ardenghi TM
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tion compared with conventional rad
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63. Banerjee A, Watson TF, Kidd EA.
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93. Rosén B, Birkhed D, Nilsson K,
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4.2 Röntgendiagnostik Slutsatser G
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antingen med kabel eller via trådl
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Risker med röntgenstrålning Rönt
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När observatörerna skulle bestäm
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Faktaruta 4.2.2 Nomogrammet som byg
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Metodik för litteraturgenomgång E
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Page 139 and 140: Method Number of teeth and surfaces
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Page 143 and 144: Method Comparison method Outcome me
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Page 157 and 158: Referenser 1. Akdeniz BG, Grondahl
Page 159 and 160: 33. Espelid I, Tveit AB. A comparis
Page 161 and 162: 66. Caliskan Yanikoglu F, Östurk F
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Page 165 and 166: 131. Wenzel A, Hintze H. The choice
Page 167 and 168: 4.3 Tilläggsmetoder för kariesdia
Page 169 and 170: kariesskada [81,82]. En diagnostisk
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Page 177 and 178: Tabell 4.3.1 Inklusionskriterier f
Page 179: Dropout/ missing data Comparison me
Page 183 and 184: Number of individuals Number of tee
Page 185 and 186: Dropout/ missing data Method or tec
Page 189 and 190: Referenser 1. Grossman ES, Cleaton-
Page 191 and 192: 30. Hall AF, DeSchepper E, Ando M,
Page 193 and 194: of occlusal caries in children. Car
Page 195: 4.4. Etiska aspekter Som det framg
Page 198 and 199: • Salivens flöde och/eller buffr
Page 200 and 201: för riskfaktorn ifråga innan sjuk
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Page 210 and 211: Övriga inkluderade studier har lå
Page 212 and 213: områdena Aiken och Portland i Nort
Page 214 and 215: studier visar att låg- och mellanr
Page 216 and 217: Faktaruta 5.1 Inklusionskriterier f
Page 218 and 219: Table 5.1 Caries prediction in pre-
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Page 228 and 229: Table 5.2 Caries prediction in pre-
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Table 5.2 continued Author Year, re
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Table 5.3 Caries prediction in scho
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Table 5.4 Caries prediction in scho
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Table 5.5 Caries prediction in adul
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Table 5.6 Caries prediction in adul
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Table 5.7 Tillförlitligheten hos t
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Table 5.8 Post-eruptive age as risk
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Table 5.9 Post-eruptive age as risk
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Table 5.10 Excluded studies. Author
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Table 5.10 continued Author, year,
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19. Karjalainen S, Söderling E, Se
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social factors and diseases. Int De
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isk assessment program in an elderl
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121. Demers M, Brodeur JM, Simard P
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study. Community Dent Oral Epidemio
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private practice. Community Dent Or
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221. Schröder U, Granath L. Dietar
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groups. Oral Surg Oral Med Oral Pat
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287. Ravald N, Birkhed D, Hamp SE.
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En nyss frambruten tand är mer mot
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Övriga produkter Ozon De syraprodu
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En studie, som undersökte effekten
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för få för slutsatser om effekti
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Table 6.2 Treatment of early corona
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Table 6.3 Treatment of early corona
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Table 6.4 Treatment of early root s
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Table 6.5 Excluded studies. Author,
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Referenser 1. Abernathy JR, Graves
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composite resin restorations. Acta
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7. Ekonomiska aspekter Slutsatser A
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Kostnaden för visuell-taktil under
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Faktaruta 7.1 Hur beräknas kostnad
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7.1 7.1 1 800 Kronor Kronor 1 600 1
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8. Tänkbara praxisförändringar T
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Referenser 1. Ekstrand K. Faglig vi
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DFS DFT dft DiFOTI Dikotomisering D
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Likelihood-kvot Lingual Makroskopis
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Rotcement Sensitivitet Specificitet
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Svante Twetman Professor, odontolog
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Bilaga 1. Sökstrategier Kapitel 4.
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Kapitel 5 fortsättning NOT Cariost
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Bilaga 2. Granskningsmallar Diagnos
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Studier om riskbedömning Första f
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Studier om behandling av tidiga kar
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Bilaga 3. Sensitivitet, specificite
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9 8 8,0 8,0 LR+ emalj LR- emalj LR
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Sensitivitet och specificitet 2,0 1
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200 Procent 180 160 140 120 100 80
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180 160 140 120 100 80 60 40 20 0 8
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15. Lussi A. Comparison of differen
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49. Kordic A, Lussi A, Luder HU. Pe
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Ont i ryggen, ont i nacken (2000),
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Rapporter på engelska Obstructive
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