A systematic review of the performance of a laser fluorescence device for detecting caries.
BACKGROUND: The DIAGNOdent, or DD (KaVo America, Lake Zurich, Ill.), a device for detecting caries using laser fluorescence, has been growing in popularity during the past three years. Although several evaluations of its diagnostic performance have appeared in the literature, the range of reported performances is extensive. TYPES OF STUDIES REVIEWED: The authors conducted a systematic review of the literature to assess the diagnostic performance of the DD. Of 115 articles identified in the search, 25 studies were included in the review according to criteria requiring histologic validation and outcomes expressed as sensitivity and specificity values. RESULTS: For detection of dentinal caries, sensitivity values ranged widely (0.19 to 1.0), although most tended to be high. Specificity values exhibited a similar pattern, ranging from 0.52 to 1.0. In comparison with visual assessment methods, the DD exhibited a sensitivity value that was almost always higher and a specificity value that was almost always lower. The body of evidence is characterized largely by in vitro studies, so that generalization to the clinical setting is uncertain. Because caries thresholds varied substantially across the studies, synthesized estimates of performance were not possible. CONCLUSIONS AND CLINICAL IMPLICATIONS: The DD clearly is more sensitive than traditional diagnostic methods; however, the increased likelihood of false-positive diagnoses compared with that with visual methods limits its usefulness as a principal diagnostic tool.