Update on clinical detection methods for noncavitated fissure caries

Aim: This review presents an updated overview and evidences on diagnostic performances of clinical detection methods to detect noncavitated fissure caries. Background: The current body of evidence regarding the progression and arrest of dental caries has made its early detection, risk assessment, and minimally invasive management the standard of care today. Hence, its diagnosis should ideally comprise of both detection and severity measurement in the form of lesion depth, demineralization severity, and mineral density distribution. A combination of this information is essential for clinicians to make informed decisions about the management of the disease process. To address the above needs, a plethora of clinical caries detection systems are available and most demonstrate differing diagnostic performance for approximal and fissure caries. In this review, the available systems are categorized based broadly upon their mechanism of actions, under the categories of conventional, nonoptical, and optical methods. This review article sought to present the published evidence of these systems in detecting noncavitated fissure caries. As far as possible, evidence from systematic reviews were presented. In cases where systematic reviews were not available, preference had been given to the present evidence from in vitro and in vivo studies that had employed histology as the validation method. Conclusion: Based on the current evidences and reviews, except for optical coherence tomography, most devices are only able to detect and determine either lesion depth or demineralization severity but not both. Clinical significance: In order to be able to gather necessary information to formulate a treatment plan for noncavitated fissure caries and monitor its efficacy, routine visual assessment will need to be supplemented by another quantification-enabled detection device that had demonstrated reasonably high sensitivity and specificity. Current evidences seem to indicate that photothermal radiometry, near-infrared transillumination, and optical coherence tomography are systems that had demonstrated such capabilities.