The International Caries Detection and Assessment System – ICDAS: A Systematic Review

Abstract

The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

Overweight/obese children are associated with lower caries experience than normal‐weight children/adolescents

“…Our results that, compared with OW, NW children have higher prevalence of dental caries at both ICDAS thresholds (“EC/DC” and “DC”) reject the null hypothesis of this investigation. A recent systematic review revealed considerable performance of the ICDAS visual criteria for evaluating carious lesions and encouraged its use in clinical practice . It should be pointed out that the use of different ICDAS thresholds may influence diagnostic accuracy.…”

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta‐analysis

“…In daily clinical practice, this evaluation is mainly performed by visual examination because this method has good overall performance . Systems for caries activity status assessment have shown moderate values concerning reproducibility and overall performance . Nevertheless, many aspects could have influence on the performance of visual examination, as examiners’ training .…”

“…10 Systems for caries activity status assessment have shown moderate values concerning reproducibility and overall performance. 28 Nevertheless, many aspects could have influence on the performance of visual examination, as examiners' training. 10 This could be crucial mainly because undergraduate students have not developed their diagnostic skills yet.…”

In vivo validity of proximal caries detection in primary teeth, with histological validation

“…A recent systematic review reported visual inspection to have good accuracy for visual inspection, which was further improved when used in conjunction with a detailed and validated index . Meticulous caries diagnostic methods, such as the International Caries Detection and Assessment System (ICDAS), meet this requirement, having been demonstrated to have high validity and reproducibility …”

“…8 Meticulous caries diagnostic methods, such as the International Caries Detection and Assessment System (ICDAS), meet this requirement, having been demonstrated to have high validity and reproducibility. 6,[9][10][11] Bitewing radiographs provide an additional diagnostic yield, especially for proximal caries, where direct visual examination is not possible. 12 Bitewing radiographs, however, show where the lesion is anatomically, in enamel or dentine, but do not confirm the presence of cavitation which is the threshold between operative and nonoperative intervention.…”