Tesis
Desempenho de estudantes de graduação em odontologia na detecção e avaliação da atividade de lesões de cárie: revisão sistemática e meta-análise
Fecha
2018-07-20Autor
Turchiello, Ronairo Zaiosc
Institución
Resumen
The caries detection is an essential topic in the curriculum of graduation courses in Dentistry, since
establishing the diagnosis is essential for the correct clinical decision making. However, many factors
can influence the performance of the visual examination, such as the examiners’ training. This could
be crucial considering the undergraduate students have not yet developed the diagnostic skills. Thus,
this systematic review and meta-analysis aimed to evaluate the performance of dental undergraduate
students in detecting and assessing the activity status of caries using visual inspection. A
comprehensive search was undertaken through PubMed/MEDLINE, Scopus, Lilacs databases and
OpenSINGLE up to June 2018 to identify literature related to research question. No publication year or
language restriction was considered. Two reviewers independently selected the studies, extracted the
data and assessed the risk of bias with Quality Assessment of Diagnostic Accuracy Studies tool
(QUADAS-2). Meta-analyses summarized the results concerning reproducibility and accuracy
(Summary Receiver Operating Characteristics analysis [SROC], diagnostic odds ratio [DOR],
considering D1 (all lesions) and D3 (only lesions into dentin, when lesion depth was assessed, or
cavitated lesions, when surface integrity was evaluated) thresholds. For activity, we considered sound
surfaces + inactive caries lesions vs. active caries lesions. Meta-regression was also performed to
assess the effect of methodological variables on the outcome. Heterogeneity was explored using
random-models and meta-regression analysis. The heterogeneity of the studies was also assessed.
From 233 potentially eligible studies, 31 were selected for full-text analysis and 14 were included in
the systematic review. Most of the included studies used the ICDAS (92.9%) for severity assessment
and Nyvad (28.6%) for caries activity. Studies showed moderate values of pooled interexaminer
agreement (0.52; 95% CI 0.39-0.66) and substantial pooled values of intra-examiner agreement (0.70;
95% CI 0.55-0.86) when severity was considered. Substantial pooled values of intra-examiner
agreement (0.62; 95% CI 0.38-0.86), but poor pooled values of interexaminer agreement (0.39; 95%
CI 0.10-0.67) were found for activity assessment. Studies showed moderate values of pooled
sensibility at D1 (0.640; 95% CI 0.620-0.660) and D3 (0.625 95% CI 0.585-0.664) thresholds.
Excellent values of pooled specificity were found at D1 (0.97 95% CI 0.967-0.973) and D3 (0.984 95%
CI 0.982-0.986) thresholds. The pooled sensitivity was also lower than pooled specificity for caries
activity. Overall, the heterogeneity was high. All included studies presented a high risk of bias in
sample selection. Students’ education level in the course and previous clinical experience did not
influence on the accuracy and reproducibility of the visual inspection. In conclusion, the undergraduate
students’ performance in detecting caries lesions using visual inspection was good, although activity
status assessment should be improved.