Study designs of evaluations included in the review
Studies of any design were eligible for inclusion. The included studies were prospective or retrospective cohort or case-control studies of test accuracy.
Specific interventions included in the review
Studies in which panoramic radiography, or the combination of panoramic radiography plus bitewing radiography, was compared with bitewing radiography for the detection of occlusal and proximal dental caries in the posterior teeth of the deciduous and permanent dentition were eligible for inclusion. Studies were excluded if they did not compare standard radiography and bitewing radiography. None of the included studies were of the combination.
Reference standard test against which the new test was compared
The reference standard was required to be standard panoramic and bitewing radiographs with a clinical examination and follow-up where possible, or histologically confirmed caries for extracted teeth. Other reference standards were considered where empirical evidence that such a reference standard test was validated was available; the only other such reference standard in the included studies was one that used an electronic conductance meter.
Participants included in the review
Studies of deciduous or permanent teeth, in vivo or in vitro, were eligible for inclusion. The studies had to have investigated individual teeth (molars or pre-molars) or surfaces of teeth. Studies in which the unit of assessment was a person were excluded.
Outcomes assessed in the review
The primary outcome of effectiveness was test accuracy, as measured by sensitivity, specificity or other measures of test accuracy. Studies were excluded where accuracy was not measured or could not be calculated. Other outcomes considered were reliability, acceptability and clinical effectiveness. All of the included studies assessed the presence or absence of caries, although one assessed only occlusal caries. Other studies also assessed the severity of caries. In the included studies, test accuracy was reported in terms of receiver operating characteristic curves, sensitivity and specificity, sensitivity alone, critical ratio analysis of maximum likelihood areas, and intra-observer variability.
How were decisions on the relevance of primary studies made?
Two reviewers independently applied the inclusion criteria. A kappa score was calculated to test inter-rater agreement. Full references were obtained where necessary and any disagreements were resolved through discussion.