Bozdemir 2013.

Study characteristics
Patient Sampling	Method of sampling: unclear Included conditions: no cavitation and early lesions Teeth: permanent molars Sealants: no Surface: occlusal
Patient characteristics and setting	Age: 20 to 25 years, mean 20.2 Sex: 7 male, 30 female Ethnicity: not reported Country: Turkey Setting: dental school Number of participants/teeth/sites: 37 teeth/156 surfaces Prevalence: not reported, only those suspected of caries received reference standard so data do not reflect full sample
Index tests	Category of test: DIAGNOdent pen and Midwest Sequence of test(s): index tests performed prior to reference standard, same 2 examiners completed all tests Examiner training and calibration: "previously trained" Teeth cleaning prior to examination: rubber cup and paste Tooth drying prior to examination: air dried for 3 seconds Threshold applied: DIAGNOdent pen: 0–13 healthy, 14–20 enamel, 21–29 superficial dentine, > 30 deep dentine Midwest: no signal/green light ‐ healthy, slow signal/red light ‐ enamel, medium signal/red light ‐ superficial dentine, rapid or continuous signal/red light ‐ deep dentine Device specifics: DIAGNOdent pen ‐ cone shaped tip
Target condition and reference standard(s)	Category: excavation ‐ only those diagnosed as having caries by index tests were investigated Sequence of index test and reference standard: index test then reference standard Training of examiner: not reported Blinding to index test: yes Multiple tests: no Site selection: complete occlusal fissure Target condition: sound, enamel (outer), enamel (inner), dentine (outer), dentine (inner)
Flow and timing	Participants with index test but no reference standard: 30 Participants with reference standard but no index test: 0 Time interval between tests: minimal Participants receiving both tests but excluded from results: 0
Comparative
Notes	Data not used because 156 sites were included but only 126 were opened
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
Could the selection of patients have introduced bias?		Unclear risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index Test (All)
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
If multiple tests were applied were different examiners used for each (in vivo)?	No
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 2: Index Test (Green fluorescence)
DOMAIN 2: Index Test (Blue fluorescence)
DOMAIN 2: Index Test (Red fluorescence)
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
If multiple tests were applied were different examiners used for each (in vivo)?	No
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	No
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
Could the reference standard, its conduct, or its interpretation have introduced bias?		High risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Low concern
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	No
Were all patients included in the analysis?	No
Could the patient flow have introduced bias?		High risk