Diniz 2011.

Study characteristics
Patient Sampling	Method of sampling: selected "sound to carious were selected from a pool of extracted teeth" so unclear the level of cavity included Included conditions: no cavitation and early lesions Teeth: permanent third molars Sealants: not reported Surface: occlusal
Patient characteristics and setting	Age: not reported Sex: not reported Ethnicity: not reported Country: Brazil Setting: extracted teeth Number of participants/teeth/sites: 55 teeth Prevalence: enamel 0.89, dentine 0.11
Index tests	Category of test: DIAGNOdent, DIAGNOdent pen and VistaProof Sequence of test(s): index tests (visual inspected but not assessed then fluorescence devices) followed by reference standard Examiner training and calibration: 2 experienced examiners Teeth cleaning prior to examination: prophylactic paste using a slow‐rotating contra angle handpiece with a Robinson brush (group 2) Tooth drying prior to examination: dried for 3 seconds Threshold applied: calculated within study DIAGNOdent: 0–15 sound, 16–25 enamel, 25+ dentine DIAGNOdent pen: 0–10 sound, 11–34 enamel, 34+ dentine VistaProof: 0–1.1 sound, 1.2–1.7 enamel, 1.7+ dentine Device specifics: VistaProof ‐ specific software (DBSWIN) that translates the rates of red and green fluorescence into numbers corresponding to lesion severity
Target condition and reference standard(s)	Category: histology Sequence of index test and reference standard: index test then reference standard Training of examiner: 2 trained examiners Blinding to index test: unclear Multiple tests: no Site selection: marked on photographs then sectioned teeth Target condition: sound, inner/outer enamel, inner/outer dentine
Flow and timing	Participants with index test but no reference standard: 0 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	Results used from stage (2) after professional prophylaxis (prophylactic paste) for 10 seconds, rinsing for 3 seconds and drying for 3 seconds
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
Could the selection of patients have introduced bias?		High 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?	No
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?		High 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)
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?	No
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?		High risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 2: Index Test (Red fluorescence)
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Could the reference standard, its conduct, or its interpretation have introduced bias?		Low 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?	Yes
Were all patients included in the analysis?	Yes
Could the patient flow have introduced bias?		Low risk