Sinanoglu 2014.

Study characteristics
Patient Sampling	Method of sampling: unclear ‐ referred patients, "Teeth exhibiting proximal caries in the radiological examination were excluded" Included conditions: non‐cavitated and early lesions, "Exclusion criteria for the teeth were the presence of proximal caries, surfaces that made it impossible to simulate the contact point, large carious lesions, enamel anomalies, any intrinsic or extrinsic staining, and any restorations or fissure sealants" Teeth: permanent molar and/or premolar tooth Sealants: no Surface: occlusal
Patient characteristics and setting	Age: not reported Sex: not reported Ethnicity: not reported Country: Turkey Setting: university dental school Number of participants/teeth/sites: 35 participants/217 teeth at first examination; 1 week later 11 participants/82 surfaces Prevalence: not clearly reported
Index tests	Category of test: DIAGNOdent pen Sequence of test(s): visual, radiograph, DIAGNOdent, then reference standard Examiner training and calibration: 2 experienced examiners and calibrated Teeth cleaning prior to examination: yes, "teeth were professionally cleaned using rotating brushes without any prophylactic pastes" Tooth drying prior to examination: "first examined wet and then air‐dried for 5 sec" Threshold applied: 0‐12 sound, 13‐24 beginning demineralization, > 25 strong demineralization Device specifics: probe tip 2
Target condition and reference standard(s)	Category: excavation of severe caries, the remainder were based on a combination of visual and radiograph examinations Sequence of index test and reference standard: index test partly informs reference standard, unclear exactly how this was done Training of examiner: not reported Blinding to index test: not possible Multiple tests: yes, visual and radiograph; plus excavation Site selection: occlusal surface under investigation Target condition: no caries, enamel, or dentine
Flow and timing	Participants with index test but no reference standard: unclear how reference standard for first series of examinations in conducted, suspected that many may be missing a reference standard Participants with reference standard but no index test: 0 Time interval between tests: up to 1 week Participants receiving both tests but excluded from results: 0
Comparative
Notes	Unclear how Table 6 results of sensitivity and specificity are calculated, whether these are only reporting the participants that underwent excavation or a hybrid reference standard was applied to assess all participants. Also Table 9 not clear with thresholds applied and whether any sound teeth were included
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?			Low concern
DOMAIN 2: Index Test (All)
Were the index test results interpreted without knowledge of the results of the reference standard?	No
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?	No
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?	No
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?	Unclear
Were all patients included in the analysis?	Unclear
Could the patient flow have introduced bias?		Unclear risk