DIGITAL TECHNOLOGIES FOR DENTAL PLAQUE ASSESSMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CORRELATION COEFFICIENTS.

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the strength of the associations between digital technologies and reference methods for dental plaque assessment. MATERIALS AND METHODS: A strategic literature search was conducted across PubMed, Web of Science, Embase, Ovid MEDLINE and Cochrane library. Two independent reviewers performed screening and data extraction. Fisher's z scores were used to summarize associations between digital technologies and the reference methods. Risk of bias was assessed using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2). The certainty of evidence was evaluated according to the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework. Subgroup analyses investigated the impact of digital technologies, disclosing agents, and reference methods. RESULTS: From 4981 identified studies, 47 studies were included in the qualitative synthesis and 16 studies in the meta-analysis. The pooled Fisher's z indicated a strong overall association, translating to a pooled Pearson's r of 0.77 (95% CI, 0.64-0.86) and a pooled Spearman's ρ of 0.76 (95% CI, 0.50-0.89) between the digital technologies and the reference methods. Subgroup analyses indicated very strong association between AI-aided methodologies (r = 0.87) and 3D intraoral scanner (IOS) systems (ρ = 0.91) with reference methods. The application of disclosing agents may improve the association between digital technologies and reference methods in certain settings, with the Pearson's r increasing from 0.53 (95% CI, 0.42-0.64) to 0.81 (95% CI, 0.68-0.89) with disclosing agents. However, substantial heterogeneity was observed (I² > 98%), and 96% of included studies presented a high or unclear risk of bias, leading to an overall very low certainty of evidence. CONCLUSIONS: Digital technologies show strong associations with reference methods, demonstrating promising potential for objective and non-invasive dental plaque assessment. However, due to substantial heterogeneity and the very low certainty of evidence, further high-quality research with detailed information about patient selection and comprehensive assessment outcomes are warranted to facilitate the widespread adoption of these promising technologies.