Comparative evaluation of caries detector dyes and laser fluorescence systems for intraoperative diagnosis during selective caries removal: a scoping review.

Background: Selective caries removal aims to preserve pulp vitality and tooth structure by eliminating only infected dentin. Caries detector dyes and laser fluorescence devices are the main diagnostic tools supporting this minimally invasive approach. Objective: To evaluate and compare the diagnostic performance, benefits, and limitations of these two modalities. Additionally, it examines potential synergies with magnification tools and proposes future directions for clinical protocol development. Methods: A scoping review was conducted following PRISMA-ScR guidelines. Of 124 articles screened, four met the inclusion criteria for direct comparison of caries detector dyes and laser fluorescence systems. Diagnostic accuracy, clinical outcomes, and bias risk (ROBINS-I/ROBINS-E) were assessed. Results: All four studies supported the effectiveness of both techniques in selective caries removal. Laser fluorescence devices showed higher sensitivity (ranging from 0.76 to 0.92) and specificity (0.74 to 0.88), along with better accuracy in detecting infected dentin compared to dyes. Dyes were noted for ease of use but showed greater variability in outcomes. Risk of bias ranged from low to moderate across studies. Conclusions: Laser fluorescence systems appear to be more reliable for intraoperative caries detection during selective caries removal. Nevertheless, a combined diagnostic approach, particularly with magnification, may optimize outcomes. These findings support the integration of fluorescence systems in caries management protocols. Further clinical trials are needed to validate these findings and develop standardized, evidence-based protocols.