You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Construct and Predictive Validity of Clinical Caries Diagnostic Criteria Assessing Lesion Activity
Abstract 1:
Even though there is no “ gold st and ard ” for determining caries lesion activity , it is nonetheless possible to evaluate the validity of such diagnostic measures . The aim of this study was to estimate the construct and predictive validity of caries lesion activity assessment s by means of their ability to reflect known effects of fluoride on caries . A three-year trial of the effect of daily supervised brushing with fluoride toothpaste was carried out among 273 12-year-old children . All children were examined clinical ly according to diagnostic criteria for activity assessment . The relative risk ( fluoride vs. control ) for caries lesion transitions among diagnostic categories was calculated . Fluoride inhibited progression of caries at all stages of lesion formation while at the same time enhancing lesion regression . The effects were most pronounced for active non-cavitated lesions . It is concluded that the clinical diagnostic criteria have construct and predictive validity for the assessment of caries lesion activity


Title 2:
Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries.
Abstract 2:
The aim of this clinical study was to test cut-offs for occlusal caries detection by the laser fluorescence device DIAGNOdent ( DD ) in comparison to visual-ranked inspection ( VI ) and bitewing radiographs ( BW ) under condition of a general dental practice . 281 occlusal surfaces of permanent molars from 97 patients were examined with VI , DD and BW . Caries extent was verified by bioptical intervention ( gold st and ard ) of 248 molars . Upon biopsy no molar was assessed as caries free , 24 teeth had caries confined to enamel and 224 teeth revealed dentine caries . For dentine caries detection DD achieved the highest values for sensitivity ( 0.93 ) , specificity ( 0.63 ) and agreement ( 0.89 ) followed by BW with figures of 0.70 , 0.96 and 0.69 , respectively . VI exhibited the lowest sensitivity ( 0.25 ) and agreement ( 0.25 ) , but the highest specificity ( 1.00 ) . It is advised to assess occlusal surfaces by a meticulous VI followed by the use of DD and /or BW as additional diagnostic tool of second choice . A DD value of > 20 could be confirmed as a sensitive cut-off for detection of occlusal dentine caries in first and second permanent molars . For the detection of early signs of enamel caries the DD seems to be less suitable


Title 3:
Clinical Study of the Use of the Laser Fluorescence Device DIAGNOdent for Detection of Occlusal Caries in Children
Abstract 3:
Diagnosis of non-cavitated occlusal caries is generally considered problematic . The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent as part of routine dental check-ups in children . A total of 613 occlusal surfaces on permanent molars and 436 surfaces on primary molars in children aged 7–8 ( n = 55 ) and 13–14 years ( n = 54 ) were examined visually , using DIAGNOdent and for most 13- to 14-year-olds also using radiographs . The teeth were not cleaned professionally before examination . To provide a gold st and ard for carious teeth , the depth of the caries lesion was determined in those lesions that were judged visually to need opening by drilling ( 51 teeth ) . The higher the visual score , the higher were the mean DIAGNOdent values , but in each visual category the variation among values was large . The presence of a clear sealant did not affect DIAGNOdent measurements . The values for permanent and primary molars differed slightly . For permanent teeth , Youden ’s index value was highest ( 60 % ) at a cut-off value of 30 , which indicates that the overall performance for DIAGNOdent in detecting dentinal caries was best at this point . Using this cut-off , sensitivity was 92 % and specificity 69 % with visual examination for validation , while sensitivity was 92 % and specificity 82 % with validation by fissure opening . Of the three methods , radiographic examination was the least accurate . In routine dental check-ups of children , DIAGNOdent appears to be useful as an adjunct to visual examination


Title 4:
Clinical performance of a laser fluorescence device for detection of occlusal caries lesions.
Abstract 4:
Children and adolescents must be examined often for occlusal caries . Diagnosis of fissure caries is difficult especially when the tooth surface appears seemingly intact . It has been shown that using traditional clinical methods , as little as 20 % of teeth with fissure caries under intact surfaces were correctly recognised as such . Therefore , new methods for increasing the accuracy of diagnosis have been sought for years . Recently , a new device , based on fluorescence measurements , was introduced . The purpose of this study was to test the device under in vivo conditions in order to provide recommendations for its use in the dental office . Seven general dental practitioners examined a total of 332 occlusal surfaces in 240 patients .  Caries extent was determined for each site after operative intervention ( = ' gold st and ard ' ) . Clinical inspection and analysis of bitewing radiographs exhibited statistically significant lower sensitivities ( 31 - 63 % ) than did the DIAGNOdent device ( sensitivity > or = 92 % ) . It is recommended that the laser device is used in the decision-making process in relation to the diagnosis of occlusal caries as a second opinion in cases of doubt after visual inspection


Title 5:
Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group.
Abstract 5:
You are back where we put you in the previous article1 on diagnostic tests in this series on how to use the medical literature : in the library study ing an article that will guide you in interpreting ventilation-perfusion ( V/Q ) lung scans . Using the criteria in Table 1 , you have decided that the Prospect i ve Investigation of Pulmonary Diagnosis ( PIOPED ) study 2 will provide you with valid information . Just then , another


Title 6:
Comparison between Visual Examination and a Laser Fluorescence System for in vivo Diagnosis of Occlusal Caries
Abstract 6:
This study compared a laser fluorescence ( LF ) system ( DIAGNOdent ) with a visual caries scoring system for in vivo detection and diagnosis of occlusal caries under the conditions of an epidemiological study , in 132 m and ibular and 38 maxillary first permanent molars in 170 children ( mean age : 6.85 ± 0.58 years ) . The teeth were cleaned and occlusal caries status in a selected investigation site recorded using both visual and LF systems . The LF readings were interpreted both according to the cut – off points recommended by the manufacturers and those based on laboratory research with histological validation . The percentage agreement of the LF and visual scoring system was better using the cut – off limits recommended by the manufacturer . Histological validation was not possible in this clinical study , but it appeared that either the LF method was overscoring some lesions or the visual method was underscoring them . Since the LF instrument can not be expected to differentiate caries from hypomineralisation , it should probably be used as an adjunct to a clinical examination
DIAGNOdentTM was found to be an accurate method for diagnosis of occlusal caries  , mainly if employed simultaneously with visual inspection