Canary System, DIAGNODent, CariVu and Bitewing Radiographs – Which System is the Most Accurate?

Limitations with DIAGNOdent (DD):

  • DD uses fluorescence as its core detection mode and is linked with organic materials in and on enamel. The organic materials that are ultimately detected are those that contain elements with intrinsic autofluorescent properties. What ultimately lights up under the wavelengths used by these products are bacteria, or more specifically the porphyrin molecules present in bacteria. Therefore, these products are really “bacteria detectors”.
  • False positives are a problem if the patient didn’t brush their teeth, has sealants with opacifying filler like titanium dioxide, or even has remnants from a prophy paste which are all reported to light up under fluorescence
  • The wavelength used by DD only penetrates up to 0.5mm into the enamel, so detecting hidden caries is not possible.
  • DD does not permit effective quantification to monitor and track remineralization or demineralization of enamel.

Limitations with CariVu (Transillumination):

  • CariVu is not quantitative and still requires a dentist to use their eyes for diagnosis which can be very subjective (i.e. like looking at a radiograph).
  • Gray spots or lesions could result in many false-positives because even natural defects will be imaged.
  • CariVu requires one to have the Dexis software to work. If you don’t have Dexis, you can’t use CariVu.
  • From what we can see, there is no evidence-based research published on CariVu specifically.
  • CariVu can only image interproximal surfaces but is impossible for buccal/lingual/occlusal surface imaging because of the way the handpiece head is engineered.  This makes it impossible to monitor any type of remineralization program.
  • CariVu cannot detect caries under sealants or under/around margins of restorations because light can’t pass through these dental materials.

Limitations with Bitewing Radiographs:

  • Sensitivity/specificity ranges from 0.26 to 0.56 (all published statistics in meta-reviews), indicating that there is high subjectivity in interpretation and high probability for the clinician to find false positives and false negatives when depending solely on bitewing radiographs for diagnoses.
  • The limit of detection for finding caries using bitewing radiographs is quite poor – by the time caries is visible on a radiograph it’s already 1/3 into the dentin and a restoration is required. Any chance of remineralization or offering the patient a minimally-invasive restoration is not possible.
  •  X-rays do not enable clinicians to identify occlusal caries, caries under sealants, caries around the margins of restorations, etc.
  • A clinical trial done at the University of Texas in 2015  and published December 2021, comparing The Canary System to bitewing radiographs found that The Canary System was able to locate 92% of the interproximal lesions while bitewings could only locate 67%. 
  • A study published in 2020 found that The Canary System was more accurate than Bitewing Radiographs and Cone Beam CT in detecting caries on the gingival floor beneath composite restorations.  The Canary System found 89% of the caries where the other devices found 40% of the lesions.
  • The issue of ionizing radiation exposure is a problem and of increasing concern to patients and parents, alike.


None of the above limitations is a problem for The Canary because:

  • PTR-LUM energy conversion technology is directly linked with status of the crystal structure of teeth;
  • Canary can detect caries on all surfaces, under sealants, cracks, around the margins of restorations, and can quantify and monitor remineralization and demineralization.
This entry was posted in Uncategorized by stephenabrams. Bookmark the permalink.

About stephenabrams

Dentist and creator of The Canary System. Device for early detection and monitoring of tooth decay and cracks in teeth. Active in Ontario Dental Association dealing with access to care issues and design of government sponsored dental programs.

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