Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

678 questions · 854 findings · 51 reviews · Dental caries

No studies found 38 · 4.4%GRADE not reported 675 · 79%Very low 61 · 7.1%Low 47 · 5.5%Moderate 32 · 3.7%High 1 · 0.1%

Preformed metal crown (PMC) vs Resin-modified glass-ionomer cement + composite resin (modified open-sandwich restoration)

Restoration failure · Children with carious primary teeth after vital or non-vital pulp therapy

In one RCT, preformed metal crowns had an annual failure rate of 2.5% after 2 years.

1 finding from 1 review

Composite resin with a beveled cavity margin vs Composite resin with no bevel (butt-joint margin)

Treatment failure (annual failure rate) · Children with Class-I carious lesions in primary molars, no pulp therapy

A beveled margin lowered composite resin failure (1.8% vs 3.5% annual failure) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Restorative materials placed by atraumatic restorative treatment (ART); mostly high-viscosity/conventional GIC, also RMGIC, glass carbomer, compomer, composite resin vs Different ART materials or application techniques (e.g., bilayer vs single-step, with vs without cavity conditioner/disinfectant), or composite resin

Treatment failure (annual failure rate) · Children with carious primary teeth treated by atraumatic restorative treatment (hand-instrument caries removal), no pulp therapy

ART restorations (mainly GIC) had a wide annual failure rate (1.2-37.1%) across 10 RCTs, with technique affecting survival; low to unclear quality of evidence (ungraded).

1 finding from 1 review

Preformed metal crown (PMC) vs Resin-modified glass-ionomer cement + composite resin (modified open-sandwich restoration)

Treatment failure (annual failure rate) · Children with carious primary molars treated by pulpotomy (vital pulp therapy)

Preformed metal crowns had a low annual failure rate (2.5%) in primary molars after pulpotomy, but the evidence is of low quality (single high-risk-of-bias split-mouth RCT; not GRADE-rated).

2 findings from 1 review

Bulk-fill composite resin with 7-second dentine etching vs Bulk-fill composite resin with 15-second dentine etching

Treatment failure (annual failure rate) · Children (aged 5-8 years) with Class-II caries in primary molars, no pulp therapy

Etching dentine for 7 s rather than 15 s lowered bulk-fill composite failure (5.8% vs 16.9% annual failure) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Metal-free single crowns (full-contour zirconia) vs Composite strip crown

Treatment failure (annual failure rate) · Children (aged 3-5.5 years) with early childhood caries in anterior primary teeth (>=2 carious surfaces), no pulp therapy

Zirconia crowns failed less than composite strip crowns (3.3% vs 15% annual failure) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Bio-active restorative materials vs Any conventional restorative material

Treatment failure (planned; no eligible studies) · Children with carious primary teeth after vital or non-vital pulp therapy

No eligible studies were found evaluating bio-active restorative materials for restoring carious primary teeth after pulp therapy.

1 finding from 1 review

Metal-reinforced glass-ionomer cement (MRGIC) restoration vs Conventional GIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Metal-reinforced GIC had a high annual failure rate (29.9%) in a single RCT; low quality of evidence (ungraded).

1 finding from 1 review

Compomer (C) vs Amalgam, RMGIC, HVGIC, composite resin, bulk-fill composite resin, another compomer, or alternative caries management

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Compomer had an annual failure rate of 0-14.7% (7 RCTs), comparable to amalgam/RMGIC/composite and better than high-viscosity GIC; low quality of evidence (ungraded).

1 finding from 1 review

Conventional GIC vs Amalgam or metal-reinforced GIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Conventional GIC had an annual failure rate of 7.6-16.6% (2 RCTs) and failed more than amalgam in one trial; low quality of evidence (ungraded).

1 finding from 1 review

Class-I (single-surface) cavity restoration vs Class-II (proximal/multi-surface) cavity restoration

Treatment failure (annual failure rate) by cavity class · Children with carious primary teeth restored in Class-I versus Class-II cavities, no pulp therapy

Class-II restorations failed more than Class-I (annual failure 5-28.9% vs 1.2-14.7% in ART studies); low quality of evidence (ungraded).

1 finding from 1 review

Hall technique vs Compomer restoration or non-restorative caries treatment

Treatment failure (annual failure rate) · Children (aged 3-8 years) with 2-surface occluso-proximal dentine caries in primary molars, no pulp therapy

Preformed metal (Hall) crowns had a low reported annual failure rate (3.1%) versus compomer (14.7%) in one RCT; low quality of evidence (ungraded).

1 finding from 1 review

Composite resin vs Compomer, glass-ionomer/RMGIC, amalgam, or glass carbomer

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Composite resin (hybrid 0-19.5%; bulk-fill 0-16.9%) performed comparably to or better than most alternatives across 11 RCTs; evidence is of low to unclear quality (ungraded).

1 finding from 1 review

Bio-active restorative materials vs Any restorative material or technique

Not applicable (no eligible studies) · Children with carious primary teeth (no pulp therapy)

No eligible RCTs assessed new bio-active restorative materials in carious primary teeth; this is an evidence gap identified by the review.

1 finding from 1 review

Glass carbomer restoration (placed after drilling) vs Composite resin or RMGIC

Treatment failure (annual failure rate) · Children with previously unrestored, vital carious lesions in primary teeth (no pulp therapy); aged 1.5-11 years

Glass carbomer had very high failure rates (up to 46.2%) in a single RCT, far worse than composite resin or RMGIC; low quality of evidence (ungraded).

1 finding from 1 review

Amalgam vs Preformed metal crown (PMC)

Treatment failure (annual failure rate) · Children with carious primary molars treated by pulpotomy (vital pulp therapy)

Preformed metal crowns had a low annual failure rate (2.4%) in primary molars after pulpotomy, lower than amalgam in the same trial (single high-risk-of-bias RCT; low quality of evidence; not GRADE-rated).

2 findings from 1 review

Triple antibiotic paste (TAP) vs Abscess remedy (AR)

Overall success (composite of clinical and radiographic success) · Immature (young) permanent teeth with open apex and vital pulp exposed to dental caries or trauma, in children aged 6-14 years

A single RCT found higher pulpotomy success with triple antibiotic paste than abscess remedy (100% vs 80%; statistically significant, P<0.05; not pooled; ungraded).

1 finding from 1 review

Glutaraldehyde + zinc oxide and eugenol (ZOE) vs Full strength formocresol (FC)

Clinical failure · Children with extensive decay involving the dental pulp in primary teeth

Glutaraldehyde + zinc oxide and eugenol (ZOE) showed no clear difference in clinical failure compared with full strength formocresol (FC); GRADE not reported.

1 finding from 1 review

Metapex (calcium hydroxide/iodoform) vs Endoflas chlorophenol free (Endoflas-CF)

Radiological failure · Children with extensive decay involving the dental pulp in primary teeth

Metapex (calcium hydroxide/iodoform) showed no clear difference in radiological failure compared with endoflas chlorophenol free (Endoflas-CF); GRADE not reported.

1 finding from 1 review