Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

20 questions · 26 findings · 6 reviews · All outcomes

No studies found 1 · 3.8%GRADE not reported 23 · 88.5%Very low 0 · 0%Low 0 · 0%Moderate 2 · 7.7%High 0 · 0%

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

30% silver diamine fluoride vs Atraumatic restorative treatment (ART)

Patient discomfort during treatment (anxiety scale) · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

One study found no significant difference in patient discomfort between SDF and ART (p = 0.15; ungraded).

1 finding from 1 review

38% SDF (every 6 months) vs no treatment

Inactive (arrested) carious lesions on permanent first molars · Children with dental caries in permanent (first) molars

Six-monthly SDF produced significantly more inactive (arrested) lesions than no treatment in children's permanent molars (0.3 vs 0.1; p<0.05; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Plaque · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

In randomized trials, clear aligners probably reduce plaque accumulation versus fixed appliances, though the subgroup estimate is imprecise and its CI crosses no effect (SMD -1.79, 95% CI -3.63 to 0.04; moderate certainty).

6 findings from 1 review
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Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

White spot lesion incidence · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

Most studies reported a lower incidence of white spot lesions with clear aligners than fixed appliances, but heterogeneous assessment methods precluded meta-analysis (ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Severity of white spot lesions (surface area and depth) · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

White spot lesion severity was assessed narratively in a small number of studies and not meta-analyzed; evidence is limited (ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Salivary caries-associated bacteria (S. mutans and Lactobacilli, subjects with >10^5 CFU/mL) · Orthodontic patients undergoing comprehensive treatment (late mixed or permanent dentition, no active caries)

Both included studies reported higher salivary caries-associated bacteria (S. mutans and Lactobacilli) with fixed appliances than clear aligners; not meta-analyzed (ungraded).

1 finding from 1 review

38% silver diamine fluoride vs Active dentine caries at baseline (single-arm before vs after proportion)

Arrest of dentine caries · Children with dentine caries in primary and permanent teeth

Professionally applied 38% silver diamine fluoride arrested about two-thirds of active dentine caries surfaces in children (pooled proportion 65.9%, 95% CI 41.2% to 90.7%; 5 studies); certainty was not GRADE-rated and heterogeneity was very high (I2=96%).

1 finding from 1 review

Silver diamine fluoride (SDF) vs Atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or glass ionomer material

Caries arrestment at the individual (patient) level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

In one trial, SDF greatly increased individual-level caries arrestment versus ART/glass ionomer cement (OR 18.03); this subgroup was not separately GRADE-rated.

1 finding from 1 review

Silver diamine fluoride (SDF) vs Atraumatic restorative treatment (ART) with glass ionomer cement (GIC) or glass ionomer material

Caries arrestment at the tooth level · Children and adults with active dental caries (aged 1-50; mostly preschool/school children with primary dentition)

Pooling two trials, SDF and ART/glass ionomer cement showed no clear difference in tooth-level caries arrestment (OR 1.22, wide CI; ungraded subgroup).

1 finding from 1 review

38% SDF (one-time application) vs inactive control

New coronal carious lesions or fillings on permanent (first) molars (caries prevention) · Children with dental caries in permanent (first) molars

One-time SDF within a brushing programme did not significantly reduce caries vs control (p>0.05; ungraded).

2 findings from 1 review

SDF applied biannually (every 6 months) vs Other non/minimally-invasive treatment (ART or 5% NaF varnish)

Caries arrest · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

Biannual SDF application significantly arrested caries (pooled ES 0.39, 95% CI 0.19-0.60; ungraded).

1 finding from 1 review

Silver diamine fluoride (SDF; 30% or 38%) vs No treatment or another non-invasive/minimally-invasive treatment (ART, sodium fluoride or silver-based varnish, or 12% SDF)

Caries arrest · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

SDF is effective in arresting caries progression in cavitated primary molars overall (pooled ES 0.33, 95% CI 0.26-0.40; ungraded).

1 finding from 1 review

Silver diamine fluoride (SDF; 30% or 38%) vs Atraumatic restorative treatment (ART)

Caries arrest · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

SDF was not significantly better than ART at arresting caries (pooled ES 0.05, 95% CI -0.42 to 0.51; ungraded).

1 finding from 1 review

SDF applied once (single application, no re-application) vs Other non/minimally-invasive treatment (ART or silver-fluoride varnish)

Caries arrest · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

A single (one-time) SDF application did not significantly arrest caries (pooled ES -0.09, 95% CI -0.48 to 0.29; ungraded).

1 finding from 1 review

Silver diamine fluoride (SDF >=30%, i.e. 30% or 38%), applied annually or biannually vs No treatment or another non-invasive/minimally-invasive treatment (ART, sodium fluoride or silver-based varnish, or 12% SDF)

Caries arrest · Children (age 1-10 years) with active cavitated dentin caries lesions in primary molars

The pooled caries arrest rate with SDF (>=30%, applied annually/biannually) was 51.62% (622/1205 lesions arrested) at >=12 months follow-up.

1 finding from 1 review

Nano-silver fluoride vs Not specified

Arrest of dentine caries · Children with active dentine caries

One randomised trial found nano-silver fluoride arrested dentine caries without the black staining seen with silver diamine fluoride; ungraded.

1 finding from 1 review

30% silver diamine fluoride vs Not specified

Arrest of dentine caries · Children with active dentine caries in primary teeth

One study reported 30% silver diamine fluoride effectively arrested dentine caries in primary teeth; ungraded.

1 finding from 1 review

12% silver diamine fluoride (SDF), single (one-off) application vs Not specified

Arrest of dentine caries · Children with active dentine caries

One trial found a single application of 12% silver diamine fluoride did not arrest dentine caries; ungraded.

1 finding from 1 review