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
Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth
At 6 months, ART had significantly higher treatment success than placebo (OR 16.18).
1 finding from 1 review
OR 16.18 [1.21, 215.73]
44 studies
GRADE not reported
Discomfort associated with the procedure · People with dental caries in primary teeth (mainly children)
The reported estimate for discomfort with ART versus conventional treatment was inconclusive (ungraded).
1 finding from 1 review
Pain during the procedure (primary analysis) · Children (3-13 years) with dentine caries in primary teeth, no pulpal involvement
The reported estimate for procedural pain with ART versus conventional treatment was inconclusive (ungraded).
1 finding from 1 review
Oral health-related quality of life · Children with dental caries
ART and placebo did not differ for oral health-related quality of life, based on an indirect network estimate with no direct trials (MD -0.01, 95% CI -0.40 to 0.38; ungraded).
3 findings from 1 review
Oral health-related quality of life · Children with dental caries
The network estimate found no statistically significant difference in oral health-related quality of life between atraumatic restorative treatment and silver diamine fluoride.
2 findings from 1 review
New coronal caries in permanent first molars (caries prevention) · Children with dental caries in permanent (first) molars
ART within a brushing programme significantly reduced caries vs control (p<0.01; ungraded).
2 findings from 1 review
Mean new caries increment (surfaces) 0.01
1 study · 1016 participants
GRADE not reported
Mean new caries increment (surfaces) 0.06
1 study · 1016 participants
GRADE not reported
Restoration failure · Children (3-13 years) with dentine caries in primary teeth, no pulpal involvement
ART with GIC was reported to increase the odds of restoration failure versus conventional restoration (OR 1.60; ungraded).
1 finding from 1 review
Restoration survival · Children with decayed primary molar teeth
Multi-surface ART restorations had a reported survival rate of 73% at 1 year.
4 findings from 1 review
Survival rate 73
9 studies
GRADE not reported
Survival rate 95
9 studies
GRADE not reported
Survival rate 59
9 studies
GRADE not reported
Show 1 more finding
Survival rate 91
9 studies
GRADE not reported
Restoration survival · Children with occlusoproximal caries in primary teeth
The reported pooled ART success estimate was 1.04.
1 finding from 1 review
Oral health-related quality of life · Children with dental caries
The direct estimate found no statistically significant difference in oral health-related quality of life between atraumatic restorative treatment plus fluoride varnish and silver diamine fluoride plus fluoride varnish.
2 findings from 1 review
Restoration survival · Children with occlusoproximal caries in primary teeth
Multiple reviews reported similar restoration survival for ART versus conventional restorations in occlusoproximal cavities (ungraded).
1 finding from 1 review
Success or failure of restoration (as defined by the USPHS criteria) · Children with carious primary teeth
ART with high-viscosity GIC and amalgam had similar class I restoration success at 24 months (ungraded).
2 findings from 1 review
RR 1.07 [0.91, 1.27]
3 studies
GRADE not reported
RR 0.93 [0.83, 1.06]
3 studies
GRADE not reported
Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth
At 6 months, the Hall technique had significantly higher treatment success than ART (OR 10.11; moderate certainty).
3 findings from 1 review
OR 10.11 [3.03, 33.71]
44 studies
Moderate
OR 6.15 [2.55, 14.83]
43 studies
Moderate
OR 5.13 [1.18, 22.38]
21 studies
Moderate
Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth
At 12 months, conventional restorations had significantly higher treatment success than ART (OR 2.10; moderate certainty).
2 findings from 1 review
OR 2.10 [1.17, 3.78]
43 studies
Moderate
OR 2.67 [1.24, 6.15]
44 studies
Moderate
Treatment success (caries lesion arrest or restoration survival) · Children (aged 3-11 y) with cavitated caries lesions in primary teeth
At 12 months, the Hall technique had significantly higher treatment success than SMART (OR 4.36; moderate certainty).
2 findings from 1 review
OR 4.36 [1.13, 16.77]
43 studies
Moderate
OR 5.61 [1.36, 23.08]
44 studies
Moderate
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
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
Dental pain or sensitivity · Children and adults (with or without carious lesions)
It is very uncertain whether silver diamine fluoride (SDF) changes dental pain or sensitivity compared with atraumatic restorative treatment (ART) with glass ionomer cement… (very low certainty).
1 finding from 1 review
Adverse effects · Children and adults (with or without carious lesions)
1 finding from 1 review
In 1 study, 115 of 118 children had black stains on teeth treated with SDF; there were no other adverse effects or allergic reactions. In 1 study, the rate of adverse effects reported by caregiver and person who…
3 studies · 482 participants
Very low