Non-Cochrane · intervention · PM42688461
Efficacy of silver modified atraumatic restorative treatment (SMART) versus atraumatic restorative treatment (ART) for caries control in primary teeth: a systematic review and meta-analysis.
Rubio-Membrillo Katia Noemi, Espinoza-Salcedo María Victoria, Arbildo-Vega Heber Isac, et al. · Frontiers in dental medicine · 2026 · PubMed · doi:10.3389/fdmed.2026.1914881
Findings
Population Children with cavitated carious lesions in primary teeth
8 findings
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Solh et al. 2026 | OR 1.29 [0.90, 1.86] GRADE not reported 5 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Mohammed et al. 2023 | OR 1.27 [0.89, 1.82] GRADE not reported 5 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years | OR 1.28 [0.91, 1.80] 62 [-23, 144] per 1000 Low Downgraded: imprecision, publication bias 6 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Jiang et al. 2020 | OR 1.66 [0.94, 2.95] GRADE not reported 5 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Aly et al. 2023 | OR 1.27 [0.90, 1.79] GRADE not reported 5 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Trim-and-fill sensitivity analysis; three imputed studies | no estimate extracted GRADE not reported Studies not reported |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Abdelhamid et al. 2025 | OR 1.27 [0.90, 1.79] GRADE not reported 5 studies |
| Silver modified atraumatic restorative treatment (SMART), 38% silver diamine fluoride | Conventional atraumatic restorative treatment (ART) | Overall clinical success 6 months to 2 years · Leave-one-out sensitivity: omit Rady et al. 2023 | OR 1.16 [0.81, 1.66] GRADE not reported 5 studies |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Aly 2023 Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in… PMID:36460236 | 2023 | 1 other review | Overall clinical success | not extracted yet |
| Mohammed 2022 Comparison of Clinical Outcomes of Silver-modified Atraumatic Restorative Technique vs Atraumatic Restorative Technique in Primary Teeth:… PMID:37073938 | 2022 | 1 other review | Overall clinical success | not extracted yet |
| Abdelhamid 2025 matched by author and year (probable) | NR | this review only | Overall clinical success | not extracted yet |
| Jiang 2020 A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth… PMID:32712307 | 2020 | this review only | Overall clinical success | not extracted yet |
| Jiang 2022 CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE… PMID:36162897 | 2022 | this review only | not stated | not extracted yet |
| Mohammed et al. 2022 DOI:10.5005/jp-journals-10024-34373 | NR | this review only | not stated | not extracted yet |
| Rady 2023 A 24-MONTH CLINICAL ASSESSMENT OF ACTIVE DENTIN CARIES ARRESTING BY SILVER DIAMINE FLUORIDE IN PRIMARY MOLARS: A RANDOMIZED CLINICAL TRIAL DOI:10.21608/edj.2023.189323.2418 | 2023 | this review only | Overall clinical success | not extracted yet |
| Solh 2026 Atraumatic Versus Silver-Modified Atraumatic Restorative Treatment in Primary Molars: A Randomized Clinical Trial on Minimally Invasive… PMID:41632901 | 2026 | this review only | Overall clinical success | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Comparative success of minimally invasive treatments for cavitated caries in primary teeth: a network meta-analysis. (2025) | 2 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Pediatric patients with cavitated carious lesions in primary teeth | Children aged 3 to 9 years with cavitated primary molar lesions (n=398 unique participants; 1,375 teeth) |
| Intervention | Silver modified atraumatic restorative treatment (SMART) | SMART with 38% silver diamine fluoride (n=7 reports from 6 trials) |
| Comparison | Atraumatic restorative treatment (ART) | Conventional ART (n=7 reports from 6 trials) |
| Outcomes | Clinical success, radiographic success, arrested caries, pain, quality of life, aesthetic perception, total cost | Overall clinical success (n=6 pooled trials, 745 patients); other outcomes narrative |
| Study designs | Randomized clinical trials with minimum 6 months follow-up | Randomized clinical trials: 4 parallel, 3 cross-over or split-mouth reports (n=6 trials) |
| Timing | Minimum follow-up of 6 months | Follow-up 6 months to 2 years |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | No | no |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | RCT: Yes · NRSI: N/A | yes |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | RCT: No · NRSI: N/A | no |
| 12Impact of risk of bias on the pooled results | Yes | No | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | High | Critically Low | no |