Effectiveness of silver diamine fluoride application with atraumatic restorative treatment in arresting the progression of dental caries in children and adults: a systematic review and meta-analysis.

Abstract

Objective: This systematic review aimed to evaluate the effectiveness of the application of silver diamine fluoride (SDF) with atraumatic restorative treatment (ART) in arresting the progression of dental caries in cavitated primary or permanent teeth compared with any other caries-arresting treatment.

Introduction: Dental caries is the most prevalent oral disease globally. Patient-friendly, minimally invasive therapeutic interventions are needed to prevent caries progression and restore cavitated caries lesions cost-effectively. This review assessed the effectiveness of the silver diamine fluoride with atraumatic restorative treatment (SDF-ART technique) in cavitated primary and permanent dentition.

Inclusion criteria: Participants of any age with cavitated dental caries lesions in either coronal or root caries of primary or permanent teeth according to International Caries Detection and Assessment System criteria were included. Tooth restoration with direct pulp capping was excluded. Eligible randomized controlled trials included primary or permanent teeth treated with the SDF-ART technique compared with a control, such as SDF application only, ART only, restoration using composite or topical application of other fluoride, placebo, or no interventions. The primary outcome assessed was caries arrest.

Methods: The review details were registered in PROSPERO, following which a primary search was conducted in MEDLINE (Ovid), Scopus, Cochrane Central Register of Controlled Trials, Dentistry and Oral Sciences Source, CINAHL (EBSCOhost), Web of Science Core Collection, ProQuest Dissertations and Theses, and Google Scholar. The search date was from January 2016 until March 31, 2024. Data was extracted from included studies regarding the main outcome variable: caries arrest. Critical appraisal was done by 2 independent reviewers to evaluate methodological quality using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. The random-effects model was employed in meta-analysis. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and a Summary of Findings was created.

Results: After removal of duplicates, 638 records were retrieved from the databases. After screening against the inclusion criteria, 7 studies were selected for narrative synthesis after meeting the eligibility criteria requirements. A total of 611 children between 3 and 13 years were included for descriptive analysis. A meta-analysis of 4 studies, with a total sampling unit of 1085 teeth, showed no significant difference in clinical effectiveness of SDF-ART compared with ART alone for caries arrest at 12-month recall (odds ratio 0.84; 95% CI 0.64, 1.11; P=0.215), and the evidence was graded very low. Similarly, pooled results from 2 studies with a sample size of 879 teeth at 24-month recall demonstrated no significant difference in the clinical effectiveness of SDF-ART compared with ART alone for caries arrest (odds ratio 0.89; 95% CI 0.60, 1.32; P=0.556), and the evidence was graded low. The pooled results were depicted as forest plots for the primary outcome.

Conclusion: Studies comparing the effectiveness of SDF-ART vs ART are insufficient to determine the effectiveness of the SDF-ART technique in caries arrest. The scientific evidence on the effectiveness of SDF-ART in children and adults is inconclusive.

Review registration: PROSPERO CRD42023426766.