Comparative Effectiveness of Silver Diamine Fluoride versus Conventional Liners for Indirect Pulp Capping in Primary and Young Permanent Molars: A Systematic Review of Randomized Controlled Trials (2020–2025)

Purpose To compare the effectiveness of silver diamine fluoride (SDF) and conventional liners for indirect pulp capping in primary and young permanent molars. Methods This systematic review followed PRISMA 2020 guidelines and a pre-registered PROSPERO protocol (CRD420251253313). Electronic databases (PubMed, Cochrane Library, ScienceDirect, and Google Scholar) were searched (2000–December 2025) for randomized controlled trials comparing SDF with calcium hydroxide, mineral trioxide aggregate, Biodentine, or resin-modified glass ionomer cement. Risk of bias was assessed using RoB 2. Meta-analysis was conducted in RevMan 5.4 using Mantel–Haenszel random-effects models. Certainty of evidence was evaluated with GRADE. Results Eight RCTs (≈2,295 teeth) were included; six contributed to clinical and seven to radiographic meta-analysis. SDF showed outcomes comparable to conventional liners for clinical success (RR 0.99; 95% CI 0.97–1.01; I² = 0%) and radiographic success (RR 0.99; 95% CI 0.97–1.01; I² = 3%). Subgroup analyses confirmed consistent findings. Evidence certainty was moderate. Adverse effects were limited to staining, reduced with potassium iodide or dilution. Conclusion SDF demonstrates equivalent effectiveness to conventional liners, with advantages of simplicity and low cost, supporting its use as a minimally invasive option for indirect pulp capping.