BACKGROUND: Early childhood caries remains a major public health burden, and silver diamine fluoride (SDF) has emerged as a minimally invasive option for managing cavitated lesions in primary teeth. This meta-analysis compared SDF with conventional restorative treatment for caries control in children. METHODS: PubMed, Embase, Web of Science, Cochrane Library, and Scopus were searched from January 2010 to June 2025 for randomized controlled trials comparing SDF (30%-38%) with conventional restorative approaches, including atraumatic restorative treatment and glass ionomer-based restorations, in children with caries in primary teeth. The primary outcome was caries arrest or lesion inactivity; outcomes based solely on restoration survival were summarized separately. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool, and pooled estimates were calculated using Hartung-Knapp random-effects models, with prespecified sensitivity analyses for outcome compatibility and clustering. RESULTS: Eight randomized trials involving 12,445 teeth/surfaces from 8,507 children were included. Seven trials involving 12,265 teeth/surfaces from 8,317 children contributed to the primary caries arrest meta-analysis. No statistically significant difference was observed between SDF and conventional restorative treatment (risk ratio (RR) = 1.25, 95% confidence interval (CI): 0.88-1.78), with considerable between-study heterogeneity (I² = 96.1%). Exploratory subgroup analyses by unit of analysis, SDF concentration, application frequency, comparator type, setting, and follow-up did not resolve the heterogeneity. The treatment-time analysis included only two studies and favored SDF. CONCLUSIONS: Current randomized evidence does not demonstrate a statistically significant difference in caries arrest between SDF and conventional restorative treatment in primary teeth; however, considerable heterogeneity and wide confidence intervals limit confidence in the pooled estimate and preclude conclusions of equivalence. SDF may be practical when minimally invasive care is preferred or conventional restorative treatment is difficult to deliver, but treatment selection should also consider esthetic staining, child cooperation, caregiver preferences, and retreatment needs.
Chang et al. (Mon,) studied this question.