Silver diamine fluoride versus atraumatic restorative treatment for management of childhood caries: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the efficacy of Silver Diamine Fluoride (SDF) in comparison with the standard Atraumatic Restorative Therapy (ART) in arresting dental caries in children. We searched the databases of CENTRAL, Embase, PubMed, and Scopus till 16 August 2025. Eligible studies were randomized controlled trials (RCTs) comparing SDF alone vs. ART alone for caries arrest in pediatric patients with at least 12 months of follow-up. Risk ratio (RR) was calculated in a random-effects meta-analysis model. Subgroup analysis was conducted based on the frequency of SDF application and follow-up. Cochrane Collaboration risk of bias-2 tool was used to assess risk of bias. The review was registered on PROSPERO database (CRD420251127028). Eight RCTs were included. All were parallel-arm studies. Comparing data of 6430 teeth or surfaces treated with SDF with 5466 teeth or surfaces treated with ART, the meta-analysis showed that SDF had marginally but significantly higher caries arrest rate as compared to ART (RR: 1.21 95% CI: 1.02, 1.44 95% I2: 96%). No publication bias was noted. Results lost significance during sensitivity analysis. Results also turned non-significant on both subgroup analyses based on the frequency of SDF application and follow-up. Very low-quality evidence suggests that SDF may be marginally better than ART at arresting dental caries in children. Evidence must be interpreted with caution given the high heterogeneity, methodological concerns in included studies and the lack of robustness of results during sensitivity and subgroup analyses.