Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis.

Area of Science:

• Dental Public Health
• Cariology
• Evidence-Based Dentistry

Background:

• Nonrestorative caries management aims to control disease progression and preserve tooth structure.
• Minimally invasive and non-invasive interventions are crucial for managing caries at a lesion level.

Purpose of the Study:

• To systematically review and network meta-analyze evidence on nonrestorative caries treatments.
• To evaluate the efficacy of interventions in arresting or reversing carious lesions and identify adverse events.

Main Methods:

• Inclusion of parallel and split-mouth randomized controlled trials.
• Systematic literature search across major databases (MEDLINE, Embase, Cochrane).
• Data synthesis using random effects models and frequentist approach with GRADE certainty assessment.

Main Results:

• Sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and high-fluoride toothpaste/gel showed effectiveness for various lesion types (low-moderate certainty).
• 5% NaF varnish was effective for noncavitated facial/lingual lesions (low certainty).
• 38% silver diamine fluoride (SDF) demonstrated high effectiveness for advanced cavitated lesions (moderate-high certainty).

Conclusions:

• Nonrestorative treatments offer effective strategies for caries management.
• Specific interventions like SDF and combined fluoride therapies show significant promise for lesion arrest and reversal.
• Evidence supports a range of options for managing carious lesions nonrestoratively.