Arresting root caries with nonrestorative strategies: A systematic review with network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials.
PubMed 42309377 · doi:10.1016/j.jdent.2026.106836
What was done
A systematic review and network meta-analysis (NMA) evaluated randomized controlled trials investigating professionally applied and self-applied nonrestorative strategies for arresting root caries. Searches were conducted across PubMed, Cochrane CENTRAL, Web of Science, Embase, Scopus, ClinicalTrials.gov, and Google Scholar. Study quality was appraised using RoB 2.0, treatment rankings were generated via Surface Under the Cumulative Ranking (SUCRA), and certainty of evidence was evaluated with CINeMA.
What was found
Seventeen RCTs were included, with 15 eligible for NMA covering 2,869 participants and 5,233 active baseline lesions (2 trials at low risk of bias, 13 with some concerns). Specific numerical effect sizes (e.g., odds ratios) were not reported in the abstract. Professionally applied treatments superior to positive controls were annual 38% silver diamine fluoride (SDF) with or without potassium iodide (KI), quarterly 5% sodium fluoride (NaF) varnish with or without CPP-ACP, and 40% chlorhexidine varnish. Self-applied regimens superior to negative controls included daily 5,000 ppm fluoride dentifrice, 1,450 ppm fluoride dentifrice with 1.5% arginine, and 1,400 ppm fluoride dentifrice combined with a 250 ppm amine/potassium fluoride mouthrinse. SUCRA ranked annual 38% SDF plus KI highest among professional strategies, and daily 1,400 ppm dentifrice plus 250 ppm mouthrinse highest among self-applied strategies. Evidence certainty was low to moderate.
Why it matters
The findings rank both in-office and at-home noninvasive options for clinicians managing root caries, highlighting SDF and high-concentration or augmented fluoride regimens over standard negative controls.
Limits
The abstract reports no numerical effect estimates or confidence intervals. Thirteen of the 15 analyzed trials had risk-of-bias concerns, limiting overall evidence certainty to low or moderate. Patient-reported outcomes, compliance with home regimens, and aesthetic side effects (such as tooth staining from SDF or chlorhexidine) were not reported in the abstract.
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