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Which management strategy has the highest success rate for occlusoproximal caries lesions in primary molars? A systematic review and network meta-analysis

Evidence-Based Dentistry volume 26, page 155 (2025)Cite this article

Subjects

Abstract

Aim

Managing occlusoproximal lesions remains a challenge for dental professionals. The aim of this systematic review was to identify the best strategy to treat occlusoproximal caries lesions in primary molars.

Methods

A systematic search was conducted in MEDLINE/PubMed, Web of Science, Scopus, EMBASE, and ProQuest up to 7th February 2024. Randomized controlled trials comparing different management strategies for occlusoproximal caries lesions with at least 12 months of follow-up were included. Network meta-analyses were carried out considering the success rate of the treatments as the outcome. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence with the GRADE tool.

Results

Seven studies were included, evaluating five treatment modalities: Hall Technique (HT), non-restorative cavity control (NRCC), conventional restorative treatment (CRT), silver diamine fluoride application (SDF), and Atraumatic Restorative Treatment (ART). HT had the highest success rate (80.8%). There was no statistical difference between other strategies. Only two studies showed a low risk of bias; the others had a high risk, primarily due to selective reporting bias.

Discussion

The HT had the highest success rate at 80.8%, making it the most effective treatment for occlusoproximal caries in primary molars. However, no significant difference was found between other treatment strategies. The certainty of evidence is limited by the high risk of bias, particularly selective reporting bias. Future research should also consider factors like patient preference and cost-effectiveness to better assess treatments in a patient-centered context.

Conclusion

HT is the most effective option for managing occlusoproximal caries in primary molars in terms of success rate. However, the evidence is based on studies with a high risk of bias, and the certainty of evidence ranges from very low to moderate.

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CRD42021281085

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Fig. 1: PRISMA flowchart showing the identification, screening, eligibility assessment, and inclusion of studies in the systematic review.
Fig. 2: Summary of the risk of bias for each domain across the included studies, evaluated using the ROB 2 tool.
Fig. 3: Network comparisons and rank probability of treatments for non-progression of carious lesions in proximal surfaces.

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Data availability

All data supporting this article are openly available on the Open Science Framework (OSF) at https://osf.io/m87uw/.

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Acknowledgements

Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (CNPq) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for partially funding this manuscript. The protocol of this study was prospectively registered on PROSPERO - CRD42021281085.

Funding

This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001, Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brasil (CNPq) provides scholarship awards for research productivity in Brazil to Dr. Raggio (310972/2021-3) and the Fundação de Amparo à Pesquisa do Estado de São Paulo to Garbim (FAPESP - 2022/04054-7). The funders had no role in the conduction of the study, interpretation of the data or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil

    Jonathan Rafael Garbim, Livia da Rosa Oliveira, Rodolfo de Carvalho Oliveira, Tamara Kerber Tedesco & Daniela Prócida Raggio

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  1. Jonathan Rafael Garbim
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  2. Livia da Rosa Oliveira
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  3. Rodolfo de Carvalho Oliveira
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  4. Tamara Kerber Tedesco
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  5. Daniela Prócida Raggio
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Contributions

D.P.R, J.R.G and T.K.T conception and design of the study; J.R.G., L.R.O. data acquisition; J.R.G., L.R.O., T.K.T., and D.P.R. data analysis and interpretation; J.R.G. and R.C.O. drafted the manuscript; D.P.R., J.R.G., L.R.O., T.K.T. and R.C.O. revised and gave final approval of the manuscript.

Corresponding author

Correspondence to Daniela Prócida Raggio.

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Supplementary information

Appendix 3. PRISMA NMA

Appendix 1. search strategies for each database

41432_2025_1164_MOESM3_ESM.docx

Appendix 2. Reasons why the articles that were read in full were excluded from the qualitative and quantitative analysis, considering the exclusion criteria.

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Garbim, J.R., Oliveira, L.d.R., Oliveira, R.d.C. et al. Which management strategy has the highest success rate for occlusoproximal caries lesions in primary molars? A systematic review and network meta-analysis. Evid Based Dent 26, 155 (2025). https://doi.org/10.1038/s41432-025-01164-1

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