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J Dent Res. 2019 Jan;98(1):14-26. doi: 10.1177/0022034518800014. Epub 2018 Oct 5.

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

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1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.
2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA.
3 Science Institute, American Dental Association, Chicago, IL, USA.
4 Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
5 Advance Education Program in Operative Dentistry, University of Iowa, Iowa City, IA, USA.
6 Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA.
7 DentaQuest Institute and DentaQuest Oral Health Center, Westborough, MA, USA.
8 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, College Park, MD, USA.
9 Department of Dental Public Health and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
10 University of Pennsylvania, Philadelphia, PA, USA.
11 Department of Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA.
12 Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA.
13 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
14 Health Sciences Library, McMaster University, Hamilton, ON, Canada.
15 College of Dental Medicine, Midwestern University, Downers Grove, IL, USA.
16 GC America, Alsip, IL, USA.
17 Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile.


The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.


caries; dental public health; evidence-based dentistry/health care; geriatric dentistry; pediatric dentistry; systematic reviews and evidence-based dentistry

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