{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:27:19Z","timestamp":1787120839257,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dent. Med."],"abstract":"\n Background<\/jats:title>\n Early childhood caries represents a severe global public health problem. Faced with this, Atraumatic Restorative Treatment (ART) and Silver Modified Atraumatic Restorative Treatment (SMART) have positioned themselves as minimally invasive approaches. The objective of this study was to evaluate and compare the clinical efficacy of SMART versus conventional ART for caries control in primary teeth.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, searching for randomized clinical trials (RCTs) across seven databases up to March 2026. Studies with a minimum follow-up period of 6 months were included. The risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seven reports derived from six randomized clinical trials with an overall low risk of bias were included in the qualitative synthesis, representing 398 unique pediatric participants. One trial generated two complementary publications reporting different outcomes; therefore, only the publication reporting clinical success contributed to the quantitative synthesis. A total of six randomized clinical trials were included in the meta-analysis, which showed no statistically significant differences in overall clinical success between SMART and ART (OR\u2009=\u20091.28; 95% CI: 0.91\u20131.80;\n p<\/jats:italic>\n \u2009=\u20090.16). Furthermore, Trial Sequential Analysis (TSA) demonstrated that the cumulative evidence remains inconclusive.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There is no statistically significant difference in overall clinical success between SMART and ART for the primary dentition. Both are viable and effective strategies; however, the certainty of the available evidence is low, and therefore future large-scale RCTs are required to establish definitive clinical guidelines.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261325936<\/jats:ext-link>\n , PROSPERO CRD420261325936.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fdmed.2026.1914881","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:44:49Z","timestamp":1787118289000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of silver modified atraumatic restorative treatment (SMART) versus atraumatic restorative treatment (ART) for caries control in primary teeth: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"7","author":[{"given":"Katia Noemi","family":"Rubio-Membrillo","sequence":"first","affiliation":[{"name":"Graduate School, Universidad Privada Antenor Orrego","place":["Trujillo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Victoria","family":"Espinoza-Salcedo","sequence":"additional","affiliation":[{"name":"Graduate School, Universidad Privada Antenor Orrego","place":["Trujillo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heber Isac","family":"Arbildo-Vega","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Dentistry School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]},{"name":"Faculty of Human Medicine, Human Medicine School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]},{"name":"Graduate School, Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas","place":["Chachapoyas, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar Edmundo","family":"Rojas-Rojas","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Dentistry School, Universidad San Mart\u00edn de Porres","place":["Chiclayo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith Esther","family":"Delgado-Asmat","sequence":"additional","affiliation":[{"name":"Graduate School, Universidad Privada Antenor Orrego","place":["Trujillo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhair Alexander","family":"Le\u00f3n-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Graduate School, Universidad Privada Antenor Orrego","place":["Trujillo, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz Tito","family":"Coronel-Zubiate","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Stomatology School, Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas","place":["Chachapoyas, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1177\/0022034517693566","article-title":"Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990\u20132015: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors","volume":"96","author":"Kassebaum","year":"2017","journal-title":"J Dent Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral diseases: a global public health challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1111\/ipd.12484","article-title":"Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective","volume":"29","author":"Tinanoff","year":"2019","journal-title":"Int J Paediatr Dent"},{"key":"B4","doi-asserted-by":"publisher","first-page":"650","DOI":"10.14219\/jada.archive.2009.0250","article-title":"Beyond the dmft: the human and economic cost of early childhood caries","volume":"140","author":"Casamassimo","year":"2009","journal-title":"J Am Dent Assoc"},{"key":"B5","first-page":"3","article-title":"The global increase in dental caries. 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