Abstract
OBJECTIVE: Dental caries remain a prevalent concern in pediatric dentistry, necessitating effective and minimally invasive management strategies to preserve tooth structure and ensure patient comfort. This meta-analysis aimed to compare the success rates of minimally invasive techniques for managing cavitated caries in primary teeth. METHODS: A systematic search across MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane’s CENTRAL databases up to November 2024 identified randomized clinical trials (RCTs) comparing minimally invasive, conventional, or placebo treatments for cavitated caries in primary teeth, with at least six months of follow-up. Risk of bias was assessed using Cochrane Risk of Bias 2.0 tool. A random-effects frequentist network meta-analysis (NMA) estimated treatment success (odds ratios, 95% confidence intervals [CIs]) at 6, 12, and 12–24 months. Evidence certainty was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework. RESULTS: Sixty-eight RCTs were included. At six months, the Hall technique showed the highest success rate among 12,094 treated primary teeth, significantly outperforming placebo (OR = 163.59, 95% CI = 10.15–2636.00), sealing (OR = 90.71, 95% CI = 1.57–5243.63), atraumatic restorative treatment (ART; OR = 10.11, 95% CI = 3.03–33.71), sodium fluoride (NaF; OR = 8.19, 95% CI = 1.44–46.63), silver-modified atraumatic restorative treatment (SMART; OR = 5.61, 95% CI = 1.36–23.08), silver diamine fluoride (SDF; OR = 4.87, 95% CI = 1.23–19.30), and conventional (OR = 3.66, 95% CI = 1.29–10.40) treatments. Conventional restorations were significantly superior to placebo (OR = 44.66, 95% CI = 3.22–620.47) and ART (OR = 2.67, 95% CI = 1.24–6.15). At 12 months, the Hall technique remained the most effective among 11,799 teeth, significantly outperforming sealing (OR = 13.93, 95% CI = 1.34–144.52), ART (OR = 6.15, 95% CI = 2.55–14.83), SMART (OR = 4.36, 95% CI = 1.13–16.77), SDF (OR = 3.23, 95% CI = 1.13–9.22), and conventional (OR = 2.92, 95% CI = 1.40–6.11). Conventional method was significantly superior to ART (OR = 2.10, 95% CI = 1.17–3.78). At 12–24 months, the Hall technique consistently achieved the highest success among 4,097 teeth, significantly outperforming ART (OR = 5.13, 95% CI = 1.18–22.38) and conventional methods (OR = 4.17, 95% CI = 1.44–12.10). Most included studies had moderate risk of bias, and according to CINeMA assessments, the certainty of evidence for treatment comparisons was generally moderate, with a few effects rated as low or high confidence depending on outcome and follow-up duration. CONCLUSION: The Hall technique was the most effective for sealing cavitated caries in primary teeth, offering superior durability. SDF showed good short-term efficacy but had aesthetic limitations. Other minimally invasive methods performed similarly to conventional restorations. REGISTRATION: The protocol for this systematic review was registered at PROSPERO with the ID CRD42025492783. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-025-06832-3.