Success Rates of Adhesive Materials in Atraumatic Restorative Treatment (ART) Restorations for Primary and Permanent Molars: A Systematic Review and Network Meta-Analysis

Aim This systematic review and network meta-analysis evaluated which adhesive material provides the highest success rate for ART restorations in primary and permanent molars. Methods Searches were conducted up to August 5, 2024, in MEDLINE/PubMed, Web of Science, Scopus, EMBASE, and ProQuest. Randomized controlled trials reported ART success rates with attrition < 30%, ≥ 12-month follow-up, standardized evaluation criteria, and at least two restorative materials were included. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Network meta-analyses were performed with treatment success as the outcome, stratified by dentition (primary/permanent), cavity type (occlusal/occlusoproximal), and follow-up at 12 or 24 months. Results Of 1,536 studies, 11 met eligibility; 10 were included in quantitative synthesis. Materials assessed were composite resin, high-viscosity GIC (HVGIC), resin-modified GIC (RMGIC), zinc-reinforced GIC (ZRGIC), compomer, and glass carbomer cement (GCC). In primary teeth, RMGIC showed the highest success at 12 months, while no significant differences were observed at 24 months. GCC consistently performed worst. In permanent teeth, RMGIC ranked highest at 12 and 24 months, while ZRGIC had the poorest outcomes. Five studies had low risk of bias. Conclusion RMGIC showed the best overall performance. HVGIC and compomers also achieved good results, while GCC and ZRGIC were less successful. Evidence should be applied cautiously given risk of bias and low-to-moderate certainty. Clinical Relevance : RMGIC demonstrated the highest success rates in ART restorations, supporting its use for occlusal and occlusoproximal carious lesions in both dentitions.