## 4 Discussion
### Clinical Performance and Long-Term Outcomes of SDF  
The studies reviewed also focused on the clinical performance and long-term outcomes of SDF interventions. For example, [PERSON] et al. found comparable clinical performance between SMART and ART, with SMART demonstrating cost-effectiveness and shorter treatment times. Additionally, [PERSON] et al. addressed the lack of consensus in post-SDF instructions, contributing evidence for effective SDF treatment protocols. [PERSON] et al. aimed to assess the clinical performance of preventive materials, including a resin-modified glass ionomer cement, resin sealant, and SDF, on primary molars over 36 months. The study, involving 32 children, found no significant difference in material retention between the groups. The resin sealant exhibited higher loss (44%) than glass ionomer cement (35%). Incipient caries incidence was highest in the SDF group (20%), but differences were not significant. Overall, the study concluded that no significant differences in material retention and caries were found, emphasizing the importance of clinical judgment in selecting appropriate preventive materials for high-risk pediatric patients [81].  
[PERSON] et al. assessed the clinical performance and cost-effectiveness of SMART and ART in primary molars over 12 months [120]. The study involved 67 children with active caries randomly assigned to SMART or ART. Both SMART and ART techniques showed comparable clinical performance, with mean survival times of 11.8 and 11.6 months, respectively. SMART had a significantly lower mean treatment time (7.8 min.) and total cost per restoration, suggesting that, despite similar clinical outcomes, SMART is less time-consuming and more cost-effective than ART in treating single-surface occlusal lesions in primary molars [82].  
The 12-month randomized controlled clinical trial by [PERSON] et al. aimed to compare post-treatment instructions for SDF therapy in arresting dentine caries in kindergarten children. The study involved at least 254 children randomized into two groups, receiving 38% SDF topically. Group A rinsed immediately, while Group B refrained from rinsing, eating, and drinking for 30 min. The primary outcome was the proportion of arrested caries lesions at the 12-month examination. Secondary outcomes included parental satisfaction and adverse effects [121]. This trial addressed the lack of consensus in post-SDF instructions and contributed evidence for effective SDF treatment protocols [83].  
[PERSON] et al.'s study aimed to assess the effectiveness and cost-effectiveness of SDF in preventing and arresting initial caries lesions on approximal surfaces in pediatric patients. The randomized clinical trial included three groups: SDF, resin infiltration, and a control group with exclusive flossing. The primary outcome was caries progression, evaluated through clinical and radiographic examinations. Secondary outcomes included patient discomfort, satisfaction, and cost analysis. The hypothesis suggested SDF as the most cost-effective option. The trial, with ethical approval, involved children and adolescents, with interventions and placebos standardized. This study addressed the challenge of controlling caries lesions on approximal surfaces, emphasizing the importance of early intervention [84].