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The high/unclear risk of bias, imprecision and indirectness of the included trials presented a low certainty of evidence. CPP-ACP-TF exhibits superiority over TF monotherapy in remineralizing existing lesions and demonstrates better antibacterial effect, whereas it is not more effective for preventing caries incidence. However, Xylitol exerts an added benefit over fluoride alone in preventing caries increment. The low-certainty evidence highlights the need for more good quality trials. CPP-ACP-TF exhibits superiority over TF monother