Aim <p>Managing occlusoproximal lesions remains a challenge for dental professionals. The aim of this systematic review was to identify the best strategy to treat occlusoproximal caries&#xa0;lesions in primary molars.</p> Methods <p>A systematic search was conducted in MEDLINE/PubMed, Web of Science, Scopus, EMBASE, and ProQuest up to 7th February 2024. Randomized controlled trials comparing different management strategies for occlusoproximal caries lesions with at least 12 months of follow-up were included. Network meta-analyses were carried out considering the success rate of the treatments as the outcome. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence with the GRADE tool.</p> Results <p>Seven studies were included, evaluating five treatment&#xa0;modalities: Hall Technique (HT), non-restorative cavity control (NRCC), conventional restorative treatment (CRT), silver diamine fluoride&#xa0;application (SDF), and Atraumatic Restorative Treatment (ART). HT had the highest success rate (80.8%). There was no statistical difference between other strategies. Only two studies showed&#xa0;a low risk of bias; the others had a high risk, primarily due to selective reporting bias.</p> Discussion <p>The HT had the highest success rate at 80.8%, making it the most effective treatment for occlusoproximal caries in primary molars. However, no significant difference was found between other treatment strategies. The certainty of evidence is limited by the high risk of bias, particularly selective reporting bias. Future research should also consider factors like patient preference and cost-effectiveness to better assess treatments in a patient-centered context.</p> Conclusion <p>HT is the most effective option for managing occlusoproximal caries in primary molars in terms of success rate. However, the evidence is based on studies with a high risk of bias, and the certainty of evidence ranges from very low to moderate.</p> PROSPERO <p>CRD42021281085</p>