Chemomechanical caries removal (CMCR) agents: Review and clinical application in primary teeth

Abstract

Chemomechanical caries removal (CMCR) is a non-invasive technique eliminating infected dentine via a chemical agent. This is a method of caries removal based on dissolution. Instead of drilling, this method uses a chemical agent assisted by an atraumatic mechanical force to remove soft carious structure. It was introduced to dentistry as an alternative method of caries removal and is mainly indicated to overcome the inconvenience of using burs and local anesthesia, causing less discomfort to patients and preserving healthy dental structure, there by complying the concept of the minimal invasive dentistry (MID). Various agents with their methods have been used in the past for CMCR, but only a few have got into a stable clinical practice. Among them we have the Carisolv, which is the most successful and commonly used agent while Papacarie gives the promising result as CMCR agent of the future. Carisolv came into use at the end of 20th century. It consists of two component mixtures (mainly amino acid and hypochlorite), forming an active gel. Papacarie is an emerging CMCR agent of the 21st century. Papacarie is composed basically of papain, chloramines and toluidine blue. Papain interacts with exposed collagen by the dissolution of dentine minerals through bacteria, making the infected dentine softer, and allowing its removal with non cutting instruments without local anesthesia and burs. This paper attempts to look into this method in detail with various agents of CMCR and also present case reports regarding the two most commonly used agents. Key words: Chemomechanical caries removal (CMCR), carisolv, papacarie, infected dentine.