One-year clinical and radiographic evaluation of young permanent molars treated with brix 3000 vs. papacárie duo: a randomized controlled clinical trial

ABSTRACTAim:Dental treatment-related pain causes fear and anxiety, particularly in children. Minimally invasive dentistry techniques, such as chemo-mechanical caries removal (CMCR) and atraumatic restorative treatment (ART), aim to minimize discomfort. This study evaluated and compared pain perception during caries removal using a CMCR agent (BRIX 3000) versus ART in children aged 4–8 years.Materials and Methods:A randomized, two-arm clinical trial was conducted with 40 children aged 4–8, each with at least two carious lesions on primary molars. Children were randomly assigned to caries removal using either BRIX 3000 (CMCR) or ART. Pain was assessed using the sound, eye, and motor (SEM) scale and the Wong-Baker FACES scale. Data were analyzed statistically.Results:In the CMCR group, 67.5% of children had an SEM pain score of 0, while 70% had an SEM score of 0 in the ART group. The mean SEM pain scores were 0.43 ± 0.71 for CMCR and 0.40 ± 0.71 for ART. The mean Wong-Baker FACES pain scores were 0.45 ± 0.96 for CMCR and 0.60 ± 1.30 for ART. There was no statistically significant difference as the P-value was not less than 0.05 for pain scores between the two groups using either SEM (P-value = 0.785) or Wong-Baker FACES (P-value = 0.412) scales.Conclusion:Both CMCR with BRIX 3000™ and ART were effective in minimizing pain during caries removal in young children. However, the difference in pain scores between the two groups was not statistically significant, as indicated by a P-value greater than 0.05 for both the SEM scale (P = 0.785) and the Wong-Baker FACES scale (P = 0.412).

BackgroundThis study aimed to compare the efficacy of BRIX3000, Carisolv, and the conventional rotary-mechanical method for caries removal and to evaluate the intraoperative pain level and the requirement for local anesthesia during caries excavation in immature mandibular permanent first molars (PFMs) of pediatric patients aged 7 to 9.Materials and methodsIt was a single-blinded, randomized, parallel-group, active-controlled trial with three arms. Forty-five specimens were assigned randomly to three groups: Group 1: Chemomechanical caries removal (CMCR) utilizing Carisolv. Group 2: CMCR utilizing BRIX3000. Group 3: Control group, caries excavation utilizing conventional rotary-mechanical method. Lesions reaching the middle or inner third of the dentine (D2/3) were observed in immature mandibular PFMs with no pulpal and/or periodontal issues included. The efficacy of caries removal was considered the primary outcome measure. It was recorded using the Ericson et al. scale by visual-tactile examination and the caries detector, which includes five levels to rate the amount of carious dentin remaining. The secondary outcome measures were subjective and objective pain assessment and the requirement of local anesthesia. Continuous and categorical data were compared using the Kruskal–Wallis and chi-square tests, respectively. A significance level of p < 0.05 was adjusted.ResultsAll conventional-method cases (100%) and the majority of Carisolv and BRIX3000 cases (80%) showed complete caries removal and a mean score of (0.27 ± 0.59) and (0.20 ± 0.41) (p = 0.185), respectively. The conventional method group showed the highest mean score (2.07 ± 0.88) of the sound, eye, motor (SEM) scale compared with the Carisolv and BRIX3000 (p < 0.05) groups, which exhibit lower mean scores (0.80 ± 0.77), (0.67 ± 0.72), respectively. For the Wong-Baker FACES scale, the conventional method group recorded the highest mean (7.07 ± 3.01) compared to the Carisolv and BRIX3000 (p < 0.05) groups, which had considerably lower mean scores of (2.53 ± 2.77) and (2.00 ± 2.39), respectively. Consequently, the majority (80.00%) of conventional-method cases asked for local anesthesia (p < 0.05).ConclusionsAll methods were equally effective in removing caries. BRIX 3000 and Carisolv agents notably reduced pain in children.Trial registrationISRCTN registry, ISRCTN12761284, registered 6 November 2024, retrospectively.

The concept of Chemomechanical Caries Removal (CMCR) includes the selective removal of caries-infected tissue while preserving caries-affected tissue. However, studies examining its application to children are scarce. The aim was to assess pain perception and time duration of CMCR agents when removing caries in primary molars in a sample of children compared to the conventional method of caries removal using rotary burs. A randomized controlled clinical trial with a split-mouth design with a sample of 60 children aged 4-9 years with 120 cavitated occlusal carious primary molars was equally distributed into 2 experiments: BRIX3000® vs. conventional method (Experiment 1) and Carie-Care™ vs. conventional method (Experiment 2). The time duration of caries removal was recorded. Perception of pain during caries excavation was evaluated using the "Wong-Baker FACES® Pain Rating Scale." Caries removal using the conventional method was significantly faster compared to CMCR agents in both experiments (P < 0.001 and P < 0.001). Caries removal using BRIX3000® was significantly faster than Carie-Care™ (P < 0.001). Caries removal with BRIX3000® or Carie-Care™ were reported less painful than the conventional method (P = 0.002 and P = 0.011, respectively). The study concluded that although CMCR methods require more time for caries removal, they were reported to be less painful. The study protocol was registered at www. gov under the identifier NCT05427591.

Background: Traditional caries removal techniques, like using a vibrating drill, have several drawbacks, including unpleasant sensations, heat that can irritate dental pulp, the need for local anesthesia, high energy consumption, and environmental concerns. A new method, CMCR (chemomechanical caries removal) with Brix 3000, aims to address these issues. It is minimally invasive, painless, and comfortable, promoting a positive attitude towards dental care, especially for pediatric patients, those with anxiety or fear, and high-risk medical patients. Objective: This literature review examines the use of Brix 3000 gel for chemomechanical caries removal. Methods: The study uses a scoping review method, conducting a comprehensive literature search on PubMed, EBSCO, ScienceDirect, Scopus, ClinicalTrials.gov, and Google Scholar databases. The search focused on articles from the last 10 years using keywords like "chemomechanical caries removal," "Papain Based Gel," "Brix 3000," and "Dental caries." Results: Brix 3000 is the latest effective, efficient, and non-cytotoxic CMCR method. It has a shorter application time and lower cytotoxicity compared to other methods. It is the only CMCR agent using Encapsulating Buffer Emulsion (EBE) technology, enhancing proteolysis to remove degraded collagen from infected dentin. Brix 3000 is easy to use, requires no special instruments, offers patient comfort, does not need local anesthesia or drills, and does not irritate healthy tissue. Conclusion: Brix 3000 gel is an effective and efficient chemomechanical agent for caries removal.

Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial

Background: Pain and the usage of local anesthetic agents are still real problem in pediatric dentistry, for these reasons, the use of minimal invasive dentistry (MID) in regard to the patient comfort is important especially for children, anxious and uncooperative patients. Chemomechanical caries removal (CMCR) methods involve the selective removal of the carious dentine hence it avoided the painful removal of the sound dentine and the anxiety resulted due to the vibration of the hand piece which is also decreased thus it appears to be more acceptable and comfortable to the patient. Aims of this study: This study was conducted among group of children to assess and compare the anxiety rating scale (during and after treatment) between the use of a recent chemomechanical caries removal method (by using Brix 3000) and the use of rotary instruments (using the ceramic bur). Materials and methods: Thirty pediatric patients aged between 8-12years, with bilateral occlusal carious permanent molars (extending into dentin) were selected for this study. Carious lesions were removed using Brix 3000 (CMCR) on one side and rotary instruments on the contra lateral side. Both cavities were restored with light cured composite filling. Anxiety scores were determined using Frankle rating scale (1962) during and after the period of caries removal. Results: The anxiety rating scale during the period of treatment showed the percentage of the negative behavior in the CMCR method was less than the percentage of the ceramic bur reverse the positive and definitely positive, which means that the new CMCR agent (Brix 3000) was more comfortable than the conventional rotary instrument (ceramic bur), that reduced the need for local anesthesia and the use of the drill. While after the treatment there is no big difference in the acceptance of the patients in two groups. Conclusion: Brix 3000 gel as a CMCR is an effective alternative method for caries removal, which appears to be more comfortable for the patients and more conservative

Conservative caries removal has become an integral part of minimally invasive dentistry (MID). Polymer burs and chemomechanical caries removal are two feasible methods of MID. The objective of this study was to assess and compare the efficacy of polymer bur and chemomechanical caries removal agent clinically and microbiologically for selective removal of infected dentin. A total of fifty primary second molars with occlusal decay involving dentin were selected from 25 patients aged between 5 and 9 years. They were randomly allocated to Group A (polymer bur group) and Group B (Carie-Care group) for caries removal. Completeness of caries excavation was assessed clinically with the application of caries detector dye. Dentinal samples were collected before and after caries removal and cultured in Luria-Bertani Agar, and total viable count was assessed. All the teeth after caries excavation were restored with Type 2 glass ionomer cement. The data obtained was tabulated and statistically analyzed using paired t-test and Chi-square test. There was a statistically significant reduction in the mean microbial count before and after treatment in polymer bur group and Carie-Care group. The reduction in mean microbial count was found significantly higher in polymer bur group compared to Carie-Care group. There was no significant association was observed between the two groups when efficacy was assessed clinically. Both polymer bur and Carie-Care were efficient caries removal agents when assessed clinically and microbiologically. Polymer bur was found to be more effective than Carie-Care when assessed microbiologically.

AimThis research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions.MethodsPatients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria.ResultsComparison of age, time and volume with study groups were made using Independent Sample’ t’ test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen’s Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups.ConclusionBrix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

PurposeThis study aims to compare the efficiency of caries removal between the chemomechanical caries removal agent Brix 3000 and the conventional method using a laser fluorescent device (DIAGNOdent Pen), caries detection dye, microbial culture, and real-time polymerase chain reaction (PCR) methods.Materials and methodsThe study involved 64 primary molars with dentinal caries between March and June 2022. Standardization was achieved based on International Caries Detection and Assessment System (ICDAS-II) criteria (score 6) and DIAGNOdent Pen measurements (30 and above). Caries were removed using the conventional method (32) and Brix 3000 (32). Following this, dentin samples were collected, and measurements were made with the DIAGNOdent Pen to evaluate the presence of residual caries in both groups. After the measurements, the presence of residual caries was evaluated in both groups using caries detection dye. The decrease in values obtained by microbial culture and real-time PCR methods of dentin samples taken before and after caries removal was evaluated.ResultsWhen DIAGNOdent Pen and caries detection dye were evaluated, the caries removal efficiency of the conventional method was found to be higher (p < 0.05). As a result of the microbial culture evaluation for Streptococcus mutans and total bacteria, the caries removal efficiencies of both methods were found to be similar (p > 0.05). The caries removal efficiency of Brix 3000 was found to be higher as a result of the evaluation with real-time PCR for S. mutans (p < 0.05).ConclusionIt is thought that Brix 3000 is an effective agent for caries removal and may be an alternative agent to the conventional method, especially considering its advantages in children.How to cite this articleAydogdu AB, Olmez A, Akca G. Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study. Int J Clin Pediatr Dent 2025;18(3):245–250.

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.

Background: Painless dentistry, minimal intervention and thus giving relief, comfort, and solace and thereby instilling a positive attitude toward dental treatments, are some of the factors justifying the specialty of pediatric dentistry. Aim: The purpose of this study was to evaluate clinically the effectiveness, total working time and pain reaction following treatment with a new chemomechanical caries removal gel (Carie-Care™) compared to conventional drilling method in primary teeth. Settings and Design: This study is a split-mouth clinical trial wherein two methods of caries removal were performed within the same patient. Methods: Two methods of caries removal were compared in the same patient. Sixty carious primary teeth were evaluated from thirty children and divided into two groups as test and control group. In the test group, the caries was removed using the new chemomechanical caries removal gel, and in control group, caries was removed using the dental bur. Statistical Analysis used: Unpaired t-test. Results: The mean time taken for complete caries excavation with Carie-Care™ was 3.24 ± 0.74 s. This was significantly longer compared with the conventional drilling wherein the mean time was 2.08 ± 0.24 s (P < 0.001). Patient treated with Carie-Care™ gel experienced significantly comfort (Score 1) (P < 0.001), and it was as effective as drill in caries removal. Conclusion: Carie-Care™, a new chemomechanical caries removal agent could be an effective caries removal method for the treatment of patients seeking an alternative to conventional methods.

Chemo-mechanical caries removal methods are known to be more effective compared with conventional methods in pain reduction. Carie-care™, a chemo-mechanical caries removal agent, was introduced in 2010 but a systematic review of its efficacy has not yet been performed. The purpose of this study was to investigate the effectiveness of Carie-care™ on the outcomes of treatment of caries in children and adolescents. The primary outcome was pain while the secondary outcomes included complete caries removal (CCR), time, need for local anesthesia and behavioral response changes.A Comprehensive literature search was performed in PubMed, EMBASE, and the Cochrane Library up to 30 September 2018. The following keywords were used in the search: ‘chemo-mechanical caries removal agent’, ‘dental caries’, ‘Carie-care’, ‘chemo-mechanical caries removal’, ‘chemo-mechanical caries excavation’, other related keywords, and their combinations. From 942 studies identified, 16 were analyzed. Finally, 4 studies met the eligibility criteria and 260 teeth in 120 children and adolescents were included in this review.This review showed that Carie-care™ reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods. Local anesthesia was not required in the Chemo-mechanical caries removal (CMCR) group. In addition, dental anxiety decreased compared to the control group, and co-operation was more positive. Therefore, it may be a useful alternative to conventional methods in children and adolescents, but further verification through additional studies is needed.

This in vitro study aimed to assess the speed and caries removal effectiveness of four different new and conventional dentine excavation methods. Eighty deciduous molars were assigned to four groups. Teeth were sectioned longitudinally through the lesion centre. Images of one half per tooth were captured by light microscope and confocal laser scanning microscopy (CLSM) to assess the caries extension. The halves were then reassembled and caries removed using round carbide bur (group 1), Er:YAG laser (group 2), hand excavator (group 3) and a polymer bur (group 4). The time needed for the whole excavation in each tooth was registered. After excavation, the halves were photographed by light microscope. Caries extension obtained from CLSM images were superimposed on the post-excavation images, allowing comparison between caries extension and removal. The regions where caries and preparation limits coincided, as well as the areas of over- and underpreparation, were measured. Steel bur was the fastest method, followed by the polymer bur, hand excavator and laser. Steel bur exhibited also the largest overpreparation area, followed by laser, hand excavator and polymer bur. The largest underpreparation area was found using polymer bur, followed by laser, hand excavator and steel bur. Hand excavator presented the longest coincidence line, followed by polymer and steel burs and laser. Overall, hand excavator seemed to be the most suitable method for carious dentine excavation in deciduous teeth, combining good excavation time with effective caries removal.

In this study, the clinical efficacy of Carisolvtrade mark system and the hand excavation method in the removal of occlusal dentine caries of primary molar teeth was evaluated. Both Carisolv system and hand excavation method were applied for the removal of caries on different teeth of the same children. After the removal of the caries, Dyract AP materials were used to restore the teeth. The clinical follow-up was made every 3 months within a year. The clinical evaluations of restorations were carried out in accordance with US Public Health Service (USPHS) criteria. To determine whether there was any statistical difference between the groups, chi-square analysis was used. During both excavation methods, pain occurrence and the need for anesthesia and the time spent were all recorded. The time spent for the removal of caries in Carisolv system and in hand excavation method was 9.03+/-4.14 min (mean+/-SD) and 7.34+/-3.41 min (mean+/-SD), respectively (P>0.05). At the end of 1 year, differences between Carisolv and hand excavation groups in terms of marginal adaptation and secondary caries were found to be statistically insignificant (P>0.05). During the removal of caries, certain children complained about pain both in Carisolv system and hand excavation method (7.1 and 35.7%, respectively). As a result, it can be argued that Carisolv system is effective in the removal of caries and causes minimum level pain occurrence. Compared to hand excavation, Carisolv system seems to be a promising restorative approach to remove occlusal caries in primary molar teeth. Studies of longer duration are needed to confirm these findings.

Introduction: Latest theories regarding the rationale of carious dentin removal are beginning to question the amount of tissue that needs to be excavated to successfully treat a carious tooth. It is not always easy to make a decision at which point to stop excavation because there is an apparent lack of objective clinical markers. However, hardness of dentin might be a useful marker in this respect. Nanoindentation test is a variety of indentation hardness test applied to small volumes such as teeth which contain nanosized structures. Aims: To compare and evaluate the nanohardness of dentin after chemomechanical (Carie-care) method of caries removal with the conventional (rotary instrument) method of caries removal in primary and permanent teeth using nanoindenter. Materials and Methods: An in vitro randomized controlled trial was conducted using fifteen primary and fifteen permanent extracted molars with active carious lesion extending into the dentin. The primary and permanent molars were further randomly divided into two subgroups by sectioning the samples into two halves. Caries removal was done using conventional drill (CD) and chemomechanical caries removal (CMCR) (Carie-care) methods. Following the caries removal, the test specimens were subjected for evaluation of nanohardness of dentin using nanoindenter. Student's t-test, analysis of variance, and Bonferroni test were used. Results: Statistically significant difference between the 4 groups with a P < 0.05 was obtained. Conclusions: After caries removal, the hardness of remaining dentin was found to be harder after CMCR method than with the CD method in both primary and permanent teeth, and the remaining dentin of the permanent teeth was found to be harder than the primary teeth after caries removal.