Chemomechanical Caries Removal Agent Research Articles

Effect of enzymatic chemo-mechanical agents on adhesion of composite resin to dentin of permanent teeth: an in vitro study.

To evaluate and compare the effect of two enzymatic chemo-mechanical caries removal agents with conventional caries removal using rotatory instruments on the adhesion of composite resin to dentin of permanent teeth. The sample comprised 30 permanent molars with caries lesions extending to the dentin, randomly distributed into three groups (n = 10 each): 1-Caries removal with rotary instruments (control group); 2-Caries removal with Papacárie Duo® (F&A Laboratório Farmacêutico, São Paulo, Brazil); 3-Caries removal with Brix 3000™ (Brix S.R.L., Carcarañá, Argentina). After caries removal, the specimens were rinsed and dried. Scotchbond Universal™ adhesive (3M, Saint Paul, Minnesota, USA) was actively applied in self-etch mode and light-cured. Resin composite increments were applied using a silicone mold (3 × 3 × 2mm) and light-cured. Shear bond strength (MPa), work-to-debonding (J/m2), and shear modulus (kPa) were evaluated. For statistical analysis, the level of significance was set at 5%. The control group presented significantly higher shear bond strength values (8.50 ± 2.69MPa) compared to the Brix 3000™ group (5.72 ± 1.55MPa, p = 0.008). There were no significant differences between Papacárie Duo® (6.66 ± 0.86MPa) and the other groups (p > 0.05). Regarding work-to-debonding, the Papacárie Duo® group had a significantly higher result (2944.41 ± 450.21J/m2) than the Brix 3000™ group (1189.41 ± 504.13J/m2, p < 0.001) and the control group (967.10 ± 270.01J/m2, p < 0.001). Concerning shear modulus, the control group showed a significantly higher result (558.67 ± 168.96kPa) than the Brix 3000™ group (339.79 ± 143.78kPa, p = 0.008) and the Papacárie Duo® group (223.04 ± 127.30kPa, p < 0.001). While the application of Papacárie Duo® did not negatively affect composite resin adhesion to dentin of permanent teeth, the application of Brix 3000™ reduced adhesive forces, potentially limiting its clinical use. Further investigations are warranted to elucidate the effects of these materials on dentin substrate, particularly through clinical studies.

Comparison of pain and efficacy of caries removal using tungsten carbide bur versus chemomechanical agent (Brix Gel): A randomized controlled trial.

Objective: To compare the pain response and efficacy of caries removal using tungsten carbide burs with that of using Brix Gel as a chemomechanical caries removal agent. Study Design: Randomized Controlled Trial. Setting: Department of Operative Dentistry, PIMS, Islamabad. Period: November 2023 to April 2024. Methods: Conducted on 40 participants were selected using a non-probability technique. Participants aged 12 to 65 years with open occlusal carious lesions involving dentin were included. Patients with symptoms of pulpitis, caries affecting maxillary or mandibular anterior teeth, severe systemic illnesses, allergies, sensitivities, or pregnancy/lactation were excluded. Caries removal methods were randomly assigned. Pain levels were assessed using a Visual Analog Scale (VAS), and caries removal efficacy was evaluated. Statistical analysis was done using chi-square and independent samples t test. Results: Among the 40 participants, 47.50% were female, and the mean age was 36.30±15.57 years. Mandibular molars were the most commonly affected teeth (n=24, 60%). No significant difference in age or gender distribution was observed between the two groups. The chemomechanical method resulted in significantly lower pain scores compared to carbide bur (2.59 ± 1.34 vs. 4.44 ± 1.61, p &lt; 0.001). Pain severity also differed significantly between groups, with more mild pain reported in the chemomechanical group (80.00% vs. 5.00%, p &lt; 0.001). However, caries removal efficacy did not significantly differ between the two methods (p = 0.48). Conclusion: Chemomechanical caries removal using Brix Gel demonstrated superior pain management compared to carbide bur. While both methods showed similar efficacy in caries removal, the chemomechanical approach may offer better patient comfort during the procedure.

COMPARATIVE EVALUATION OF BEHAVIOUR OF CHILDREN AND TIME TAKEN BY THREE TECHNIQUES OF CARIES REMOVAL: CHEMOMECHANICAL CARIES REMOVAL, CARIES REMOVAL WITH SMART BURS AND CONVENTIONAL CARIES REMOVAL- A CLINICAL PROSPECTIVE STUDY

Background: Many chemomechanical caries removal (CMCR) agents have been introduced and marketed since 1970s, with each new one being better and effective than the previously introduced. CMCR and Smart Burs (mechanical caries removal) are minimally invasive treatment approaches which selectively remove caries-infected tissue while leaving intact caries-affected tissue-conserving tooth structure. Aim: to compare the effectiveness of different caries removal techniques in primary teeth using the BRIX-3000, conventional caries removal , and Smart Burs in removing dentinal caries. The time taken for caries removal, the efficacy of caries removal and patient acceptance will be evaluated for clinical success with different caries removal techniques. Materials and methods: the study will be carried in thirty primary teeth in children aged 5-10 years with asymptomatic carious lesion. The teeth will be randomly divided into three groups depending on type of caries removal method used. Results: There was statistically significant difference among the groups with respect to childs behaviour , time taken and efficiency of caries removal Conclusion:The time taken to remove caries by Conventional method was observed to be significantly lower as compared to that taken by smart burs and Brix - 3000. The clinical efficacy of caries removal was highest with conventional method followed by almost comparable effectiveness by smart burs and Brix-3000. However,Patient acceptance during caries removal was found to be highest with Brix - 3000 followed by Smart burs and least by Conventional method.

An in-vitro evaluation of residual dentin retained after using novel enzymatic-based chemomechanical caries removal agents

To assess the biochemical, mechanical and structural characteristics of retained dentin after applying three novel bromelain-contained chemomechanical caries removal (CMCR) formulations in comparison to the conventional excavation methods (hand and rotary) and a commercial papain-contained gel (Brix 3000). Seventy-two extracted permanent molars with natural occlusal carious lesions (score > 4 following the International Caries Detection and Assessment System (ICDAS-II)) were randomly allocated into six groups (n = 12) according to the excavation methods: hand excavation, rotary excavation, Brix 3000, bromelain-contained gel (F1), bromelain-chloramine-T (F2), and bromelain-chlorhexidine gel (F3). The superficial and deeper layers of residual dentin were examined by Raman microspectroscopy and Vickers microhardness, while the surface morphology was assessed by the scanning electron microscope (SEM). A multivariate analysis of variance followed by Tukey’s test (p > 0.05) was performed for data analysis. The novel formulations showed an ability to preserve the partially demineralized dentin that showed a reduced phosphate content with a higher organic matrix. This was associated with lower Vickers microhardness values in comparison to sound dentin and rotary excavation. The collagen integration ratio in all methods was close to sound dentin (0.9–1.0) at the deeper dentin layer. The bromelain-chloramine-T gel (F2) produced the smoothest smear-free dentin surface with a higher number of opened dentinal tubules. In contrast, dense smearing covering the remaining dentin was observed in the manual and rotary methods with obstructed dentin tubule orifices. The bromelain-contained formulations can be considered a new minimally invasive approach for selectively removing caries in deep cavitated dentin lesions.

The Revolution of Brix 3000 as Chemomechanical Caries Removal (Cmcr) Agent, A Scoping Review

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.

Evaluation of staining potential of Silver Diamine Fluoride, Potassium Iodide, Nanosilver Fluoride: an in vitro study

BackgroundThe black staining effect of silver-containing solutions for use to arrest caries can have a negative aesthetic impact on children and parents. This study aims to assess the staining effects of Silver Diamine Fluoride/Potassium Iodide (SDF/KI), SDF and Nanosilver Fluoride (NSF).Materials and methodsForty-four extracted carious primary molars were collected and randomly divided into four groups (n = 11). The carious tissue in all teeth was removed using a chemo-mechanical caries removal agent with an excavator. After caries removal in all groups, SDF, SDF/KI, and NSF were applied to the different groups, while no solution was applied to the control group. Subsequently, the teeth in all groups were restored with compomer. Color values L*, a* and b* were measured using a spectrophotometer at three time points: immediately after compomer restoration (T0), one week later (T1), and four week later (T2). Changes in brightness (ΔL) and color (ΔE) over time were calculated and comparisons among groups were made.ResultsThe SDF solution induced statistically significant black staining (p = 0.013) and a decrease in L* value (p < 0.001) on the compomer material compared to the other groups over time.ConclusionsIt was observed that SDF/KI has the potential to reduce the black staining effect of SDF, though not entirely. Novel experimental solutions like NSF may offer an alternative to counteract the staining effect of SDF.

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation

BackgroundThis study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent.MethodsForty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy.ResultsVickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization.ConclusionsIt was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

To evaluate the efficiency and effectiveness of three minimally invasive (MI) techniques in removing deep dentin carious lesions. Forty extracted carious molars were treated by conventional rotary excavation (control), chemomechanical caries removal agent (Brix 3000), ultrasonic abrasion (WOODPECKER, GUILIN, China); and Er, Cr: YSGG laser ablation (BIOLASE San Clemente, CA, USA). The assessments include; the excavation time, DIAGNOdent pen, Raman spectroscopy, Vickers microhardness, and scanning electron microscope combined with energy dispersive X-ray spectroscopy (SEM–EDX). The rotary method recorded the shortest excavation time (p < 0.001), Brix 3000 gel was the slowest. DIAGNOdent pen values ranged between 14 and 18 in the remaining dentin and laser-ablated surfaces recorded the lowest reading (p < 0.001). The Ca:P ratios of the remaining dentin were close to sound dentin after all excavation methods; however, it was higher in the ultrasonic technique (p < 0.05). The bur-excavated dentin showed higher phosphate and lower matrix contents with higher tissue hardness that was comparable to sound dentin indicating the non-selectiveness of this technique in removing the potentially repairable dentin tissue. In contrast, the MI techniques exhibited lower phosphate and higher organic contents associated with lower microhardness in the deeper dentin layers. This was associated with smooth residual dentin without smearing and patent dentinal tubules. This study supports the efficiency of using MI methods in caries removal as conservative alternatives to rotary excavation, providing a promising strategy for the clinical dental practice.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial

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.

Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study.

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Clinical Efficacy and Pain Perception with Novel Chemomechanical Caries Removal Agent and Conventional Method in Primary Molars: A Randomized Controlled Study

Clinical Efficacy and Pain Perception with Novel Chemomechanical Caries Removal Agent and Conventional Method in Primary Molars: A Randomized Controlled Study

Assessment of Smear Layer Formation After Caries Removal Using Erbium Laser and Papain-Based Chemo-Mechanical Caries Removal Agent: An In Vitro Scanning Electron Microscopy Study.

Introduction With the advancement in the field of adhesive dentistry, there has been a significant and groundbreaking shift towardthe adoption of minimally invasive caries removal techniques where substrate modification is known to enhance adhesive bonding. The smear layer has always been controversial, as its modification helps in bonding, but if contaminated with bacteria, it compromises the formation of a satisfactory marginal seal. Thus, the recognition of the role played by the smear layer highlights the importance of the type of caries removal method employed. Hence, the aim of the present study was to assess and compare smear layer formation after caries removal using an erbium laser and chemo-mechanical caries removal agent by scanning electron microscopy. Methods The study involved the evaluation of 30 extracted human molars with occlusal caries. Based on the method of caries excavation, the samples were allocated into two separate groups: group 1 - caries removed using erbium laser (Waterlase, Biolase, Lake Forest, CA); group 2 - caries removed using papain-based chemo-mechanical caries removal agent (Carie Fix, Dengen Dental, Bahadurgarh, India). To assess the smear layer, the samples underwent examination using a scanning electron microscope at 1500x and 3000x magnification after removal of caries. Statistical analysis was done using SPSS version 22 software (IBM Corp., Armonk, NY). Mann-Whitney test was used to compare the mean smear layer (nonparametric) between both groups. Results Group 1 (Er:YAG laser) showed significantly greater removal of the smear layer than group 2 (papain-based chemo-mechanical caries removal agent) on the excavated caries surfaces(p < 0.001). In group 1, the dentinal tubules exhibited greater patency when compared to the partial patency observed in group 2. Conclusion Both techniques for caries removal were effective; however, the Er:YAG laser method was determined to be more efficient in comparison to the chemo-mechanical agent. These caries removal methods can be considered the future of minimally invasive dentistry.

The in-vitro development of novel enzyme-based chemo-mechanical caries removal agents

ObjectivesBromelain is a potent proteolytic enzyme that has a unique functionality makes it valuable for various therapeutic purposes. This study aimed to develop three novel formulations based on bromelain to be used as chemomechanical caries removal agents. MethodsThe novel agents were prepared using different concentrations of bromelain (10–40 wt. %), with and without 0.1–0.3 wt. % chloramine T or 0.5–1.5 wt. % chlorhexidine (CHX). Based on the enzymatic activity test, three formulations were selected; 30 % bromelain (F1), 30 % bromelain-0.1 % chloramine (F2) and 30 % bromelain-1.5 % CHX (F3). The assessments included molecular docking, Fourier-transform infrared spectroscopy (FTIR), viscosity and pH measurements. The efficiency of caries removal was assessed by DIAGNOdent pen, measuring the excavation time and number of applications, followed by a morphological evaluation of the remaining dentine using scanning electron microscopy (SEM). The results were compared to Brix 3000 as a control. ResultsThe chloramine and chlorhexidine were chemically compatible with bromelain without compromising the enzyme activity. All experimental formulations showed higher viscosity and pH in comparison to Brix 3000. The DIAGNOdent readings were <20 in all groups, and the lowest readings were observed in F2. The excavation time and number of applications were lowest in F2 and F1. Both F2 and F3 produced smooth dentine surfaces with less tissue debris, but more patent dentine tubules were observed in F1 and F2. ConclusionsThe bromelain-contained formulations showed a potential to be used as chemomechanical caries removal agents in vitro. Further laboratory and clinical studies are needed to validate this claim. Clinical significanceThe bromelain from pineapple stem has broad specificity for cleavage the peptide bonds in denatured protein to facilitate their removal. The study proved the efficiency of this enzyme to remove the dental caries chemomechanically when used alone or conjugated with chloramine and/or chlorhexidine to enhance the disinfecting and cleansing properties.

Optimizing Adhesive Bonding to Caries Affected Dentin: A Comprehensive Systematic Review and Meta-Analysis of Dental Adhesive Strategies following Chemo-Mechanical Caries Removal

Although there are several studies that have evaluated the bond strength of various adhesives to healthy dentin and caries-affected dentin after traditional caries removal, the objective of this systematic review aimed to assess the bond strength of various adhesives to caries-affected dentin (CAD) after chemo-mechanical caries removal (CMCR) treatment. The review adhered to PROSPERO protocol registration and followed PRISMA guidelines. The research question focused on the bonding effectiveness of dental adhesives to CAD after employing the chemo-mechanical caries removal method. PubMed, the TRIP database, and Scopus were searched, with the last search conducted in February 2023. Two reviewers independently screened and evaluated articles, resulting in 30 articles for full-text analysis out of 434 retrieved from databases. Twelve eligible studies were included in the review. The bond strength of etch-and-rinse (ER) and self-etch (SE) adhesive systems was assessed following CMCR treatment on CAD. SE adhesive systems exhibited higher bond strength to CAD compared to ER adhesive systems. Meta-analysis indicated that the bond strength achieved with self-etching adhesive systems remained consistent, regardless of the CMCR agent (Carisolv or Papacarie) used on dentin. The findings of this systematic review suggest that self-etch adhesive systems show favorable bond strength to caries-affected dentin following chemo-mechanical caries removal, regardless of the specific CMCR agent used. These results support the use of minimally invasive dentistry techniques aimed at preserving healthy tooth structure, dentin in particular.

Enhanced Clinical Decision-Making and Delivery of Minimally Invasive Care Using the ICCMS4D Integrated with Hands-Free Fluorescence-Based Loupes and a Chemomechanical Caries Removal Agent.

The purpose of this case report was to evaluate an approach for enhanced clinical decision-making while providing minimally invasive treatment, using the combined International Caries Classification and Management System (ICCMS 4D) with hands-free fluorescence-enhanced loupes (Reveal, Designs for Vision Inc., New York City, NY, United States) and a chemo-mechanical caries removal agent (Papacárie Duo Gel, Formula & Acao, Sao Paulo, Brazil). In recent decades, a shift towards a conservative approach to caries management has developed. The use of adequate operative techniques and correct decision-making are of paramount importance for early caries detection and tooth-preserving operative care. The use of noninvasive fluorescence-based adjuncts for enhanced diagnostic accuracy has gained popularity. Fluorescence describes the absorption of photons by a molecule, followed by its partial emission at a longer wavelength. Fluorescence detection of bacterial activity is largely based on the red/orange fluorescence emanating from bacterial metabolism, and has been shown to be found particularly in active caries and mature anaerobic plaque. The combined approach of using the standardized visual International Caries Detection and Assessment System (ICDAS) with fluorescence as an operative adjunct was shown to enhance the advantages of both systems. The approach may potentially increase detection sensitivity without compromising the specificity of the visual tactile method. A recent hands-free device is aimed to combine simultaneous diagnosis and therapy (theragnosis) using fluorescence, while overcoming possible obstacles to workflow continuity. The "Reveal" fluorescence-enhanced loupes are fitted with a dual white light/fluorescence light, and are said to allow the clinician to conduct any operational procedure with optional fluorescence guidance, from detection to caries removal, to treatment completion. Using the described method, a comprehensive pathway that emphasizes evidence-based information, correct clinical decision-making, and a minimally invasive therapeutic approach was proposed. The approach may represent a potential advancement in providing minimally invasive caries care.

Investigation on the effect of antimicrobial photodynamic therapy as an adjunct for management of deep caries lesions—study protocol for a randomized, parallel groups, controlled clinical trial

BackgroundAlternatively to conventional treatments, chemo-mechanical caries removal agents can be used. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana is being researched for application in aPDT. This protocol aims to determine the effectiveness of aPDT with Bixa orellana extract in deep caries lesions.MethodsA total of 160 teeth with deep occlusal dental caries will be selected and divided into 4 groups: G1 - control group (Caries removal with a low-speed drill); G2 - Partial Caries Removal with Papacarie™ (Fórmula e Ação, São Paulo, SP, Brazil); G3 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) (Fórmula e Ação, São Paulo, SP, Brazil); G4 - Partial Caries Removal with Papacarie™ and application Bixa orellana extract (20%) with LED (Valo Cordless Ultradent®, South Jordan, UT, USA) (aPDT). After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at immediately, 1 week, and 1, 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The efficacy of treatments will be assessed with microbiological (colony-forming units, before and after carious tissue removal), radiographic (integrity of the periapical area and eventual changes in the radiolucent zones), and clinical examinations (retention of the restorative material in the cavity and occurrence of secondary caries), as well as with the time required for the procedures and the need for anesthesia during the procedures. In case data distribution is normal, analysis of variance (ANOVA) will be used for both the dependent and independent variables. In case the data distribution is not normal, the Friedman test will be used for the dependent variables. For independent variables, the Kruskal-Wallis test will be used.DiscussionProcedures using aPDT have been developed for the treatment of dental caries, but there are few controlled clinical trials in the literature confirming its efficacy.Trial registrationThis protocol is registered at ClinicalTrials.gov under the number NCT05236205 and it was first posted on 01/21/2022 and last updated on 05/10/2022.

Evaluation of caries removal using papain versus conventional bur in primary teeth

IntroductionConventional treatments for caries removal in children are often associated with pain and fear, so chemomechanical caries removal agents as Brix 3000 have been developed as one of minimally invasive technique which consists of applying a proteolytic substance that only softens the infected dentin tissue and preserves healthy tooth tissue providing more comfortable, and conservative treatment.ObjectivesThe aim of this study was to evaluate the clinical efficacy of papain compared to the conventional bur preparation in caries removal in primary teeth.Patients and methodsA randomized controlled clinical trial with sample consisted of 30 healthy children aged from 4 to 7 years old. On 60 bilaterally cavitated primary molars, a split mouth approach was used, where caries excavation was carried out with Brix 3000 on one side and traditional burs on the other. The variables evaluated were pain response, the average treatment time needed and Streptococcus mutans and Lactobacillus counts before and after caries removal.ResultsRegarding pain response, there was a statistically significant difference between the two techniques, however Brix 3000's caries removal time was significantly longer than the bur's. S. mutans and Lactobacillus counts were reduced using each of the methods, and a statistically significant difference was found; however, the reduction was slightly greater using the chemomechanical method than the conventional method, but this difference was not statistically significant.ConclusionsBrix 3000 is an efficient alternative for caries removal in primary teeth with no pain and great microbiological efficacy, however it requires longer time.

Clinical and Microbiological Evaluation of the Chemomechanical Caries Removal Agents in Primary Molars.

Chemomechanical caries removal (CMCR) is a noninvasive procedure that uses a chemical substance to remove the diseased dentin. The natural dental architecture is also preserved using this technique, preventing patient discomfort and pulp irritation. This method of eliminating caries is based on disintegration. This method removes soft carious dentin using chemical agents and non-traumatic mechanical force. This study was carried out to evaluate the clinical and microbiological evaluation of the chemomechanical caries removal agents in primary molars. For the elimination of caries, teeth in category I (polymer bur category) were treated with Smartburs II® (SS White Dental, Lakewood, New Jersey, United States) (n = 40). Teeth treated with the new Carisolv® technology (Mediteam, Sweden) to remove caries (n = 40). Teeth were treated for removal cavities in category III (conventional group) using excavators and carbon steel low-speed round burs from Dentsply Maillefer in Switzerland (n = 40). There was an evaluation of the efficacy of caries removal, the time required for caries removal, patient satisfaction, and microbial culture assessment. In comparison to the other two categories, the conventional category median caries detector dye values were considerably lower (p value<0.05). There was no substantial difference observed between study participants belonging to category I and category II with a p-value greater than 0.05. Time taken during the removal of caries was substantially greater in category I (455.46±73.7) as compared to category II (129.21±44.18) and the traditional category (113.26±37.7). The value of significance was less than 0.05. Contrarily, no discernible difference was observed between category I and category III (the p-value was greater than 0.05). In comparison to the other two categories, the conventional group's median facial expression scale scores were substantially higher (p = 0.02). In comparison, there was no discernible difference between categories I and II (p = 0.65). It was observed that there was no substantial variation in three categories regarding the number of colonies of bacteria prior to the eradication of caries (p-value greater than 0.05). After caries had been removed, the number of living bacterial colonies in category I was noticeably greater than those in the other two categories. However, there was no discernible variation between category II and category 1 (p-value greater than 0.05). The mechanical approach has the highest clinical efficacy for removing caries. Carisolv required the most time to remove cavities. Patient satisfaction levels were greater with Carisolv than with the mechanical approach. It was also observed that Carisolv as well as the mechanical technique had greater antibacterial effectiveness.

Comparative evaluation of caries removal efficacy between chemomechanical agents &amp; conventional methods regarding time consumption

Introduction: The use of minimally invasive procedures and attention to patient comfort are of great importance, especially for dental treatment in young children. This has led to the development of chemomechanical methods for caries removal. Aim: To evaluate and compare the efficacy in terms of time consumption between the chemomechanical caries removal agent Papacarie and conventional method of caries removal. Methods: Subjects for this study were chosen from the outpatients of the Dept of Pediatric &amp; Preventive Dentistry, Karpaga Vinayaga Institute of Dental Sciences. Twenty five children (age 6 -10 years) with bilateral frank cavitated lesions were included in this study. Bilateral primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with Papacarie and rotary instruments. The time taken for caries removal was measured using stopwatch. Results The time taken for caries removal in chemomechanical caries removal method was longer than the conventional method which was assessed using the student t test. Conclusions: Papacarie can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars but requires longer time as compared to conventional method.

Chemomechanical Caries Removal Agents and Their Applications in Pediatric Dentistry

Chemomechanical Caries Removal Agents and Their Applications in Pediatric Dentistry