Chemomechanical Caries Removal Methods Research Articles

A clinical and microbiological assessment of the efficacy of chemo-mechanical caries removal versus conventional caries removal methods in children: a randomized controlled clinical trial

A clinical and microbiological assessment of the efficacy of chemo-mechanical caries removal versus conventional caries removal methods in children: a randomized controlled clinical trial

Chemo mechanical caries removal CMCR: Efficacy of Carisolv gel in primary molar teeth.

To evaluate the efficacy of CariSolv gel with respect to chemo-mechanical caries removal in primary molar teeth. The cross-sectional study was conducted at the Department of Paediatric Dentistry, Bakhtawar Amin Dental College and Hospital, Multan, Pakistan, from July to December 2022, and comprised patients of either gender aged 6-12 years having vital, primary molar teeth with clinical and radiographic evidence of carious lesion. Freshly prepared CariSolv gel 0.2 ml to 1.0ml was applied to carious dentine for a minimum of 30 seconds, using chemo-mechanical caries removal hand instruments. The cavity preparation was rinsed and dried. Image caries detector dye was applied by micro brush for 10 seconds. After the cavity preparation was washed and dried, any red-stained dentine indicated residual infected dentine. A maximum of 3 chemo-mechanical caries removal cycles were allowed. Data was analysed using SPSS 26.0. Of the 134 patients, 74(55.2%) were boys and 60(44.8%) were girls. The overall mean age was 8.55±1.58 years. The procedure was successful in 115(85.8%) cases. Age and gender were not significantly associated with the outcome (p>0.05). Chemo-mechanical caries removal method using CariSolv gel was found to be a viable alternative to traditional drilling techniques for caries removal in primary molar teeth.

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.

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.

Concepts on Chemo-Mechanical Caries Removal Method

Minimal invasive dentistry embraces beliefs that assimilate remineralisation, and inhibition as well as minimal intervention for restorations. By using the least intrusive surgical approach, minimally invasive dentistry affects the treatment objective where a minimal number of healthy tissues are removed. Various methods are now accessible for the excavation of caries. The crudest way to deal with the management of cavities can be done by using hand equipment or instruments, which was an excruciating as well as insufficient strategy for caries removal. Accordingly, the "mission" for more current materials and procedures in the field of caries management led to the utilization of minimally invasive methodologies. Among all the minimally invasive dentistry procedures, the chemo mechanical caries removal method can remove carious tooth material efficiently by hand instruments and a solution. The concept of caries removal by chemo mechanical method reveals the initial diagnosis of carious lesions and helps in minimal destruction of tooth structure during caries removal. This review paper highlights the caries removal methods by the chemo mechanical concept and discusses the various chemo mechanical caries removal agents as well as their properties.

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.

The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial

BackgroundChemomechanical techniques for caries removal have been introduced to overcome the shortcomings of the conventional rotatory instruments. This study aimed to clinically evaluate the effectiveness of the chemomechanical method of caries removal (Carie-Care™) over mechanical caries removal through the Atraumatic Restorative Technique in pediatric patients.MethodsA randomized controlled clinical trial was conducted. Fifty children fulfilling inclusion criteria were recruited from the outpatient clinic of Pediatric and Dental Public health department, Faculty of Dentistry, Alexandria University. Fifty open carious primary molars were randomly assigned into 2 equal groups according to the method of caries removal. In Group I (test group), caries was removed using the Carie-Care™ system and in Group II (control group), by using mechanical caries removal through the atraumatic restorative technique. Resin modified glass ionomer was used for teeth restoration, the two techniques were compared in each child according to time taken for caries removal, efficacy of caries removal, pain assessment, and child behavior.ResultsThe mean time taken for caries removal in the Carie-Care™ treatment group was (575.6 ± 114.8) seconds which was statistically significant higher as compared with the ART treatment group (346.1 ± 97.4) seconds (p < 0.001). The mean score of efficacy in caries removal was (0.6 ± 0.8) in the Carie-Care™ group, and (1.3 ± 0.7) in the ART treatment group. When compared to ART, Carie-Care™ was significantly more efficient in caries removal (p < 0.002). When pain was assessed by the SEM scale, it was observed that the Carie-Care™ caries removal technique showed statistically significantly more comfort during the procedure compared with the ART procedure (p < 0.001).Moreover, children in the Carie-Care™ group enjoyed the process and showed more cooperative behavior when assessed at the end of procedure than those in the ART group with statistically significant difference (p = 0.002).ConclusionsRemoval of carious tissue in primary teeth using Chemomechanical Carie-Care™ gel proved to be more time consuming than ART, but on the other hand it was more efficient, comfortable, and accepted by the pediatric patients.

Evaluation of the Efficiency of Enzyme-Based Chemomechanical Method in Atraumatic Restorative Treatment of Primary Molars

Aim: To compare clinical and radiographic successes and pain dimensions this chemomechanical agent and traditional Atraumatic Restorative Treatment (ART) method. Material and Methods: Children aged 3-8 years who applied clinic with their parents were included our study (n=38). Teeth included study; Traditional ART method with excavator, enamel chisel and probe and chemomechanical carious tissue removal method with Brix 3000 material were applied. After caries removal methods, restorations were completed with high viscosity glass ionomer cement (YVCIS). After restoration applications, evaluation was made according the Wong Baker Pain Scale. The clinical success restorations was followed up 3, 6 and 12 months according the modified USPHS criteria. Radiographic evaluation was performed 6 and 12 months. In whole study, error value was 5% and load was accepted maintaining the p&lt;0.05 value. Results: 3 and 6 months, there was difference marginal compliance criteria between chemomechanical caries removal and YVCIS restorations applied after traditional ART methods, under surveillance (3rd month p=0.040; 6th month p=0.047). YVCIS restorations applied after chemomechanical caries removal method had Charlie score 2.8% in secondary caries criterion 6th month follow-up. In evaluation made with Wong Baker Pain Scale, facial expression representing no pain expression was preferred most both groups. When all results were evaluated between the two groups, no difference was found when removed (p=0.536). Conclusion: Our study; The chemomechanical caries removal method used non-surgical and acceptable caries removal technique similar the conventional ART method.

Chemomechanical caries removal methods : A review

Chemomechanical caries removal methods : A review

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.

A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000.

Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.

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.

Comparative study of caries removal using BRIX 3000 and classic mechanical method

Introduction. In dental practice, despite the constant improvement of dental equipment and materials, caries removal using rotational instruments is still not a satisfactory way. The caries removal treatment constantly offers numerous alternatives in order to replace machine tools, and one of them is the chemo-mechanical method. The aim of this paper is to examine the effectiveness of the chemo-mechanical method of caries removal using BRIX 3000 and classic method. Material and Method. We used BRIX 3000; a material intended for atraumatic caries removal. Both caries elimination methods were performed in 40 patients with evident carious lesions. Twenty patients underwent atraumatic caries removal while in the other twenty carious tissue was removed using rotating instruments. Results. BRIX 3000 was effective in caries removal. A significant reduction in the use of local anesthetics was noticed. Patients did not experience discomfort or pain during treatment with BRIX 3000, but the duration of caries removal using this atraumatic method was significantly longer than with the classic method. Conclusion. Atraumatic method of caries removal is an adequate alternative to conventional therapeutic procedures for caries removal, which finds a place in the domain of modern minimally invasive dentistry.

Removal of Caries by Chemomechanical Caries Removal (CMCR) Methods

Removal of Caries by Chemomechanical Caries Removal (CMCR) Methods

Comparative Study of Erbium Laser Versus A Chemo-Mechanical Caries Removal Method in Primary Teeth

Comparative Study of Erbium Laser Versus A Chemo-Mechanical Caries Removal Method in Primary Teeth

Stop Drill, Make a Change: An In Vivo Study.

BackgroundThe chemomechanical method of caries removal is a modality that is non-invasive, cost-effective, and if some caries preventive measures could be added to them, then it might render the remaining dentin more resistant to future caries attacks also. Thereby, this study is conducted to evaluate the in vivo aspect of newly developed “one man army material—Apacaries gel”.Aim and objectiveTo evaluate and compare the antimicrobial efficacy, efficiency, and pain perception of a chemomechanical caries removal agent (Apacaries gel) with a conventional method.DesignTwenty children (aged 6–12 years) with bilateral occlusal caries making a sample size of 40 were included in the study. Group I: caries removal using rotary instruments and Group II: caries removal using Apacaries gel (n = 20 each). Caries removal time and pain perception were measured using a stopwatch and Wong–Baker Pain Scale. Dentin samples of both groups were taken before and after caries removal for microbiological analysis.Statistical analysis usedThe data were statistically analyzed using the Student's t-test to compare the two groups.ResultsThere was a non-significant difference in bacterial count while a significant difference was seen in time consumption and pain perception in both methods of caries removal.ConclusionChemomechanical caries removal (Apacaries gel) can be an effective clinical alternative treatment for caries removal in children.Key messagesIt is the only in vivo study on “Apacaries gel—a one man army” which eliciting the unique property of prevention of dental caries.How to cite this articleDogra M, Gupta MP, Sheikh T, et al. Stop Drill, Make a Change: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(2):258–262.

A New Efficient Agent to Chemo-mechanical Caries Removal

O objetivo deste estudo foi realizar uma breve revisão da literatura sobre remoção químico-mecânica da cárie e descrever um caso clínico com a utilização de um novo produto. De acordo com o diagnóstico clínico e radiográfico, o dente apresentava lesão de cárie em dentina sem comprometimento pulpar. Foi utilizado um novo produto químico-mecânico, BRIX 3000®, para remoção da cárie com 1 aplicação de gel por 2 minutos. Posteriormente, a cavidade foi restaurada usando um compósito bulk fill flow e uma resina composta convencional para estratificação final. Levando em consideração o caso clínico apresentado, a aplicação do gel BRIX 3000® parece ser uma boa alternativa para a remoção da cárie seguida de um tratamento restaurador, uma vez que o desconforto da criança diminuiu, resultando em um comportamento positivo. BRIX 3000 é um método eficiente de remoção químico-mecânica da cárie.

Evaluation Of Efficacy Of Chemo-mechanical Method Of Caries Removal Using BRIX- 3000 Compared To Conventional Excavation With Burs- A Randomized Controlled Trial – Original Research

Introduction and Aim The study was designed as a randomized double-blind trial to evaluate the efficacy of chemo-mechanical method of caries removal using BRIX 3000 as compared to conventional excavation with burs. Methods The double blind randomized control trial was performed using a split mouth design where patients with bilateral deep carious lesion underwent treatment with Brix 3000 on one side and high speed bur excavation with aerotar on the contralateral side. This was performed to compare the efficacy of Brix 3000 with the conventional high speed caries excavation using aerotar. Group 1 (G1 = 67 teeth) chemomechanical removal with Brix 3000 and Group 2 (G2= 67 teeth) high speed bur excavation with aerotar. The criteria assessed were the time (T) required for each protocol to be completed and pain perceived by the patient at the end of caries excavation. Results All statistical analysis were done using (SPSS) version 17.0 statistics software. Independent sample t test and Mann Whitney U test were one to analyze the data. Conclusions Though time taken for caries excavation was more using BRIX than the high speed procedures, there was less or no pain while caries excavation using BRIX 3000 along with more patient comfort and cooperation during procedure. From the current study, it was observed that BRIX 3000 can be considered as an effective alternative/adjuvant for caries removal in deep carious lesions as compared to aerosol inducing high speed rotary techniques. Keywords : Chemo-mechanical caries removal, non aerosol inducing caries removal techniques, COVID, BRIX 3000, randomised controlled trial, novel caries removal, dentin preservation.

Clinical Evaluation of Carie-Care as Chemo-Mechanical Caries Removal Agent in Disabled Egyptian Children

Purpose: compare the chemo-mechanical method of caries removal (CMCR) using Carie-Care™ and conventional technique (Drilling) in normal and disabled Egyptian children. Materials and Method: A total of 40 children were divided into two equal groups .Group A: 20 healthy and normal children. Group B: 20 children with different types of disabilities, either intellectual disability, hearing impairment or visual impairment. Their age ranged from 5-8 years .Two primary carious teeth were chosen in each child according to inclusion criteria (total 80 teeth). The eighty primary teeth from forty children were further subdivided equally into two subgroups (40 teeth in each subgroup) according to caries removal technique. Subgroup Ӏ: caries was removed with CMCR using the Carie-Care system. Subgroup ӀӀ: caries was removed with the conventional drilling technique. Then all teeth were restored with Activa kids bioactive restorative material and followed up at baseline, one month, three months and six months intervals. Results: Results of this study showed that there was no significant difference between patients’ groups regarding complete caries removal, total time taken for complete caries removal, pain and patient comfort, but there was a statistically significant difference between both techniques regarding complete caries removal in disabled children group (Group B), and a significant difference was also found in the time taken for complete caries removal , pain and patient comfort in both patients’ groups. Also, there was no statistically significant difference between patients’ groups regarding the longevity of Activa kids bio-active restorative material at base line, one month, three months and six months follow up periods. Conclusion: Carie‑Care™ gel was an efficacious alternative method to treat carious lesions in both normal and children with different disabilities since it allies atraumatic characteristics. Activa kids bioactive restorative material had an excellent performance as a permanent restorative material in vital primary teeth in both normal and disabled children in a period of 6 months.

Impact of Brix 3000 and conventional restorative treatment on pain reaction during caries removal among group of children in Baghdad city

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