Chemomechanical Removal Research Articles

Evaluation of Carisolv in the Chemico-Mechanical Removal of Carious Dentine in Primary Molars (In vivo study)

Caries removal by the Chemo-mechanical technique involves the application of chemical agents, to cause a selective softening of the carious dentine and facilitate removal by gentle excavation. Carisolv is one such new chemical agent used in this minimal invasive technique of carious dentine removal. The aims of this study was to evaluate the efficacy of Carisolv in the chemo-mechanical removal of carious dentine in primary teeth, the time taken for caries removal and to evaluate the restorations radiographically. Forty primary 1st and 2nd molars with dentinal carious lesions were excavated using this technique of caries removal. After isolation of the involved tooth, the Carisolv " new gel" marketed by Mediteam Dental AB (Goteborg, Sweden) was applied then the superficial softened carious dentine was gently excavated and scraped using a spoon excavator, the procedure repeated until the cavity was free from caries and the cavity was checked for remaining caries using an explorer. The time taken for the removal of carious dentine, beginning from the application of the gel until the completion of the procedure was evaluated using a stopwatch. After the placement of the restoration an intra-oral periapical radiograph was taken for immediate evaluation and after a period of six months, the longevity of the restorations and the presence of secondary caries at the restoration- dentine interface were evaluated radiographically. The statistical analysis of the results showed that the soft carious dentine was removed more effectively than the hard carious dentine and the removal of the soft carious dentine required a shorter period of time (4.96±0.99) minutes when compared to the removal of hard carious dentine (6.09±1.04) minutes and on radiographic evaluation of the restoration, none of the treated lesions showed the presence of secondary caries. In conclusion, the chemico-mechanical caries removal technique using Carisolv proved to be an effective atraumatic treatment modality with potential interest for use in clinical pediatric dentistry.

Chemo-mechanical removal versus conventional removal for deep caries lesion.

Dental caries have been traditionally managed with the non-selective removal of carious tissue (total removal). However, the adverse effects and fear that this technique produces in patients has promoted the use of more conservative caries removal techniques such as chemo-mechanical removal, but there is still controversy regarding its effectiveness and safety. We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings tables using the GRADE approach. We identified seven systematic reviews including 34 studies overall, of which 30 correspond to randomized trials. We concluded that chemo-mechanical caries removal probably reduces the need for anesthesia. Additionally, chemo-mechanical caries removal may decrease the pain experienced by the patient, decrease the risk of restoration failure and increase the time of the procedure for the removal of deep caries, but the certainty of the evidence is low. We are uncertain whether chemo-mechanical caries removal reduces the risk of pulp exposure as the certainty of the evidence has been assessed as very low.

Comparison of the Effectiveness of Chemo-mechanical and Traditional Caries Removal Methods in Primary Teeth Using Micro-Computed Tomography

Purpose: The purpose of this study was to evaluate dentin mineral density before and after caries removal with the traditional caries removal technique and chemo-mechanical method, with or without the use of caries detection dye. Our null hypothesis was that the chemo-mechanical method with minimally invasive treatment would achieve an effect similar to that of conservative pediatric dentistry treatment. Materials & Methods: Forty-eight medium-sized, interfacial decayed primary molar teeth without pulpal perforation were selected. Two groups were formed by Papacarie Duo and conventional method; then four sub-groups were formed by two caries detection dye applied or not applied groups, twelve teeth were randomly divided into each group. The teeth were then treated with chemo mechanical and traditional caries removal approach. Teeth were scanned with the same voxel sizes using micro-computed tomography images to figure out the difference dentin mineral density and to calculate the removed dentinal volume after chemo-mechanical or traditional method application. Results: The results showed increase of cavity volume in the chemo-mechanical and traditional method groups. No significant difference was found for cavity volume and dentinal carious volume in both groups (p>0.05). The mineral density values of demineralized dentin were between 0.52-0.66 g/cm3 before caries removal, and 1.39-1.59 g/cm3 after removing caries. These values were found to be within the range of healthy dentin mineral density values again without any significant difference between groups (p>0.05). Conclusion: In conclusion, chemo-mechanical methods can be used effectively for removing the caries in the primary molar teeth similar to conservative treatments.

Pain perception of children after restorative treatments: Atraumatic restorative treatment versus chemomechanical removal - A noninferiority randomized clinical trial.

Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques. To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal. A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil. Children between 4 and 9 years old were selected. In both groups - ART (n = 20) and chemomechanical caries removal (Papaya® gel) (n = 20) - oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique. Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables. No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013). Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

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.

Comparison between conventional and chemomechanical approaches for the removal of carious dentin: an in vitro study

The present study aimed to evaluate the efficiency, effectiveness, and biocompatibility of two agents used for the chemomechanical removal of carious dentin. Sixty extracted carious human teeth were treated with a conventional bur (CBG) or chemomechanical agents – Papacarie Duo (PG) and Brix 3000 (BG). Treatment efficiency and effectiveness were assessed by the working time for carious dentin removal and Knoop microhardness values, respectively. Human pulp fibroblasts (FP6) were used to evaluate cytotoxicity by incorporating MTT dye, and genotoxicity was evaluated with the micronuclei test. The carious tissue was removed in a shorter time with CBG (median = 54.0 seconds) than the time required for chemomechanical agents (p = 0.0001). However, the time was shorter for Brix 3000 (BG) than that for Papacarie Duo (PG), showing mean values of 85.0 and 110.5 seconds, respectively. Regarding microhardness testing, all approaches tested were effective (p < 0.05). The final mean microhardness values were 48.54 ± 16.31 KHN, 43.23 ± 13.26 KHN, and 47.63 ± 22.40 KHN for PG, BG, and CBG, respectively. PG decreased cell viability compared to that of BG, but it presented no genotoxicity. Brix 3000 may be a good option for chemomechanical dentin caries removal due to its reduced removal time and lower cytotoxicity compared to the other treatment options.

Formulation Optimization and Performance Evaluation of Papain and Clove Oil based Chemo-mechanical Caries Removing Gel

Objective: To formulate and optimise stable caries removing gel using naturally extracted papain and clove, for non– invasive chemo–mechanical removal of dental caries. Methodology: Gel formulation was prepared using natural polymer such as pectin along with other excipients and optimized for desired level of papain activity and viscosity for effective application on carious tooth using 32 factorial design. Optimized formulation was evaluated for its physicochemical properties, in–vitro antibacterial activity and ex-vivo chemo-mechanical performance. Results: FTIR and DSC studies confirmed compatibility of papain with other excipients. Formulation with ratio of 2.5: 2.5: 0.225 pectin : propylene glycol : triethanolamine was found to give stable gel with viscosity of 7800cp, proteolytic activity of 91.64% with satisfactory in-vitro antibacterial activity and ex-vivo chemomechanical performance. Conclusion: Papain and clove containing chemo-mechanical caries removing gel can serve as potential alternative to other invasive caries removing techniques which will also reduce chances of microbial infection at the site of application with symptomatic pain relief. Key words: Clove, Chemomechanical removal, Dental caries, ex-vivo performance, Papain.

Evaluation of Glass Ionomer Cement Restoration after Chemo-mechanical Removal of Caries

Evaluation of Glass Ionomer Cement Restoration after Chemo-mechanical Removal of Caries

Chemomechanical Removal of Caries – An Invasive Method as Extension for Prevention: A Review

The traditional treatment of caries was merely surgical. Conventionally, the only effective method of eliminating the disease was to completely remove all of the demineralized area of the tooth structure. Even the smallest area of demineralization required the excavation of a standard amount of sound tooth structure to prevent the progression of disease. Chemomechanical caries removal (CMCR) is a non-invasive technique in which chemical agents are used to eliminate the infected dentin. This dissolution-based caries removal method uses a chemical agent assisted by atraumatic mechanical vigor for the excavation of soft carious dentine. This technique was developed by Dr. G. V. Black as “extension for prevention” which led to specific of sound tooth structure. In later years, the profession moved toward practicing preventive dentistry and following more conservative and tooth-preserving procedures. This paper discusses newer invasive techniques for caries excavation.

Efficacy of using Carisolv in the removal of decayed tooth structure in primary teeth.

Data sourcesMedline, Web of Science and Scopus were searched using a unique search strategy.Study selectionTwo authors independently reviewed and selected Clinical Trials, Randomised Clinical trials and Controlled Trials assessing the efficacy on primary dentition of Carisolv compared to traditional caries removal with drilling instruments. Only studies where total caries removal in each group was completed using Carisolv systems or rotary instruments used without any time limit were considered suitable. Studies assessing the complete caries removal by different methods from the clinical criteria selected (ie using a sharp probe) were excluded.Data extraction and synthesisThe outcomes considered for the review were: the caries removal rate (binary yes/no), the time required to complete the tissue removal (continuous) and the pain threshold during the procedure, assessed through the need for local anaesthesia by the patients (binary yes/no).For dichotomous data Odds Ratio (OR) was calculated along with 95% Confidence intervals (CIs) and for continuous data, the Mean Difference (MD) with 99% Confidence Intervals (CIs) was calculated. Meta-analysis was performed with studies analysing the same outcomes.ResultsFrom 195 studies identified, 28 were analysed. Ten met eligibility criteria. The trials included involved a total of 348 patients for 532 treated teeth. Three studies evaluated clinical efficacy in caries removal. When the data were collected in a meta-analysis no statistically significant difference was observed in regard of the clinical efficacy between Carisolv and the rotary instruments (p= 0.50, OR= 0.33 95% CI 0.01-8.22).In seven studies the length of time to perform the procedures was evaluated and data analysis demonstrated a statistically significant difference (p < 0.01, MD 310.92, 99 % CI 234.57- 387.27) with the Carisolv system, which required a greater amount of time than the conventional drill technique. With regard to pain threshold, a near statistically significant difference was found (p=0.06, OR=0.09 95% CI 0.01-1.07) with less anaesthesia required by patients treated using the Carisolv system technique.ConclusionsThe systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as with rotary instruments. However, the results should be interpreted cautiously due to the hetero-geneity among study designs and to the shortage of available data. Further large-scale, well-designed randomised controlled trials are needed.

Comparative Evaluation of Microleakage in Restored Primary Molars using Conventional and Chemomechanical Removal of Carious Tissue: An in vitro Study

ABSTRACTBackground and objectiveMicroleakage of restored teeth can be considered as a major contributing factor for the occurrence of tooth discoloration, secondary caries, deterioration of restorative material, postoperative tooth sensitivity, and pulpal irritation. The objective of this study was to compare the microleakage of primary molars restored with conventional glassionomer cement (GIC) and Giomer after caries removal using conventional cavity preparation (CCP) and chemo-mechanical caries removal (CMCR) techniques.Materials and MethodsSixty extracted carious human primary molars were randomly assigned into three groups of 20 each based on the method of caries removal: Group A: CCP technique; group B: CMCR using Papacarie gel; and group C: CMCR using Carisolv gel. Each group was further divided into two of 10 teeth each according to the restorative material used – conventional GIC (Fuji II) and Giomer (Beautifil II). The restored teeth were thermocycled, immersed in methylene blue dye, sectioned, and examined under stereomicroscope to elicit the dye penetration scores.ResultsThe results demonstrated that none of the restorative materials were free from microleakage. In Fuji II samples highest microleakage scores were noticed in group A (2.09) followed by group B (0.64), and least in group C (0.27), which were statistically significant. However, in Giomer samples no statistical significant difference in microleakage scores was noticed among the three groups.ConclusionChemo-mechanical caries removal technique showed less microleakage when compared to CCP technique and the marginal sealing ability of Giomer was superior to conventional GIC.How to cite this articleSankar AJS, Birra C, Bandi S, Chinta M, Enuganti S, Mukthineni S. Comparative Evaluation of Microleakage in Restored Primary Molars using Conventional and Chemomechanical Removal of Carious Tissue: An in vitro Study. J Contemp Dent 2016;6(2):108-113.

Effect of papain-based gel on type I collagen--spectroscopy applied for microstructural analysis.

Considering the improvement of biomaterials that facilitate atraumatic restorative techniques in dentistry, a papain-based gel can be used in the chemomechanical removal of decayed dental tissue. However, there is no information regarding the influence of this gel on the structure of sound collagen. The aim of the present study was to investigate the adsorption of a papain-based gel (PapacarieTM) to collagen and determine collagen integrity after treatment. A pilot study was first performed with 10 samples of type I collagen membrane obtained from bovine Achilles deep tendon to compare the influence of hydration (Milli-Q water) on infrared bands of collagen. In a further experiment, 10 samples of type I collagen membrane were used to evaluate the effects of PapacarieTM on the collagen microstructure. All analyses were performed using the attenuated total reflectance technique of Fourier transform infrared (ATR-FTIR). The results demonstrated that the application of PapacarieTM does not lead to the degradation of collagen and this product can be safely used in minimally invasive dentistry. As the integrity of sound collagen is preserved after the application of the papain-based gel, this product is indicated for the selective removal of infected dentin, leaving the affected dentin intact and capable of re-mineralization.

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using Papacarie™ gel.

ObjectivesCompare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and MethodsA randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. ResultsNo statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. ConclusionPapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia.

Assessment of chemomechanical removal of carious lesions using Papacarie Duo ™: Randomized longitudinal clinical trial

Chemomechanical removal of carious lesions consists of the dissolution of carious tissue by the application of a natural or synthetic agent, followed by atraumatic mechanical removal. The aim of the present study was to assess the effectiveness of Papacarie Duo ® gel in the chemomechanical removal of carious lesions in primary teeth in comparison to the traditional method (low-speed bur). A randomized clinical trial was conducted with 20 children between 5 and 8 years of age. Two teeth were treated in each child (split-mouth design), with the randomization of two methods: Group 1 - chemomechanical caries removal with Papacarie Duo™; and Group 2 - removal of carious dentin tissue using a low-speed bur. Both methods involved restoration with glass ionomer cement and follow up. The following aspects were evaluated: time required for the procedure; pain (face evaluation scale); retention of the restorative material in the cavity; and the presence of secondary caries after 30 days. Chi-squared test, Student's t-test, and Wilcoxon test. No statistically significant differences between methods were found regarding time required for the procedure (P = 0.13), the occurrence of pain (P = 0.585), or restoration status at the 30-day clinical evaluation (P = 0.713). The findings of the present study demonstrate that the two methods achieve similar results. The advantages of minimally invasive treatment, such as chemomechanical caries removal with Papacarie Duo™, are its ease of use, patient comfort, and the fact that it causes less damage to dental tissue.

Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques

ObjectiveThis study evaluated the effect that different techniques for removing dental caries had on the strength of the microtensile bond to caries-affected human dentine created by three bonding agents. Materials and methodsForty-five human molar teeth containing carious lesions were randomly divided into three groups according to the technique that would be used to remove the caries: a conventional bur, an Er:YAG laser or a chemo-mechanical Carisolv® gel (n=15). Next, each of the three removal-technique groups was divided into three subgroups according to the bonding agents that would be used: Clearfil® SE Bond, G-Bond®, or Adper® Single Bond 2 (n=5). Three 1mm2 stick-shaped microtensile specimens from each tooth were prepared with a slow-speed diamond saw sectioning machine fitted with a diamond-rim blade (n=15 specimens). For each removal technique one dentine sample was analysed using scanning electron microscopy. ResultsThere were statistically significant differences in the resulting tensile strength of the bond among the techniques used to remove the caries and there were also statistically significant differences in the strength of the bond among the adhesive systems used. The etch-and-rinse adhesive system was the most affected by the technique used to remove the caries; of the three techniques tested, the chemo-mechanical removal technique worked best with the two-step self etch adhesive system. ConclusionThe bond strength values of the etch-and-rinse adhesive system were affected by the caries removal techniques used in the present study. However, in the one- and two-step self etch adhesive systems, bond strength values were not affected by the caries removal techniques applied. While a chemo-mechanical caries removal technique, similar to Carisolv®, may be suggested with self etch adhesive systems, in caries removal techniques with laser, etch-and-rinse systems might be preferred. Clinical significanceCaries removal methods may lead to differences in the characteristics of dentine surface. Dentine ultra structure generally affects the bonding of adhesive materials commonly used in restorative dentistry. Whereas etch-and-rinse system, like the ones used in the present study, are affected by these changes, the self etch systems are not affected. Hence, clinicians may opt for caries removal methods and systems appropriate for each patient and practice.

An Evaluation of Different Caries Removal Techniques in Primary Teeth: A Comparitive Clinical Study

To compare the efficacy of caries removal, time taken and to evaluate the pain threshold experienced by the patient during various caries removal methods. Eighty patients between the age groups of 5-9 years were selected and caries removal was done by hand instruments, airotor, carisolv and papacarie. The efficacy, time taken and the pain threshold was evaluated during the caries removal by Ericson D et al scale, visual analogue scale respectively. Highly significant relation (< 0.05) was observed when intergroup comparison was made using one way analysis of variance (ANOVA). It was concluded that chemomechanical removal of caries with Papacarie and Carisolv were found to be effective measures of caries removal and could be considered as viable alternatives to painful procedures like Airotor in management of dental caries especially in children.

Chemomechanical caries removal

The dental profession has progressed towards practicing preventive dentistry and adopting tooth-preserving procedures. This has been in response to advances in materials science; a greater understanding that restorations are not only expensive but also destructive, this led to the conclusion that a restoration should be as minimal and biologically based as possible. The introduction of Carisolv focused again interest on the chemomechanical removal of caries. The advantages claimed for the Carisolv technique are of effective & painless removal of caries lesions without affecting sound parts of the tooth and periodontal tissues. A mechanism that is used in over 80% of caries incidences without using neither local analgesia nor drill. It completely removes dentine and cementum caries, and strengthens the bond of adhesive materials.

Removal mechanisms in polishing of silicon based advanced ceramics

Advanced ceramics with high surface quality and integrity are of increased interest in mold and die making and optics. The demanded qualities are widely ensured by polishing. However, due to the great variety of parameters and interactions the removal mechanisms are still not fully understood. Therefore, polishing processes of silicon based advanced ceramics are investigated. It is shown that depending on the slurry the material removal mechanisms differ. Observed effects can be explained by dominating mechanical or chemo-mechanical removal. This is discussed based on the phenomenological analysis of experimental results using advanced metrology, such as AFM, SEM and TEM.

The efficacy of chemo-mechanical removal of dentin carious lesion

Mechanical removals in decayed teeth have been performed using drill and sharp hand instruments. These methods have some disadvantages such as pain, local anesthesia and overextended cavities Therefore chemo-mechanical excavation of dentin carious lesions has been introduced. The purpose of this study was to evaluate the efficacy of traditional mechanical methods using burs and chemo-mechanical methods (Carisolv) of caries dentin. Mechanical caries removal was carried with low speed round bur Chemo-mechanical caries excavation was performed with Carisolv (Medi-team), using the Carisolv hand instruments. The mean time to remove caries with two different methods was evaluated and the data analyzed with SPSS software (ver 11.5) by t-test (p 23 sharp explorers, Caries Detector (Kuraray Co. Japan), and standard apical radiography. 1. Chemo-mechanical method was taken more times than mechanical method (1.5 fold) (p 0.05). 4. The remaining carious dentin was detected after the ckemo-mechanical removal of the carious dentin, and no smear layer were seen after the mechanical and chemo-mechanical removal of the carious dentin.

Pain related to mechanical and chemomechanical removal of caries in children

The objective of the present study is to compare the pain response associated with the chemomechanical method and hand excavation method during caries removal. Previous studies have indicated that a chemomechanical caries removal system (Carisolv™) has been effective in minimizing the use of conventional mechanical instruments and that it may reduce the need for local anaesthesia. In the present study, a comparison of the pain experienced during treatment with a chemomechanical tecnique and during conventional hand excavation method was carried out in 34 patients. Patients between 4 and 6 years of age were selected for the research. In our study, during the removal of caries some children felt pain both using the Carisolv system and hand excavation method (26.5% and 58.8%, respectively). In the Carisolv group 11.8% of the children wanted local anaesthesia to remove the pain which occurred during the operation; in the hand excavation group 23.5% wanted anaesthesia. In conclusion, the Carisolv system is effective in the removal of caries, causes less pain and need for anaesthesia, decreases the fear, anxiety and stress of children especially created by injectors and drills and increases cooperation.