Meta-analysis of Prospective Randomized Clinical Trials on Chemomechanical Caries Removal

Method: An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The inclusion criterion for the met-analysis was, studies should be recent prospective randomized two-arm clinical trials comparing either Carisolv or Papacarie-based chemo-mechanical caries removal methods with conventional (rotary or hand-excavation) caries removal methods. The following categories were excluded during the assessment process; non-English studies, published before 2000, animal studies, review articles, laboratory studies, case reports and non-randomized or retrospective clinical trials. Then the methodologies of the selected clinical trials were comprehensively assessed. Furthermore, the selected clinical trials were subjected to meta-analysis for quantifying the difference in the excavation time between the conventional and the chemomechanical caries removal methods.

Result: Only 19 randomized clinical trials could fit the inclusion criteria of this meta-analysis. The Meta-analysis results revealed that the shortest estimated mean excavation time (2.99 ± 0.001) minutes was recorded during   rotary caries excavation, followed by Papacarie-based chemomechanical caries removal method (6.36 ± 0.08) minutes and the hand excavation method (ART) (6.98± 0.17) minutes. The longest caries excavation time (8.12 ±0.02) minutes was recorded for the Carisolv-based chemomechanical caries removal method. Moreover, none of the 19 reviewed trials completely fulfills Delphi’s ideal criteria for quality assessment of randomized clinical trials.

Conclusion: The current scientific evidence shows that the Carisolv-based chemomechanical caries removal method is a time consuming method compared to Papacarie-based chemomechanical, and the conventional caries removal methods.  Further prospective randomized controlled clinical trials evaluating the long-term follow-up of Papacarie-treated permanent teeth are needed.