Evaluation of the methodologies used in clinical trials and effectiveness of chemo-mechanical caries removal with CarisolvTM

Abstract

This investigation aims to discuss the methodologies applied in clinical trials published about Carisolv, in order to assess the best scientific evidence concerning chemo-mechanical caries removal. Papers concerning the use of Carisolv were sought using a search strategy. The titles and abstracts of all the reports identified through the search were analyzed by a single reviewer. The inclusion criterion involved: clinical trials having Carisolv in one of the study groups. Then, those that fulfilled the inclusion criterion underwent methodology assessment and data extraction. Only 12 papers met the inclusion criterion. It was observed that none of these studies complied with all the evaluated research methodological principles required in order to have power of evidence generation. Carisolv proved to be effective in caries removal. Appointment mean time was greater, but the perceived time was shorter than that using conventional techniques due to patients' perception of more comfort and a reduction of anesthesia needs. There were no adverse effect in long-term assessments. In studies with microbiological evaluation of the remaining dentine, it was observed that both the conventional and chemo-mechanical methods produced statistically significant reduction on counts of viable microorganisms.

Caries Removal by Chemomechanical (Carisolv™) vs. Rotary Drill: A Systematic Review

“…There has been an earlier attempt at meta-analysis by Marquezan and coworkers in 2006, comparing the efficacy of chemomechanical studies with conventional drilling technique for caries removal. An observation by Marquezan et al was that the studies available then did not have power of evidence generation [ 14 - 17 ]. Considering the various systematic, randomized clinical trials published in recent years, it is highly significant to generate clinical evidence for the use of chemomechanical caries removal methods.…”

Efficacy of antimicrobial property of two commercially available chemomechanical caries removal agents (Carisolv and Papacarie): An ex vivo study

“…The ideal requirements for a chemomechanical agent used for caries removal include the following: It should have tissue-specific action[ 27 ] (able to differentiate between infected and affected dentin); it should have good antibacterial activity in order to facilitate the eradication of bacteria, if at all they gain access into the affected dentin which will be preserved during cavity preparation;[ 28 ] it should be effective in removing the smear layer; it should be non-irritant to the pulp and the surrounding hard and soft tissues;[ 3 ] it should neither discolor the tooth structure nor interfere with the properties of the restorative materials; it should have long shelf life; it should be easy to manipulate and less expensive. Although extensive research has been conducted in the field of CMCR technique, only two commercially available CMCR agents (Carisolv and Papacarie) were found to meet most of the above-mentioned requirements, if not all.…”

Machining human dentin by abrasive water jet drilling

“…Therefore, in the last decades several advanced methods have been developed to prepare tooth tissues [2,3,[5][6][7][8][9][10]12,13], but none of these techniques meets all criteria necessary to fulfil the demands of both dentists and patients. However, this technique has disadvantages for both dentists and patients (e.g.…”

“…Unlike a traditional dental bur, this technique is only end cutting and therefore lacks sensory feedback on the hardness of the tissues being cut. Several studies have found that this technique is effective in the selective removal of caries, although the operating time is generally prolonged [3,12,13]. Furthermore, there are problems from clouds of particle dust, which may lead to inhalation and cross-infection [2].…”