Efficacy and Patient’s Acceptance of Alternative Methods for Caries Removal—A Systematic Review

Abstract

Dental caries is a disease of dental hard tissues, considered the most common non-communicable disease worldwide. Conventional treatments for caries removal are often associated with pain and fear, so different therapeutic approaches have been developed towards more conservative and pleasant treatments. This systematic review aimed to assess the efficacy and patient’s acceptance of alternative methods for caries removal compared to conventional methods. The Cochrane Library, Embase, Medline/Pubmed, Web of Science, and Clinical Trials databases were searched. Clinical trials of primary dental caries treated with alternative methods were included. The last search was performed on 5 August 2020. The Population, Intervention, Comparison, and Outcome (PICO) strategy was followed. Thirty-seven clinical trials were included, reporting caries removal using alternative (chemomechanical—Brix 3000, Carie-care, Carisolv and Papacarie, laser—Er:YAG (Erbium-doped Yttrium Aluminium Garnet) and Er,Cr:YSGG (Erbium, Chromium-doped Yttrium, Scandium, Gallium and Garnet), and a system combining air and sono-abrasion—Vector® System) and conventional methods. Alternative methods tended to prolong treatment time and lessen anesthesia need. All treatments were effective in reducing cariogenic flora, and the restoration’s performance did not differ significantly. Chemomechanical solutions seemed to be the best option towards minimally invasive treatments, with good control during application and action and good treatment experiences for patients. Papacarie was demonstrated to be an effective method for caries removal with less pain, and superior acceptance by patients when compared to conventional treatments.

Effect of Hydro- abrasion versus Conventional Cavity Preparation on the Clinical Performance of Composite Resin Restoration

“…Among the alternative methods of caries removal, air-abrasion may be preferable, allowing more conservative treatments, being more selective in removing decayed tissue and preserving more healthy tissue despite of prolonged treatment times. However, high speed burs yielded preparations 1.5 times quicker than air abrasion techniques 19 .…”

A Novel Dental Caries Model Replacing, Refining, and Reducing Animal Sacrifice

“…Caries removal was mostly done by traditional low-speed and high-speed rotatory instruments. Recently, several innovative techniques have been suggested for minimal-invasive caries removal: sonic and ultrasonic oscillating devices [22], lasers [23], and chemo-mechanical solutions [24]. Caries modeling is necessary for evaluating innovative restorative and removal materials before clinical trials.…”

Computer Aided Design Modelling and Finite Element Analysis of Premolar Proximal Cavities Restored with Resin Composites

“…Caries is a common oral disease caused by initial demineralization of the tooth structure because of bacteria acid production in the presence of fermentable carbohydrates, and following enamel and dentin mechanical resistance loss [ 1 ]. The tooth decay can emerge in different forms, from a small, demineralized area in the enamel to a large cavity in the dentin with or without pulpal involvement [ 2 ].…”

“…The tooth decay can emerge in different forms, from a small, demineralized area in the enamel to a large cavity in the dentin with or without pulpal involvement [ 2 ]. In some cases, when proximal caries (class II) progress extensively in dentin, it is necessary to remove the intact marginal ridge to gain access to the carious lesion [ 1 ].…”