Efficacy of chemo-mechanical caries removal: a 24-month randomized trial

Kemporn Kitsahawong; Ana Lucia Seminario; Patimaporn Pungchanchaikul; Anoma Rattanacharoenthum; Pipop Sutthiprapaporn; Waranuch Pitiphat

doi:10.3389/froh.2024.1458530

Efficacy of chemo-mechanical caries removal: a 24-month randomized trial

Front Oral Health. 2024 Dec 3:5:1458530. doi: 10.3389/froh.2024.1458530. eCollection 2024.

Authors

Kemporn Kitsahawong¹, Ana Lucia Seminario^{2

3}, Patimaporn Pungchanchaikul¹, Anoma Rattanacharoenthum¹, Pipop Sutthiprapaporn¹, Waranuch Pitiphat¹

Affiliations

¹ Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
² School of Dentistry, Timothy A. DeRouen Center for Global Oral Health, University of Washington, Seattle, WA, United States.
³ Department of Pediatric Dentistry, School of Dentistry, Universidad Peruana Cayetano Heredia, Lima, Peru.

Abstract

Introduction: Chemo-mechanical caries removal (CMCR) offers an alternative to conventional drilling for carious dentin removal, but limited evidence exists on its long-term effects on treating caries in primary teeth. The primary aims of this study were to compare CMCR to drilling in terms of restoration status and the presence of secondary caries after 24 months.

Methods: A randomized, parallel-group, single-blinded, controlled trial was conducted in Thailand. Participants were children aged 7-8 years with occlusal caries in second primary molars, randomly assigned to CMCR with Papacarie® (n = 242) or drilling (n = 246). All cavities were restored using glass ionomer cement. Completeness of caries removal was evaluated clinically by two blinded dentists, and patients' discomfort was measured using a facial visual analogue scale. Restoration status and development of secondary caries were assessed every six months clinically and every 12 months radiographically over a 2-year period.

Results: Both groups achieved complete caries removal, but the CMCR took significantly longer than the drilling method (9 vs. 2.3 min, p < 0.001). Children in the CMCR group reported significantly lower discomfort during treatment (p < 0.001). At 24 months, ten (4.6%) restorations in the CMCR group failed, compared to three (1.2%) in the drilling group. Clinically, four restorations (CMCR = 2, control = 2) exhibited secondary caries at the margin, while nine restorations (CMCR = 8, control = 1) showed radiographic evidence of secondary caries beneath the restoration. However, neither clinical nor radiographic evaluations revealed statistically significant differences in treatment outcomes at the two-year mark.

Conclusion: CMCR demonstrated comparable efficacy to conventional drilling for complete caries removal and restoration success at 24 months in primary teeth. Despite a longer chair time, it resulted in less discomfort during treatment.

Clinical trial registration: https://clinicaltrials.gov/study/NCT01641861, identifier: NCT01641861.

Keywords: deciduous tooth; dental atraumatic restorative treatment; dental caries; glass ionomer cements; papain.

Associated data

ClinicalTrials.gov/NCT01641861

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Fogarty International Center, National Institutes of Health (NIH), USA (Award Number D43TW007768); Khon Kaen University Faculty of Dentistry and the Graduate Research Fund (Grant Number 56212102). Additional support was provided by the National Institute of Dental and Craniofacial Research (NIDCR/NIH, Award Number D43DE032294). The funder had no role in the design, data collection, data analysis, and reporting of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.