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Removal of Caries Using only Hand Instruments: A Comparison of Mechanical and Chemo–Mechanical Methods

The aim of this study was to evaluate the efficacy, comfort and efficiency of removing dentin caries using only hand instruments. The Carisolv™ system for caries removal consisting of a solvent gel and a set of specially designed hand instruments (chemo–mechanical) was compared to the use of conventional spoon excavators (mechanical). This was a clinical randomised controlled trial where the two techniques were compared in the same individual. The outcome variables were: complete caries removal; pain during caries removal; anaesthesia requested by the patient during caries removal; time taken to remove caries. Sixty–six individuals, each with a pair of similar cavities in permanent teeth were selected. After caries removal, a ‘blinded’ evaluator assessed the clinical status of the cavity, with the use of a probe. The times for caries removal of the chemo–mechanical and mechanical methods were respectively: 9.2±3.8 and 8.6±3.8 min (p>0.05). There were 4 cavities arguably presenting signs of caries after cavity preparation in the 66 cavities treated with the mechanical method and 7 in the 66 chemo–mechanical cavities (p>0,05). Some pain/discomfort was reported by 21 (32%) participants when the chemo–mechanical method was used, compared with 43 (65%) when the mechanical method was used (p<0.05). During the chemo–mechanical and the mechanical treatment, 2 (3%) and 5 (8%) patients, respectively, requested local anaesthesia (p>0.05). The chemo–mechanical method appeared to be more comfortable for most patients.