Background:Chemomechanical caries removal is an
effective alternative to the traditional rotary drilling method. The advantages
of chemomechanical techniques in terms of the need for anesthesia, pain
patient preference are systematically reviewed and a meta-analysis of the time
required for caries removal is reported.
Method: Randomized controlled studies of comparison of
chemomechanical techniques with conventional rotary drill were selected from a
systematic search of standard biomedical databases, including the PubMed and
Cochrane clinical trials. Non-repeated search results were screened for
relevance and risk of bias assessment, followed by methodology assessment.
Statistical models were applied to the outcome parameters - time required, pain
perception, need of anesthesia and patient preference - extracted from the
studies. Results: Out of the 111 non-repeated search
results, 26 studies
receiving a low bias score were selected for the review, and 16 randomized
clinical trials of rotary and Carisolv techniques were considered for
meta-analysis. Meta-analysis by fixed effect as well as random effect models
indicate that Carisolv takes more time (3.65 ± 0.05 and 4.09 ± 0.29 min) than
rotary drill (8.65 ± 0.09 and 8.97 ± 0.66 min) method. Advantages of reduced
pain (14.67 for Carisolv vs. 6.76 for rotary drill), need for anesthesia
(1.59% vs. 10.52%) outweigh the longer time requirement and make it the
preferred (18.68% vs. 4.69%) method. Conclusion:
Chemomechanical techniques stand out as a minimally invasive and preferred
method based on the meta-analyses. Evaluation of pain experienced using robust
methods is needed to strengthen the evidence for their use.
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Address correspondence to this author at the Department of Pedodontics
and Preventive Dentistry, Rajarajeswari Dental College & Hospital, Mysore
Road, Kumbalgodu, Bangalore 560 074, India; Tel: 09867220417;