Chemo-Mechanical Removal of Caries in an Adolescent Patient Using a Papain Gel: Case Report

Abstract

The chemo-mechanical model of caries removal has been introduced as an alternative method of caries removal and is indicated to overcome the inconvenience of using burs and local anesthesia, causing less discomfort to the patient, and preserving healthy dental structure. Papacarie® is a papain gel composed basically of papain, chloramines, and toluidine blue. Papain interacts with exposed collagen by the dissolution of dentin minerals through bacteria, making the infected dentin softer, and allowing its removal with non-cutting instruments without local anesthesia and burs. This paper proposes the use of a papain-based gel for the removal of active caries with infected tissue followed by a glass ionomer restoration in an adolescent patient. Removal of caries tissue with Papacarie® proved to be efficient, easy and comfortable for the patient.

Efficacy of Papacarie for Caries Removal: An in vivo Study

“…7 The teeth treated with papacarie were caries-free and were clinically and radiographicaly asymptomatic with good retention of restorations after one year, indicating reduction in occurrence of secondary caries. 8 Kirzioglu et al compared the chemomechanical and mechanical method of caries removal; at 3, 6, 9 and 12 months and showed that at the end of 1 year, in terms of marginal adaptation and secondary caries, there was no statistical significance which was in accordance to the present study. 9 After a period of 10 months secondary caries in teeth treated with papain gel was 21.6% and in conventional method it was 15.7%.…”

Alternative Caries Removal Methods

“…Bu ürün; papain ve chloramine gibi aktif içerikleri ve aynı zamanda bakterisid , bakteriostatik, antienflamatuar özellikleri kapsamaktadır. 36 Papain, kollajen molekülleri kısmen degrade olmuş olan ve normalde sağlıklı dokularda sindirim görevini inhibe eden α1-anti-tripsin enziminin eksikliğinden dolayı özellikle enfekte ve ölü dokuları parçala-maktadır. 37 Bu sebeple Papacarie, sağlıklı dentinde minimal hasara yol açacak şekilde çürük dentinin uzaklaştırılmasına olanak tanımaktadır.…”

“…46 Buna ilave olarak; papain sadece plazma proteaz intihibitörü olan alfa-1-antitripsin enizminden yoksun olan çürük doku üzerine etki eder; ancak papain'in proteolitik etkisi sağlıklı doku üzerindeyken inhibe olmaktadır. 36 Apacarie jel ise daha önce de belirtildiği gibi mangosten ekstractlarından elde edilen polifenol ve papain jel karışımı olup antibakteriyel etkisi üzerine yoğunlaşılmaktadır. 47 F Fo ot to o--a ab bl la as sy yo on n Y Yö ön nt te em ml le er ri i: : Günümüzde çürü-ğün uzaklaştırılmasında lazer uygulanması da ayrıca büyük ilgi görmektedir.…”

Current update of chemomechanical caries removal methods

“…27,49,75 Several studies have evaluated the pain response and patient satisfaction rate after Papacarie treatment. 62,63,76,77 Kochhar et al 59 reported, using a Visual Analogue and Verbal (VAV) scale, that the least pain was associated with the Papacarie caries excavation method, followed by Carisolv, while the highest pain response was observed in both hand and rotary caries excavation methods. Moreover, Singh et al 63 reported that Papacarie exhibited a high patient comfort level compared to a rotary caries excavation method using the Wong Baker Faces Pain (WBFP) scale.…”