Evaluation of the chemomechanical removal of dentine caries in vivo with a new modified Carisolv gel

Abstract

Carisolv is a minimally invasive method for softening and removing dentine caries. A new, modified Carisolv gel has been developed in order to optimise the efficiency if its chemical caries dissolution. The aim of the present study was to compare the caries removal efficiency of the original gel with that of the new gel, which contains almost double the concentration of sodium hypochlorite. Ten dentists treated 202 cavities in 170 patients; 104 cavities were randomised to the new gel and 98 to the original gel. Their mean treatment times for caries removal were 6.7+/-4.1 min and 7.6+/-4.2 min, respectively ( P>0.05). In close-to-pulp lesions, constituting 32% of the cavities, the mean times for caries removal were 9.0+/-7.0 min and 11.6+/-4.4 min for the new and original gels, respectively ( P<0.01). Questionnaires revealed that 81% of the patients preferred chemomechanical treatment to drilling. In conclusion, the improved efficiency of the modified Carisolv gel did reduce the time for caries removal in deep lesions. However, it still needs more time than conventional drilling.

Efficacy of chemomechanical caries removal in reducing cariogenic microbiota: a randomized clinical trial

“…Although the remaining dentine hardness is considered a subjective criterion to indicate adequate caries removal, this is the most commonly used method in similar clinical trials. 10,13,14,22,24 Moreover, it must be borne in mind that, regardless of the method used to excavate caries, there is little evidence to support the concept of complete caries removal. Actually, it is not even possible to remove all the infected dentine.…”

“…8,10 In order to disseminate the large-scale use of the chemomechanical method to remove carious dentine, and considering the high cost of Carisolv ™ , a proteolytic gel named Papacá-rie ® was released in Brazil. Papacárie ® combines the collagen degradation effect of papain (a natural protease) and the bactericide effect of chloramines.…”

Current update of chemomechanical caries removal methods

“…49 In 2004, the new Carisolv gel was introduced after several attempts to improve the efficiency of the gel and reduce the excavation time. 27 Fure and Lingstr€ om 27 compared the caries excavation time of the original and new Carisolv gels and reported there was no significant difference in moderately-sized carious lesions; (new gel 6.7 AE 4.1 min vs original gel: 7.6 AE 4.2 min; p > 0.05). Conversely, in deep lesions, the new gel exhibited a shorter mean excavation time compared with the original gel; (new gel: 9.0 AE 7.0 min vs original gel 11.6 AE 4.4 min; p < 0.05).…”

“…However, Fure and Lingstr€ om did not provide a logical explanation for these findings. 27 Subsequent studies, including the Fure and Lingstr€ om study, 27 reported that Carisolv chemomechanical caries removal is considered as a time-consuming method compared with conventional rotary methods. A recent study 39 showed that the relatively longer excavation time using Carisolv may be attributed to the number of times the gel has to be applied; usually in the order of six, to remove the carious lesion.…”

“…74 However, some studies have reported negative feedback with regard to the unpleasant taste and odour of Carisolv. 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.…”