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.