How to make choice of the carious removal methods, Carisolv or traditional drilling? A meta-analysis

Despite Carisolv has been used to remove carious dentine for 14 years, it still has not reached consensus regarding its effectiveness and efficacy. We undertook a systematic review and meta-analysis of published randomised controlled trials (RCTs) to assess the effectiveness and efficacy of the chemomechanical caries removal (CMCR) system - Carisolv. A systematic electronic literature search was conducted to identify RCTs comparing the use of Carisolv with a control (rotary instruments) in patients with dental caries. Results were expressed as risk ratios (RRs) or mean differences with accompanying 95% confidence intervals (CIs). The outcome measurement included the complete caries removal rate (CCR: the number of cases with complete caries removal in study and control groups after different treatment), the treatment time (min) and the use of local anaesthesia. The meta-analysis was performed with the fixed-effect or random-effect model according to the heterogeneity. Six studies involving 578 teeth met our inclusion criteria. There was no statistically significant difference in CCR between Carisolv group and rotary instruments group; in Carisolv group, the treatment time (min) was significantly longer no matter whether the caries was located in coronal or root area, while the use of local anaesthesia was less. Compared with rotary instruments, Carisolv did not show increased CCR. Carisolv reduced the use of local anaesthesia although it took longer treatment time. However, the results should be interpreted cautiously due to the heterogeneity among study designs. Further large-scale, well-designed RCTs are needed.