Non-Cochrane · intervention · PM42399929
Comparative efficacy of chemomechanical caries removal and conventional mechanical caries removal for the treatment of primary molar caries in children: a meta-analysis.
Zhang Yuanyuan, Zhang Lixia · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-09130-8
Findings
Population Children with carious primary molars
26 findings
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Pain intensity (continuous) Control: conventional curette (all agents) | SMD -0.04 [-0.26, 0.17] GRADE not reported Studies not reported |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Pain intensity (continuous) Control: conventional bur (all agents) | SMD -2.22 [-2.88, -1.55] GRADE not reported Studies not reported |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Operative time Study design: split-mouth | SMD 2.75 [0.78, 4.73] GRADE not reported 4 studies |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Pain (binary: no pain or comfort) | OR 3.35 [1.01, 11.17] 57.7% vs 78.5% High 5 studies · 260 participants |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Operative time Study design: non-split-mouth | SMD 1.89 [0.99, 2.79] GRADE not reported 10 studies |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Caries removal efficacy | SMD 1.18 [0.5, 1.85] High 4 studies · 287 participants |
| Any chemomechanical caries removal gel (BRIX3000, Carisolv, Carie Care, Papacarie/Papacarie DUO) | Conventional mechanical caries removal (rotary bur, curette/spoon excavator or polymer bur) | Pain, no pain (comfort) rate Common effect model | OR 2.85 [1.61, 5.04] High 5 studies · 260 participants |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Pain intensity (continuous) | SMD -1.7 [-2.19, -1.21] High 9 studies · 1635 participants |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Child behavior (Frankl scale) | SMD 0.95 [0.69, 1.21] Low Downgraded: imprecision 2 studies · 100 participants |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Pain intensity (continuous) Control: polymer bur (all agents) | SMD -0.52 [-0.81, -0.24] GRADE not reported Studies not reported |
| Chemomechanical caries removal (CMCR), any agent | Conventional mechanical caries removal (bur, curette or polymer bur) | Operative time | SMD 2.1 [1.31, 2.89] Moderate Downgraded: imprecision 14 studies · 1209 participants |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Operative time Control: conventional curette (spoon excavator) | SMD -0.55 [-2.23, 1.14] GRADE not reported 2 studies |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Pain intensity (continuous) | SMD -1.0 [-1.59, -0.41] GRADE not reported 4 studies |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Pain intensity (continuous) Control: conventional curette (spoon excavator) | SMD -0.04 [-0.26, 0.17] GRADE not reported 1 study |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Pain intensity (continuous) Control: conventional bur | SMD -1.43 [-1.96, -0.91] GRADE not reported 3 studies |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Operative time | SMD 1.14 [-0.78, 3.06] GRADE not reported 4 studies |
| Chemomechanical caries removal with BRIX3000 | Conventional mechanical caries removal | Operative time Control: conventional bur | SMD 2.88 [1.99, 3.77] GRADE not reported 2 studies |
| Chemomechanical caries removal with Carisolv | Conventional mechanical caries removal | Operative time Control: conventional bur | SMD 3.66 [1.96, 5.36] GRADE not reported 6 studies |
| Chemomechanical caries removal with Carisolv | Conventional mechanical caries removal | Pain intensity (continuous) Control: conventional bur | SMD -1.97 [-2.97, -0.97] GRADE not reported 4 studies |
| Chemomechanical caries removal with Carisolv | Conventional mechanical caries removal | Pain intensity (continuous) | SMD -1.74 [-2.6, -0.87] GRADE not reported 5 studies |
| Chemomechanical caries removal with Carisolv | Conventional mechanical caries removal | Operative time Control: conventional curette (spoon excavator) | SMD 0.7 [-2.14, 3.54] GRADE not reported 2 studies |
| Chemomechanical caries removal with Carisolv | Conventional mechanical caries removal | Operative time | SMD 2.95 [1.61, 4.29] GRADE not reported 9 studies |
| Chemomechanical caries removal with Papacarie | Conventional mechanical caries removal | Operative time Control: conventional bur | SMD 1.42 [-0.14, 2.98] GRADE not reported 4 studies |
| Chemomechanical caries removal with Papacarie | Conventional mechanical caries removal | Pain intensity (continuous) Control: conventional bur | SMD -4.56 [-8.43, -0.69] GRADE not reported 2 studies |
| Chemomechanical caries removal with Papacarie | Conventional mechanical caries removal | Pain intensity (continuous) | SMD -3.31 [-4.99, -1.62] GRADE not reported 3 studies |
| Chemomechanical caries removal with Papacarie | Conventional mechanical caries removal | Operative time | SMD 1.54 [0.18, 2.91] GRADE not reported 6 studies |
Included primary studies 24
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Motta 2014 Randomized controlled clinical trial of long-term chemo-mechanical caries removal using Papacarie™ gel. PMID:25141203 | 2014 | 1 other review | Operative time | not extracted yet |
| Akindele 2025 Comparative evaluation of the clinical effectiveness of chemomechanical (Papacarie) and conventional mechanical caries removal methods in… DOI:10.1186/s12903-025-05654-7 | 2025 | this review only | not stated | not extracted yet |
| Akindele 2025 Comparative evaluation of the clinical effectiveness of chemomechanical (Papacarie) and conventional mechanical caries removal methods in… PMID:39987050 | 2025 | this review only | Operative time; Pain, no pain (comfort) rate | not extracted yet |
| Asal 2021 Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. PMID:34720507 | 2021 | this review only | Operative time; Pain intensity (continuous) | not extracted yet |
| Choudhary 2022 Clinical and Microbiological Evaluation of the Chemomechanical Caries Removal Agents in Primary Molars. PMID:36523725 | 2022 | this review only | Operative time; Caries removal efficacy | not extracted yet |
| de Souza 2021 Treatment time, pain experience and acceptability of the technique for caries removal in primary teeth using the ART approach with or… DOI:10.1007/s40368-021-00669-4 | 2021 | this review only | not stated | not extracted yet |
| de Souza 2021 Treatment time, pain experience and acceptability of the technique for caries removal in primary teeth using the ART approach with or… PMID:34599744 | 2022 | this review only | Operative time | not extracted yet |
| Elfeel 2023 Evaluation of the Efficacy of Minimal Invasive Methods Versus Conventional Methods for Caries Removal in Primary Molars. PMID:38249188 | 2023 | this review only | Operative time; Pain intensity (continuous) | not extracted yet |
| Ghanem 2023 The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial DOI:10.1186/s12903-023-03594-8 | 2023 | this review only | not stated | not extracted yet |
| Ghanem 2023 The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial. PMID:37980471 | 2023 | this review only | Operative time; Pain, no pain (comfort) rate; Child behavior (Frankl scale) | not extracted yet |
| Goel 2025 Pain Perception During Minimally Invasive Caries Removal in Children: A Randomized Clinical Trial Comparing Chemo-Mechanical Caries Removal. PMID:40951723 | 2025 | this review only | Pain intensity (continuous); Pain, no pain (comfort) rate | not extracted yet |
| Gupta 2024 Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized… DOI:10.22514/jocpd.2024.066 | 2024 | this review only | not stated | not extracted yet |
| Gupta 2024 Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized… PMID:38755991 | 2024 | this review only | Operative time | not extracted yet |
| Hegde 2016 Clinical Efficiency of Three Caries Removal Systems: Rotary Excavation, Carisolv, and Papacarie. PMID:27098717 | 2016 | this review only | Operative time; Pain intensity (continuous); Caries removal efficacy; Child behavior (Frankl scale) | not extracted yet |
| Kitsahawong 2024 Efficacy of chemo-mechanical caries removal: a 24-month randomized trial. PMID:39697785 | 2024 | this review only | Operative time; Pain intensity (continuous) | not extracted yet |
| Kochhar 2011 Bis[2-(cyclo-pentyl-imino-meth-yl)-4-nitro-phenolato-κN,O]cobalt(II). PMID:21522900 | 2011 | this review only | Operative time; Pain intensity (continuous); Caries removal efficacy | not extracted yet |
| Kochhar 2011 An evaluation of different caries removal techniques in primary teeth: a comparitive clinical study. PMID:22900437 | 2011 | this review only | not stated | not extracted yet |
| Lozano-Chourio 2006 Clinical randomized controlled trial of chemomechanical caries removal (Carisolv). PMID:16643536 | 2006 | this review only | Operative time; Pain, no pain (comfort) rate | not extracted yet |
| Maashi 2025 Clinical performance of two chemomechanical caries removal agents in primary molars: a randomized controlled trial DOI:10.1007/s40368-025-01030-9 | 2025 | this review only | not stated | not extracted yet |
| Maashi 2025 Clinical performance of two chemomechanical caries removal agents in primary molars: a randomized controlled trial. PMID:40205159 | 2025 | this review only | Operative time; Pain intensity (continuous) | not extracted yet |
| Maragakis 2001 Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients. PMID:11385201 | 2001 | this review only | Operative time | not extracted yet |
| Matsumoto 2013 Assessment of chemomechanical removal of carious lesions using Papacarie Duo™: randomized longitudinal clinical trial. PMID:24047844 | 2013 | this review only | Pain, no pain (comfort) rate | not extracted yet |
| Rajab 2025 Comparative evaluation of BRIX3000 and Carisolv in chemomechanical caries removal in immature permanent first molars: a randomized… DOI:10.1186/s12903-025-06319-1 | 2025 | this review only | not stated | not extracted yet |
| Rajab 2025 Comparative evaluation of BRIX3000 and Carisolv in chemomechanical caries removal in immature permanent first molars: a randomized… PMID:40462090 | 2025 | this review only | Pain intensity (continuous); Caries removal efficacy | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Comparative success of minimally invasive treatments for cavitated caries in primary teeth: a network meta-analysis. (2025) | 1 | 0.01 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children with carious primary molars | Children aged mainly 3 to 12 years with carious primary molars (n=1,306) |
| Intervention | Chemomechanical caries removal (CMCR) | CMCR with BRIX3000, Carie Care, Papacarie/Papacarie DUO or Carisolv |
| Comparison | Conventional mechanical caries removal | Conventional bur, curette/spoon excavator or polymer bur |
| Outcomes | Pain intensity, operative time, caries removal efficacy, child behavior, satisfaction, microbiological evaluation | Operative time (14 studies); pain continuous (9) and binary (5); caries removal efficacy (4); child behavior (2); satisfaction and microbiology narrative |
| Study designs | RCTs | 17 RCTs (parallel group and split-mouth) from 2001 to 2025 |
| Timing | Searched to 27 September 2025; no language restriction stated (English and Chinese articles included) | Short-term outcomes only |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | NRSI: N/A · RCT: Yes | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Moderate | yes |