Efficacy of using Carisolv in the removal of decayed tooth structure in primary teeth.

Data sources Medline, Web of Science and Scopus were searched using a unique search strategy. Study selection Two authors independently reviewed and selected Clinical Trials, Randomised Clinical trials and Controlled Trials assessing the efficacy on primary dentition of Carisolv compared to traditional caries removal with drilling instruments. Only studies where total caries removal in each group was completed using Carisolv systems or rotary instruments used without any time limit were considered suitable. Studies assessing the complete caries removal by different methods from the clinical criteria selected (ie using a sharp probe) were excluded. Data extraction and synthesis The outcomes considered for the review were: the caries removal rate (binary yes/no), the time required to complete the tissue removal (continuous) and the pain threshold during the procedure, assessed through the need for local anaesthesia by the patients (binary yes/no).For dichotomous data Odds Ratio (OR) was calculated along with 95% Confidence intervals (CIs) and for continuous data, the Mean Difference (MD) with 99% Confidence Intervals (CIs) was calculated. Meta-analysis was performed with studies analysing the same outcomes. Results From 195 studies identified, 28 were analysed. Ten met eligibility criteria. The trials included involved a total of 348 patients for 532 treated teeth. Three studies evaluated clinical efficacy in caries removal. When the data were collected in a meta-analysis no statistically significant difference was observed in regard of the clinical efficacy between Carisolv and the rotary instruments (p= 0.50, OR= 0.33 95% CI 0.01-8.22).In seven studies the length of time to perform the procedures was evaluated and data analysis demonstrated a statistically significant difference (p < 0.01, MD 310.92, 99 % CI 234.57- 387.27) with the Carisolv system, which required a greater amount of time than the conventional drill technique. With regard to pain threshold, a near statistically significant difference was found (p=0.06, OR=0.09 95% CI 0.01-1.07) with less anaesthesia required by patients treated using the Carisolv system technique. Conclusions The systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as with rotary instruments. However, the results should be interpreted cautiously due to the hetero-geneity among study designs and to the shortage of available data. Further large-scale, well-designed randomised controlled trials are needed.