An In-vitro Study on the Efficacy of a Papain Gel to Conventional Methods of Carious Dentine Removal

Aim: The study was aimed at finding out the efficacy of the caries removal ability of a chemomechanical agent (papain gel) and comparing it with that of conventional slow-speed rotary carbide burs and mechanical hand excavators in deciduous extracted molars.

Introduction: The foundation of minimally invasive dentistry is based on caries removal techniques that preserve as many healthy teeth as possible. Because of this, the current goal of operating on carious dentine is to stop the carious lesion's growth and provide a solid foundation for restorative dentistry by removing only soft, diseased tissue. Chemomechanical caries excavation is a great illustration of a conservative caries eradication technique. This technique preserves a larger thickness of caries-affected dentine (CAD) while removing only the infected dentine. On the same principle, this study was conducted to compare the effectiveness of papain gel, a chemico-mechanical agent, in removing dental cavities to mechanical hand excavators and traditional slow-speed rotating carbide burs.

Materials and Methods: A total of 30 extracted teeth that were used for the present study were distributed equally among two major categories (15 each) by simple random sampling technique. The teeth were sectioned into two halves mesiodistally in a longitudinal plane through the center of the caries.

In each category, the corresponding halves were sectioned off randomly but in equal numbers further into two groups as follows:

Category 1: Group I hand excavators and Group II carbide burs.

Category 2: Group III hand excavator group and Group IV Papacarie group.

Parameters recorded included total time taken for caries removal and residual caries remaining using caries detection dye in each group and category, which were estimated and observed under a stereomicroscope (magnification 12.5×). The data was computed and statistically analyzed to find out and compare the efficacy of caries removal of three different methods used.

Results: As per the critical difference (CD), the results of the study showed the caries removal meantime for group IV (Papacarie group) when compared to other groups was significantly higher (p < 0.01). Group II had a significantly lower mean time than the other groups (p < 0.01). Results also showed group II had a significantly lower mean area of residual caries than the other groups (p < 0.01). A significantly lower mean of residual caries was found in Group IV than in Group I and Group III (p < 0.05). The duration of treatment is often a challenge in treating pediatric dental; this can be a potential limitation. However, in a clinical situation, the difference in time consumption between papain gel, hand excavator, and carbide bur may be less because papain gel and a hand excavator usually do not require local anesthesia, thus reducing the actual operative period.

Conclusion: It is concluded that papain gel can be used as an effective alternative method compared to conventional methods for caries removal, especially in pediatric patients, owing to its lesser time commitment and better outcome. This study can be further supported by microbiological validation to find the proportion of bacteria in the residual carious dentin after excavation and their significance.