Year : 2010 | Volume
: 28 | Issue : 2 | Page : 73--77
Comparative evaluation of the efficacy of chemomechanical caries removal agent (Papacarie) and conventional method of caries removal: An in vitro study
D Jawa1, S Singh2, R Somani3, S Jaidka4, K Sirkar5, R Jaidka6,
1 Post graduate student, Department of Pedodontics and Preventive Dentistry, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
2 Postgraduate student, Department of Oral & Maxillofacial Pathology, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
3 HOD & Professor, Department of Pedodontics and Preventive Dentistry, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
4 Reader, Department of Pedodontics and Preventive Dentistry, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
5 HOD & Professor, Department of Oral & Maxillofacial Pathology, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
6 Department of Preventive and community Dentistry, D.J. College of Dental Sciences & Research, Niwari Road, Modinagar, Uttar Pradesh, India
A-28 Defence Colony, Meerut-250 001, Uttar Pradesh
Painless dentistry, minimal intervention and thus giving comfort, relief and solace and instill positive attitude toward dental treatments, are some of the factors justifying the specialty of pediatric dentistry. Thus, this in vitro study was undertaken to compare the efficacy of a new chemomechanical caries removal agent, Papacarie (Formula and Acao), with conventional slow-speed rotary instrument (bur). Papacarie is a new formulation and has the main active ingredient papain, an endoprotein with bactericidal, bacteriostatic and anti-inflammatory actions. Twenty extracted human molar teeth with deep dentine caries and no enamel coverage were selected for the study. After the preparation of the teeth and removal of the caries with the respective methods, they were decalcified, dehydrated and embedded in paraffin blocks for histologic studies. Serial sections of 5 μm thickness were examined for the presence of bacteria under light microscope. Though complete removal of caries was achieved significantly in both the methods, there was less marked destruction of dentinal tubules in chemomechanical caries removal method by Papacarie. Thus, Papacarie is recommended as an efficient, easy to perform, comfortable and less destructive solution for the patient seeking an alternative to the conventional method.
|How to cite this article:|
Jawa D, Singh S, Somani R, Jaidka S, Sirkar K, Jaidka R. Comparative evaluation of the efficacy of chemomechanical caries removal agent (Papacarie) and conventional method of caries removal: An in vitro study.J Indian Soc Pedod Prev Dent 2010;28:73-77
|How to cite this URL:|
Jawa D, Singh S, Somani R, Jaidka S, Sirkar K, Jaidka R. Comparative evaluation of the efficacy of chemomechanical caries removal agent (Papacarie) and conventional method of caries removal: An in vitro study. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2020 Aug 8 ];28:73-77
Available from: http://www.jisppd.com/text.asp?2010/28/2/73/66739
The concept of conserving healthy tooth structures during cavity preparation has gained popularity with the advent of adhesive resin bonding systems. Due to adhesive property of filling materials, the excessive tooth cutting required to obtain resistance and retention form in conventional cavity preparation is minimized. Traditional means of cavity preparation is based on a philosophy of extension for prevention and includes high-speed handpieces and slow rotating instruments. However, this modality of cavity preparation usually induces pain, annoying sounds and vibration. Drilling often removes parts of tooth, which are healthy, in addition to the decayed areas. This weakens the tooth and makes it less durable in the long run. Therefore, chemomechanical removal of caries has been developed as an alternative to the conventional methods of removing caries. Chemomechanical method of caries removal was first introduced in 1975 by Habib et al. by using 5% sodium hypochlorite, which was followed by introduction of GK-101,  Caridex system,  and carisolv.  But because of their certain disadvantages like short shelf life, high corrosiveness, requirement of specialized instruments and high cost, in 2003, a research project in Brazil by Bassadori et al. led to the development of new formula to universalize the use of chemomechanical method for caries removal and promote its use in public health, which is commercially known as Papacarie; . Papacarie has as its main active ingredient papain, an endoprotein with bactericidal, bacteriostatic and anti-inflammatory actions, and contains chloramine which is a disinfectant. It allows the maximum preservation of healthy dental structures, with antibacterial and anti-inflammatory effects. Papacarie is a biomaterial that allows the atraumatic chemomechanical removal of caries. The advantage of Papacarie is its easy application which does not need special instruments.
The aim of the study was to evaluate its microbiological aspect and compare its efficacy with the conventional method. During the course of this study, time factor was also evaluated.
Materials and Methods
Twenty extracted human carious molar teeth, involving the dentin, were selected for the study. All soft tissue and extrinsic deposits were removed using hand scalers. After cleaning with pumice and water slurry to remove the debris, each tooth was rinsed in distilled water to remove the solution and dried with compressed air for 5 seconds.
Cavitated teeth were sectioned through the lesions in the mesio-distal longitudinal plane using a disk rotating at low speed [Figure 1] and [Figure 2]. After the teeth were sectioned through the centre of the carious lesion, one half was removed with a slow-speed round steel bur. The other half of carious tissue was removed with Papacarie gel [Figure 3]. Carious lesion was covered with Papacarie gel and left undisturbed for 30 seconds [Figure 4]. When the gel was cloudy, it was removed gently by scraping with the spoon excavator without applying pressure, after which additional fresh gel was applied on the excavation site. Removal of carious dentine was continued until the gel was no longer cloudy. The gel was then removed and the cavity was wiped with a moistened cotton pellet and rinsed. The cavities prepared with each caries removal method were checked as being caries-free with conventional visual and tactile criteria [Figure 5]. The preparation time for each caries removal technique was also evaluated using a stopwatch. The sound samples were decalcified in 10% nitric acid for 48 hours at room temperature [Figure 6]. After washing, the teeth were dehydrated in ascending degrees of ethanol, cleared in xylene and embedded in paraffin [Figure 7]. Serial sections of 5 ΅m were cut and stained with eosin and hematoxylin to evaluate the presence of bacterial deposits. Sections were evaluated with Olympus-BH2 light microscope and images were captured and analyzed using B 5 40 software. The results were statistically evaluated. Paired t-test was used to compare the groups and Z-test was used for comparing the time taken for caries removal.
The number of cavities with bacteria and the average time taken for caries removal are shown in [Table 1] and [Table 2], respectively. In tooth specimens prepared with conventional method, bacteria were detected in only one tooth which was observed to be penetrating the tubules of the dentine [Figure 8]a Destruction of dentinal tubules was observed in the same specimen [Figure 8]b. The remaining specimens in this group (19/20) were bacteria-free (95%).
In the tooth specimens prepared with Papacarie, bacteria were detected in four of the sections but they were generally at the dentinoenamel junction (DEJ) without deep penetration into dentinal tubules and were also few as compared to the conventional method [Figure 9]a. Moreover, the tubular structure of dentine was not destroyed in the specimens prepared with Papacarie [Figure 9]b. There was no statistically significant difference between the efficacy of conventional and chemomechanical caries removal methods as the calculated t value is 20.38 which is <0.001.
The mean time for complete caries excavation with Papacarie was 328.5 seconds (range: 230-430 seconds). This was significantly longer compared with the conventional method wherein the mean time was 124.6 seconds (range: 78-169 seconds) [Table 2].
Papain is an enzyme that is similar to human pepsin, and is used in food technology, pharmaceutical and cosmetic industries. Guzman and Guzman  performed clinical studies on patients with skin lesions caused by burns and observed that the enzymatic action of papain was excellent in areas with necrotic and purulent processes. Udok and Storojuk  also verified that papain aided cleansing the necrotic tissue and secretions, shortening the period of tissue repair.
According to Flindt,  papain acts only on damaged tissue due to the absence of an anti-plasmatic protease, alpha-l-antitrypsin, that hinders its proteolytic action in tissues considered normal.
The absence of alpha-l-antitrypsin in infected tissues allows papain to break the partially degraded molecules. Dawkins showed that papain has bactericidal and bacteriostatic properties which inhibit the growth of gram positive and gram negative organisms.
An in vitro evaluation done by Bussadori and Martins  of Papacarie cytotoxicity using fibroblast culture in different concentrations (2, 4, 6, 8, and 10%) of papain led to the finding that the same was not cytotoxic. Hence, Papacarie was proved to be safe to be used in pediatric patients.
Previous investigations of chemomechanical caries removal method done by Eriksson et al., Nadanovsky et al., and Maragakis et al. revealed the consumption of significantly higher time as compared with the conventional method, which is in accordance with our study.
Corolla et al. in 2008 concluded that the chemomechanical removal of carious tissue using the Papacarie gel presented a treatment duration of 8 minutes per tooth. The increased treatment time in his study was due to the evaluation done on disabled children.
Regarding the microorganism in the present study, out of 20 samples the bacteria were detected in four samples in chemomechanical caries removal method and there was much preservation of dentinal structure compared with the conventional method. This may be due to its noncorrosive nature.
Bussadori  also observed through an electronic scanning microscope that in conventional techniques for decayed tissue removal in permanent teeth with caries (using diamond points and/or burs), dentin surfaces showed a residual smear layer, whereas while using Papacarie there was more preservation of dentin structure and bacterial removal.
The use of Papacarie is recommended as a solut ion for the treatment of patients seeking an a lternative to conventiona l methods . Removal of carious tissue with Papacarie proved to be efficient, easy to perform, comfortable, and less destructive to the dental tissues . The restoration met functiona l needs, and is an easy and inexpensive solution in the case of very apprehensive patients.
|1||Habib CM, Kronman J, Goldman M. A chemical evaluation of collagen and hydroxyproline after treatment with GK-101 (N-chloroglycine). Pharmacol Ther Dent 1975;2:209-15. |
|2||Schutzbank SG, Galaini J, Kronman JH, Goldman M, Clark RE. A comparative in vitro study of the effect of GK-101 and GK-101E in caries removal. J Dent Res 1978;57:861-4. |
|3||Beeley JA, Yip HK, Stevenson AG. Chemomechanical caries removal: a review of techniques and latest developments. Br Dent J 2000;188:427-30. |
|4||Ericson D, Zimmerman M, Raber H, Gφtrick B, Bornstein R, Thorell J. Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries: A multicentre study. Caries Res 1999;33:171-7. |
|5||Bussadori SK, Castro LC, Galvγo AC. Papain gel: a new chemomechanical caries removal agent. J Clin Pediatr Dent 2005;30:115-9. |
|6||Guzman AV, Stein De Guzman MG. The enzymatic debridement of suppurations, necrotic lesions and burns with papain. J Int Coll Surg 1953;20:695-702. |
|7||Udod VM, Storozhuk VT. Use of papain in trating suppurative postoperative soft tissue complications and diases. Khirurgiia (Mosk) 1981;19:99-101. |
|8||Flindt M. Health and safety aspects of working with enzymes. Process Biochem 1979;13:3-7. |
|9||Dawkins G, Hewitt H, Wint Y, Obiefuna PC, Wint B. Antimicrobial effects of Carica papaya fruit on common wound organisms. West Indian Med J 2003;52:290-2. |
|10||Bussadori SK, Silva LR, Guedes Cc. Utilization of Papacarie for chemical and mechanical removal of decayed tooth in Atraumatic Restorative Technique (ART): Minimum invention technique for treatment of deep dental decay. 2005. p. 391-400. |
|11||Ericson D, Zimmerman M, Raber H, Gφtrick B, Bornstein R, Thorell J. Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries. Caries Res 1999;33:171-7. |
|12||Nadanovsky P, Cohen Carneiro F, Souza de Mello F. Removal of caries using only hand instruments: a comparison of mechanical and chemomechanical methods. Caries Res 2001;35:384-9. |
|13||Maragakis GM, Hahn P, Hellwig E. Clinical evaluation of chemomechanical caries removal in primary molars and its acceptance by patients. Caries Res 2001;35:205-10. |
|14||Carrillo CM, Tanaka MH, Cesar MF, Camargo MA, Juliano Y, Novo NF. Use of papain gel in disabled patients. J Dent Child (Chic) 2008;75:3-5.|