Evaluation of the atraumatic restorative treatment of primary molars using enzyme-based chemomechanical method

Dental caries is a non-infectious disease of microbial origin characterized by demineralization of the hard tissues of the tooth. The most preferred method for the removal of carious tissue is the traditional method in which the caries tissue is removed with rotary instruments. There are some disadvantages that come with this method. These disadvantages can be listed as the need for local anesthesia due to the pain during the procedure, and the discomfort felt by the patient due to sound and vibration. For this reason, there is a need for a painless treatment method for children with dental phobia and inability to cooperate. One of these recently preferred methods is the chemomechanical carious tissue removal method. In this study, it was aimed to compare the clinical and radiographic successes and pain levels of a chemomechanical agent and traditional Atraumatic Restorative Treatment (ART). Our study included children aged 3-8 years with their parents and organs from Necmettin Erbakan University, Faculty of Dentistry, Department of Pedodontics (n=38). The people included in the study had caries on the occlusal surfaces of the primary second molars and had ART indications; Traditional ART method with excavator, enamel chisel and probe and chemomechanical carious tissue removal method with Brix 3000 material were applied. After caries removal methods, restorations were completed with high viscosity glass ionomer cement (YVCIS). After the restoration applications, evaluation was made according to the Wong Baker Pain Scale. The clinical success of the restorations was followed up at 3, 6 and 12 months according to the modified USPHS criteria. Radiographic evaluation was performed at 6 and 12 months. All print analyzes were made with IBM SPSS version 25 package program. The Compare Column Proportions Test was used to compare the two caries removal methods in which YVCIS was applied according to clinical and radiological evaluation criteria in time periods, and the Chi-Square Test was used for the evaluation of the same group within itself. The Kruskal Walli H Test was used to evaluate the distribution of perceived pain dimensions by age with the Wong Baker Pain Scale. In the whole study, the error value was 5% and the load was accepted as maintaining the p<0.05 value. Istatistical significant difference was found between the YVCIS restorations applied after chemomechanical caries removal and traditional ART methods at the 3rd and 6th months in terms of marginal compatibility (3rd month p=0.040; 6th month p=0.047). YVCIS restorations applied after the chemomechanical caries removal method had a Charlie score of 2.8% in the secondary caries criterion at the 6th month follow-up. Secondary caries was not observed in any of the time periods in YVCIS restorations applied after the traditional ART method. Considering the radiographic evaluation criteria at 6 and 12 months, no pathology was found in any tooth in either group. In the evaluation of the pain level made with the Wong Baker Pain Scale, the facial expression representing the expression of no pain was preferred the most in both groups. When all the results were evaluated between the two groups, no statistically significant difference was found (p=0.536). Our study; It has been shown that the chemomechanical caries removal method using Brix 3000 material is a painless and acceptable caries removal technique similar to the traditional ART method. Keywords: Minimal Interventional Dentistry, Atraumatic Restorative Treatment, Chemomechanical Caries Removal, Brix 3000, Wong Baker Pain Scale