Chemomechanical Caries Removal Versus Conventional Drilling for Managing Deep Carious Lesions in Primary Molars of Preschool Children
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Background: Conventional rotary caries excavation may produce pain and unfavorable behavioral responses in preschool children, whereas chemomechanical techniques may provide a less mechanically intensive alternative. Objective: To compare immediate pain perception, behavioral cooperation, and caries-removal time between papain-based chemomechanical excavation with Cariclast and conventional rotary bur excavation in preschool children with deep carious lesions in primary molars. Methods: This assessor-blinded, two-arm parallel randomized controlled trial was conducted in Central Punjab, Pakistan, from August 2025 to December 2025. Eighty children aged 3–5 years were randomized equally between treatment groups. Pain was assessed using the Wong-Baker FACES Pain Rating Scale, behavioral cooperation using the Frankl Behavior Rating Scale, and procedure duration in minutes. Complete-case outcome analyses included 76 children (38/group). Results: Mean post-treatment pain was lower with Cariclast than with rotary excavation (1.84 ± 0.92 vs 4.68 ± 1.14; mean difference −2.84, 95% CI −3.31 to −2.37; p<0.001). Frankl scores were higher with Cariclast (3.42 ± 0.55 vs 2.21 ± 0.66; mean difference 1.21, 95% CI 0.93 to 1.49; p<0.001). Caries-removal time was longer with Cariclast (18.45 ± 3.12 vs 9.24 ± 2.05 minutes; p<0.001). Conclusion: Cariclast was associated with lower immediate pain and more favorable behavioral cooperation but required longer caries-removal time than conventional rotary excavation
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