ART with or without the aid of chemo-mechanical agents: a systematic review.

Objectives: To investigate whether the use of chemo-mechanical carious tissue removal (CMCTR) agents is effective for Atraumatic Restorative Treatment (ART).

Materials and methods: Searches were conducted in 6 databases for inclusion of clinical studies. Risk of bias was assessed (RoB 2 and ROBINS-I), a meta-analysis was performed with data from time of carious tissue removal (TCTR), and the certainty of evidence was estimated. ART + CMCTR was compared to ART for the treatment of caries lesions in primary teeth (pt) and permanent teeth (PT) of humans, considering acceptability, pain/discomfort, survival and success of restorations (SSR), Oral Health-Related Quality of life (OHRQol), satisfaction, TCTR, total treatment time (TTT), carious tissue removal efficacy and adverse effects.

Results: Of 12 included studies, 4 showed low risk of bias, considering pain, TTT and TCTR outcomes. ART + CMCTR was similar or more accepted than ART for pt, causing similar or less pain/discomfort for both dentitions. There was no difference in SSR, OHRQol for PT, and adverse effects (pt), although greater satisfaction was reported after ART + CMCTR in case of PT. ART + CMCTR was better or as effective as ART in removing carious tissue (pt). TTT for pt was divergent between the groups, but without difference of TCTR for both, pt and PT (MD 0.11 [-1.56, 1.77] p = 0.90, I ² =93%).

Conclusions: In general, ART + CMCTR is effective, providing greater satisfaction, with no difference in SSR, OHRQol and adverse effects compared to ART, which did not present advantages in relation to pain/discomfort and efficacy in removing carious tissue. The TTT was influenced by the CMCTR agent; however, there was no difference for TCTR in the overall quantitative synthesis with Papacárie DuoGel^®.

Clinical relevance: The use of chemo-mechanical agents for carious tissue removal in the ART may benefit patients with reduced pain/discomfort.