Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study.

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causing damage or pulp cytotoxicity.9 It also has bactericidal, bacteriostatic, and anti-inflammatory properties.10 In the literature, various studies had been managed to evaluate the efficacy of other chemomechanical agents. [11]][12][13][14][15] However, there are limited studies on Brix 3000®.3,8,16,17 In addition, there are very few studies investigating the chemomechanical agents' caries removal efficacy microbiologically, [18][19][20][21] and there is one study which evaluated the caries removal efficacy with real-time polymerase chain reaction (PCR) technique.22 The aim of this study was to evaluate and compare the caries removal efficacy of chemomechanical caries removal agent Brix 3000® with conventional caries removal method using a laser IntroductIonDental caries is defined as a biofilm-mediated, noninfectious, and multifactorial disease. 1 The ecological shift of the bacteria in the dental biofilm brings about an imbalance between demineralization and remineralization. 2 As a result of this process, the caries lesion develops.1 Conventional caries removal methods use burs and rotary instruments.The most severe problems encountered during caries removal are anxiety, fear, and pain.In spite of pain control with local anesthesia, 3 noise and vibration of mechanical handpieces, and fear of the needle still cause discomfort.4 In addition, the removal of healthy tooth structure leads to unnecessary weakening of the tooth, harmful thermal effects on the pulp, and iatrogenic pulp exposure.5 Minimally invasive caries removal methods have been developed to overcome these problems.6 The chemomechanical caries removal method is a minimally invasive method that removes infected dentin, preserves the healthy structures, prevents pulp irritation, and patient discomfort.5 Chemomechanical caries removal agents are characterized by solutions or gels that can dissolve carious tissue to aid in removing caries.7 These agents, which facilitate caries removal by softening the carious tissue, are sodium hypochlorite (NaOCl) or enzymebased.3 Brix 3000® is a papain-based gel formulation introduced in Argentina.8 Unlike other papain-based agents, Brix 3000® contained a high concentration of papain (3000 U/mg in each 10%), and the papain was bioencapsulated by encapsulation buffer emulsion (EBE) technology.7 Thus, it can remove the carious tissue without 1,