***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Chemomechanical removal of carious lesions consists of the dissolution of carious tissue by the application of a natural or synthetic agent , followed by atraumatic mechanical removal . AIM The aim of the present study was to assess the effectiveness of Papacarie Duo ® gel in the chemomechanical removal of carious lesions in primary teeth in comparison to the traditional method ( low-speed bur ) . SETTING S AND DESIGN A r and omized clinical trial was conducted with 20 children between 5 and 8 years of age . MATERIAL S AND METHODS Two teeth were treated in each child ( split-mouth design ) , with the r and omization of two methods : Group 1 - chemomechanical caries removal with Papacarie Duo ™ ; and Group 2 - removal of carious dentin tissue using a low-speed bur . Both methods involved restoration with glass ionomer cement and follow up . The following aspects were evaluated : time required for the procedure ; pain ( face evaluation scale ) ; retention of the restorative material in the cavity ; and the presence of secondary caries after 30 days . STATISTICAL ANALYSIS USED Chi-squared test , Student 's t-test , and Wilcoxon test . RESULTS No statistically significant differences between methods were found regarding time required for the procedure ( P = 0.13 ) , the occurrence of pain ( P = 0.585 ) , or restoration status at the 30-day clinical evaluation ( P = 0.713 ) . CONCLUSION The findings of the present study demonstrate that the two methods achieve similar results . The advantages of minimally invasive treatment , such as chemomechanical caries removal with Papacarie Duo ™ , are its ease of use , patient comfort , and the fact that it causes less damage to dental tissue OBJECTIVE To determine the efficacy of chemo-mechanical  caries removal using Carisolv and compare it to the conventional method of caries removal . DESIGN A quasi-experimental study . PLACE AND DURATION OF STUDY The Department of Operative Dentistry , Fatima Jinnah Dental College Hospital , Karachi , from October 2003 to March 2004 . PATIENTS AND METHODS Thirty patients with contralateral cariously involved m and ibular molars participated in the study . Patients were selected using convenience sampling . One side of each patient was r and omly selected for treatment with either Carisolv or the conventional method . In the study group , carious lesion was removed with Carisolv instruments , whereas in control group excavators and round steel burs were used . Single observer assessed all the treated lesions . Time required to remove caries and completeness of caries removal was observed for both techniques . Data was compared using ' Fisher 's exact test ' and ' Independent sample s t-test ' . RESULTS Time taken to remove caries using Carisolv was 12.19 ( SD 3.7 ) minutes , whereas time taken to remove caries by conventional method was 7.4 ( SD 3.21 ) minutes . The difference was statistically significant ( p-value<0.005 ) . Caries could not be removed in 3 teeth in the study group with Carisolv . Complete caries removal was , however , achieved in the control group . The difference was statistically insignificant ( p-value>0.005 ) . CONCLUSION Chemo-mechanical caries removal with Carisolv is as effective as conventional methods in removing dental caries , however , it is significantly more time-consuming OBJECTIVES The purpose of this study was to compare the chemomechanical caries-removal system ( Carisolv ) with high-speed excavation in cavitated occlusal caries of primary molars . Design and setting . The study was a r and omized controlled , clinical trial in which the two techniques were compared in each subject . Participants were chosen from public schools , in Maracaibo County , Zulia State , Venezuela . SAMPLE AND METHODS The sample consisted of 80 primary molars selected from 40 children ( mean age 7.7+/-0.7 years ) . Each patient had at least two contralateral primary molars with cavitated occlusal caries and approximately equal-size access to lesions . The outcome variables were : clinical ly complete caries removal , size of the opening of the cavity , volume of carious tissue removed , pain during caries removal , anaesthesia requested by the patient , caries-removal time , and behaviour and preference of patients . RESULTS All treated molars were clinical ly caries free whichever caries-removal procedure was used . When Carisolv ' was used the final cavity entrance sizes were smaller ( P<0.001 ) and the estimated volume of tissue removed was less ( P<0.001 ) . The time taken for caries removal was three times longer ( 7.51+/-1.83 min , P<0.001 ) . Some pain was reported by seven ( 17.5 % ) participants when Carisolv was used , compared with 16 ( 40 % ) when high-speed excavation was used ( P<0.05 ) . Using the Carisolv method there was a higher proportion of patients with positive behaviour ( P<0.01 ) , and 71.0 % ( P<0.05 ) preferred this treatment . CONCLUSION Carisolv is an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars ; it is more conservative of dental tissue and appeared to be more comfortable for most patients , although the clinical time spent is longer than when using high-speed excavation PURPOSE The purpose of this controlled clinical trial was to compare the working time for caries removal in primary teeth , the need for local anesthesia and patient cooperation , when the chemomechanical Carisolv or the conventional mechanical method were used . METHODS The sample consisted of primary teeth of children who had occlusal or buccal carious lesions into dentin .  High speed and /or low speed were used as the conventional mechanical method of caries removal . The efficiency in caries removal was judged on the basis of clinical criteria . Length of working time , need of local anesthesia , and level of patient cooperation were recorded for both methods . Statistical analysis was performed using the student 's t test and chi-square test . RESULTS Working time with the chemomechanical method was much more prolonged than with the mechanical method ( P < .001 ) , but it did not negatively affect children 's cooperation . Furthermore , the chemomechanical method reduced the need for administration of local anesthesia for Class V cavity preparations . CONCLUSIONS The chemomechanical method , although more prolonged , is effective in caries removal in primary teeth , does not influence children 's cooperation and may reduce the need of local anesthesia in Class V restorations The aim of this r and omized clinical study was to compare the efficacy of a fluorescence-controlled erbium-loaded yttrium aluminum garnet ( Er : YAG ) laser with conventional bur treatment  for caries therapy in adults . Twenty-six patients with 102 carious lesions were treated using either the Er : YAG laser , at threshold levels of 7 , 8 , 9 , and 10 [ U ] , or rotary burs . Both techniques were applied to each lesion at separate locations . After treatment , dentine sample s were obtained using a carbide bur . The viable counts of Streptococcus mutans ( SM ) and lactobacilli ( LB ) [ expressed as colony-forming units ( log10 CFUs ) ] , treatment time , pain , vibration , and sound intensity were determined . The median numbers of CFUs for SM and LB were not statistically different between laser and bur treatment at threshold levels 7 and 8 [ U ] . At threshold levels 9 and 10 [ U ] , the median number of CFUs for LB [ 1.11 ( range : 0.00 - 2.04 ) ] were significantly higher following laser treatment than following bur treatment [ 0.30 ( range : 0.00 - 0.60 ) ] . The results indicate that treatment with a fluorescence-controlled Er : YAG laser at threshold levels of 7 and 8 removed caries to a level similar to that achieved using conventional bur treatment , with clinical ly irrelevant amounts of remaining bacteria . Although more time consuming , laser treatment provided higher patient comfort than bur treatment OBJECTIVE To evaluate the clinical performance and radiographic outcome of glass ionomer cement ( GIC ) restoration in primary molars using three caries removal techniques . BASIC RESEARCH DESIGN R and omised clinical controlled trial . CLINICAL SETTING Two st and ard dental clinics in 2 hospitals near Bangkok . PARTICIPANTS A total of 276 children , aged 6 - 11 , having dentinal caries on the occlusal and /or proximal surface extending at least one-third of dentine without signs and /or symptoms of irreversible pulpitis . INTERVENTION Children were r and omly allocated into 3 study groups with different caries removal techniques : Group 1 , partial soft caries removal at enamel-dentine junction ( EDJ ) by spoon excavation ; Group 2 , complete soft caries removal by spoon excavation ; and Group 3 , conventional caries removal by steel burs . All cavity preparations were restored with GIC ( Fuji IX , GC Corp. , Japan ) . MAIN OUTCOME MEASURES Clinical and radiographic evaluations were carried out at 6 and 12 months after restoration . RESULTS After 12 months , 89 , 89 , and 88 restorations in Groups 1 , 2 and 3 were evaluated . The cumulative survival rates of GIC restorations in Groups 1 , 2 and 3 were 83 % , 83 % , and 89 % while the cumulative survival rates of pulp were 99 % , 100 % and 98 % respectively . There were no statistically significant differences in the survival of GIC restorations  or pulp in the three groups ( p > 0.05 ) . CONCLUSION The clinical and radiographic evaluations after 12 months indicated that partial soft caries removal at EDJ followed by GIC restoration was comparable to that of ART and conventional approaches OBJECTIVES : The aim of the present study was to analyze the efficacy of Papacarie ® gel compared with the traditional method ( low-speed bur ) in reducing the counts of total bacteria , Lactobacillus , total Streptococcus and Streptococcus mutans group . METHODS : A r and omized , controlled clinical trial with a split-mouth design was performed . The sample comprised 40 deciduous teeth in 20 children ( 10 males and 10 females ) aged four to seven years . The teeth were r and omly allocated to two groups : G1 , or chemomechanical caries removal with Papacarie Duo ® , and G2 , or the removal of carious dentin tissue with a low-speed bur . Infected dentin was collected prior to the procedure , and the remaining dentin was collected immediately following the removal of the carious tissue . Initial and final counts of bacterial colonies were performed to determine whether there was a reduction in the number of colony-forming units ( CFUs ) of each microorganism studied . Clinical Trials.gov : NCT01811420 . RESULTS : Reductions were found in the numbers of total bacteria , total Streptococcus and Streptococcus mutans group following either of the caries removal methods ( p<0.05 ) . A reduction was also noted in the number of Lactobacillus CFUs ; however , this difference did not achieve statistical significance ( p>0.05 ) . CONCLUSION : Papacarie ® is an excellent option for the minimally invasive removal of carious tissue , achieving significant reductions in total bacteria , total Streptococcus and S. mutans with the same effectiveness as the traditional caries removal method OBJECTIVE The purpose of this project was to evaluate the performance of a dentin adhesive system on carious and noncarious primary dentin in vivo . METHOD AND MATERIAL S Forty-eight primary molars with carious lesions were r and omly assigned to 2 different treatments : group 1 ( control , n = 24)--All identifiable , irreversibly infected dentin was removed prior to the application of the bonding agent and restorative material ; group 2 ( experimental , n = 24)--Irreversibly infected dentin was partially removed prior to the application of the bonding agent and restorative material . The control and experimental teeth were clinical ly monitored every 3 months and evaluated 12 months after restoration . The teeth were extracted around the time of exfoliation and processed for scanning electron microscopy . RESULTS Retention rate , marginal integrity , and pulpal symptoms were identical in both groups . Radiographically , the radiolucent area associated with the experimental restorations did not increase with time in 75 % of the cases . For the control group , the adhesive system formed a hybrid layer . In the experimental group , there was morphologic evidence of the formation of an acid-resistant " altered hybrid layer . " An acid-resistant tissue , result ing from the interdiffusion of adhesive resin within the area of carious dentin , was observed adjacent to and under the altered hybrid layer . CONCLUSION Application of an adhesive restorative system to irreversibly infected dentin did not affect the clinical performance of the restoration To measure the amount of viable bacteria after excavation using conventional rose-bur or the chemo-mechanical Carisolv method , a total of 22 lesions were analyzed ( one vital tooth per patient ) in this open , controlled and r and omized study . Two sample s per lesion were taken under aseptic conditions using a rose-bur , one superficially in the caries lesion and one after completed excavation . In in vitro tests more material was collected from the hard caries free dentine as compared to the carious dentine . The sample s were incubated on blood agar ( aerobically and anaerobically ) , Rogosa ( SL ) agar and mitis salivarius ( MS ) agar . For blood agar ( aerobic ) both methods result ed in a significant decrease in CFU , for blood agar ( anaerobic ) and MS ag 
    Output:
    
Risk of complications was highest when excavating until only non-stainable dentine remained , and lowest when not attempting to remove all softened dentine .
Risk of pain significantly decreased if self-limiting chemo-mechanical excavation or fluorescence-assisted lasers were used instead of excavating until all dentine was hard .
When not attempting to remove all softened dentine , the time required for excavation was shortest , whilst the greatest number bacteria remained .
Not attempting to remove all softened or stainable dentine might reduce the risk of complications .
CLINICAL SIGNIFICANCE Given current evidence , dentists might not need to attempt excavation until only hard dentin remains in proximity to the pulp .