Evaluation of different methods for the diagnosis of primary caries lesions: Study protocol for a randomized controlled clinical trial.

BACKGROUND: According to the World Health Organization (WHO), dental caries is considered one of the greatest pediatric health problems in the world, due to its high prevalence and incidence. Therefore, the early diagnosis of caries lesions is a fundamental procedure for planning treatment aimed at prevention, minimal intervention and promotion of oral health. The present study aims to evaluate, through a randomized and controlled clinical study, which is the best strategy for diagnosing primary caries lesions located in the interproximal region. MATERIALS AND METHODS: Eighty patients, aged between 4 and 10 years will be randomized and allocated into 2 groups for analysis and comparison of methods for diagnosing caries lesions. The following diagnostic methods will be analyzed and compared: visual clinical examination using ICDAS (International Caries Detection and Assessment System), the iTero Element 5D System (intraoral scanner with near infrared imaging (NIRI) technology) and bitewing radiography (BWX). All evaluations will be carried out by 02 examiners. Examiners will be trained and calibrated to use the visual and radiographic criteria and also to use the iTero 5D intraoral scanner, following the manufacturer's instructions. TRIAL REGISTRATION: NCT04900246 in ClinicalTrial.gov. First released in 05/11/2021 and last updated in 10/06/2021.

Accuracy of a portable breath meter test for the detection of halitosis in children and adolescents.

OBJECTIVES: This study aimed to determine the accuracy of the Breath-Alert™ portable breath meter (BA) for the detection of halitosis in children and adolescents, considering the organoleptic test (OT) as the gold standard in this assessment. METHODS: A cross-sectional study was conducted on 150 children (aged 6-12 years). OT was performed by three independent examiners on a single occasion, obtaining three scores of 0-5 points on the Rosenberg's organoleptic scale. The median of the three evaluations for each child was used for analysis. BA was used according to the manufacturer's instructions, with breath odor scored from 0-5 points. Scores ≥2 on both tests were considered indicative of halitosis. RESULTS: A total of 26 (17.3%) and 23 (15.3%) children were detected with halitosis on the OT and BA tests, respectively. The sensitivity and specificity of the BA scores for the detection of halitosis were 80.76% and 98.38%, respectively. The positive and negative predictive values for BA were 91.3% and 96.06%, respectively. CONCLUSION: In the present study involving children, who require fast, practical examinations, BA proved to be an auxiliary tool to OT for the detection of halitosis in the practice of pediatric dentistry, demonstrating high sensitivity and specificity.

Accuracy of a portable breath meter test for the detection of halitosis in children and adolescents

OBJECTIVES: This study aimed to determine the accuracy of the Breath-Alert™ portable breath meter (BA) for the detection of halitosis in children and adolescents, considering the organoleptic test (OT) as the gold standard in this assessment. METHODS: A cross-sectional study was conducted on 150 children (aged 6-12 years). OT was performed by three independent examiners on a single occasion, obtaining three scores of 0-5 points on the Rosenberg's organoleptic scale. The median of the three evaluations for each child was used for analysis. BA was used according to the manufacturer's instructions, with breath odor scored from 0-5 points. Scores ≥2 on both tests were considered indicative of halitosis. RESULTS: A total of 26 (17.3%) and 23 (15.3%) children were detected with halitosis on the OT and BA tests, respectively. The sensitivity and specificity of the BA scores for the detection of halitosis were 80.76% and 98.38%, respectively. The positive and negative predictive values for BA were 91.3% and 96.06%, respectively. CONCLUSION: In the present study involving children, who require fast, practical examinations, BA proved to be an auxiliary tool to OT for the detection of halitosis in the practice of pediatric dentistry, demonstrating high sensitivity and specificity.

Halitosis: prevalence and association with oral etiological factors in children and adolescents.

Halitosis is a condition that can have negative social impacts. Although common, its prevalence and associated etiological factors have been studied little in the child/adolescent population. The aim of the present study was to associate the occurrence of halitosis with oral etiological factors in children aged 6-12 years. A cross-sectional study was conducted with 150 male and female children and adolescents. The organoleptic test (OT) was used to determine halitosis. All patients and caregivers answered a questionnaire addressing personal data, general health and oral health, including hygiene habits, and received clarifications regarding the procedures to which the children/adolescents would be submitted in a second session. During the second session, the children were clinically evaluated for halitosis using the OT. The bacterial plaque index, coated tongue index, pH, salivary flow and the presence of dental caries were also determined. Differences in the proportions of the factors were compared between groups (with and without halitosis) using the chi-squared test and Fisher's exact test for categorical variables and the non-parametric Mann-Whitney U test for continuous variables. Halitosis was diagnosed in 17.3% of the children and was associated with a fair score on the Simplified Oral Hygiene Index (OR: 3.5; p = 0.008), the non-daily use of tooth floss (OR: 8.7; p = 0.017), percentage of coated tongue (p = 0.005), abnormal salivary flow (OR: 4.2; p < 0.001) and dental caries (OR: 3.8; p = 0.002). No associations with brushing performed by a caregiver or salivary pH were found.

Efeito citotóxico dos cimentos de ionômero de vidro em cultura celular / Cytotoxic effect of glass ionomer cements in cell culture

Objetivo: Avaliar a toxicidade de cimentos de ionômero de vidro (CIV) quimicamente ativados em culturas de células, após aglutinação do material e reação de presa. Materiais e Métodos: Dividiu-se os materiais em 9 grupos experimentais: I: controle, li (AP) Riva Self Cure (SOl), 111 (PP) Riva Self Cure (SOl), IV (AP) Maxxion R (FGM), V (PP) Maxxion (FGM), VI (AP) Vitro Molar (DFL), VII (PP) Vitro Molar (OFL), VIII (AP) KetacMolar Easymix, IX (PP) Ketac Molar Easymix (3M!ESPE). Manipularam-se os CIV conforme instruções do fabricante sendo depositados em laminulas em contato com a cultura de células logo após a aglutinação do material e após a reação de presa. A ação dos materiais sobre os fibroblastos cultivados foi analisada sobre o crescimento celular no curto, longo prazo e no ensaio de viabilidade e proliferação celular. Resultados: Grupos que receberam materiais após a presa apresentaram número de células viáveis e porcentagens menores que o grupo controle, porém permitiram crescimento celular durante todo experimento. Quando colocados em contato com as células logo após a aglutinação, induziram morte celular imediata. O material que demonstrou menor atividade citotóxica em fibroblastos foi o Ketac- Molar Easymix (3M!ESPE). Conclusão: Todos os CIV testados apresentaram-se tóxicos antes da reação de presa, entretanto após a reação de presa, permitiram crescimento celular

Aim: The aim of the present study was to assess the toxicity of different chemically activated GICs in fibroblast cell cultures post-agglutination (PA) and post-setting reaction (PS). Material and Methods: The materiais were divided into nine experimental groups: Group I - control; Group li (PA) - Riva Self Cure (SOl); Group 111 (PS) - Riva Self Cure (SOl); Group IV (PA) - Maxxion R (FGM); Group V (PS) - Maxxion (FGM); Group VI (PA) - Vitro Molar (OFL); Group VII (PS) - Vitro Molar (OFL); VIII (PA) - Ketac Molar Easymix; and Group IX (PS) - Ketac Molar Easymix (3M! ESPE). The cements were mixed following the manufacturers' instructions, deposited on glass slip covers and placed into contact with the cell cultures immediately following the agglutination of the material or after the setting reaction. The effect of the materiais on the cultivated fibroblasts was analyzed in terms of short-term and long-term cell growth as well as in viability and cell proliferation assays. Results: When placed in contact with the cells immediately follo- wing agglutination, the materiais caused immediate cell death. The groups having received the materiais following the setting reaction had a lower number and percentage of viable cells in comparison to the control, but the materiais allowed cell growth throughout the experiment. KetacMolar Easymix (3M!ESPE) was the glass ionomer cement with the least amount of cytoto- xic activity on fibroblasts. Conclusion: Ali glass ionomer cements tested were toxic prior to the setting reaction.However after setting reaction, allowed cell growth

Production of extracellular matrix proteins by human pulp fibroblasts in contact with papacárie and carisolv.

PURPOSE: To evaluate the effect of two products for the chemomecanical removal of carious tissue (Papacárie and Carisolv) on human dental pulp fibroblasts and the synthesis of extracellular matrix proteins. MATERIALS AND METHODS: Fibroblasts were divided into three groups: group 1 (control), group 2 (Papacárie) and group 3 (Carisolv). Collagen I, III , fibronectin and osteonectin were analysed by immunofluorescence and compared among the groups. RESULTS: The groups exhibited similar immunolabeling for vimentin, type I collagen and fibronectin, but were negative for type III collagen. Osteonectin staining was strongly positive in the cells treated with Papacárie and Carisolv and weakly positive in the control group. CONCLUSION: The findings of the present study showed that Papacárie and Carisolv are not cytotoxic to pulp fibroblast cells. Moreover, these products stimulate fibroblasts to produce osteonectin, likely leading to the formation of dentin matrix. These findings confirm the safe, beneficial use of both gels in minimally invasive techniques.

Assessment of chemomechanical removal of carious lesions using Papacarie Duo™: randomized longitudinal clinical trial.

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). SETTINGS AND DESIGN: A randomized clinical trial was conducted with 20 children between 5 and 8 years of age. MATERIALS AND METHODS: Two teeth were treated in each child (split-mouth design), with the randomization 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.

Association between parafunctional habits and signs and symptoms of temporomandibular dysfunction among adolescents.

PURPOSE: To determine associations between signs and symptoms of temporomandibular disorder (TMD) and harmful oral habits. MATERIALS AND METHODS: Two hundred forty-four adolescents from a public school in the city of São Roque, Brazil, were evaluated. A screening questionnaire for orofacial pain and TMD recommended by the American Academy of Orofacial Pain was used to determine signs and symptoms of TMD. Patient histories and clinical exams were used to determine harmful oral habits. RESULTS: Eighty-three participants (34%) displayed no signs or symptoms of TMD, 161 (66%) responded affirmatively to at least one item on the questionnaire and 49 (20.1%) gave at least three affirmative responses. Headache was the most frequently reported sign or symptom of TMD (40.6%; n = 99). There was no statistically significant association between gender and signs or symptoms of TMD (P = 0.281). Twenty-five percent (n = 61) of the patients had no harmful oral habits, while 16.4% (n = 40) had only one habit, the most common of which was nail biting. A total of 20.1% (n = 49) reported two harmful oral habits and 38.5% (n = 94) reported three or more such habits. There was a statistically significant association between signs and symptoms of TMD and three or more habits. CONCLUSION: A statistically significant association was found between signs and/or symptoms of TMD and harmful oral habits in adolescents.

Clinical status of permanent first molars in children aged seven to ten years in a Brazilian rural community

Aim: To evaluate the clinical status of permanent first molars and associations with dental caries, gingival bleeding, dental fluorosis and malocclusion. Methods: An observational study wascarried out in a rural community denominated Morro do Saboó in the city of São Roque, state of São Paulo, Brazil. A total of 194 children aged seven to ten years were examined for dental caries using the index proposed by the World Health Organization. Other conditions were determined using the Gingival Alterations Index, Dean’s Index and Dental Aesthetic Index. The chi-squared test was used for the statistical analysis of the data. Results: A total of 85.5% of the sample exhibited gingival bleeding and 69.9% exhibited malocclusion. A total of 53.6% had a clinical aspect of normality with regard to dental fluorosis. There was a predominance of sound teeth in the upper arch and teeth with carious lesions in the lower arch. No significant differences were found between sexes regarding gingival bleeding, dental fluorosis or malocclusion. Significant associations were found between tooth status and oral alterations (gingival bleeding, malocclusion and fluorosis) in teeth 16, 26 and 46 and between tooth status and gingival bleeding in tooth 36 (p<0.001). Conclusions: Caries activity in the permanent first molars was mainly associated with dental fluorosis and malocclusion. Strategies aimed at health promotion should be adopted on a large scale to minimize the prevalence of oral diseases.

Remoción quimico-mecánica de lesión de caries en diente permanente con Papacárie Duo(TM): reporte de un caso / Chemomechanical removal of carious lesion in a permanent tooth with Papacárie Duo(TM): report of a case

Este trabajo tiene como objetivo presentar el protocolo clínico de Papacárie Duo(TM), desde el diagnóstico de la lesión de caries hasta el procedimiento restaurador. Una paciente femenina de 12 años de edad se presentó a la consulta odontopediátrica por dolor al frío y durante la ingesta de alimentos dulces. El examen clínico y radiográfico reveló caries en la pieza 46, clasificada como score 6, según el sistema ICDAS (cavidad extensa con exposición de la dentina). La conducta clínica consistió en la eliminación del tejido infectado por medio de la remoción quimico-mecánica de la caries utilizando el gel a base de papaína y restauración con ionómero vítreo. Se concluye, a partir de este protocolo, que la eliminación quimico-mecánica de la lesión de caries es un método de fácil aplicación basdado en la odontología mínimamente invasiva.

Remoción quimico-mecánica de lesión de caries en diente permanente con Papacárie Duo(TM): reporte de un caso / Chemomechanical removal of carious lesion in a permanent tooth with Papacárie Duo(TM): report of a case

Este trabajo tiene como objetivo presentar el protocolo clínico de Papacárie Duo(TM), desde el diagnóstico de la lesión de caries hasta el procedimiento restaurador. Una paciente femenina de 12 años de edad se presentó a la consulta odontopediátrica por dolor al frío y durante la ingesta de alimentos dulces. El examen clínico y radiográfico reveló caries en la pieza 46, clasificada como score 6, según el sistema ICDAS (cavidad extensa con exposición de la dentina). La conducta clínica consistió en la eliminación del tejido infectado por medio de la remoción quimico-mecánica de la caries utilizando el gel a base de papaína y restauración con ionómero vítreo. Se concluye, a partir de este protocolo, que la eliminación quimico-mecánica de la lesión de caries es un método de fácil aplicación basdado en la odontología mínimamente invasiva.(AU)

Análisis clínico y radiográfico de las técnicas ART y remoción químico-mecánica de caries: estudio piloto / Clinical and radiographic assess of ART technique and chemical and mechanical caries removal: pilot study

Objetivo: Comparar clínica y radiográficamente el Tratamiento Restaurador Atraumático (ART) y remoción químico-mecánica con Papacárie® en molares deciduos con caries oclusal verificando dolor, integridad clínica de las restauraciones y evolución de la lesión. Metodología: Estudio clínico randomizado en 16 molares deciduos, en pacientes de ambos sexos, con edades entre 3 y 6 años. Esos dientes fueron divididos aleatoriamente en G1 (n=8) ART convencional y G2 (n=8) Papacárie® y restaurados con ionómero de vidrio. La sintomatología se analizó mediante la Escala de Evaluación Facial. Seis meses después se evaluó clínicamente la integridad de las restauraciones (Escala de Frencken) y radiográficamente el aumento o no del área radiolúcida de la lesión. Resultados: No fue relatado dolor durante la ejecución de ambas técnicas. Luego de seis meses no hubo progresión de las lesiones y el material restaurador se mantuvo retenido adecuadamente. Conclusiones: Ambas técnicas demostraron éxito clínico y radiográfico luego de seis meses de evaluación.

Association between halitosis and mouth breathing in children.

OBJECTIVE: To determine whether there is a correlation between halitosis and mouth breathing in children. STUDY DESIGN: Fifty-five children between 3 and 14 years of age were divided into two groups (nasal and mouth breathing) for the assessment of halitosis. A descriptive analysis was conducted on the degree of halitosis in each group. The chi-square test was used for comparison between groups, with a 5% level of significance. RESULTS: There was a significantly greater number of boys with the mouth-breathing pattern than girls. A total of 23.6% of the participants had no mouth odor, 12.7% had mild odor, 12.7% had moderate odor and 50.9% had strong odor. There was a statistically significant association between halitosis and mouth breathing. CONCLUSIONS: The occurrence of halitosis was high among the children evaluated, and there was a statistically significant association between halitosis and mouth breathing.

Association between halitosis and mouth breathing in children

OBJECTIVE: To determine whether there is a correlation between halitosis and mouth breathing in children. STUDY DESIGN: Fifty-five children between 3 and 14 years of age were divided into two groups (nasal and mouth breathing) for the assessment of halitosis. A descriptive analysis was conducted on the degree of halitosis in each group. The chi-square test was used for comparison between groups, with a 5 percent level of significance. RESULTS: There was a significantly greater number of boys with the mouth-breathing pattern than girls. A total of 23.6 percent of the participants had no mouth odor, 12.7 percent had mild odor, 12.7 percent had moderate odor and 50.9 percent had strong odor. There was a statistically significant association between halitosis and mouth breathing. CONCLUSIONS: The occurrence of halitosis was high among the children evaluated, and there was a statistically significant association between halitosis and mouth breathing.

O uso da fibra de vidro na confecção de prótese adesiva direta na dentição decídua: relato de caso clínico / . Fiberglass use in direct adhesive prosthesis in primary dentition: clinical case report

O objetivo deste estudo foi relatar um caso clínico onde foi utilizada a fibra de vidro reforçada com resina composta na confecção de uma prótese adesiva direta em paciente de quatro anos de idade com ausência do dente 51 e alteração de cor no dente 61, ambos resultantes de trauma...

The aim of this study was to report a clinical case using reinforced-fiberglass composite to the manufacture of a direct adhesive prosthesis in a four years-old patient with absence of dental element number 51 and color alteration of dental element number 61, both caused by dental trauma...

Avaliação cefalométrica de pacientes respiradores bucais / Cephalometric evaluation of mouth-breathing patients

Introdução: A respiração ocupa um importante papel na matriz functional, assim como no crescimento e desenvolvimento do complexo maxilofacial. Objetivo: A proposta deste estudo foi avaliar a cefalometria de pacientes respiradores bucais. Método: A análise foi realizada em 40 pacientes, 22 do gênero feminino e 18 do masculino, de 5 anos a 14 anos e 4 meses de idade. Foram obtidas telerradiografias laterais, nas quais se realizou a análise cefalométrica sumária de Ricketts e o cálculo VERT. Resultados: Os resultados das análises apontaram uma diminuição do ângulofacial, altura facial inferior e arco mandibular e aumento da altura facial total, convexidade do ponto A e do grau de convexidade do perfil mole. A profundidade facial, ângulo do plano mandibular e profundidade maxilar ficaram dentro dos valores de normalidade. Na análise dentária, os incisivos inferiores e os molares superiores mostraram-se em posições normais, assim como a inclinação do incisivo inferior. Além disso, após análise estatística dos dados, constatou-se uma característica dolicofacial severa. Conclusão: O padrão de respiração bucal foi responsável por várias anormalidades no crescimento e desenvolvimento craniofacial.

Introduction: Breathing plays a part in the functional matrix, acting on plastic dynamics as well as the growth and development of the maxillofacial complex. Objective: The aim of the present study was to assess the cephalometrics of mouth-breathing patients. Methods: Analysis was carried out on 40 patients (22 females and 18 males), between five and 14 years of age at the Functional Orthopedics of the Maxillae Clinic of the Universidade Camilo Castelo Branco (SP, Brazil). Lateral tele-radiographs were obtained, for which Ricketts’s cephalometric analysis was performed and the VERT index was calculated. Results: The results of the analysis revealed a reduction in the angles of facial axis, height of the lower face and mandibular arch as well as an increase in total facial height, convexity of Point A and the degree of convexity of the soft profile. Facial depth, angle of the mandibular plane and maxillary depth were within the range of normality. In the dental analysis, the lower incisors, upper molars and inclination of the lower incisors were positioned normally. The VERT index value was high, indicating a severe dolichocephalic (long face) characteristic. Conclusion: The mouth breathing pattern was responsible for various abnormalities in craniofacial growth and development.

Avaliação in vitro da microinfiltração nas faces proximais de molares decíduos com diferentes compômeros / In vitro evaluation of microleakage in deciduos teeth in the proximal faces using different compomers

Foi avaliada neste estudo a microinfiltração em slot proximal de molares decíduos restaurados com os seguintes compômeros disponíveis no mercado: Freedom (SDI), Compoglass (Vivadent), Dyract/AP (Dentsply) e F2000 (3M). Selecionou-se 16 molares decíduos provenientes do Banco de Dentes Humanos da FOUSP, nos quais foram realizados praparos tipo slot proximal. Após os preparos, os dentes foram divididos em 4 grupos e restaurados seguindo as especificações dos fabricantes. Após o tempo de presa, realizou-se a impermeabilização dos dentes seguida de imersão em corante azul de metileno pelo período de 4 horas. As amostras foram então seccionadas em sentido longitudinal e três examinadores previamente calibrados atribuiram notas para o grau de microinfiltração...

The aim of the study was to evaluate microleakage in proximal slot of deciduos molares using eight different marks of compomers. Sixteen deciduos molars were selected the Human Dental Bank os FOUSP underwent proximal slot cavities. They were then randomly divided into 4 groups Freedom (SDI), Compoglass (Vivadent), Dyract (Dentsply) e F2000 (3M) and restored falowing the manufactures specifications. After setting time, we performed waterproofing followed by submersion in blue methyilene during 4 hours. Molars were crosscut on a longtudinal fashion and three blinded examiners acored the microleakage from 0 to 4...

Alternativa estética para manchas de fluorose empregando técnicas de microabrasão e clareamento em adolescentes / Alternative aesthetic to fluorosis' stains using microabrasion and bleaching techniques in young dentistry

A estética dental aliada à saúde geral é considerada um fator importante na vida do adolescente. Manchas produzidas por fluorose em níveis mais acentuados causam desconforto aos pacientes jovens e, por isso, tornam-se um desafio para o profissional que lida com essa faixa-etária. O presente trabalho relata um caso clínico de paciente adolescente portador de fluorose severa cujas manchas foram minimizadas empregando-se a técnica de microabrasão com ácido fosfórico a 37% e pedra-pomes combinada ao clareamento clínico com material clareador fotoativado à base de peróxido de hidrogênio a 35%. A combinação das técnicas abordadas nesse trabalho promoveu um resultado estético satisfatório, sendo indicada como uma alternativa viável para o uso clínico.

The aesthetic dental associated with the general health is considered an important factor for adolescent's life. High levels of fluorosis cause spots and discomfort becoming a challenge for the professional who deals with this age group. This paper reports a case of adolescent patient with a severe fluorosis which spots were treated employing the microabrasion technique (phosphoric acid at 37% and pumice stone) associated with clinical clearing using a bleaching agent (hydrogen peroxide at 35%). The combination of these both techniques has promoted a satisfactory cosmetic outcome and could be considered as a viable alternative for the clinical practice.

Utilização do gel à base de papaína para a remoção química e mecânica do tecido cariado / The use of papain gel for the chemomechanical caries removal

O método de remoção química-mecânica da cárie foi desenvolvido para superar os inconvenientes quanto à utilização de brocas e anestesia local, sendo mais confortável para o paciente e preservando o tecido dentário sadio. O Papacárie®, um gel à base de papaína, foi formulado com o intuito de tornar a remoção química-mecânica da cárie mais acessível. A papaína interage com o colágeno exposto pela dissolução dos minerais da dentina pela ação das bactérias, tornando a dentina infectada mais amolecida, permitindo sua remoção por meio de instrumentais não cortantes. Este trabalho tem como objetivo relatar um caso clínico onde foi utilizado o gel para remoção do tecido infectado.

The chemical mechanical removal of decay was developed to replace the use of burs and anesthetic. It is more comfortable for the patient and preserves healthy tissue. Papacarie®, is a papain gel formulated in order to make the chemical mechanical removal decay easier and more accessible. Papain acts "breaking" collagen molecules partiality degraded by caries action facilitating the removal of decayed tissue using no cutting tools. The aim of this study was to report a clinical case report the use of papain gel for the chemo mechanical caries removal.