Comparative efficacy of chemomechanical caries removal and conventional mechanical caries removal for the treatment of primary molar caries in children: a meta-analysis.

objectiveThis study aimed to systematically appraise the clinical efficacy of chemomechanical caries removal (CMCR) compared with conventional mechanical caries removal for the treatment of primary molar caries in children.

methodsThe protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251133359. PubMed, Web of Science, Cochrane Library, and Embase were retrieved until September 27, 2025 to collect randomized controlled trials (RCTs) comparing CMCR with conventional mechanical caries removal. The inclusion criteria were established as per the population, intervention, comparison, outcome, study design (PICOS) principle: Population (P): Children with carious primary molars. Intervention (I): CMCR. Comparison (C): Conventional mechanical caries removal. Outcomes (O): Pain intensity, operative time, caries removal efficacy, child behavior, satisfaction, and microbiological evaluation. Study design (S): RCTs. The risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. We also conducted a quality assessment of evidence, namely the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. A meta-analysis was performed using Stata/MP 15.1.

resultsA total of 17 RCTs involving 1,306 child patients were included. The meta-analysis showed that the CMCR group had substantially lower pain scores than the conventional group (standardized mean difference (SMD) = - 1.70, 95% confidence interval (CI): - 2.19 to - 1.21). The operative time was significantly longer in the CMCR group (SMD = 2.10, 95% CI: 1.31-2.89), and the child behavior scores were substantially higher in the CMCR group (SMD = 0.95, 95% CI: 0.69-1.21, I² = 0%). Caries removal was more thorough in the conventional group. Subgroup analyses based on different gel types yielded generally consistent results, although the limited number of studies in certain subgroups precluded definitive comparisons between products.

conclusionCMCR showed advantages over conventional mechanical caries removal in terms of pain control, child behavior, and patient satisfaction, with comparable antibacterial efficacy, but required longer operative time. This technique may be considered a potential alternative for the treatment of primary molar caries in children, particularly for uncooperative children and for deep caries near the pulp. However, these findings should be interpreted with caution due to the limited number of included studies and high heterogeneity across outcomes.