DOI: https://doi.org/10.53350/pjmhs22163338 ORIGINAL ARTICLE 338 P J M H S Vol. 16, No. 03, MAR 2022 Assessment of Success of Restoration after Chemo Mechanical Caries Removal by Using Papain Based Gel ASMA RASHID 1 , WAJAHAT HUSSAIN 2 , HIRA ASGHAR 3 , MAMOONA SHAH 4 , SAJIDA GUL 5 , FATIMA KHALID QAZI 6 1 Lecturer, Science of Dental Materials, Women Medical and Dental College, Abbottabad 2 Resident, MPhil Science of Dental Materials, Peshawar Dental College, Peshawar 3 Associate Professor, Science of Dental Materials, Azra Naheed Dental College, Lahore 4,5 Lecturers, Science of Dental Materials, Sardar Begum Dental College, Peshawar 6 Research Associate, ORIC-Khyber Medical University, Peshawar Correspondence to: Wajahat Hussain, Email: wajahathussain7861@gmail.com, Cell: 0306-6505030 ABSTRACT Objective: To assess the restoration’s success after chemo mechanical caries removal by using papain based gel. Study Design: Descriptive case study Place and Duration of Study: This study was conducted at the Operative Dentistry Department from March, 2019 to August, 2021. Methodology: Two hundred patients were selected. All Patients of both genders having age of 8-16 years were included and patients with presence of fistula and patients having history of pain were excluded. Papain based gel had been applied to the cavity and allows 40-50 seconds for the gel to work, and the patients had been followed up for 30 days for evaluation of restoration. Results: The average age was 14.07±1.88 years. The success of restoration was present in 82.0% while it was absent in 18.0%. Conclusion: Removal of caries after chemo mechanical by using papain based gel showed high efficacy of success of restoration. Keywords: Chemo-mechanical caries removal (CMCR), Chemo mechanical, Papain based gel INTRODUCTION Caries is one of the most common incidences in youngsters around the world (about 60%). 1 It should be addressed quickly; else it will not only have effect on the child's speech, chewing function, psychological wellbeing and smile. 2 Dental complaints are at significant cost to compact around the world, and an easy and efficient way to knob this problem is to prevent it. 3 Dental caries contains the hard structures of the teeth that has been associated to a multi-factorial etiology. Caries is an avoidable disease that is broadly known as key cause of oral uneasiness leading to tooth loss and become vigorous for people of all age clusters to accomplish and withstand good oral maintenance. 4 Caries has a varied microbial populace, with microorganisms of both facultative and obligatory anaerobes including Streptococcus Mutans, Lactobacillus and Actinomyces. 5 It is very dominant and progressive disease, which have impact on 50% to 80% of school going age cluster and grownups all over the world. 6 Managements for caries prevention may have a noteworthy effect on preventing the growth of caries. 7 Fluoride application topically in form of gel and supplements are easy and economical way of dipping the occurrence of tooth demolition by making the tooth surface more resilient to bacterial acid. 1,6,7 Pit and fissure sealants and varnishes comprising fluoride seems to be valuable in decreasing the caries risk. Grounded on the available studies, prevention and minimal interferences are performing to be helpful in handling dental cavities. 3,5,7,8 As a substitute to the old-style drilling method, other caries abolition approaches have been projected and established. 9 In paediatric dental treatment, chemo-mechanical caries removal (CMCR) appears as an encouraging method. It decreases patient concern, decreases the necessity for local anesthetic, and permits for more discerning elimination of carious tooth structure. CMCR are non-invasive substitutes to elongated recognized approaches to deal with caries with application of a proteolytic material to soften carious dental tissue and make it easier to eliminate with manual gadget. 10,11 Without the use of burs or local anesthesia, this approach can be used to preserve healthy dental tissues. Papain based gel used for Chemo-mechanical caries removal that contains papain with the cleaning and wound curing properties and chloramine with disinfectant property. 11 In year of 2004 in Brazil papain based gel was articulated for first time and it showed satisfactory clinical results about its efficacy. Papain based gel is selective and conservative in nature therefore, it decreases the danger of pulp exposure. The uses of the gel for caries removal improve the bond between tooth surface and restorative material thus prolongs the life of a restoration as it prevents the development of smear layer. Therefore, bonding becomes sturdy and it precisely aims the infected tooth area. 12 Besides using Papain based gel to remove caries chemically and mechanically minimizes patient concern and discomfort, allowing it to be accepted in clinical practice. Papain based gel contains papain (papaya extract), an endo-protein with anti-inflammatory qualities, bacteriostatic, and bactericide, as well as chloramine, toluidine blue, water, salts, and thickeners. The procedure is based on the chemo mechanical elimination of unhealthy dentin. It has antibacterial and anti-inflammatory properties, allowing for the maximal care of healthy tooth structures. 12,13 Papain based gel is a biomaterial that permits for the a traumatic elimination of caries by chemo-mechanical methods. 13 Its use has the benefits of being simple to implement and not demanding the use of any special instruments. 14 Grounded on the available resources, the currently accessible chemo mechanical caries abolition measures are possible substitute to outdated rotational approaches. These methods are mainly helpful to patients, who are tremendously concerned, incapacitated, or children. 12 This study was designed to evaluate the effectiveness and competence of papain based gel for caries removal. MATERIALS AND METHODS This descriptive study was conducted at Operative Dentistry Department of Bacha Khan College of Dentistry, Mardan after taking approval of institutional Ethical Review Committee. A total of 200 patients were calculated with level of confidence is 95%, margin of error is 5% and taking expected percentage of success 60% after using papain based gel for removal of caries in children. 15 An knowledgeable consent had been taken from parents or guardian. All patients of both genders having age of 8- 16 years, patients having frank carious lesion with extension into dentin, but without pulpal involvement assessed clinically (VAS score=0),patients with permanent molars, radio-graphically (presence of periapical radiolucency), and no proximal caries as evidenced by bitewing radiographs were included. Patients having compromised pulp with forked, fistula, teeth exhibiting pulp exposure on clinical assessment (absence of pain VAS score 4-8)