Comparative Evaluation of Novel Chemo-mechanical, Atraumatic Restorative Technique and Conventional Caries Removal Techniques in Primary Teeth - A Randomized Clinical Trial.

This study aims to compare and evaluate the clinical efficacy, efficiency, and pain response of three caries removal techniques: Bromelain gel chemo-mechanical caries removal, Atraumatic Restorative Treatment (ART), and conventional caries removal. The primary objective is to assess the efficacy, efficiency, and pain response of Bromelain gel in primary mandibular molars. Secondary objectives include evaluating and comparing ART and conventional techniques, as well as examining the anxiety and fear experienced by pediatric patients during the procedures. The study is a triple-blinded, parallel-arm, randomized clinical trial involving three groups, each consisting of 25 primary mandibular molars, for a total of 75 teeth. The intervention group will undergo Bromelain gel chemo-mechanical caries removal, while the comparison groups will receive ART and conventional caries removal. Inclusion criteria involve children aged 4 to 10 years with occlusal caries in primary mandibular molars and dentinal caries. Exclusion criteria include teeth with extensive damage, pulp involvement, or a history of pain, as well as children with medical or developmental conditions that may impact treatment. Caries removal will be evaluated through visual inspection and tactile sensation, with procedure duration recorded. Pain perception will be assessed using the Wong-Baker FACES pain scale (subjective) and the FLACC scale (objective).