{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T20:50:56Z","timestamp":1776199856330,"version":"3.50.1"},"reference-count":66,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,10,23]],"date-time":"2020-10-23T00:00:00Z","timestamp":1603411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Dental caries is a disease of dental hard tissues, considered the most common non-communicable disease worldwide. Conventional treatments for caries removal are often associated with pain and fear, so different therapeutic approaches have been developed towards more conservative and pleasant treatments. This systematic review aimed to assess the efficacy and patient\u2019s acceptance of alternative methods for caries removal compared to conventional methods. The Cochrane Library, Embase, Medline\/Pubmed, Web of Science, and Clinical Trials databases were searched. Clinical trials of primary dental caries treated with alternative methods were included. The last search was performed on 5 August 2020. The Population, Intervention, Comparison, and Outcome (PICO) strategy was followed. Thirty-seven clinical trials were included, reporting caries removal using alternative (chemomechanical\u2014Brix 3000, Carie-care, Carisolv and Papacarie, laser\u2014Er:YAG (Erbium-doped Yttrium Aluminium Garnet) and Er,Cr:YSGG (Erbium, Chromium-doped Yttrium, Scandium, Gallium and Garnet), and a system combining air and sono-abrasion\u2014Vector\u00ae System) and conventional methods. Alternative methods tended to prolong treatment time and lessen anesthesia need. All treatments were effective in reducing cariogenic flora, and the restoration\u2019s performance did not differ significantly. Chemomechanical solutions seemed to be the best option towards minimally invasive treatments, with good control during application and action and good treatment experiences for patients. Papacarie was demonstrated to be an effective method for caries removal with less pain, and superior acceptance by patients when compared to conventional treatments.<\/jats:p>","DOI":"10.3390\/jcm9113407","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T03:51:47Z","timestamp":1603684307000},"page":"3407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Efficacy and Patient\u2019s Acceptance of Alternative Methods for Caries Removal\u2014A Systematic Review"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9170-4334","authenticated-orcid":false,"given":"Miguel","family":"Cardoso","sequence":"first","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Institute of Biophysics, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2924-7926","authenticated-orcid":false,"given":"Ana","family":"Coelho","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-354 Coimbra, Portugal"}]},{"given":"Rui","family":"Lima","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"}]},{"given":"In\u00eas","family":"Amaro","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-4173","authenticated-orcid":false,"given":"Anabela","family":"Paula","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-354 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-5417","authenticated-orcid":false,"given":"Carlos Miguel","family":"Marto","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Institute of Biophysics, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-354 Coimbra, Portugal"}]},{"given":"Jos\u00e9","family":"Sousa","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3769-9786","authenticated-orcid":false,"given":"Gianrico","family":"Spagnuolo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples \u201cFederico II\u201d, 80125 Napoli, Italy"},{"name":"Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5968-6161","authenticated-orcid":false,"given":"Manuel","family":"Marques Ferreira","sequence":"additional","affiliation":[{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-354 Coimbra, Portugal"},{"name":"Institute of Endodontics, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5759-5557","authenticated-orcid":false,"given":"Eunice","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-354 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), 3000-354 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6533","DOI":"10.1038\/s41598-019-41270-6","article-title":"Reliability of colour and hardness clinical examinations in detecting dentine caries severity: A systematic review and meta-analysis","volume":"9","author":"Hon","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_2","first-page":"12","article-title":"Caries risk assessment","volume":"66","author":"Gannam","year":"2018","journal-title":"Gen. Dent."},{"key":"ref_3","unstructured":"Rathee, M., and Sapra, A. (2020). Dental Caries. StatPearls, StatPearls Publishing LLC."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"462","DOI":"10.2174\/1874210601509010462","article-title":"Caries Removal by Chemomechanical (Carisolv (TM)) vs. Rotary Drill: A Systematic Review","volume":"9","author":"Maru","year":"2015","journal-title":"Open Dent. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Dorri, M., Martinez-Zapata, M.J., Walsh, T., Marinho, V.C., Sheiham, A., and Zaror, C. (2017). Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database Syst. Rev., 2017.","DOI":"10.1002\/14651858.CD008072.pub2"},{"key":"ref_6","first-page":"137","article-title":"Modern management of dental decay in children and adolescents\u2014A review","volume":"88","author":"Muntean","year":"2015","journal-title":"Clujul Med."},{"key":"ref_7","unstructured":"(2020, August 05). Sugars and Dental Caries. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/259413\/WHO-NMH-NHD-17.12-eng.pdf?sequence=1."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s12098-017-2381-6","article-title":"Dental Caries: A Disease Which Needs Attention","volume":"85","author":"Mathur","year":"2017","journal-title":"Indian J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.prosdent.2013.07.014","article-title":"Dental caries: An updated medical model of risk assessment","volume":"111","author":"Kutsch","year":"2014","journal-title":"J. Prosthet. Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2174\/1874210601812010443","article-title":"A Randomized Controlled Trial Comparing Er:YAG Laser and Rotary Bur in the Excavation of Caries\u2013Patients\u2019 Experiences and the Quality of Composite Restoration","volume":"12","author":"Sarmadi","year":"2018","journal-title":"Open Dent. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1159\/000484985","article-title":"Ecological Approaches to Dental Caries Prevention: Paradigm Shift or Shibboleth?","volume":"52","author":"Philip","year":"2018","journal-title":"Caries Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"388","DOI":"10.4103\/0976-237X.107420","article-title":"A comparative microbiological study to assess caries excavation by conventional rotary method and a chemo-mechanical method","volume":"3","author":"Anegundi","year":"2012","journal-title":"Contemp. Clin. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF03262786","article-title":"The effect of low level laser therapy on pain during dental tooth-cavity preparation in children","volume":"12","author":"Tanboga","year":"2011","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/j.1365-2842.1988.tb00143.x","article-title":"Chemomechanical caries removal?A clinical evaluation","volume":"15","author":"Zinck","year":"1988","journal-title":"J. Oral Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/1807-3107BOR-2014.vol28.0031","article-title":"Efficacy of chemomechanical caries removal in reducing cariogenic microbiota: A randomized clinical trial","volume":"28","author":"Ammari","year":"2014","journal-title":"Braz. Oral Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/BF03262603","article-title":"Case Report: Air Abrasion Cavity Preparation for Caries Removal in Paediatric Dentistry","volume":"8","author":"Anyunes","year":"2007","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1111\/adj.12214","article-title":"Current update of chemomechanical caries removal methods","volume":"59","author":"Hamama","year":"2014","journal-title":"Aust. Dent. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/j.1875-595X.2001.tb00841.x","article-title":"Chemomechanical caries removal: A comprehensive review of the literature","volume":"51","author":"Maragakis","year":"2001","journal-title":"Int. Dent. J."},{"key":"ref_19","first-page":"ZE04","article-title":"Minimal Intervention Dentistry\u2014A New Frontier in Clinical Dentistry","volume":"8","author":"Jingarwar","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_20","first-page":"CD010229","article-title":"Lasers for caries removal in deciduous and permanent teeth","volume":"9","author":"Montedori","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/sj.ebd.6401303","article-title":"Caries removal using lasers","volume":"19","author":"Wong","year":"2018","journal-title":"Evid. Based Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"268","DOI":"10.4103\/ejd.ejd_232_16","article-title":"Evidence provided for the use of oscillating instruments in restorative dentistry: A systematic review","volume":"11","author":"Ntovas","year":"2017","journal-title":"Eur. J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref_25","first-page":"38","article-title":"Avalia\u00e7\u00e3o do risco de vi\u00e9s de ensaios cl\u00ednicos randomizados pela ferramenta da colabora\u00e7\u00e3o Cochrane","volume":"18","author":"Silva","year":"2013","journal-title":"Diagn. Trat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/j.1365-263X.2006.00719.x","article-title":"Clinical randomized controlled trial of chemomechanical caries removal (Carisolvtm)","volume":"16","author":"Zambrano","year":"2006","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"109","DOI":"10.17796\/jcpd.39.2.n25754863557k727","article-title":"Efficacy and Tolerance of Papain Gel with Conventional Drilling Method: A Clinico-Microbiological Study","volume":"39","author":"Goyal","year":"2015","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1089\/pho.2006.24.489","article-title":"Acceptance and Efficiency of Er:YAG Laser for Cavity Preparation in Children","volume":"24","author":"Liu","year":"2006","journal-title":"Photomed. Laser Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"215","DOI":"10.17796\/jcpd.32.3.1r08w6k1478865u7","article-title":"Comparison of the Antimicrobial Efficacy of Chemomechanical Caries Removal (carisolv (TM)) with that of Conventional Drilling in Reducing Cariogenic Flora","volume":"32","author":"Subramaniam","year":"2008","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_30","first-page":"29","article-title":"An\u00e1lisis cl\u00ednico y radiogr\u00e1fico de las t\u00e9cnicas ART y remoci\u00f3n qu\u00edmico- mec\u00e1nica de caries: Estudio piloto","volume":"13","author":"Mizuno","year":"2011","journal-title":"Odontoestomatolog\u00eda"},{"key":"ref_31","first-page":"80","article-title":"The effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser therapy on pain during cavity preparation in paediatric dental patients: A pilot study","volume":"12","author":"Eren","year":"2013","journal-title":"Oral Health Dent. Manag."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"610","DOI":"10.3109\/00016357.2012.700064","article-title":"Er:YAG laser or high-speed bur for cavity preparation in adolescents","volume":"71","author":"Hjertton","year":"2012","journal-title":"Acta Odontol. Scand."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"488","DOI":"10.4103\/0970-9290.118393","article-title":"Assessment of chemomechanical removal of carious lesions using Papacarie Duo\u2122: Randomized longitudinal clinical trial","volume":"24","author":"Matsumoto","year":"2013","journal-title":"Indian J. Dent. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/896381","article-title":"Pain during Removal of Carious Lesions in Children: A Randomized Controlled Clinical Trial","volume":"2013","author":"Motta","year":"2013","journal-title":"Int. J. Dent."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"23","DOI":"10.17796\/jcpd.38.1.p3324121m66n1737","article-title":"Evaluation of Three Different Caries Removal Techniques in Children: A Comparative Clinical Study","volume":"38","author":"Rajakumar","year":"2013","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"080","DOI":"10.1055\/s-0040-1703807","article-title":"Clinical Evaluation of Chemo-Bechanical Caries Removal Using Carie-Care System Among School Children","volume":"4","author":"Hegde","year":"2014","journal-title":"J. Health Allied Sci. NU"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1590\/1678-775720130488","article-title":"Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel","volume":"22","author":"Motta","year":"2014","journal-title":"J. Appl. Oral Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"319","DOI":"10.6061\/clinics\/2014(05)04","article-title":"Efficacy of Papacarie (R) in reduction of residual bacteria in deciduous teeth: A randomized, controlled clinical trial","volume":"69","author":"Motta","year":"2014","journal-title":"Clinics"},{"key":"ref_39","first-page":"500","article-title":"Perception Of Er-Yag Laser Dental Caries Treatment In Adolescents\u2014A Clinical Evaluation","volume":"20","author":"Zhegova","year":"2014","journal-title":"J. IMAB Annu. Proceeding Sci. Pap."},{"key":"ref_40","first-page":"699","article-title":"Er-Yag Laser And Dental Caries Treatment Of Permanent Teeth In Childhood","volume":"21","author":"Zhegova","year":"2014","journal-title":"J. IMAB Annu. Proceeding Sci. Pap."},{"key":"ref_41","first-page":"22","article-title":"Clinical Efficiency of Three Caries Removal Systems: Rotary Excavation, Carisolv, and Papacarie","volume":"83","author":"Hegde","year":"2016","journal-title":"J. Dent. Child. (Chicago, Ill.)"},{"key":"ref_42","first-page":"65","article-title":"Caries removal in deciduous teeth using an Er:YAG laser: A randomized split-mouth clinical trial","volume":"20","author":"Borsatto","year":"2015","journal-title":"Clin. Oral Investig."},{"key":"ref_43","first-page":"444","article-title":"Evaluation of the efficacy of caries removal using papain gel (Brix 3000) and smart preparation bur(in vivo comparative study)","volume":"11","author":"Ismail","year":"2019","journal-title":"J. Pharm. Sci. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"108","DOI":"10.15171\/jlms.2019.18","article-title":"Selective Removal of Necrotic Dentin in Primary Teeth Using Laser Irradiation: One-Year Clinical Evaluation of Composite Restorations","volume":"10","author":"Polizeli","year":"2019","journal-title":"J. Lasers Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"219","DOI":"10.17796\/1053-4628-41.3.219","article-title":"Effect of Papacarie and Alternative Restorative Treatment on Pain Reaction during Caries Removal among Children: A Randomized Controlled Clinical Trial","volume":"41","author":"Khalek","year":"2017","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"DenBesten, P.K., White, J.M., Pelino, J., Lee, K., and Parkins, F. (2000, January 22\u201328). A randomized prospective parallel controlled study of the safety and effectiveness of Er: YAG laser use in children for caries removal. Proceedings of the BiOS 2000: The International Symposium on Biomedical Optics, San Jose, CA, USA.","DOI":"10.1117\/12.380824"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1078\/1615-1615-00025","article-title":"The Safety and Effectiveness of an Er:YAG Laser for Caries Removal and Cavity Preparation in Children","volume":"16","author":"DenBesten","year":"2001","journal-title":"Med. Laser Appl."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s40368-014-0140-1","article-title":"A comparative clinical study of various methods of caries removal in children","volume":"16","author":"Soni","year":"2014","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"103280","DOI":"10.1016\/j.jdent.2020.103280","article-title":"Comparing the efficacies of two chemo-mechanical caries removal agents (2.25% sodium hypochlorite gel and brix 3000), in caries removal and patient cooperation: A randomized controlled clinical trial","volume":"93","author":"Alkhouli","year":"2020","journal-title":"J. Dent."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/1735-3327.249558","article-title":"A comparative study of the clinical efficiency of chemomechanical caries removal using Carie-Care gel for permanent teeth of children of age group of 12\u201315 years with that of conventional drilling method: A randomized controlled trial","volume":"16","author":"Sontakke","year":"2019","journal-title":"Dent. Res. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1159\/000016602","article-title":"Evaluation of Carisolv (TM) for the chemo-mechanical removal of primary root caries in vivo","volume":"34","author":"Fure","year":"2000","journal-title":"Caries Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"777","DOI":"10.14219\/jada.archive.2000.0277","article-title":"A laser-powered hydrokinetic system\u2014For caries removal and cavity preparation","volume":"131","author":"Hadley","year":"2000","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4103\/0970-4388.33456","article-title":"Various methods of caries removal in children: A comparative clinical study","volume":"25","author":"Pandit","year":"2007","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"5","DOI":"10.17796\/jcpd.36.1.u2421l4j68847215","article-title":"An Evaluation of Different Caries Removal Techniques in Primary Teeth: A Comparitive Clinical Study","volume":"36","author":"Kochhar","year":"2011","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/BF03320813","article-title":"Pain perception in children during caries removal with the Vector\u00ae system: A pilot study","volume":"1","author":"Kwapinska","year":"2006","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5005\/jp-journals-10024-1093","article-title":"Clinical Evaluation of Caries Removal in Primary Teeth using Conventional, Chemomechanical and Laser Technique: An in vivo Study","volume":"13","author":"Bohari","year":"2012","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_57","first-page":"631","article-title":"Subjective acceptance of pediatric patients during cavity preparation with Er:YAG laser and conventional rotary instruments","volume":"20","author":"Belcheva","year":"2014","journal-title":"J. IMAB Annu. Proceeding Sci. Pap."},{"key":"ref_58","first-page":"634","article-title":"Pain Perception Of Pediatric Patients During Cavity Preparation With Er:Yag Laser And Conventional Rotary Instruments","volume":"20","author":"Belcheva","year":"2014","journal-title":"J. IMAB Annu. Proceeding Sci. Pap."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"17908","DOI":"10.1038\/s41598-018-36092-x","article-title":"Costs and benefits of Papacarie in pediatric dentistry: A randomized clinical trial","volume":"8","author":"Bottega","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"320","DOI":"10.4103\/ams.ams_191_18","article-title":"Conscious Sedation in Dentistry","volume":"8","author":"Kapur","year":"2018","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Beaudette, J.R., Fritz, P.C., Sullivan, P.J., and Ward, W.E. (2017). Oral Health, Nutritional Choices, and Dental Fear and Anxiety. Dent. J., 5.","DOI":"10.3390\/dj5010008"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"642","DOI":"10.12998\/wjcc.v2.i11.642","article-title":"Pathways of fear and anxiety in dentistry: A review","volume":"2","author":"Carter","year":"2014","journal-title":"World J. Clin. Cases"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"47","DOI":"10.14219\/jada.archive.2007.0020","article-title":"Chemomechanical caries removal in childrenAn operator\u2019s and pediatric patients\u2019 responses","volume":"138","author":"Inglehart","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"277","DOI":"10.17245\/jdapm.2018.18.5.277","article-title":"New treatment method for pain and reduction of local anesthesia use in deep caries","volume":"18","author":"Yun","year":"2018","journal-title":"J. Dent. Anesth. Pain Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/154405910408301s16","article-title":"DIAGNOdent: An Optical Method for Caries Detection","volume":"83","author":"Lussi","year":"2004","journal-title":"J. Dent. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1159\/000224222","article-title":"Novel Operative Treatment Options","volume":"21","author":"Ricketts","year":"2009","journal-title":"Monogr. Oral Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3407\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:27:18Z","timestamp":1760178438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/11\/3407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,23]]},"references-count":66,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["jcm9113407"],"URL":"https:\/\/doi.org\/10.3390\/jcm9113407","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,23]]}}}