Comparison of smart burs and chemo-mechanical caries removal systems in primary molars – A systematic review and meta-analysis

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BACKGROUND: Smart burs and chemo-mechanical caries removal (CMCR) systems are considered viable alternatives to traditional cavity preparation techniques. Numerous clinical studies have been conducted to assess and compare the impact of these two techniques; nevertheless, these studies have demonstrated considerable variability in their findings. The objectives of the present systematic review and meta-analysis were to compare the efficacy, efficiency, and patient comfort of CMCR systems and smart burs in primary molars. METHODOLOGY: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Ten electronic databases up to May 30, 2024 were searched for in vivo clinical studies comparing at least one CMCR system with smart burs in terms of clinical and/or microbiological efficacy, efficiency (time taken for complete caries removal), and patient comfort in primary molars. Reviews, abstracts, case series and reports, letters to the editor, animal studies, and unpublished data were excluded. The risk of bias (ROB) assessment was conducted using the ROBINS-I and Cochrane ROB tools for nonrandomized and randomized clinical studies, respectively. The analysis was performed using Review Manager version 5.4.1 provided by the Cochrane Collaboration. The standardized mean difference served as the summary with a random effects model (P < 0.05). RESULTS: A total of 154 studies were identified and screened out of which five were included in the qualitative synthesis and four studies were deemed suitable for a meta-analysis. The overall quality assessment revealed a presence of moderate-to-low ROB. The data extracted from the five studies were tabulated. The summary odds ratio for clinical efficacy (0.43 [95% confidence interval (CI) = 0.13-1.49]) showed no statistically significant difference between CMCR systems and Smart burs (Z = 1.33 and P = 0.18). A statistically significant difference ([Z = 5.85 and P < 0.00001] and [Z = 2.84 and P = 0.005]) in terms of microbiological efficacy (446.46 [95% CI = 296.89-596.02]) and efficiency (-0.68 [95% CI = -1.16--0.21]) was observed between CMCR systems and smart burs. Smart burs performed better in terms of microbiological efficacy and efficiency. Due to variability in the scales used to evaluate patient comfort, meta-analysis was not possible. CONCLUSION: Within the limitations of this study, Smart burs performed better in terms of microbiological efficacy and efficiency and hence can be used as an alternative to CMCR systems in primary molars.

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