Comparative Evaluation of Mechanical and Chemo-Mechanical Methods of Caries Excavation in Permanent Teeth: A Randomized Clinical Trial

Objective: To compare excavation efficacy and pain perception among air-rotor (carbide bur), polymer bur, and chemo-mechanical excavation (Carie-Care™)  in adult permanent posterior teeth as a confirmatory, population-specific evaluation. Materials and Methods: A single-center, single-blind, randomized split-mouth clinical trial was conducted in 29 adults with three permanent posterior teeth each (total = 87 teeth) presenting with occlusal caries and an ICDAS score of 4 or 5. The trial was registered with the Clinical Trials Registry of India (CTRI Ref No.: REF/2025/07/109637). Each participant received all three interventions in the same session under standardized conditions. Excavation efficacy was assessed using a caries detector dye followed by the Ericson residual caries scale, and pain was recorded immediately after each procedure using a 10-point Visual Analogue Scale (VAS) by a blinded examiner. Results: Excavation efficacy differed significantly among the groups (p < 0.001): the air-rotor showed the lowest residual caries scores (mean Ericson score: 0.48), followed by Carie-Care™  (2.17) and polymer bur (3.21). Pain also differed significantly (p < 0.001): the air-rotor produced the highest pain (mean VAS: 5.79), polymer bur produced intermediate pain (3.76), and Carie-Care™ produced the lowest pain (0.93). All pairwise comparisons were statistically significant (p < 0.001). Conclusion: In adult permanent posterior teeth, an efficiency–comfort trade-off was confirmed: the air-rotor achieved the most complete caries removal but caused the greatest discomfort, whereas Carie-Care™ provided superior comfort with moderate excavation efficacy. Limitations include the single-center design, modest sample size, and restriction to immediate excavation outcomes without long-term restorative follow-up.