Effectiveness of BRIX3000 for chemo-mechanical caries removal: a systematic review and meta-analysis of time and pain outcomes

Clinical Snapshot

Key Findings

• P Value: Time: p < 0.0001; Pain: p = 0.009

• Effect Size: Time: MD 4.58 minutes longer; Pain: MD -2.50 points lower on Wong-Baker scale

• Primary Outcome: Caries removal time and pain scores

• Nnt Or Sensitivity: Complete caries removal: OR 0.45 (paediatric), OR 0.73 (adult) - no significant difference

• Confidence Interval: Time: 95% CI 2.45 to 6.70; Pain: 95% CI -4.37 to -0.62

Clinical Application

Requires additional 4.6 minutes per procedure but may reduce patient discomfort Relevant to Australian dental practice; consider cost-effectiveness under private practice model; may align with RACGP preventive care guidelines for anxious patients Primarily paediatric patients and anxiety-prone individuals requiring caries removal

Abstract

AIMS: This systematic review was conducted to critically assess and statistically synthesise data from all available clinical studies on this topic. This study focused on the efficacy and safety of this agent (BRIX3000), the time required for caries removal, and the pain experienced by patients during the procedure, to provide clinicians and researchers with clear evidence on whether BRIX3000 is genuinely effective. MATERIALS AND METHODS: Electronic literature searches were performed using PubMed, Scopus, and Web of Science to collect eligible randomised clinical trials that had evidence regarding the efficacy of BRIX3000 for chemo-mechanical caries removal in comparison with the conventional rotary instruments and other atraumatic restorative treatment (ART) methods. The selected studies included children and adults of both sexes, with no age or gender preference, who had dentinal carious lesions in primary or permanent teeth without pulpal involvement. RESULTS: Nine randomised trials (eight in paediatric and one in adult populations) were included. Pooled analyses indicated that BRIX3000 was associated with a longer mean caries removal time than control techniques (MD 4.58 min, 95% CI 2.45 to 6.70; p < 0.0001; I² = 96%) and with lower pain scores on the Wong-Baker FACES scale among paediatric patients (MD - 2.50, 95% CI - 4.37 to - 0.62; p = 0.009; I² = 92%). Complete caries removal did not differ significantly between groups in either the paediatric (OR 0.45, 95% CI 0.02 to 8.34; p = 0.59) or adult (OR 0.73, 95% CI 0.15 to 3.49; p = 0.69) subgroup. All pooled estimates exhibited substantial heterogeneity, and the adult evidence comprised only two trials. Most included studies were judged to be at low overall risk of bias on the RoB 2 tool. CONCLUSION: Within the limits of substantial heterogeneity, short follow-up, and a small adult evidence base, BRIX3000 may represent a useful chemo-mechanical alternative - particularly in paediatric and anxiety-prone patients - at the cost of a modest increase in procedural time. Adequately powered trials with longer follow-up are required to confirm these preliminary findings. CLINICAL RELEVANCE: Our results indicate that BRIX3000 can be a viable option for patients with extensive fear of conventional methods, as well as for the paediatric population.

References

1. 1.AlShawish, J. F., Al-Hanaktah, M., Alsunna, A., Ali, A., Jamous, A. A., Ali, D., Alhasan, T. O., & Abu Agha, T. S. (2026). Effectiveness of BRIX3000 for chemo-mechanical caries removal: a systematic review and meta-analysis of time and pain outcomes. Clinical Oral Investigations. https://doi.org/10.1016/s0304-3959(03)00003-4