Comparative evaluation of caries removal using smart bur and ceramic bur in pediatric patients: an in vivo study

Background: Minimally invasive caries removal is a key principle in pediatric dentistry that preserves healthy tooth structure, maintains pulp vitality, and enhances patient comfort. Smart burs (polymer burs) and ceramic burs are conservative excavation systems designed for selective removal of infected dentin. This study compared the efficiency, efficacy, and patient comfort associated with these two minimally invasive caries removal techniques in children. Methods: An in vivo randomized split-mouth clinical trial was conducted among 26 healthy children aged 6-12 years. Two carious primary mandibular molars in each participant were randomly assigned to smart bur and ceramic bur groups. Following topical anesthesia and rubber dam isolation, caries excavation was performed using the allocated bur. Efficiency was assessed by excavation time, efficacy by visual, tactile, and caries-detecting dye assessments, and patient discomfort using the face, legs, activity, cry, and consolability (FLACC) scale. Results: Ceramic burs demonstrated significantly greater efficiency (2.72±0.26 versus 3.54±0.53 min; p<0.0001) and superior caries removal efficacy (0.88±0.33 versus 1.92±0.27; p<0.0001). Smart burs caused no significant increase in FLACC scores (p=0.5), whereas ceramic burs significantly increased patient discomfort (p<0.0001). Conclusions: Both systems were effective for minimally invasive caries removal. Ceramic burs provided superior efficiency and efficacy, while smart burs offered greater patient comfort, making them a valuable option for pediatric minimally invasive caries management.