## 4 Discussion
However, one group of investigators reported marginally better clinical parameters for Papacarie, particularly about the length of the treatment and the number of dental cavities encountered [49; 50; 70]. The mode of action of Papacarie involves breaking partially degraded collagen molecules, contributing to the degradation and elimination of the fibrin \"mantle\" formed during the carious process. Papacarie's papain enzyme specifically targets dead cells and infected tissues lacking or showing no antitrypsin, which inhibits protein digestion. Therefore, sound collagen fibers in the inner affected and normal dentin are not affected by Papacarie [71]. Despite the promising results of Carisolv and Papacarie in terms of bond strength and clinical parameters, it is important to consider that the success of adhesive restorations depends on various factors beyond caries removal alone. Factors such as proper isolation, effective moisture control, adhesive system properties, and technique sensitivity can significantly influence the longevity and durability of the restoration. Furthermore, it is worth mentioning that the studies included in this systematic review had certain limitations, including variations in methodology, small sample sizes, and heterogeneity in the adhesive systems and protocols used. In the included articles, no standardized protocols were followed, brief details about the control groups were not mentioned, and the method of randomization into groups was not mentioned in any of the articles. These factors can introduce bias and affect the generalizability of the findings. Therefore, further well-designed studies with standardized protocols are needed to provide more robust evidence on the influence of Carisolv and Papacarie on bond strength to caries-affected dentin. In conclusion, the selection of a caries removal method can impact the bond strength of adhesive restorations to carious dentin. Carisolv and Papacarie have shown comparable bond strength to adhesive systems when used for caries removal. Their selective removal of carious tissue while preserving sound dentin provides a potentially favorable substrate for bonding. However, it is essential to consider various factors and ensure proper technique and protocol adherence to achieve optimal bonding outcomes. The present systematic review has some limitations as articles included in the review had low sample sizes, heterogeneity in the adhesive systems, and no proper information about the control group in the studies was provided. In addition, no standardized protocols were mentioned and followed. It is important to note that the quality of the studies included in the systematic review varied, indicating a need for further high-quality research. Additional research is necessary to confirm the findings of this review and identify optimal strategies for chemo-mechanical caries removal and bonding techniques in order to enhance clinical outcomes. Further research is needed to elucidate the long-term clinical performance and stability of adhesive restorations using these caries removal methods. Further research on biomimetic dental adhesives and dental restorative materials containing bioactive particles should be conducted as they may exhibit remineralizing potential to enamel and/or dentin-resin interface [72; 73; 74; 75].