Data sourcesPubMed, Embase, Cochrane Central Register of Controlled Trials and the Web of Science were searched. Whether any limits on language were applied remains unclear. Studies published up to January 2018 were included.Study selectionTwo reviewers independently selected randomised or controlled clinical trials (RCTs, CCTs) investigating carious tissue removal using Papacarie, an enzyme-based chemomechanical method, versus conventional' techniques in primary molars in children or adolescents.Data extraction and synthesisData were abstracted independently by two reviewers and risk of bias assessed. Three outcomes, bacterial counts after carious tissue removal (measure: log10 colony-forming units [CFU]), pain (measured on Wong-Baker scale) and the time needed for carious tissue removal (in seconds), were submitted to meta-analysis (effect estimate: weighted means).ResultsSix RCTs and four CCTs, published 2009-2016, were included. After Papacarie-based removal, fewer bacteria remained compared with conventional treatment (MD 0.57 log10 CFU, 95% CI 0.04 to 1.09, based on two studies). Pain was also significantly lower in the Papacarie group (-1.01, -1.72 to -0.30, based on three studies). Papacarie-based removal took significantly longer (200.8 seconds, 152.5 to 249.1, based on seven studies).ConclusionsPapacarie-based carious tissue removal is efficacious for bacteria removal, and exerts significantly less pain than conventional removal. However, treatment times are longer.