Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration

Optimizing Resin Infiltration Procedure in Molar Incisor Hypomineralization Lesions

OBJECTIVE

This article aims to describe a new technique for predicting the results of resin infiltration procedure in molar incisor hypomineralization lesions, named Infiltration Monitoring by Transillumination. The technique involves the use of transillumination together with ethanol application during the steps of lesion body opening and resin penetration. It provides color contrast that enhances the removal of the less porous surface layer and controls the effectiveness of resin infiltration within the lesion.

CLINICAL CONSIDERATIONS

The clinical procedure presented illustrates the steps involved in the resin infiltration procedure for color masking of molar incisor hypomineralization lesions in anterior teeth, highlighting the use of transillumination both for monitoring the lesion body opening step and the resin infiltration process.

CONCLUSIONS

The monitoring with transillumination during the ethanol test can assist the removal of the enamel external layer over the lesion, necessary to expose the inner porosity to be infiltrated, in a very precise and conservative way. In addition, it can effectively help to determine the moment when the infiltrant resin has fully penetrated the lesion.

CLINICAL SIGNIFICANCE

The Infiltration Monitoring by Transillumination technique offers the possibility to precisely control the infiltration procedure in molar incisor hypomineralization lesions, thereby improving the predictability of the esthetic outcome.

Does the Transillumination Technique Using a Diagnostic White Tip Influence the Degree of Conversion of the Infiltrant Resin? A Case Report With In Vitro Insights: A New Technique to Improve the Predictability During the Application of Resin Infiltration: Transillumination Using a Diagnostic White Tip

OBJECTIVE

This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).

MATERIALS AND METHODS

A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light-curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light-curing devices. Statistical analysis was performed using two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light-curing unit.

CONCLUSIONS

The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.

CLINICAL SIGNIFICANCE

The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization.

Theobromine for Remineralization of White Spot Lesions on Dental Enamel: A Systematic Review and Meta-analysis

AIM

This systematic review and meta-analysis evaluated theobromine's (Theobroma cacao) potential in remineralizing white spot lesions in dental enamel. Methods: This study is reported according to the PRISMA checklist and was registered in PROSPERO (CRD42023414371). In vitro tests that evaluated the remineralizing potential of theobromine compared to fluoride ion after demineralization for the formation of white spot lesions on enamel were selected, with no limitation on the year of publication. Electronic searches were performed in PubMed/MEDLINE, Scopus, and Web of Science by two independent researchers. Thirty articles were received of which six were selected according to the inclusion criteria.

RESULTS

The selected studies evaluated the Enamel Surface Microhardness (SMH), Vickers or Knoop, before and after treatment with theobromine and fluoride solutions. For the SMH Vickers, there were no differences between groups at baseline (p=1.00; mean difference: -0.00; CI: -11.36 to 11.36) and after treatment (p=0.51; mean difference: 4.12; CI: -8.16 to 16.41). The results of SMH Knoop showed differences between groups at baseline, favoring the experimental group (p=0.002; mean difference: 9.84; CI: 3.65 to 16.02) and after treatment favoring the control group (p=0.00001; mean difference: -5.45; CI: -7.62 to -3.27).

CONCLUSION

The use of theobromine increases the microhardness of dental enamel subjected to a demineralization process, thus being effective in the remineralization of this tissue with success equivalent to that obtained with the use of fluoride.

Influence of different pre-treatments on the resin infiltration depth into enamel of teeth affected by molar-incisor hypomineralization (MIH)

OBJECTIVES

This in vitro pilot study aimed to evaluate whether different pre-treatments (demineralization, deproteinization, (chemo-)mechanical reduction of the surface layer) influence the penetration depth of a resin infiltrant into MIH-affected enamel compared to initial carious lesions.

METHODS

Thirty extracted human permanent molars with non-cavitated initial carious lesions (n = 5) or MIH (n = 25) were chosen and randomly assigned to six experimental groups: IC: initial caries; M: MIH; MN: MIH, 5.25% sodium hypochlorite; MM: MIH, microabrasion; MA: MIH, air abrasion; MAN: MIH, air abrasion and 5.25% sodium hypochlorite. A modified indirect dual fluorescence staining method was adopted to assess the penetration depth (PD) of the resin infiltrant and the lesion depth (LD) by confocal laser scanning microscopy (CLSM). Exemplarily, scanning electron microscopic (SEM) images were captured. The relationship between group assignment and penetration/lesion depth was estimated using a linear mixed model incorporating the tooth as random effect (two observations/tooth). The significance level was set at p < 0.05.

RESULTS

For MIH-affected molars, the mean PD (in µm; median, [minimum-maximum]) were M (178.2 [32.5-748.9]), MN (275.6 [105.3-1131.0]), MM (48.7 [0.0-334.4]), MA (287.7 [239.4-491.7]), and MAN (245.4 [76.1-313.5]). Despite the observed differences in PD between the groups, these could not be statistically verified (Bonferroni, p = 0.322). The percentage penetration was significantly higher for IC than for MIH groups (Bonferroni, p < 0.05).

SIGNIFICANCE

Compared to IC, resin infiltration into MIH-affected enamel ist more variable. Different pre-treatments influence the resin penetration into developmentally hypomineralized enamel to a fluctuating level.

Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A randomized-controlled clinical trial

AIMS

This study aimed to evaluate the visual improvement of resin infiltration of white spot lesions (WSL) during orthodontic treatment with the multibracket appliance (MBA) compared to fluoride varnish.

METHODS

Patients aged 12-17 years with at least one WSL with an International Caries Detection and Assessment System (ICDAS) score of 1-2 during an active MBA treatment were included and randomized to receive either resin infiltration (Icon) or fluoride application (Flairesse). Standardized digital images were obtained before, one-day, one-week, one-month, three-months and six-months after treatment using a DSLR camera and a matching polarization filter. A grey reference card was used for color standardization. A Matlab routine was used to measure the color difference between adjacent healthy enamel and treated WSL. The independent-samples t-test was used for intergroup and paired-samples t-test for intragroup comparison.

RESULTS

Images of 116 teeth from 36 patients were analyzed. The ΔE for the "Icon" treated WSL was smaller (T1ICON = 5.0 ± 1.4) than in the fluoride group (T1Fluoride = 8.4 ± 3.2). Caries infiltration significantly improved the aesthetic appearance of WSL (p < 0.001), which remained satisfactory at six months (T5ICON = 5.2 ± 1.6).

CONCLUSION

WSL infiltration management during orthodontic treatment was superior to topical fluoridation in not only arresting the enamel lesions but also significantly improving the aesthetic appearance of demineralized regions around the brackets.

CLINICAL RELEVANCE

WSL treatment in orthodontic patients is usually initiated after debonding. Research has shown that the earlier WSL is treated, the better the aesthetic outcome. There is limited data on the efficacy of resin infiltration of WSL during orthodontic treatment.

Development of an Artificial White Spot Lesion Creation Protocol: A Preliminary Study

BACKGROUND AND OBJECTIVES

Protocols that determine the lesion depth of specific demineralization solutions are lacking. This in vitro study aimed to evaluate various lesion depths of artificial white spot lesions (WSLs) at different exposure times.  Materials and methods: Artificial WSLs were created by placing 30 extracted human premolar teeth into 0.05M acetate buffer solution with a controlled environment of pH 4.4 at 37ºC, which were then exposed in the solution for various durations of 4, 5, 6, 8, 10, and 12 days. The specimens were visually examined using the Ekstrand-Ricketts-Kidd (ERK) system to confirm the WSL, followed by buccolingual sectioning, and evaluated under a scanning electron microscope (SEM) to measure the lesion depth.

RESULTS

The SEM showed that the mean lesion depths of representative specimens were 101.33 µm (day 4), 124 µm (day 5), 159 µm (day 6), 187 µm (day 8), 202 µm (day 10), and 212 µm (day 12). The artificial WSL was visually demonstrated in grades 1 and 2 of the ERK system.

CONCLUSIONS

The depths of the lesions increased as the duration increased from day 4 to day 12, indicating that the lesion depths increased with the more prolonged exposure to the acetate buffer solution.

Evaluation of Penetration Depth and Caries Progression using Resin Infiltrant in Natural White Spot Lesions of Primary Molars

Background

Management of white spot lesions (WSLs) using resin infiltrants, like ICON®, is a novel technique that emphasizes the concept of minimally invasive dentistry.

Aim

Evaluate penetration depth and its effect on caries progression of ICON® in natural WSLs of primary molars.

Design

A total of 30 human primary molars with natural WSLs were selected. A total of 15 samples each were randomly selected to evaluate penetration depth and caries progression. To evaluate penetration depth, lesion surfaces were sectioned into two halves, wherein one half served as control, while the other half received ICON® infiltration treatment. To evaluate the effect on caries progression, samples were sectioned into two halves, wherein one half served as a control to its experimental counterpart, which received ICON® infiltration. The initial depth of the subsurface lesion (baseline data) was measured, and all the sample subsets underwent pH cycling. Confocal laser fluorescence microscope (CFLM) evaluation was performed, and penetration depth was assessed using a laser scanning microscopy (LSM) image reader, while caries progression was evaluated using PhotoScape® software.

Results

ICON® resin infiltrant penetrated to significant depths into the WSLs (p < 0.001) and demonstrated significant inhibition of caries progression (p < 0.001).

Conclusion

The novel technique using ICON® could be an invaluable tool in the management of WSLs in primary teeth.

How to cite this article

Babu G, Mallikarjun S, Vijayan V, et al. Evaluation of Penetration Depth and Caries Progression using Resin Infiltrant in Natural White Spot Lesions of Primary Molars. Int J Clin Pediatr Dent 2024;17(4):390-394.

Clinical and Radiographic Progression of Proximal Enamel Caries of Primary Molars Following the Application of Resin Infiltrant vs Tooth Mousse

Background

Resin infiltration is a technique in which a low-viscosity resin penetrates the proximal carious lesions and stops caries progression.

Aim

This study aimed to compare the progression of proximal enamel caries of primary molars following the application of resin infiltrant clinically and radiographically vs Tooth Mousse.

Materials and methods

This case-control split-mouth study evaluated 64 proximal surfaces of primary molars in 32 patients. Each patient had one pair of noncavitated proximal caries in two primary molars from different quadrants with radiographic evidence of enamel involvement. The carious lesions in each patient were randomly treated with resin infiltrant and Tooth Mousse. Progression of carious lesions was evaluated clinically and radiographically after 12 months. The two groups were compared by Fisher's exact test.

Results

No caries progression was noted in the resin infiltrant group at 12 months, and all 32 surfaces (100%) showed cessation of caries. Four surfaces (12.5%) in the Tooth Mousse group showed caries progression. The two groups were not significantly different in this regard (p = 0.242).

Conclusion

Resin infiltrant and Tooth Mousse were both effective in stopping the progression of proximal enamel caries of primary molars.

How to cite this article

Baniebrahim G, Seraj B, Ghonche Z, et al. Clinical and Radiographic Progression of Proximal Enamel Caries of Primary Molars Following the Application of Resin Infiltrant vs Tooth Mousse. Int J Clin Pediatr Dent 2024;17(4):385-389.

An in vitro evaluation of Icon resin infiltrant penetration into demineralized enamel lesions using an indirect staining technique with confocal laser scanning microscope analysis in dual fluorescence mode

Context

White spot lesion is the first clinical sign of a caries lesion and represents mineral loss from the enamel subsurface.

Aim

The aim of this study was to evaluate the penetration depth (PD) of Icon resin infiltrant into artificially demineralized enamel lesions using confocal laser scanning microscope (CLSM) analysis in dual fluorescence mode.

Settings and Designs

The design of the study was an in vitro study.

Materials and Methods

22 extracted human permanent maxillary central incisor teeth were collected, and enamel sections were obtained from the coronal middle third. All enamel specimens were exposed to demineralization and remineralization solutions for 14 days. On positive confirmation of enamel demineralization by scanning electron microscope analysis, 20 specimens were then subjected to Icon resin infiltration following manufacturer instructions. Specimens were processed with indirect staining technique using rhodamine B and sodium fluorescein dyes and examined under CLSM at ×10 magnification in dual fluorescence mode using ImageJ software to evaluate PD of resin infiltrant into demineralized enamel lesions.

Statistical Analysis Used

Obtained data were analyzed using an independent t-test. P ≤0.05 was considered statistically significant.

Results

The maximum depth of demineralized enamel lesion was 590 μm, and the mean depth was 290.78 ± 14.80 μm. The maximum depth of resin infiltrant penetration was 580 μm, and the mean depth was 279.08 ± 13.88 μm; P = 0.006. The percentage penetration of resin infiltrant was 95.99%.

Conclusion

Icon resin infiltrant was highly effective in its depth of penetration into demineralized enamel lesions. The use of indirect staining and CLSM analysis in dual fluorescence mode is more reliable and accurate technique to evaluate the PD of resin infiltrant.

Surface topography and spectrophotometric assessment of white spot lesions restored with nano-hydroxyapatite-containing universal adhesive resin: an in-vitro study

BACKGROUND

White spot lesion (WSL) is a main shortcoming accompanied by orthodontic treatment. It impairs the esthetic, surface hardness, and surface texture of enamel. So, this study was conducted to analyze the surface characteristics and color change of white spot lesions treated with nano-hydroxyapatite (nHA)-enriched universal adhesive resin.

MATERIALS AND METHODS

Eighty sound human permanent molars crowns were sectioned into two halves, producing 160 specimens. 16 specimens were left untreated, and 144 specimens were artificially-demineralized to generate WSLs. The specimens were classified according to the treatment approach applied as follows: I; Sound enamel, Group II; artificially-created WSLs, Group III; ICON resin-restored WSLs, Group IV; Universal adhesive resin-restored WSLs, Group V; 0.5 wt% nHA-containing universal adhesive resin-restored WSLs, Group VI; 1 wt% nHA-containing universal adhesive resin- restored WSLs, and Group VII; 3 wt% nHA-containing universal adhesive resin-restored WSLs, Group VIII; 5 wt% nHA-containing universal adhesive resin-restored WSLs, Group IX; 7 wt% nHA-containing universal adhesive resin-restored WSLs, and Group X; 10 wt% nHA-containing universal adhesive resin-restored WSLs. Some surface characteristics and color changes were assessed. Data was collected and analyzed statistically using ANOVA and the Tukey test at p < 0.05.

RESULTS

Surface microhardness of WSLs was significantly improved with all investigated ratios of nHA-containing universal adhesive (p < 0.0001), with the highest mean belonging to 10 wt% nHA-containing universal adhesive resin treated WSLs. All ratios of nHA-containing universal adhesive resin significantly reduced the surface roughness of WSLs (p < 0.0001). The investigated ratios of 1, 3, 5, 7, and 10 wt% nHA-containing universal adhesive resin treatment approach could mask the WSLs significantly (p < 0.0001).

CONCLUSIONS

Nano-hydroxyapatite-containing universal adhesive is a promising contemporary approach for the management of WSLs, coupled both the remineralizing concept and the minimally invasive resin infiltration.

Evaluation of experimental resin infiltrant containing nanohydroxyapatite on color stability and microhardness in demineralized enamel

OBJECTIVE

The aim of the study was to evaluate the effect of the addition of 10% nanohydroxyapatite in an experimental resin infiltrant on color stability and mineral loss.

MATERIAL AND METHODS

Bovine enamel blocks were randomized into five groups (n = 27/group): SE (sound enamel); ICL (initial caries lesion); I (Icon®); E (experimental infiltrant); EH (experimental infiltrant containing 10% nanohydroxyapatite). Color evaluation (n = 15) was performed and CIEL*a*b* values were obtained at points T0 (baseline), T1 (14 days immersed on coffee solution), and T2 (28 days immersed) and data were calculated ∆E00, ∆WID, ∆L*, ∆a*, and ∆b*. Cross-sectional microhardness (n = 12) was performed and lesion area (∆S) was calculated. Images were obtained with polarized light optical microscopy at 40 × magnification (n = 5).

RESULTS

In color stability results, there was significant difference between time (14 and 28 days); ICL demonstrated significant difference among treated groups in all measures (∆L*, ∆a*, ∆b*, ∆E00, ∆WID) regardless of time; I and E demonstrated similar behavior on those measures and EH differed from I in ∆L*. For ∆S, ICL group showed a significant difference compared to I and EH groups, but did not differ from E.

CONCLUSION

The nanohydroxyapatite incorporation suggested an effective mineral recovery on initial caries lesion in depth; however, it showed high color variation, such as Icon. In terms of ∆S, I and EH had lower mineral loss, suggesting a reinforcement on initial caries lesion.

CLINICAL RELEVANCE

Commercial and experimental infiltrants containing nanohydroxyapatite present low color stability and might reinforce mineral in initial caries lesion.

Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces

BACKGROUND

Resin infiltration is a micro-invasive treatment for molar incisor hypomineralisation (MIH). In this study it was aimed to evaluate the masking effect of resin infiltration treatment (ICON) on hypomineralised enamel surface of permanent anterior teeth by using laser fluorescence, spectrophotometer, and cross-polarisation photography.

METHODS

A total of 116 permanent central incisors in 37 patients were included in the study. The resin infiltration treatment (Icon®) was applied to the teeth with MIH; the healthy teeth received no treatment (control). Hypomineralised enamel lesions were evaluated by ICDAS II criteria. DIAGNOdent Pen was used to assess the lesions and healthy enamel surface quantitatively. Colour changes in enamel lesions were evaluated by using a spectrophotometer (VITA EasyShare). Each enamel lesion was imaged using a cross-polarization technique before and after treatment. All photos were assessed using Image J to evaluate the changes in lesion size. Enamel lesions were evaluated before; immediately after; 1; 3; and 6 months after treatment. Statistical significance was set as p < 0.05.

RESULTS

After the resin infiltration, significant decreases were found in the mean DIAGNOdent values for the treatment group (p < 0.05). The colour differences before and after treatment significantly differed in all follow-ups (p < 0.05). In the treatment group, lesion areas decreased significantly after treatment (p < 0.05).

CONCLUSIONS

The resin infiltration treatment has a masking effect on MIH lesions without cavities, with stable outcomes after six months. The cross-polarization photography technique may be use to evaluate the lesion size instead of photography with flash.

TRIAL REGISTRATION

NCT04685889 (registered 28 December 2020).

Effectiveness of resin infiltration (ICON) and microabrasion-remineralization technique with two remineralizing agents (Tooth Mousse and Toothmin) on permanent incisor hypoplasia - A randomized clinical trial

Aims

The study aims to compare the effect of resin infiltration and microabrasion-remineralization (MAb-Re) with Tooth Mousse and Toothmin on permanent incisor hypoplasia.

Materials and Methods

The study included children with permanent incisor hypoplasia above 9 years of age, 171 teeth divided randomly into four groups: Group A - ICON, Group B - MAb-Re using Tooth Mousse, Group C - MAb-Re using Toothmin, and Group D - control group. Process involved taking standardized photographs at T1 - before intervention, T2 - immediately after treatment, and T3 - 6-month follow-up. Color evaluation, area calculation, participant and expert opinion using a Likert scale, treatment time, and cost-effectiveness were all taken into consideration during the assessment.

Statistical Analysis Used

Data were collected, entered into a computer, and analyzed; one-way ANOVA was used for intergroup assessment.

Results

Overall color change was evident immediately after treatment in the ICON group compared to other groups (P < 0.05). However, no significant difference in color change was visible between the groups after 6 months. Reduction in hypoplastic area was seen in all the groups. The mean time was similar for all the groups. Toothmin was found to be the most cost-effective in comparison with the other two interventions.

Conclusions

ICON proved to be more effective immediately after treatment for masking incisor hypoplasia. However, at 6-month follow-up interval, all the groups gave similar results.

Methylene Blue Penetration of Resin Infiltration and Resin Sealant in Artificial White-Spot Lesions

OBJECTIVE

 This study determined the potency of resin infiltrations and resin sealant in impeding microleakage on artificial white-spot lesions (AWL) by methylene blue penetration.

MATERIALS AND METHODS

 Eighty AWL specimens were randomly separated into two groups for water storage for 24 hours (groups 1-4) and 20,000 cycles of thermocycling (TC) (groups 5-8). Each group was then separated into four subgroups (n = 10) based on the AWL surface treatments: (1) no Tx, (2) treated with resin infiltration (ICON, DMG, Hamburg, Germany), (3) treated with resin infiltration (Surface pre-reacted glass-ionomer (S-PRG) barrier coat, SHOFU, Kyoto, Japan), (4) treated with resin sealant (Clinpro sealant, 3M ESPE, Minnesota, United States). Nail varnish was covered to all samples, with the exception of a 4 × 4 mm2 patch on the buccal measurement region, which was subsequently submerged in a 2% methylene blue solution and cut into buccolingual sections. Stereomicroscope measurements were used to calculate methylene blue penetration scores.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test and the Bonferroni post-hoc correction were performed to evaluate the data.

RESULTS

 Application of resin infiltrants and resin sealant reduced microleakage in AWL by methylene penetration both before and after thermal cycling. In addition, group 6 (ICON + TC) and group 7 (S-PRG + TC) had a significantly different value from group 8 (sealant + TC).

CONCLUSION

 Both the resin infiltration approach and the resin sealant seem to help seal AWL and might perhaps offer long-term defense against microleakage in AWL caused by methylene blue penetration. The greatest sealing and defense for microleakage in AWL were demonstrated by the resin infiltrations.

Conservative esthetic management of brown enamel fluorosis using combination therapy: A clinical report

Dental fluorosis is caused by ingestion of excessive fluoride during tooth development resulting in hypomineralization of the enamel and can present as white or brown intrinsic lesions. This case report describes a combination of minimally invasive techniques: microabrasion, bleaching, and resin infiltration to address brown enamel fluorosis present on the maxillary anterior teeth of a young patient. Before resin infiltration, air microabrasion was targeted at subsurface lesions located on the maxillary central and lateral incisors, and chairside bleaching was done with 37% hydrogen peroxide (Opalescence). After which, hypoplastic lesions on the buccal surfaces were etched before being treated with two sessions of resin infiltration (ICON and DMG). Following treatment, satisfactory esthetic outcomes were achieved. Accurate diagnosis, depth of lesions, and understanding the effectiveness and limitations of each technique are essential to select the appropriate type of treatment to obtain the best esthetic outcome. In conclusion, the conservative management of varying severity of dental fluorosis may require the appropriate use of combination treatment modalities, such as microabrasion, bleaching and resin infiltration, when clinically indicated, to address the treatment needs and achieve a desired outcome.

Microleakage, microgap, and shear bond strength of an infiltrant for pit and fissure sealing

Objectives

This study aimed to evaluate the potential clinical application of an infiltrant with different etchants as pit and fissure sealants and to compare them with a conventional resin-based sealant.

Materials and methods

Seventy-five molars were randomly divided into three groups (n = 25): phosphoric acid etchant + conventional resin-based sealant (Group A); 15% hydrochloric acid etchant + infiltrant (Group B); phosphoric acid etchant + infiltrant (Group C). Fifteen teeth in each group were subjected to pit and fissure sealing procedures. After 500 thermocycling and methylene blue dye penetration, ten specimens were sectioned and the pencentages of dye penetration were measured under a stereomicroscope. Another five teeth in each group were sectioned and the microgaps between materials and enamel surface were measured using electron microscope scanning. Ten teeth in each group were used to measure shear bond strength and the failure mode was analyzed.

Results

The results showed that infiltrant exhibited significantly less microleakage and microgap than resin-based sealant, no matter which echant was used. Although there was no significant difference betweern the three groups, infiltrant applied with 15% hydrochloric acid etching showed higher shear bond strength than resin-based sealant etching with 35% phosphoric acid.

Conclusions

The infiltrant has significant advantages in reducing the degree of microleakage and microgap. Moreover, the infiltrant could achieve the same bonding strength as conventional resin-based sealant. Although, manufacturers do not currently recommend the infiltrant for fissure sealing, the potential clinical application would be an off-label use.Clinical relevance This report provides a theoretical basis for the potential clinical application of the infiltrant as a pit and fissure sealant, and provides a new perspective for selecting pit and fissure sealants.

Application of laser on enamel surface with three types of bioactive glasses-based resin infiltrants: An in vitro study

OBJECTIVE

The study aimed to evaluate and compare the surface micro-hardness, roughness, color, and morphology of enamel after Er,Cr:YSGG laser irradiation, followed by application of three types of bioactive glasses-based resin infiltrants, and the samples groups were challenged with the pH cycle.

METHODOLOGY

Experimental photoactivated resin infiltrants were synthesized using dimethacrylate resins, whereby three different types of bioactive glasses (BGs), i.e., 45S5, fluoridated-BG (F-BG), and borosilicate-BG (B-BG), were incorporated into the resin system. Initially, white spot lesions were created artificially on the toosth enamel surface, then irradiated with Er,Cr:YSGG laser. Then, the resin-only and BG-based resins were infiltrated on the enamel surface. All samples were pH challenged for 14 days, and the micro-hardness, surface roughness, surface morphology, and color stability (ΔE) analyses were conducted before and after the 14 days pH challenge.

RESULTS

After laser irradiation, the micro-hardness was significantly high with 45S5 group compared to resin-only (p = 0.021), F-BG (p = 0.042), and B-BG (p = 0.001) groups. After the pH challenge, the micro-hardness values for all groups were reduced significantly (p ≤ 0.05). The surface roughness was least with the resin-only group and showed a non-significant difference with F-BG (p = 0.34) and significant differences with both B-BG (p = 0.005), and 45S5 (p = 0.010) groups. After the pH cycle, the roughness of all groups was increased significantly (p ≤ 0.05), except B-BG group showed a non-significant difference (p = 0.528). The B-BG group showed significantly high ΔE between day 0 and baseline compared to resin-only (p = 0.0008), F-BG (p = 0.017), and 45S5 (p = 0.029), whereas between day 14 and baseline, the lowest ΔE value was observed for B-BG (14.2 ± 2.10) and maximum for the resin-only (20.57 ± 2.47) group. The SEM images showed pitting on the surface of all resin infiltrant groups after 14 days of pH challenge.

CONCLUSION

The morphological difference was observed after the laser irradiation on the enamel surface. The differences in micro-hardness, surface roughness, and color were observed after the application of experimental resin infiltrants and significant differences were observed after the pH challenge.

Long-Term Chromatic Durability of White Spot Lesions through Employment of Infiltration Resin Treatment

Background and Objectives: White spot lesions (WSLs) denote regions of subsurface demineralization on the enamel that manifest as opaque and milky-white regions. Treatment for WSLs is essential for both clinical and aesthetic reasons. Resin infiltration has been identified as the most efficacious solution for alleviating WSLs, but studies with long-term monitoring are scarce. The aim of this clinical study is to assess the color change stability of the lesion after four years of implementing the resin infiltration technique. Materials and Methods: Forty non-cavity and unrestored white spot lesions (WSLs) were treated with the resin infiltration technique. The color of the WSLs and adjacent healthy enamel (SAE) was assessed using a spectrophotometer at T0 (baseline), T1 (after treatment), T2 (1 year after) and T3 (4 years after). The Wilcoxon test was utilized to determine the significance of the variation of color (ΔE) between WSLs and SAE over the observed time periods. Results: When comparing the color difference ΔE (WSLs-SAE) at T0-T1, the Wilcoxon test demonstarated a statistically significant difference (p < 0.05). For ΔE (WSLs-SAE) at T1-T2 and T1-T3, the color variation was not statistically significant (p = 0.305 and p = 0.337). Conclusions: The study's findings indicate that the resin infiltration technique is an effective solution for resolving the appearance of WSLs, and the results have demonstrated stability for a minimum of four years.

An Insight into Enamel Resin Infiltrants with Experimental Compositions

Resin infiltration is a conservative treatment of initial enamel carious lesions. Only one infiltrant material is available on the market (Icon, DMG), and research is now investigating new chemical compositions so as to further exploit the benefits of the resin infiltration technique. A literature search of the articles testing the effects of different formulations on mechanical properties, resin penetration ability, remineralizing, and antibacterial activities was conducted. Of 238 articles, 29 resulted in being eligible for the literature review. The formulations investigated were all different and consisted in the inclusion of hydrophobic monomers (i.e., BisEMA, UDMA), solvents (ethanol, HEMA), alternative etchants (PAM) or molecules with antibacterial or bioactivity features (i.e., AgNP, YbF_3, MTZ, chitosan, DMAMM, HAp, MC-IL, NACP, PUA, CHX) and microfilled resins. Information on the long-term performances of the tested experimental materials were scarce. The combination of TEGDMA with hydrophobic monomers and the inclusion of a solvent alternative to ethanol reinforced mechanical properties of the materials. Hybrid-glass materials demonstrated an enhanced remineralization capacity. Techniques such as tunnelization increased the penetration depth and preserved the recourse to less-conservative treatments. Combining the min-invasive infiltrant approach with remineralizing and bacteriostatic properties would be beneficial for therapeutic and economical aspects, according to the principles of minimally invasive dentistry.

Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review

The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.

A novel dental infiltration resin based on isosorbide-derived dimethacrylate with high biocompatibility, hydrolysis resistance, and antibacterial effect

Objectives: The available infiltration resin has raised biosafety and treatment stability concerns because of the cytotoxicity of the main component, TEGDMA, and its susceptibility to hydrolysis in the oral environment. This study aimed to develop a TEGDMA-free infiltration resin to overcome these drawbacks. Methods: Using the synthetic bioderived monomer bis(methacrylate) isosorbide (IBM) and the zwitterionic compound 2-methacryloyloxyethyl phosphorylcholine (MPC), a novel infiltrant IBMA was developed and preferentially selected. We investigated the performance of the IBMA resin regarding cytotoxicity, antibiofilm adhesion, and hydrolysis resistance and further verified its ability to restore the demineralized enamel and stability of the infiltrated area under artificial aging conditions. Results: Compared with the commercial TEGDMA-based infiltration resin ICON, IBMA not only demonstrated similar enamel morphologic and esthetic restorative effects in chalky lesions but also exhibited favorable cell viability, durable Streptococcus mutans UA159 biofilm-repellent performance, and higher enamel microhardness (204.0 ± 5.12 HV) of the infiltrated enamel. Specifically, because of the high crosslink density [(47.77 ± 5.76) ×103 mol/mm3] and low water sorption [12.79 ± 2.56 µg/mm3] of the polymer network, the IBMA resin was more resistant to hydrolysis than ICON, which prevents the disruption of the infiltrant's micropore-blocking effect after aging. Enamel lesions treated with IBMA demonstrated good color stability after the tea-staining challenge, which was significantly better than that in the ICON group. Conclusion: Based on these findings, the IBMA resin exhibits favorable cell viability, hydrolysis resistance, and biofilm-repellent properties, which alleviates the defects of traditional TEGDMA systems. Therefore, it is a better alternative for microinvasive treatment involving early caries and enamel whitish discoloration.

Three-dimensional characterization of naturally developed early caries lesions using high-resolution micro-computed tomography

OBJECTIVES

The goal of this micro-Computed-Tomography (μCT) study was to characterize the structural parameters of natural, early proximal enamel caries lesions and correlate them with two-dimensional radiographic findings.

METHODS

Extracted human premolar teeth with ICDAS score 2 proximal lesions were examined using visual-tactile, μCT and simulated bitewing radiographs (BTX). Sound enamel and caries-lesions' structural and mineral density (MD) parameters were analyzed which included surface layer (SL) status and thickness, depth of lesion, and MD.

RESULTS

Thirty-six extracted premolars with 54 proximal early enamel caries lesions were analyzed. Lesions varied notably in lesion depth and MD. SL thickness ranged between 20 and 139μm. Three teeth (5.6%) had micro-cavitations upon the μCT examination despite being "clinically" non-cavitated. Cavitation status had no significant association with μCT nor BTX radiographic depth. Depth of lesions correlated weakly but statistically significantly with mineral loss (ML) at body of lesion (r=0.301, p=0.027). SL thickness also correlated negatively with ML at SL (r=-0.501, p&lt;0.001).

CONCLUSIONS

Early proximal enamel lesions with ICDAS 2 score as determined by visual-tactile examination exhibited a wide range of lesion parameters and cavitation status when examined by μCT. Visual-tactile examination may fail to detect micro-cavitations in enamel surface that are detectable by μCT.

CLINICAL SIGNIFICANCE

Clinicians have direct access to early proximal enamel lesions during orthodontic separation, exfoliation, extraction or restoration of adjacent teeth. This study invites the clinician to consider more decisive management options in high risk individuals (e.g. micro-invasive techniques), given the finding of vast structural variability of such lesions.

Evaluation of Infiltrant Application in the Course of Root Cementum Caries with Different Methods of Surface Preparation—An In Vitro Study

The aim of this study is to evaluate the depth of penetration of an experimental preparation with the characteristics of a dental infiltrant into the decalcified root cementum tissue and observation of the root cementum tissue subjected to a single and repeated twice hydrochloric acid etching process. The study material consisted of 20 human teeth (the study group—12 demineralised teeth, the control group—8 teeth). A commercially available Icon preparation and an experimental preparation were used for the study with addition 2% of YF3 (yttrium trifluoride) added as an indicator to facilitate microscopic observation. Each tooth was divided into two zones, blue (Icon) and red (experimental preparation). The teeth were divided into two subgroups—in the first subgroup, the etching preparation was applied once, in the second subgroup twice, and at the end the teeth were infiltrated with the experimental preparation and the Icon preparation. The study of tooth longitudinal section morphology and chemical composition was performed with the use of a Hitachi S-3400N scanning electron microscope. Microscopic observations show that the applied YF3 tracer in most cases agglomerates and remains in the form of conglomerates on the surface of the root cementum. Single particles of YF3 are visible, penetrating through the cementum tissues into the root dentine structure. The degree of tissue infiltration with the resin (depth of penetration into decalcified tissues) is visible at a depth of approx. 80–120 μm. In the test group subjected to a single etching process, good penetration of both resins was noticeable, however, excessive erosion of the root surface was evident in several of the specimens—indicating that damage occurred as a result of the etching process. In the test group subjected to two etching processes, excessive erosion of the cementum is visible in each deposit.

Penetration ability and microhardness of infiltrant resin and two pit and fissure sealants in primary teeth with early enamel lesions

To determine the penetration depth and enamel microhardness (EMH) of an infiltrant resin and two fissure sealants in primary teeth with early enamel lesions. We randomly divided 174 sound teeth into six groups (n = 29): (1) phosphoric acid (PA) + Clinpro, (2) PA + Aegis, (3) Icon, (4) hydrochloric acid (HCl) + Clinpro, (5) HCl + Aegis, and (6) control. Percentage penetration (%PP) was analyzed by confocal laser scanning microscopy (n = 15). EMH was measured (n = 12), and the percentage of EMH recovery (%REMH) was calculated. Twelve samples were examined under a scanning electron microscope (SEM). All data were analyzed with the Kruskal–Wallis and one-way ANOVA tests (p < 0.05). Groups 3 and 4 showed the highest %PP (all, p < 0.05). Icon application led to significantly higher %REMH compared to the others (p < 0.05). Groups 2 and 5 showed the lowest reduction in %REMH after pH-cycling. Application of Icon and Clinpro with HCl pretreatment showed the greatest %PP. pH-cycling led to a decrease in %REMH for all of the materials, although this effect was lower in teeth treated with Aegis.

In vitro effect of resin infiltrant on resistance of sound enamel surfaces in permanent teeth to demineralization

OBJECTIVE

To investigate the effect of resin infiltrant on resistance of sound permanent enamel surfaces to demineralization.

METHOD

Eighty healthy premolars were sectioned to obtain enamel blocks from the buccal surface. Specimens with baseline surface microhardness values of 320-370 were selected. The experimental group were treated with resin infiltrant, while the control group was not. Specimens from each group were artificially demineralized and the surface microhardness values were measured again. Confocal laser scanning microscopy was used to measure the depth of demineralization and detect the penetration ability of the resin infiltrant. The specimens were subjected to a simulated toothbrushing abrasion test. Scanning electron microscopy was used to observe changes in the surface morphology of specimens after each of these procedures.

RESULTS

No significant differences between the experimental and control groups were observed in the baseline microhardness values or in the experimental group after resin infiltration compared with the baseline conditions. After artificial demineralization, the microhardness value in the control group was significantly lower than that in the experimental group (266.0 (±34.5) compared with 304.0 (±13.0), P = 0.017). Confocal laser scanning microscopy results showed that the demineralization depth in the control group was significantly deeper than that in the experimental group (97.9 (±22.8) µm vs. 50.4 (±14.3) µm, P < 0.001), and that resin infiltrant completely penetrated the acid-etched demineralized area of the tooth enamel with a mean penetration depth of 31.6 (±9.0) µm. Scanning electron microscopy showed that the surface morphology was more uniform and smoother after simulated toothbrushing. The enamel surface structure was more severely destroyed in the control group after artificial demineralization compared with that of the experimental group.

CONCLUSION

Resin infiltrant can completely penetrate an acid-etched demineralized enamel area and improve resistance of sound enamel surfaces to demineralization. Our findings provide an experimental basis for preventive application of resin infiltrant to sound enamel surfaces to protect tooth enamel against demineralization.

Effect of Resin Infiltration on Enamel: A Systematic Review and Meta-Analysis

Subsurface enamel demineralization beneath an intact surface layer or white spots lesions (WSL) can and should be treated with non-invasive procedures to impede the development of a cavitated lesion. We aim to analyze if infiltrative resin improves enamel roughness, microhardness, shear bond strength, and penetration depth. MEDLINE [via Pubmed], Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scholar, and LILACS were searched until May 2021. Methodological quality was assessed using the Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. Pairwise ratio of means (ROM) meta-analyses were carried out to compare the enamel properties after treatment with infiltrative resin on sound enamel and WSLs. From a total of 1604 articles, 48 studies were included. Enamel surface roughness decreased 35% in sound enamel (95%CI: 0.49–0.85, I² = 98.2%) and 54% in WSLs (95%CI: 0.29–0.74, I² = 98.5%). Microhardness reduced 24% in sound enamel (95%CI: 0.73–0.80, I² = 99.1%) and increased by 68% in WSLs (95%CI: 1.51; 1.86, I² = 99.8%). Shear bond strength reduced of 25% in sound enamel (95%CI: 0.60; 0.95, I² = 96.9%) and increased by 89% in WSLs (95%CI: 1.28–2.79, I² = 99.8%). Penetration depth was 65.39% of the WSLs (95%CI: 56.11–74.66, I² = 100%). Infiltrative resins effectively promote evident changes in enamel properties in sound and WSLs. Future studies with long-term follow-ups are necessary to corroborate these results from experimental studies.

A comparison of resin infiltration and microabrasion for postorthodontic white spot lesion

INTRODUCTION

The objective of this research was to evaluate and compare the effectiveness of microabrasion and resin infiltration for white spot lesions (WSLs).

METHODS

Patients with postorthodontic WSLs were enrolled and randomly assigned to the control, microabrasion, and resin-infiltration groups. Intraoral photographs were taken before and after (6 months later) treatment. WSL sizes were determined through ImageJ (Wayne Rasband, Kensington, Md). Integrated optical density (IOD) was determined for a WSL and its surrounding normal enamel through Image-Pro Plus (version 6.0; Media Cybernetics, Rockville, Md), and their differences of IOD were considered as the IOD surrogate for that WSL. The color change of WSL were measured through ΔE.

RESULTS

A total of 27 eligible patients were enrolled; 9 subjects were assigned to each group, resulting in 56 teeth in the control group, 72 in the microabrasion group, and 58 in the resin-infiltration group. The ratios of WSL size (after/before) were similar between the microabrasion and resin-infiltration group (43.94 ± 0.03% vs 45.02 ± 0.03%; P = 0.96 > 0.05), but those of the 2 groups were significantly lower than those of the control group (92.15 ± 0.02%) (P <0.001). Moreover, the ratios of IOD (after/before) were significantly lower in the resin-infiltration group (22.94 ± 0.02%) than in the microabrasion (78.11 ± 0.03%) and control (83.79 ± 0.02%) (P <0.001) groups. The highest ΔE improvement was obtained by infiltration, but there was no significant difference between microabrasion and control group.

CONCLUSIONS

Resin infiltration and microabrasion are comparably effective in reducing the sizes of WSL, but resin infiltration enjoys an esthetic advantage over microabrasion.

A comparative evaluation of penetration depth and surface microhardness of Resin Infiltrant, CPP-ACPF and Novamin on enamel demineralization after banding: an in vitro study

Background

The field of dentistry has been revolutionized by various concepts. Minimal invasive dentistry is the preferred treatment approach in the present era; therefore, various techniques have been advocated to arrest caries lesions at an early stage on the grounds of better understanding of the dynamic nature of dental caries. Thus, study was conducted to compare and evaluate the penetration depth and enamel microhardness of Resin Infiltrant, CPP-ACPF and Novamin on artificial demineralized enamel surface after orthodontic banding.

Material and methods

Eighty extracted sound premolars were banded. The bands were cemented with type 1 GIC and further divided into – Group I: Resin Infiltrant, Group II: CCP-ACPF, Group III: Novamin and Group IV: Control. The samples were incubated for 30 days and then thermocycled. A window of 4 mm × 4 mm was prepared on the buccal surface of samples and artificially demineralized for 4 weeks. A single application was made for Resin Infiltrant, while Novamin and CCP-ACPF were applied twice daily. These samples were otherwise immersed in artificial saliva, and this was protocol was observed for 14 days. For the evaluation of penetration depth, 10 samples from each group were bucco-lingually sectioned and immersed in methylene blue dye solution for 24 h and then evaluated under stereomicroscope. For the enamel surface microhardness, remaining 10 samples from each group were embedded in acrylic resin with outer buccal surface exposed and were tested by a using digital Micro-Vickers hardness tester.

Results

All groups showed a significant difference in the depth of dye penetration and surface microhardness compared to the control group. As compared to the other tested groups, Resin Infiltrant exhibited the highest significant reduction in demineralization and increased microhardness. Novamin had a deeper penetration and increase in microhardness as compared to CCP-ACPF.

Conclusion

Resin Infiltrant exhibited the highest potential to impede caries and constitutes a competent aerosol free micro-invasive strategy for combating non cavitated lesions approaching the outer layer dentine which are too advanced for remineralizing agents but do not necessarily require any drilling of tooth.

Comparing Impact of Two Resin Infiltration Systems on Microhardness of Demineralized Human Enamel after Exposure to Acidic Challenge

AIM: This study compared the impact of two resin infiltration systems on microhardness of demineralized enamel before and after an acidic challenge. MATERIALS AND METHODS: A total of forty human maxillary molar teeth were used in this study. Each tooth has 4 groups (four standardized windows onto each tooth). Group A1: Untreated sound enamel surface (positive control), Group A2: Artificially demineralized enamel surface (negative control), Group A3: Icon resin infiltrating to demineralized enamel, while Group A4: Single bond universal adhesive applied to the demineralized enamel surface. All teeth were immersed in a demineralizing solution. The groups (A3 and A4) were further subdivided into two subgroups according to acidic ethanol challenge Subgroup B1: Specimens tested before an acidic challenge and B2: Specimens tested after an acidic challenge. Vickers microhardness test was done for all groups. One-way analysis of variance (ANOVA) was used to study the difference between tested groups on mean microhardness within each group. Tukey’s post-hoc test was used for pair-wise comparison between the means when ANOVA test was performed, and the significance level was set at p ≤ 0.05. RESULTS: Icon resin infiltration and single bond universal adhesive showed significantly higher mean microhardness than negative control, but significantly lower mean microhardness than positive control. However, insignificant difference was found between icon and single bond universal adhesive. After the acidic challenge, icon resin infiltration showed significantly higher mean microhardness than negative control. However, single bond universal adhesive showed insignificant difference as compared to the negative control. CONCLUSION: After an acidic challenge, icon resin infiltration was more successful than single bond universal total-etch adhesive system in microhardness. RECOMMENDATION: Icon resin infiltration technique is a promising, noninvasive approach that prevents the progress of the carious lesion.

Response of pulp cells to resin infiltration of enamel white spot-like lesions

OBJECTIVES

To investigate the trans-enamel and trans-dentinal biological effects of treating enamel white spot-like lesions (EWSLs) with resin infiltration components (RICs) on odontoblast-like cells (MDPC-23) and human dental pulp cells (HDPCs).

METHODS

EWSLs were induced in 60 enamel/dentin discs (4.0 ± 0.2 mm thick) using S. mutans. The discs were adapted into artificial pulp chambers and MDPC-23 were seeded on the dentin surface. The components of a resin infiltration system (Icon) were applied individually or in combination on the enamel surface as following (n = 10/treatment): Etch, Infiltrant, Etch+Infiltrant, or Etch+Dry+Infiltrant. The application of water or hydrogen peroxide served as negative and positive controls, respectively. After 72 h, MDPC-23 viability was evaluated. The extracts were exposed for 72 h to pre-cultured MDPC-23 and HDPCs in 96-well plates to evaluate cell viability, alkaline phosphatase activity (ALP), mineralized nodule formation (MN), and the expression of inflammatory cytokines (ICs) and mineralization-related genes (MRs). Data were analyzed by ANOVA complemented with Tukey or Games-Howell post-hocs (α = 5%).

RESULTS

Cell viability, ALP activity, and MN formation were significantly reduced in response to the RICs, presenting intermediate values compared to positive and negative controls. Likewise, ICs were upregulated, whereas MRs were downregulated. Among the RICs, the Etch component caused the most notorious detrimental effects.

SIGNIFICANCE

Resin infiltration of EWSLs negatively affected the metabolism of pulp cells in vitro. Therefore, even though resin infiltration is a micro-invasive therapy for non-cavitated caries in enamel, it should be closely followed up seen that components may diffuse and unbalance pulp homeostasis.

Comparison of Resin Infiltration Technique with Conventional Preventive Applications on Occlusal Fissures in Terms of Chemical Analysis and SEM

Objective

To compare the subsurface mineral loss preventing capability of resin infiltration technique with topical fluoride and fissure sealant applications to demineralized occlusal fissures under simulated oral conditions.

Materials and Methods

Occlusal surfaces of 64 extracted intact human third molars were demineralized. Next, the teeth were classified into four groups according to preventive applications (n = 16): G1, Specimens used as the control group with no preventive treatment; G2, Topical fluoride application (APF Gel/ DEEPAK); G3, Fissure sealant application (ClinproTMSealant/ 3M ESPE); and G4, Resin infiltration technique (Icon/ DMG). Chemical compositions before pH cycling were evaluated for eight specimens from each group. The remaining eight teeth from each group were subjected to pH cycling for 15 days to simulate the oral conditions. Subsequently, the specimens were fractured after immersion in liquid nitrogen and the subsurface fluoride (F), calcium (Ca), phosphorus (P) levels, and Ca/P ratio of each specimen were measured using energy dispersive x-ray spectrometer (EDS). The data were subjected to statistical analysis (p = 0.05). The effects of preventive applications to surface topography of specimens were evaluated using scanning electron microscope (SEM).

Results

There were no significant differences among the groups in subsurface F, Ca, and P levels and Ca/P ratios before or after pH cycling (p > 0.05). All three preventive applications were effective during pH cycling according to SEM observations.

Conclusions

The subsurface mineral loss preventing capability of resin infiltration technique applied to occlusal fissures was comparable to topical fluoride and fissure sealant applications.

Clinical significance

The resin infiltration technique could represent a valid alternative to traditionally used both preventive and restorative treatments for treating initial carious lesions on occlusal fissures, offering the advantages of better resin penetration and retention.

Erosion Infiltration in the Management of Molar-Incisor Hypomineralization (MIH) Defects

White spot lesions caused by enamel demineralization are frequently encountered in dental practice. Their management has always been an important issue in modern dentistry. However, the real dilemma was treating aesthetic demands with noninvasive or minimally invasive techniques preserving the natural tissues. The introduction of resin infiltration technique seems to provide an intermediary treatment modality between prevention and restorative therapy. This case report is aimed at reporting the management of MIH opacities in anterior teeth with resin infiltration technique.

Sealing Proximal Non- and Micro-Cavitated Carious Lesions Using a One-Session Separator Technique: A 2-Year Randomised Clinical Study

The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.

Esthetic Management of Incisors with Diffuse and Demarcated Opacities: 24 Month Follow-up Case Report

CLINICAL RELEVANCE

A minimally invasive esthetic treatment can provide longevity and color stability.

SUMMARY

This clinical case report describes a minimally invasive approach to mask diffuse and demarcated opacities in permanent anterior teeth in an eight-year-old child who was upset with the appearance of her incisors. Clinical examination showed diffuse opacities in teeth 7, 8, 9, and 10, diagnosed as dental fluorosis associated with yellow demarcated opacity in tooth 9 related to molar-incisor hypomineralization. The treatment was based on conservative dentistry using the low-viscosity resin infiltration technique and resin composite restoration in an attempt to mask the lesions. The follow-up time was 24 months.

Experimental self-etching resin infiltrants on the treatment of simulated carious white spot lesions

OBJECTIVES

To evaluate the penetration depth (μm) of experimental resin infiltrants containing different percentages of triethylene glycol dimethacrylate (TEGDMA) and phosphoric acid 2-hydroxyethyl methacrylate ester (PAM) in artificial carious white spot lesions (WSL).

METHODS

WSL were produced in 65 bovine flat enamel specimens by pH cycling protocol, which were treated with either Icon (control) or experimental acidic infiltrants based on different percentages of TEGDMA and PAM monomers (acidic), and their association or not with previous acid-etching with phosphoric acid. Ten readings using Confocal Laser Scanning Microscopy were conducted on each specimen and the penetration depth was calculated from the surface until the deepest point with the fluorescent dye Rhodamine B (0.02 mg/mL). The pH and the viscosity of the experimental infiltrants were also tested. Data were statistically analyzed with two-way ANOVA and Tukey tests (α < 0.05).

RESULTS

The material factor and the interaction material*acid-etching were statistically significant. The lowest penetration depth was observed for the samples treated with the commercial infiltrant after etching with 15% hydrochloric acid. When specimens were pre-treated with PA, highest penetration was seen for specimens treated with 100% TEGDMA, which differed from all other groups. The lowest penetration was seen for those treated with 50:50 TEGDMA:PAM infiltrants. When specimens were not previously etched, highest penetration was seen for Icon, which differed only from those treated with 25% TEGDMA 75% PAM, where the lowest values were seen. The values of viscosity increased and the pH decreased with the addition of PAM in the infiltrant formulations.

CONCLUSION

the association between TEGDMA and PAM seems to allow similar infiltration depth reached by Icon infiltrant without acid etching the enamel surface.

Can composition and preheating improve infiltrant characteristics and penetrability in demineralized enamel?

The composition of infiltrants can influence their physical properties, viscosity and depth of penetration (DP). Strategies are used to increase the DP, such as the addition of diluents or the use of heat. This study aimed to evaluate the effect of preheating and composition on physical properties and DP of infiltrants in demineralized enamel. The groups were assigned, and the following experimental formulations were made: 25%BisEMA +75%TEGDMA; 25%BisEMA +65%TEGDMA +10%ethanol; 25%BisEMA +65%TEGDMA +10%HEMA; 100%TEGDMA; 90%TEGDMA +10%ethanol; 90%TEGDMA +10%HEMA. The samples were photoactivated at two temperatures (25°C and 55°C). Degree of conversion (DC) was performed using an infrared spectrophotometer. Elastic modulus (E), flexural strength (FS) and contact angle (CA) tests were also performed. The DP of an infiltrant in demineralized enamel was determined by confocal laser scanning microscopy (CLSM) using an indirect labeling technique. The data were analyzed by two-way ANOVA and Tukey's test. DC increased after preheating in all the groups; however, 90%TEGDMA+10%ethanol showed the lowest DC for both temperatures, and the lowest E. Preheating did not influence E or FS. The CA increased at 55°C for most groups, but decreased for groups containing HEMA. Temperature did not seem to influence DP, and Icon showed the lowest DP values. The 100%TEGDMA composition showed more homogeneous penetration, whereas Icon showed heterogeneous and superficial penetration. The preheating technique does not improve all properties in all the material compositions. The composition of a material can influence and improve its properties.

Effect of resin infiltration application on early proximal caries lesions in vitro

Background/purpose

Resin infiltration (RI) material ICON is used in treating early proximal caries lesions, as it depends on a micro-invasive infiltration technology. This in vitro study aimed to evaluate the effect of ICON resin infiltration (RI) on early proximal caries by comparing surface roughness and hardness before and after treatment with RI using atomic force microscopy (AFM), automated microhardness testing system (AMHTS), and scanning electron microscopy (SEM) in vitro.

Materials and methods

Twenty seven premolars extracted for orthodontic reasons were sectioned buccolingually, creating 54 specimens. Each specimen was immersed in demineralizing solution to induce caries. Only teeth with "International Caries Detection and Assessment System" codes 1 and 2 were selected. The specimens were divided randomly into either AFM, AMHTS or SEM groups, which examined demineralized enamel before and after treatment with ICON.

Results

The mean average surface roughness and root mean square roughness values of demineralized enamel treated with ICON were significantly higher than untreated lesions (P < 0.001). The mean Vickers hardness values for demineralized enamel treated with ICON was significantly higher than untreated lesions (P < 0.001). SEM showed irregular, pitted and rough demineralized enamel surface with destruction of enamel rods and dissolution of enamel crystals. After ICON application, the surface showed complete blockage of enamel rods with RI and irregular, rough uneven topography.

Conclusion

RI application on proximal incipient caries increased surface roughness and hardness significantly.

Spectrophotometric Evaluation of Enamel Color Variation Using Infiltration Resin Treatment of White Spot Lesions at One Year Follow-Up

The aim of this study is to evaluate the color changes and the stability at a 1-year follow-up of white spot lesions (WSLs) treated with an infiltrating technique by using etching and TEGDMA resin. The color of 22 white spot lesions and the sound adjacent enamel (SAE) were assessed with a spectrophotometer at T0 (baseline), T1 (after treatment), and T2 (1 year after). The color change ΔE (WSLs-SAE) at T0 vs. T1 were compared to evaluate the camouflage effect efficiency, and at T1 vs. T2 to assess the stability of outcomes. To evaluate the effect on the treatment outcome of gender, the presence or not of previous orthodontic treatment, WSLs onset more/less than 10 years, the age of the patient, and the ΔE WSL (T0 vs. T1) was analyzed. The difference between ΔE (WSLs-SAE) at T0 and T1 resulted in statistical significance (p < 0.01). No statistical difference was found between ΔE (WSLs-SAE) at T1 vs. T2. The variables considered showed no statistical differences in treatment outcomes. The results of our investigation show that the technique used is immediately effective and the camouflage effect keeps up and steady one year after treatment. Such results do not appear to be influenced by analyzed clinical variables.

Pediatric Dentists' Educational Experiences, Attitudes, and Professional Behavior Concerning Resin Infiltration: Implications for Dental Education

Minimally invasive dentistry (MID) is receiving increased attention. Resin infiltration (RI) is one micro-invasive technique for treating initial caries by sealing white spot lesions on tooth surfaces. The aims of this study were to assess pediatric dentists' RI-related educational experiences, attitudes, and professional behavior and to determine if their educational experiences were significantly related to their professional attitudes and behavior regarding RI. This cross-sectional study used an online survey to collect data from members of the American Academy of Pediatric Dentistry (AAPD) in March-April 2017. Of the 2,367 AAPD members invited to participate, 43 emails could not be delivered, and 273 surveys were completed, for a response rate of 11.8%. While only 9% of the 273 respondents reported that their classroom-based dental education had informed them about RI and only 1% that it had prepared them well to use RI with pediatric patients, higher percentages said they had been informed/prepared well by their classroom-based (24%) and clinical residency education (12%). The majority wanted to learn more about RI (71%) and would like to take a related CE course (59%). The respondents' average RI-related attitudes were positive (on five-point scale with 1=worst attitude: Mean=3.84). Regarding use of RI, 28% of respondents said they used RI sometimes and 4% often/very often, with 64% considering implementing RI in their clinics. Graduation year did not correlate with RI attitudes and use. However, the more education about RI the respondents had received during their residency (r=0.20; p<0.01) and in professional development after graduation (r=0.34; p<0.001), the more they used RI in their own work. This study found that the pediatric dentists' RI-related education was positively correlated with their professional behavior. Increasing predoctoral, resident, and continuing professional education about RI should therefore be considered.

Color masking prediction of posterior white spot lesions by resin infiltration in vitro

OBJECTIVE

To investigate parameters that could predict the color masking effect (ME) of white spot lesions (WSLs) after resin infiltration (RI).

METHODS

Sixty extracted human teeth with natural WSLs were selected (28 premolars, 29 molars and 3 incisors). At baseline, the laser fluorescence (LF) of surrounding sound enamel (SE) and the WSLs were analyzed with DIAGNOdent. Standardized photographs were obtained under D65 and UV illuminants, from which the CIE L*a*b* color coordinates and natural fluorescence (NF) of the WSLs and SE were obtained. The color difference (ΔE₀₀) and differences of NF and LF between the SE and WSLs were calculated. The lesion dimensions (area, perimeter, width, and height) were determined. After RI, the assessments were repeated. ME was considered as the reduction of ΔE₀₀ values after RI. One-way ANOVA and the Tukey tests were used to analyze the absolute means of the LF and NF values. The t test was used to compare the ΔE₀₀ values and lesion dimensions before and after infiltration. The correlations between all parameters at baseline and ME were analyzed.

RESULTS

The absolute mean values of LF at the baseline (B) and after infiltration (I) were SE/B-3.98a, WSL/B-13.28c, SE/I-3.36a, WSL/I-7.95b (p = 0.001). The mean values for NF were SE/B-7.93a; WSL/B-6.29b, SE/I-7.93a, WSL/I-7.27a (p = 0.001). The results for ΔE₀₀ were B-11.74a, I-8.66b (p = 0.001). RI significantly reduced lesion dimensions. No correlations were observed between the baseline parameters and the ME.

CONCLUSIONS

The WSLs presented higher LF and smaller NF than SE, which were respectively reduced and increased after RI. Prediction of the masking effect by the parameters evaluated at baseline was not possible, which could be due to the choice of mainly caries lesions in posterior teeth. Nonetheless, infiltration was found suitable to mask most of the WSL.

CLINICAL SIGNIFICANCE

The color masking effect of white spot lesions after resin infiltration cannot be predicted by a previous analysis of fluorescence, color, or dimensions of the lesion.

The Use of Resinous Infiltrants for the Management of Incipient Carious Lesions: a Literature Review

AbstractThe objective of this work was to analyze scientific evidence from a literature review pertaining to the effectiveness of resinous infiltrants for minimally invasive treatment of incipient carious lesions. Studies published between 2002 and 2019 were queried from the following databases: Capes, PubMed, Medline, BBO, Lilacs and SciELO. The search keywords included "Dental Caries", "Tooth Remineralization", "Dental Leakage". Most of the studies found resin-infiltrating treatment to be a viable option for the minimally invasive treatment of incipient carious lesions; this treatment was able to fulfill the primary expected effects: inhibition of carious progression and the lesions esthetic improvement. However, some issues need to be clarified to improve the safety of this treatment because it can be recommended in clinical practice. In conclusion, the use of resinous infiltrants has been reported as promising for the treatment of incipient carious lesions. However, there is a need for long-term studies to confirm the effectiveness of this treatment to determine its applicability for clinical use. Keywords: Dental Caries. Dental Leakage. Tooth Remineralization. ResumoO objetivo desse trabalho foi analisar evidências científicas, por meio de uma revisão de literatura, sobre a eficácia do uso de infiltrantes resinosos para o tratamento minimamente invasivo de lesões cariosas incipientes. A seleção do material literário utilizado foi realizada por pesquisa sobre o tema nas bases de dados: portal de periódicos Capes, PubMed, Medline, BBO, Lilacs e SciELO, abrangendo prioritariamente, o período de 2002 a 2019. Para busca nas bases de dados foram utilizadas palavras-chave como “Cárie Dentária”, “Remineralização Dentária”, “Infiltração Dentária”, assim como suas correspondentes na língua inglesa.  A maioria dos estudos encontrados aponta o tratamento infiltrante resinoso como uma opção viável para o tratamento minimamente invasivo de lesões cariosas incipientes sendo capaz de cumprir os principais efeitos esperados: inibição da progressão cariosa e melhoria estética das lesões. Entretanto, alguns impasses necessitam ser esclarecidos para que o tratamento seja recomendado com mais segurança na prática clínica. Conclui-se que o uso de infiltrantes resinosos tem sido relatado como promissor para o tratamento de lesões cariosas incipientes, contudo há necessidade de novas pesquisas e estudos a longo prazo para confirmar sua eficácia em todos aspectos desejáveis para seu uso clínico. Palavras-chave: Cárie Dentária. Infiltração Dentária. Remineralização Dentária.

Resin infiltration of enamel white spot lesions: An ultramorphological analysis

OBJECTIVE

There is not a clear understanding of the ultramorphology of enamel white spot lesions (WSLs). The purpose of this study is to characterize resin infiltration of enamel WSLs using electron microscopy.

MATERIALS AND METHODS

Enamel sections with sound enamel and WSLs were sectioned from extracted teeth and assigned to three groups: (a) left untreated; (b) etched with 15% hydrochloric acid (Icon-Etch); (c) restored with the resin infiltration sequence (Icon-Etch, Icon-Dry, and Icon-Infiltrant). Restored specimens were demineralized to obtain replicas. Observations were carried out under a field-emission scanning electron microscope.

RESULTS

Icon-Etch resulted in an array of pits and funneled holes on the WSL. Replicas of WSLs depicted 0.5-6.0-μm-thick shaggy resin tags up to a depth of 465 μm. Enamel crystallites were enveloped with resin at the bottom of the WSL forming a hybrid layer.

CONCLUSIONS

The resin infiltrant filled the spaces between the crystallites and resulted in an enamel hybrid layer.

CLINICAL SIGNIFICANCE

In addition to masking enamel WSLs, resin infiltration is able envelop residual enamel crystallites forming an enamel hybrid layer. This hybridization makes resin-embedded enamel more resistant to acid attack than sound enamel.

Evaluation of the value of re-wetting prior to resin infiltration of post-orthodontic caries lesions

OBJECTIVES

Assessment of the influence of colour changes during the re-wetting process as a possible predictor for the final result after resin infiltration to mask post-orthodontic white spot lesions.

MATERIALS AND METHODS

Resin infiltration (ICON; DMG, Hamburg, Germany) was performed according to the manufacturer's recommendation with the exception of repeated, at maximum three etching procedures based on the subjective decision of the dentist during a so called re-wetting process using ethanol. The masking effect by ethanol as well as after resin infiltration was evaluated by digital images taken before, for nine seconds during re-wetting and one week after treatment using CIE L*a*b* colour space.

RESULTS

Twenty-nine patients (16 female) with a total of 221 lesions (ICDAS 2) were included (mean age 16 years). Mean time after debonding the orthodontic appliances was ten weeks. Colour changes during re-wetting, evaluated in the first ten patients (71 lesions) showed a significant correlation between the minimum ΔE observed during re-wetting and the final ΔE after resin infiltration (r = 0.65, p < 0.001; Spearman correlation). The main drop in ΔE becomes visible after three seconds when performing the re-wetting process. Regarding the 221 lesions, resin infiltration significantly reduced the colour difference between sound and lesion areas from a baseline ΔE (25^th/75^th percentiles) of 10.9 (8.2/13.2) to a ΔE of 4 (2.1/5.8) after one week (p < 0.001). The number of etching procedures correlated significantly with baseline ΔE (p < 0.05).

CONCLUSIONS

The minimum ΔE observed during the re-wetting process seems to be a useful predictor for the final result of resin infiltration of post-orthodontic caries lesions. More prominent lesions with higher ΔE at baseline seem to require more erosion of the surface layer. In general, a significant and considerable clinical reduction of ΔE could be observed.

CLINICAL SIGNIFICANCE

We corroborate that resin infiltration technique is a very useful method to mask caries lesions having developed during treatment with fixed orthodontic appliances. Colour changes while re-wetting the lesions with ethanol seem to be a valuable indicator for the number of required etching procedures.

Effectiveness of polyacrylic acid-bioactive glass air abrasion preconditioning with NovaMin remineralization on the microhardness of incipient enamel-like lesion

Background:

Bioactive glass (BAG) remineralization is a promising method for dental hard tissue regeneration. The aim of this study was to evaluate the microhardness of incipient enamel-like lesions with or without preconditioning by air abrasion using polyacrylic acid (PAA)-BAG before application of NovaMin remineralizing agent.

Materials and Methods:

Forty extracted human molars were selected, sectioned mesiodistally obtaining buccal and lingual halves, and embedded in resin molds. Specimens were randomly assigned to four groups (n = 10) according to the remineralization protocol: G1 (control, artificial saliva), G2 (preconditioning), G3 (NovaMin), and G4 (preconditioning and NovaMin). Enamel windows 4 mm × 4 mm were done on the buccal and lingual surfaces. Specimens were immersed in a daily renewed demineralizing solution to create white spot lesions. Remineralizing agents were applied according to the manufacturer's instructions, and specimens were stored in a daily renewed artificial saliva. Microhardness was assessed using Vickers hardness number (VHN) at baseline (positive control), after demineralization (negative control), and after 24-h and 1-month remineralization.

Results:

The preconditioning/NovaMin group after 1 month showed a statistically significant high VHN, with no statistically significant difference between it and the positive control. This was followed by the NovaMin group after 1 month, while the lowest VHN was found in the demineralized group, with no statistically significant difference between it and the preconditioning group, whether after 24 h or 1 month.

Conclusions:

Enamel preconditioning with PAA-BAG air abrasion play a major role in enhancement of remineralization when it is accompanied with NovaMin. Furthermore, an extended period of time had helped to attain more benefits from NovaMin remineralization.

Clinical Significance:

Enamel remineralization with NovaMin after conditioning by bioactive glass air abrasion, provides the patients with a fast and durable treatment of incipient enamel lesions, which would reduce the possibility of future progression of demineralization and caries occurrence.

Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up

OBJECTIVE

The aim of this split-mouth, randomized, controlled clinical trial was to evaluate the efficacy of resin infiltration in controlling the progression of non-cavitated proximal lesions in primary molars after two-years follow-up.

METHODS

Fifty healthy children presenting at least two primary molars with proximal lesion detected radiographically (in the inner half of enamel or the outer third of dentin) were included in the study. The proximal lesions were randomly allocated into resin infltration + flossing (test group) or flossing (control group). All patients received oral hygiene instructions for daily brushing with fluoride toothpaste (1100 ppmF) and flossing. The proportion of caries progression was compared using the McNemar test. The main outcome after 2-years, caries progression in the radiography was assessed by pair-wise reading by an independent examiner who was blind regarding the treatment.

RESULTS

The sample comprised 28 (56%) girls and 22 (44%) boys with a defs of 7,3 (SD = 6,5), mainly of moderate (46%) to high (48%) caries risk. Results after one year were published previously. After 2-years, 29 (58%) patients were assessed. Caries progression was observed in 24.1% (7/29) of the test lesions, compared with 55.2% (16/29) of the control lesions (p = 0.012). The therapeutic effect was 31.1% and the relative risk reduction (RRR) was 56.3%. Eigth lesions from the control group and two lesions from the test group progressed to the inner third of dentin and were restored.

CONCLUSIONS

In conclusion, resin infiltration was more efficacious in controlling proximal caries lesions in primary molars than non-invasive approach alone.

CLINICAL SIGNIFICANCE

The results indicate that resin infiltration was an efficacious method in controlling proximal caries lesions in primary molars after 2 years, even in patients with high caries risk, reaffirming the results of 1-year follow-up.

Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial

Background

The aim of this trial was to comparatively evaluate Icon® resin infiltration and Clinpro™ XT varnish in restoring aesthetics of white spot lesions (WSLs) present post-orthodontic treatment.

Materials and methods

Two hundred forty WSLs were detected in 193 teeth of 12 patients. The participants were analysed—before intervention (T₀), immediately after intervention (T₁), 3 months later (T₂) and 6 months later (T₃), with a 1:1 allocation ratio for the application of Icon® resin infiltration and Clinpro™ XT varnish. Using a computer-generated allocation sequence, block randomization was done. A spectrophotometer was used to assess the colour of WSLs and the adjacent enamel, while a DIAGNOdent® was used to assess the fluorescence loss.

Results

Immediately after the intervention, Icon® resin infiltration showed statistically significant better improvement than Clinpro™ XT varnish in restoring the colour (p = 0.000); however, at 3 (p = 0.001) and 6 months (p = 0.000), this was reversed. Except at 3 months, the fluorescence loss sequentially reduced more for Icon® resin infiltration (4.48 ± 1.42 at T₀ to 1.48 ± 0.81 at T₃) and was not statistically significant.

Conclusions

Clinpro™ XT varnish showed significantly better improvement than Icon® resin infiltration in restoring the colour and lightness of the WSLs at 3 and 6 months. The fluorescence loss significantly recovered with both intervention methods between immediate application and at 6 months. However, Clinpro™ XT varnish-treated WSLs showed a statistically significant difference compared to the adjacent sound enamel at 6 months.

Resin Infiltration of Artificial Enamel Lesions: Evaluation of Penetration Depth, Surface Roughness and Color Stability

Aim

To evaluate the penetration depth, surface roughness, and color stability of resin infiltration restoration of artificial enamel lesions induced in primary and permanent teeth.

Materials and methods

Primary (group I, n = 30) and permanent (group II, n = 30) extracted non-carious human anterior teeth were subjected to demineralization for four days after creating a window of 5 mm × 5 mm on the labial surfaces. Demineralized area was infiltrated with the low viscosity resin. Ten samples from each group were evaluated for penetration depth, surface roughness, and color stability, respectively. Penetration depth was determined using a stereomicroscope at 80× magnification. Surface roughness of sound and infiltrated enamel was recorded using a profilometer. The color stability was assessed at 2, 4, and 8 weeks along with baseline values using vita easy shade spectrophotometer.

Results

Data were analyzed using the student “t” test and Friedman test. The degree of resin penetration was observed to be higher in primary teeth (32.6 ± 15.72 μm) compared to permanent teeth (24.23 ± 6.85 μm), but no significant difference was found (p = 0.138). Surface roughness values of resin infiltrated enamel is similar to that of sound enamel in both primary (p = 0.617) and permanent teeth (p = 0.234). The mean color stability scores immediately after resin infiltration at 2, 4, and 8 weeks intervals showed no statistically significant difference in primary (p = 0.998) and permanent teeth (p = 0.213).

Conclusion

Resin penetration into enamel lesions was more in primary teeth enamel compared to permanent. The early enamel lesions, when treated with resin infiltration, showed surface characteristics similar to sound enamel and also exhibited acceptable color up to 8 weeks duration.

Clinical significance

Resin infiltration can be considered as an effective and predictable treatment option for the restoration of early enamel lesions owing to its deeper penetration, provision of better surface characteristics, and reliable masking of white spot lesions in both primary and permanent dentitions.

How to cite this article

Aswani R, Chandrappa V, Uloopi KS, et al. Resin Infiltration of Artificial Enamel Lesions: Evaluation of Penetration Depth, Surface Roughness and Color Stability. Int J Clin Pediatr Dent 2019;12(6):520–523.

Is Resin Infiltration a Microinvasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review

Aim

The treatment of white lesions should aim at arresting the lesion progression of carious lesions and improving the esthetics by diminishing the opacity of the developmental disturbances of a tooth. The objective of this review was to present the scientific basis, the principles of resin infiltration and to discuss its inherent clinical applications.

Data sources

Data were identified by PubMed searches. Papers published in English between 2010 and 2015 were selected and most up-to-date or relevant references were chosen.

Conclusion

The resin infiltration technique, while promising, needed more clinical evidence for conclusive findings. However, based on available laboratory and clinical studies, it seems convincing that resin infiltration of enamel lesions should aim at arresting the progression of white spot lesions. Combining this microinvasive approach with a substantial caries remineralization program may provide therapeutic benefits and significantly reduce both long term restorative needs and costs, thus complementing the concept of minimum intervention dentistry.

How to cite this article

Manoharan V, Kumar AS, et al. Is Resin Infiltration a Micro invasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent 2019;12(1):53-58.