Evaluation of the staining potential of a caries infiltrant in comparison to other products

Effect of Bleaching on Resin-Infiltration-Masked Artificial White Spots In Vitro

Resin infiltration is an effective method to mask vestibular white spots. If needed, external bleaching is usually recommended before infiltration, whilst in clinical practice, this sequence may not always be feasible. This in vitro study evaluated the effect of bleaching after resin infiltration regarding surface roughness and color using bovine incisors. Unlike for the untreated specimens (control, n = 25), artificial caries lesions were created within the test group (n = 25) using a demineralization solution at 37 °C for five days (pH = 4.95). The lesions were subsequently infiltrated using a resin infiltrant (Icon, DMG, Hamburg, Germany), followed by polishing. Afterwards, all specimens were bleached with a 10% carbamide peroxide gel (Opalescence, Ultradent, South Jordan, UT, USA) for 8 h/day over a ten-day period. Between bleaching treatments, specimens were stored in an opaque container with moistened paper tissues at 37 °C. Surface roughness was measured using a profilometer, and color in the L*a*b* space was assessed spectrophotometrically before and after bleaching. Bleaching increased the L*-values of both infiltrated (mean ± SD; ΔL* = 3.52 ± 1.98) and untreated (control) specimens (ΔL* = 3.53 ± 2.30) without any significant difference between the groups (p = 0.983). Bleaching also induced a significant increase in the mean surface roughness of both infiltrated (p < 0.001) and untreated (p = 0.0134) teeth. In terms of clinical relevance; it can be concluded that bleaching resin-infiltrated enamel is as effective as bleaching sound enamel.

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.

Time-dependent effect of intense capsule-coffee and bleaching on the color of resin-infiltrated enamel white spot lesions: an in vitro study

Background and Objectives

White spot lesions (WSLs) are a common problem that can be conservatively managed by resin infiltration. Consumption of dark beverages such as coffee causes staining of dental hard tissues, which can deteriorate the esthetic qualities of treated WSLs. The aims of this study were to investigate the effect of dark coffee heavy consumption on ICON^® resin infiltrated WSLs and the influence of bleaching on them after staining.

Methods

Twenty surfaces from sound human extracted third molars were used in the study. Two square-shaped buccal and lingual window areas had artificially created WSLs (received buccal resin infiltration afterward). Using VITA Easyshade, the baseline ΔE was recorded. Espresso coffee was used to immerse all surfaces for 8 days. The color coordinates according to CIE LAB were recorded for all surfaces at 2, 4, 6, and 8 days of immersion, and ΔE was calculated at each timepoint. After 8 days, in-office bleaching was applied to all surfaces according to the manufacturer's instructions and the color. Coordinates and ΔE were recorded. For statistical analysis, an independent sample t-test was used to compare each group. A general linear mixed model (GLMM) repeated measure ANOVA was applied for statistical analysis of L^*and changes due to staining over time.

Results

Analysis of time as a main effect on the L values of surfaces was statistically highly significant (p < 0.01). The interaction of time with surfaces under investigation and type of surface (test vs. control) as a main effect were non-significant (p = 0.47 and p = 0.35, respectively). Bleaching showed a significant difference in color lightness in both test and control surfaces compared to the mean L value at 8 days of staining (p < 0.01).

Conclusion

Capsule-coffee consumption gradually influences the esthetic of resin infiltration on treated teeth. However, bleaching materials might restore an esthetic shade.

Assessment of Enamel Color Stability of Resins Infiltration Treatment in Human Teeth: A Systematic Review

(1) The evolution of techniques and materials used in dentistry has led to the introduction of a technique known as micro-infiltration, using ICON infiltrating resin. The purpose of this study was to evaluate whether the resin infiltrant can remain stable in the enamel color of human teeth over time or if it causes discoloration and review current knowledge on color stability based on the literature selected solely on studies performed on human teeth and to provide a perspective on the methods proposed by clinicians in the infiltration procedure; (2) Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement; (3) Results: Twelve studies were selected for this review. The study results suggest that the device content is sufficiently comprehensive. The reviewers expressed strong support for the device's content for assessing the quality of reviews. The paper summarizes current reports regarding the color stability assessment of enamel treated by in- filtration resin confirmed in in vitro and in vivo studies; (4) Conclusions: Based on these considerations, the resin infiltration method can be recommended to improve the appearance of enamel lesions. The infiltrated lesions remained chromatically stable, showing no significant color changes in the long term.

Colour stability of resin infiltrated white spot lesion after exposure to stain-causing drinks

Background

The resin-based materials are used extensively in esthetic restorations but are.

prone to color changes over time.

Aims

To assess the discoloration effect of red tea, Arabic coffee, and black coffee on the resin infiltrated white spot lesions (WSL). Moreover, to investigate the impact of time (1d, 3d, and 7d) on the discoloration of the resin infiltrated WSLs.

Materials and methods

Thirty-three extracted human premolar teeth were used to create WSLs, and ICON resin infiltration treatment was performed to obliterate the enamel pores. Teeth with resin infiltrated WSLs were sectioned into two halves by cutting mesio-distally and cross-sectionally at 1 mm below the CEJ. The resin infiltrated specimens was exposed to control (artificial saliva) and staining subgroups. Colour stability was assessed using the CIE L*a*b* system.

Results

Analysis of variance (p < 0.05) and Tukey’s multiple comparison tests revealed an insignificant color change in the control group. The immersion of resin infiltrated specimens at time intervals of 1 d (p < 0.001), 3 d (p < 0.001), and 7 d (p < 0.001) showed significant differences in color change.

Conclusion

Resin infiltrated WSLs showed marked color changes after exposure to red tea, black coffee, and Arabic coffee over time. Severe discoloration of the infiltrant was evident with the use of red tea compared to black coffee and Arabic coffee. This suggests that ICON resin-based composite material might not be a suitable material for WSL infiltration.

Systematic Review on White Spot Lesions Treatments

The difference in refractive index between the healthy enamel and the demineralized area generates a lesion with a milky white opaque appearance, clearly distinguishable from the surrounding healthy enamel. The aim of this systematic review was to evaluate if the infiltration technique is the most efficient treatment to resolve a white spot lesion when compared with remineralization and microabrasion techniques. The Population/Intervention/Comparison/Outcome question investigated: “in enamel WS lesion, the infiltration treatment compared to remineralization or microabrasion treatments is more or less effective in the camouflage effect?.” The research was performed on electronic databases, including Ovid MEDLINE, PubMed, and web of science. The search was conducted up to April 1, 2020. The scientific search engines produced 324 results. Only 14 were screened after screening. Based on the articles analyzed in this systematic review, the resin infiltration technique seems to be the most effective and predictable treatment for the aesthetic resolution of WSLs.

Do bleaching gels affect the stability of the masking and caries-arresting effects of caries infiltration-in vitro

Objectives

The aim of this study was to evaluate the influence of different bleaching gels on the masking and caries-arresting effects of infiltrated and non-infiltrated stained artificial enamel caries lesions.

Materials and methods

Bovine enamel specimens (n = 240) with each two sound areas (SI and SC) and each two lesions (DI and DC) were infiltrated (DI and SI), stained (1:1 red wine-coffee mixture,70 days), and randomly distributed in six groups to be bleached with the following materials: 6%HP (HP-6), 16%CP (CP-16), 35%HP (HP-35), 40%HP (HP-40), and no bleaching (NBl,NBl-NBr). Subsequently, specimens were pH-cycled (28 days, 6 × 60 min demineralization/day) and all groups except NBl-NBr were brushed with toothpaste slurry (1.100 ppm, 2×/day, 10 s). Differences in colorimetric values (ΔL, ΔE) and integrated mineral loss (ΔΔZ) between baseline, infiltration, staining, bleaching, and pH cycling were calculated using photographic and transversal microradiographic images.

Results

At baseline, significant visible color differences between DI and SC were observed (ΔE_baseline = 12.2; p < 0.001; ANCOVA). After infiltration, these differences decreased significantly (ΔE_infiltration = 3.8; p < 0.001). Staining decreased and bleaching increased ΔL values significantly (p ≤ 0.001). No significant difference in ΔΔE was observed between before staining and after bleaching (ΔE_bleaching = 4.3; p = 0.308) and between the bleaching agents (p = 1.000; ANCOVA). pH-cycling did not affect colorimetric values (ΔE_pH-cycling = 4.0; p = 1.000). For DI, no significant change in ΔZ during in vitro period was observed (p ≥ 0.063; paired t test).

Conclusions

Under the conditions chosen, the tested materials could satisfactorily bleach infiltrated and non-infiltrated stained enamel. Furthermore, bleaching did not affect the caries-arresting effect of the infiltration.

Clinical relevance

The present study indicates that bleaching is a viable way to satisfactorily recover the appearance of discolored sound enamel and infiltrated lesions.

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.

Staining potential differences between an infiltrative resin and an esthetic, flowable composite

OBJECTIVE

To compare color change magnitude of an infiltrative resin and a flowable composite resin after immersion in commonly consumed beverages.

MATERIALS AND METHODS

Disks (1 × 9 mm) of a flowable composite (Filtek Supreme Ultra Flowable) and a resin-infiltrative product (Icon) were made. Specimens were dark-stored in tap water (24 hours). Baseline color parameters (CIE L*a*b*) were obtained using a colorimeter (Easyshade V4, VITA). Specimens were immersed (dark stored, 37°C, 1 week) in commercial beverages: Kool-Aid, coffee, Coca-Cola, and tap water (control). ΔE₀₀ between final and baseline conditions for each material/beverage combination was determined (N = 10/group). Initial analysis of variance indicated significant impact of major factors/interactions on ΔE₀₀ . Subsequently, t-tests between ΔE₀₀ values of restorative materials within each beverage was performed: alpha 0.05.

RESULTS

Kool-Aid produced the greatest color change for flowable composite, with a ΔE₀₀ significantly greater than the infiltrative product. No significant ΔE₀₀ differences were noted between products immersed in coffee, however color parameters causing these differences were not similar. Water or Coca-Cola immersion showed lowest ΔE₀₀ values for both materials, considered visually imperceptible: ΔE₀₀ values <0.8.

CONCLUSIONS

Color change potential of infiltrative resin or resin composite was highly dependent on beverage type, with no general trends observed in which material was affected more.

CLINICAL SIGNIFICANCE

Staining potential of an infiltrative restorative resin differs from that of a filled, flowable composite material on a beverage-by-beverage basis. The potential for color change seems not related to the presence or absence of fillers in the restorative material.

Resin infiltrant for non-cavitated caries lesions: evaluation of color stability

BACKGROUND

The objective of this in vitro study was to evaluate the over time color stability of one resin infiltrant (Icon) upon exposure to staining solutions (coffee and wine) compared with one nano-hybrid sealant (Grandio Seal), one transparent fissure sealant with fluoride (Control Seal) and one nanofilled composite (Filtek Supreme XTE).

MATERIAL AND METHODS

All materials were polymerized according to manufacturers' instructions into silicon rings (height 1 mm; internal diameter 6 mm; external diameter 8 mm) to obtain specimens identical in size. The specimens were immersed in staining solutions at room temperature over a 28-day test period. The control samples have not been subjected to the staining process. A colorimetric evaluation according to the CIE L*a*b* system was performed by a blind trained operator at 7, 14, 21, 28 days of the staining process. Shapiro Wilk test and Kruskal Wallis ANOVA were applied to assess significant differences among different materials. Means were compared with Scheffe's multiple-comparison test at the 0.05 level of significance.

RESULTS

In the case of all materials, immersion in solutions resulted in clinically perceivable color changes after 1 week (∆E < 3.3). Lowest CIE L* variation was registered for Control Seal and Grandio Seal both after 1 week and after 1 month, while Icon showed significantly higher variation (P < 0.05). Color coordinate CIE a* varied significantly more for Icon samples (P > 0.05). Color coordinate CIE b* varied similarly for all materials tested (P > 0.05).

CONCLUSIONS

Immersion in coffee or red wine resulted in clinically perceivable color changes for all materials tested. Icon showed the highest color variations both after 1 week and 1 month. Icon can fix the initial esthetic problem associated with white spot lesions, but the resin may become more discolored than other materials over time. Key words:CIE Lab, color stability, resin infiltrant.

Surface Properties and Color Stability of Resin-Infiltrated Enamel Lesions

OBJECTIVES

To examine the surface topographies, microhardness, and color stability of resin-infiltrated enamel lesions before and after aging challenges in vitro using three-dimensional laser scanning profilometry, surface microhardness testing, spectrophotometry, and scanning electron microscopy.

METHODS

Forty human third molars were embedded in epoxy resin, and each tooth was prepared to have two white spot lesions and one sound enamel area. One white spot lesion received resin infiltration and the other was untreated. Ten specimens were subjected to thermocycling for 10,000 cycles, 10 specimens were immersed in coffee solutions, and 10 specimens were placed in water storage. Surface area roughness (Sa), Vickers microhardness (VHN), and CIE L*a*b* color values were measured on sound enamel, resin-infiltrated lesions, and untreated lesions before and after aging. The surface morphology of resin-infiltrated lesions was observed after aging under scanning electron microscopy and compared with 10 specimens that were not subjected to aging challenge.

RESULTS

Resin infiltration increased the surface microhardness of the enamel lesions from 89.3 to 212.0 VHN. The surface microhardness of resin-infiltrated enamel lesions was not significantly affected by aging. The surface roughness of resin-infiltrated lesions (0.32-0.37 μm) was greater than that of sound enamel (0.05-0.06 μm) and untreated lesions (0.12-0.13 μm). Thermocycling and water storage further increased surface roughness of resin-infiltrated surfaces. Resin-infiltrated enamel lesions showed greater discoloration than sound enamel surfaces. Surface microfissures and microcracks were observed on resin-infiltrated enamel lesions after thermocycling.

CONCLUSIONS

Surface hardness of enamel lesions increased significantly after resin infiltration and remained stable following thermocycling. Surface roughness and color stability of resin-infiltrated enamel lesions were less than ideal and might further deteriorate after aging in the oral environment.

Evaluation of staining and color changes of a resin infiltration system

OBJECTIVE

To analyze the staining and color changes of a resin infiltrant system used for management of white spot lesions (WSLs).

MATERIALS AND METHODS

WSLs were artificially created on left buccal halves of 48 extracted human teeth. These sites were then treated with resin infiltration (RI) while the right halves of the teeth remained as nonresin (NRI) areas. Six groups were formed (n = 8 teeth/group) and were exposed to the following: red wine, coffee, orange juice, combined staining agents, accelerated aging, and distilled water for 1 week. The teeth were then polished with a prophy cup and polishing paste. Color properties were assessed using a spectrophotometer at baseline (T0), after each exposure (T1), and after polishing (T2). Color difference (ΔE*) was calculated between each time point for both halves of the teeth (RI and NRI). Data were analyzed with a two-way analysis of variance with presence of resin infiltration and staining agents as the main effects for each time point pair. Multiple comparisons were made with a Bonferroni post hoc test. The level of significance was set at P < .05.

RESULTS

The red wine and combined staining agent groups caused the greatest color change between all intervals (P < .05). Significant interactions were recorded between resin infiltration application and staining agents at all time periods (P < .05). The presence of resin infiltration as a main effect did not affect color change between T0 and T2 (P > .05).

CONCLUSIONS

RI areas showed higher staining susceptibility than did NRI areas. However, prophylaxis had a strong effect on reversing the discoloration of both RI and NRI areas.

Influence of Staining Solution and Bleaching on Color Stability of Resin Used for Caries Infiltration

OBJECTIVE

The objective of this study was to evaluate the color stability of Icon-infiltrated white spot lesions after staining and the bleaching effect on the infiltrated and stained surfaces.

METHODS AND MATERIALS

Enamel-dentin specimens (N=30, 5 × 5 × 3 mm, 1-mm enamel + 2-mm dentin thickness) were prepared from bovine incisors and randomly allocated into three groups (n=10): control, demineralized, and infiltrated. Artificial enamel subsurface lesions were created using 50 mL of 0.05 M acetate buffer solution. Specimens were produced by Icon application in enamel caries-like lesions, according to the manufacturer's instruction. Baseline color readings were assessed using a spectrophotometer, and CIE L*a*b* measurements of each specimen were performed using a white background. To simulate extrinsic dietary staining, specimens were placed into a 4-mL coffee infusion, three times daily for 15 minutes, for 14 days. After the staining procedure, color measurements were performed again. Then, bleaching procedures were performed using 16% carbamide peroxide gel for four hours daily for 21 days, and a final color assessment was performed. To compare the baseline and final measurements, t-test was used (α =0.05). The statistical comparison between the groups was performed using the one-way analysis of variance and Tukey tests (α =0.05).

RESULTS

Coffee staining provided a significant reduction of L* values and an increase of a* and b* in all groups (control, decayed, and infiltrated). The bleaching procedure provided a significant increase in L* and decrease of a* and b* values in all groups. There was no significant difference in ΔE values between decayed and infiltrated groups before bleaching, and after bleaching, the infiltrated group showed the lowest ΔE values.

CONCLUSION

It can be concluded that enamel infiltrated with Icon presents significant alteration of color after staining when compared with sound enamel. However, if there is discoloration of the infiltrant, the bleaching treatment can be used successfully.