Effect of Resin Infiltration on Artificial Caries: An in vitro Evaluation of Resin Penetration and Microhardness

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.

Effect of CPP-ACPF, resin infiltration, and colloidal silica infiltration on surface microhardness of artificial white spot lesions in primary teeth: An in vitro study

Background

Remineralizing agents such as fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) are popular treatment choices for incipient enamel lesions. Recently introduced resin infiltration enhances the esthetics of teeth affected by these enamel lesions. Furthermore, few studies reported the utilization of colloidal silica infiltration for the white spot lesions. However, the potency of these materials for treatment in primary teeth necessitates investigation.Thus, this study evaluated and compared the effectiveness of CPP-ACP fluoride (CPP-ACPF), resin infiltration, and colloidal silica infiltration on surface microhardness in artificial white spot lesions in primary incisors using the Vickers microhardness testing machine.

Materials and Methods

In this in vitro study, on the labial surface of 45 primary incisors, artificial white spot lesions were created by immersing them in a demineralizing solution. According to the evaluation method, random distribution of specimens into three groups: Group 1: CPP-ACPF, Group 2: resin infiltration, and Group 3: colloidal silica infiltration. Specimens after treatment were stored in artificial saliva, followed by microhardness evaluation using Vickers microhardness. Microhardness readings at baseline, post demineralization, and after treating them with different materials were taken. The level of significance was 0.01.

Results

Enamel specimens treated with resin infiltration showed a high microhardness mean value compared to CPP-ACPF and colloidal silica infiltration.

Conclusion

Resin infiltration is a promising and effective treatment option for incipient enamel lesions followed by CPP-ACPF compared to colloidal silica infiltration in primary teeth.

Can the hydrogel form of sodium ascorbate be used to reverse compromised resin infiltrant penetration after bleaching?

Aims

The aim of this study was to investigate the effects of an antioxidant on the bleaching-induced reduction in the penetration depth of infiltrant resins.

Materials and Methods

White spot lesions (WSLs) were created on 105 bovine tooth samples, each measuring 6 × 4 × 4 mm. Five samples were randomly selected for the examination of lesion characteristics. The remaining 100 samples were then divided into four groups (n = 25). In Group I, the WSLs were treated with resin infiltration (RI) only. RI was performed on Group II immediately after bleaching. In Group III, an antioxidant was applied for 2 h after bleaching, and this was immediately followed by RI. The Group IV samples were treated with RI at the end of a 1-week waiting period after bleaching. The penetration depths were evaluated through confocal laser scanning microscopy.

Results

The lowest penetration rate, which was approximately 57%, was observed in Group II. This was followed by Group III (87%), Group IV (90%), and Group I (92%). Group II, in which the samples were infiltrated immediately after bleaching, had the lowest mean penetration percentage. All the bleached groups exhibited significantly lower penetration percentages than the nonbleached group (Group I) (P < 0.05). Antioxidant application increased the penetration significantly (P < 0.05).

Conclusion

Application of sodium ascorbate was found to reverse the reduced resin penetration depth and penetration percentages resulting from bleaching. The postponement of adhesive procedures after bleaching yielded similar results.

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.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

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 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.

Effects of different anti-caries procedures on microhardness and micromorphology of irradiated permanent enamel

To explore the effects of infiltration resin, casein phosphate polypeptide-amorphous calcium phosphate (CPP-ACP) and fluoride on microhardness and micromorphology of irradiated enamel. Sixty human permanent teeth were mesiodistally sectioned, yielding 120 enamel samples, which randomly divided into 8 groups: G1: blank control; G2: irradiation control; G3: irradiation+fluoride; G4: irradiation+CPP-ACP; G5: irradiation+CPP-ACP+fluoride; G6: irradiation+infiltration resin; G7: irradiation+infiltration resin+fluoride; G8: irradiation+infiltration resin+CPP-ACP. A progressive improvement was observed on the superficial morphology of enamel treated with different anti-caries procedures. The order of microhardness values after irradiation from the highest to the lowest was as follows: G1>G8~G7>G6>G5>G4~G3>G2. CPP-ACP, infiltration resin and fluoride can effectively restore the direct destruction of enamel caused by irradiation and promote the occurrence of remineralization. Infiltration resin and its combined effects with fluoride or CPP-ACP have the most potential anti-caries agent to resist radiation-caries.

Effect of Resin Infiltration Technique on Improving Surface Hardness of Enamel Lesions: A Systematic Review and Meta-analysis

OBJECTIVE

White spot lesion (WSL) is recognized as the first clinical sign of enamel caries; it is a very critical phase because it can be prevented from progression to frank caries by changing the surrounding destructive environment. The present study was undertaken to systematically review the effect of resin infiltration (RI) technique on surface hardness (SH) of WSL.

METHODS

Five electronic databases were searched with proper key words. Related titles and abstracts, up to October 2018, were screened, selected, and subjected to quality assessments. After collecting data, meta-analyses were carried out to compare the effect of RI with untreated WSL and sound enamel by using the STATA software.

RESULTS

A total of 4567 articles were included in the study after initial search. Finally, 10 studies were reliable enough in methodology to be included in the study. Metadata analyses, carried out on 7 studies that compared SH of RI group with untreated samples, showed a significant increase in SH with 3.66 mean difference (95% confidence interval = 2.56‒4.77, Q value = 36.07, I² = 83.4%). However, meta-analysis on 4 studies that compared SH of RI with sound enamel showed a significant decrease in SH with -2.35 overall mean difference (95% confidence interval = -3.91-0.98, P = .00, Q value = 31.75, I² = 90.6%).

CONCLUSION

The RI technique can enhance SH of WSL; however, regaining the SH of RI-treated WSLs similar to sound enamel is doubtful. Application of RI is more effective than other methods, including application of fluoride, enamel pro-varnish, adhesive, and colloidal silica infiltration for enhancing SH of WSLs.

Effects of different anti-caries agents on microhardness and superficial microstructure of irradiated permanent dentin: an in vitro study

BACKGROUND

To compare different anti-caries agents on microhardness and micromorphology of irradiated permanent dentin in vitro, and try to find the most effective agent to prevent radiation-dentin-destruction.

METHODS

A total of 120 dentin samples were prepared from 60 human teeth and randomly divided into 8 groups (n = 15), [ (1)] blank control [2]; irradiation control [3]; irradiation+ fluoride [4]; irradiation+ casein phosphate polypeptide-amorphous calcium phosphate (CPP-ACP) [5]; irradiation+ CPP-ACP+ fluoride [6]; irradiation+ infiltration resin [7]; irradiation+ infiltration resin+ fluoride [8]; irradiation+ infiltration resin+ CPP-ACP. Seven samples of each groups were chosen randomly for microhardness test and eight for scanning electron microscope observation.

RESULTS

A decrease of microhardness (P < 0.05) and an obvious morphological change were presented on dentin surface after radiotherapy. After applications of anti-caries agents, the morphological destructions were effectively restored. The infiltration resin plus fluoride group (56.00 ± 4.02 Kg/mm2), infiltration resin plus CPP-ACP group (56.05 ± 3.69 Kg/mm2), infiltration resin group (54.70 ± 4.42Kg/mm2) and CPP-ACP plus fluoride group (53.84 ± 6.23Kg/mm2) had the highest dentin microhardness value after radiotherapy, and no statistically significant difference were found between them.

CONCLUSIONS

Infiltration resin, CPP-ACP, fluoride and their pairwise combination can effectively prevent radiation-dentin-destruction. Among them, infiltration resin with CPP-ACP, infiltration resin with fluoride, CPP-ACP with fluoride, and infiltration resin have the most protective effects on irradiation-dentin-destructions.

The Efficacy of Different Sealant Modalities for Prevention of Pits and Fissures Caries: A Randomized Clinical Trial

Objectives

This clinical trial evaluates the efficacy of different pit and fissure sealant modalities as a caries prevention tool.

Materials and Methods

Forty-four children aged 6-8 years with completely erupted first permanent molars participated in sealant placement randomized clinical trial. Split-mouth technique used and each child received four treatment modalities (ICON, Seal It, GCP glass seal, ICON/Seal It combination). Caries progression and sealant retention monitored over a period of 24 months.

Results

Seal It and combination modalities had the highest efficacy in the prevention of pits and fissures caries, whereas the ICON had the lowest efficacy. Regarding retention, there were no significant differences among the four modalities during the 1, 3, and 6 months follow-up intervals. However, at 12, 18, and 24 months, the retention of Seal It and combination modalities were better than ICON and better than GCP, but the differences were not statistically significant. In addition, the retention of combination modality was better than Seal It, but the difference was not significant. At the end of the trial, the caries incidence was the highest in ICON group (20 lesions) followed by GCP group (13 lesions), Seal It group (3 lesions) and the lowest observed in combination group (2 lesions).

Conclusions

Both Seal It and combination modalities are highly effective in the prevention of pits and fissures caries, GCP has acceptable effect while the use of ICON alone was not effective. The Seal It and ICON combination improves their clinical efficacy in caries prevention.