Resin infiltration for white spot lesions: An in vitro experimental trial

OBJECTIVE

To evaluate the aesthetic outcome by varying the duration allowed for infiltrant penetration when treating white spot lesions with resin infiltration.

DESIGN

An in vitro, experimental randomised study.

METHODS

Artificially created white spot lesions (WSLs) were induced on 100 extracted anterior teeth (T1). Teeth were divided into enamel and dentine groups depending on the extent of the lesion and then randomly assigned into different treatment protocol groups: penetration times of 3, 6 and 9 min. Resin infiltration treatment was applied according to the treatment protocol assigned (T2). Samples were thermocycled for 10,000 cycles (1 clinical year) (T3). The samples from the 3-min enamel and dentine groups were then randomly assigned into either a repeat treatment or no additional treatment group (T4). Samples were then thermocycled for an additional 10,000 cycles (T5). Spectrophotometric analysis was measured colour change (ΔE) for all groups.

RESULTS

Mean ΔE values equal to or greater than the critical value (3.7) indicate a detectable clinical difference in colour of the treated WSL when compared to before WSL formation. Mean ΔE values, for the enamel groups, were slightly above or significantly below the critical value, and for the dentine groups, were significantly above the critical value. Mean ΔE values within the enamel and dentine groups both demonstrated a downward trend with increasing time allowed for resin infiltrant penetration (P < 0.05). No significant mean ΔE difference (P = 0.53) was found between groups that received a single or repeat treatment. After the first thermocycling event, no significant difference in colour change was observed in all groups except for the deep dentine lesion treated for 3 min. There was a significant difference in colour change for all groups except the enamel group that received a single treatment following thermocycling after a single or repeat treatment.

CONCLUSION

Increasing the resin infiltrant penetration time to at least 9 min is advised as the most optimised treatment protocol. Resin infiltration treatment should be done only once to treat a particular white spot lesion as subsequent treatment for the same lesion results in marginal colour improvement. The colour improvement of WSLs resulting from the resin infiltration treatment can be expected to last for at least 1 year. Resin infiltration treatment of shallow lesions with a single and optimised infiltration technique can be expected to last an additional year.

Influence of the Resin System and Sand Type on the Infiltration of 3D-Printed Sand Tools

Binder jetting is a highly productive additive manufacturing (AM) method for porous parts. Due to its cost-effectiveness, it is used for large components and quantities ranging from prototyping to series production. Post-processing steps like sintering or infiltration are common in several applications to achieve high density and strength. This work investigates how 3D-printed sand molds can be infiltrated with epoxy resins without vacuum assistance to produce high-strength molds for thermoforming applications. Specimens 3D-printed from different sand types are infiltrated with resins of different viscosity and analyzed for infiltration velocity and depth. The infiltration velocities corresponded well with the correlation described in Washburn's equation: The resins' viscosities and the saturation level were decisive. Amongst the investigated sand types commonly used in foundries, sand type GS19 was found most suitable for infiltration. However, the sand type proved to be a less relevant influencing factor than the resins' viscosities and quantities applied. Infiltration of topology-optimized 3D-printed sand tools up to a wall thickness of 20 mm for thermoforming applications was found to be feasible.

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.

Esthetic Effects and Color Stability of Resin Infiltration on Demineralized Enamel Lesions: A Systematic Review

Aims and Objectives

The aim of this study was to systematically review the ability of resin infiltration to conceal demineralized enamel lesions to normal enamel translucency and to maintain color stability.

Materials and Methods

A literature search of PubMed, MEDLINE, Web of Science, and Scopus databases and a manual search of articles from 2009 to 2021 for randomized controlled trials (RCTs) and clinical efficacy trials (nonrandomized) were performed. Methodological quality and risk of bias (RoB) of included papers was assessed using Cochrane Collaboration Risk of Bias Tool 2.0 for RCTs and ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) tool for nonrandomized studies.

Results

A total of 352 titles and abstracts were reviewed. Eight RCTs and three clinical efficiency studies were included in this review. The masking effects of the demineralized enamel lesion were reported immediately after resin infiltration, and the color stability of this material was up to 24 months, with no adverse effects noted. For RCTs, four studies were classified as "some concerns" and four were as "low RoB." For nonrandomized studies, all of the studies presented an overall moderate RoB.

Conclusion

Resin infiltration achieves the best esthetic outcomes compared with microabrasion and remineralization therapy. Color stability was achieved with this material for up to 24 months and no adverse effects were noted. Factors contributing to the esthetic outcomes of the resin include the elimination of the hypermineralized surface layer, the homogeneity of the resin itself, and polishing after resin infiltration. Longitudinal follow-up and improved control of confounding variables should characterize future high-quality systematic reviews.

Effect of bleaching on color and surface topography of teeth with enamel caries treated with resin infiltration (ICON®) and remineralization (casein phosphopeptide-amorphous calcium phosphate)

Background

Dental bleaching is not recommended on teeth with enamel caries.

Aim

The study aimed to assess the efficacy of in-office bleaching on demineralized enamel managed by resin infiltration (RI) as well as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).

Methodology

Forty-eight sound enamel specimens were divided into four groups based on the surface treatment performed before in-office bleaching. Group I consisted of no caries and no treatment (NT); Group II had artificial caries (AC) and NT; Group III had AC treated with RI, and Group IV had AC remineralized with CPP-ACP. Pre- and postbleaching teeth color and surface topography were evaluated using spectrophotometer and scanning electron microscope (SEM), respectively.

Statistical Analysis Used

One-way analysis of variance and Tukey's post hoc test were performed for inter-group comparisons.

Results

The color change postbleaching was the least in Group IV; and this was significantly less than Group I (P < 0.05) and Group II (P < 0.001). The bleaching efficiency in Group III was not significantly different from the control group. In addition, the enamel topographic changes were less in the surface-treated group.

Conclusion

RI can be considered a treatment modality for teeth with enamel caries requiring tooth whitening as the bleaching efficiency was like that of sound enamel.

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.

Repeated Etching Cycles of Resin Infiltration up to Nine Cycles on Demineralized Enamel: Surface Roughness and Esthetic Outcomes-In Vitro Study

Resin infiltration (RI) is used to mask enamel opacities. There are three recommended etching cycles. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. This study aimed to evaluate the effects of repeated etching cycles during RI application on esthetic changes and surface roughness of demineralized enamel at multiple treatment stages. Artificial demineralization was prepared on the buccal surface of ninety sound extracted premolars. The teeth were divided into nine groups (n = 10); with each consecutive group having one additional etching cycle up to nine etching cycles. Resin infiltrant was performed twice, first for 3 min (Resin 1) and again for 1 min (Resin 2). Surface roughness and esthetic changes were assessed using a profilometer (Ambios XP-200) and Minolta spectrophotometer, respectively, at baseline (sound enamel), etching, resin 1, resin 2, 7 days, and 28 days post resin applications. Data were analyzed with two-way ANOVA (p < 0.05). There was a significant interaction between the different stages and various groups of etching cycles on surface roughness, F(48, 126) = 3.48, p < 0.001. There was a significant interaction between the different stages and various groups of etching cycles on color changes, F(4, 126) = 1.177, p = 0.045. The surface roughness of demineralized enamel infiltrated with RI was less than that of sound enamel (baseline). There is a significant difference in color changes between resin 1 and resin 2 (p < 0.05). After five etching cycles, RI improved the esthetic of the color of teeth similar to the baseline. Surface roughness and color changes remained constant for 28 days. RI can be considered an effective and predictable treatment option for the restoration of early enamel lesions owing to its better surface characteristics and reliable masking effects. The color stability and surface roughness stay unaltered for up to 28 days.

The Penetration Depth of Resin Infiltration Into Enamel: A Systematic Review

Aims and Objectives

Studies on resin infiltration and its penetration capability are becoming the focus of emerging dentistry. The depth of resin penetration could be a key determining factor in creating a diffusion barrier and in the success of infiltration. The aim of this review article was to evaluate the penetration depth of commercially available resin infiltration in early caries lesions and to identify factors that influence the penetration capability of resin infiltration.

Materials and Methods

A literature search was performed in four databases (PubMed, Science Direct, Scopus, and Web of Science) and manual searching from 2009 to December 2022. Eligibility criteria included in vitro studies pertaining to factors affecting the penetration depth of resin infiltration into the enamel. The risk of bias assessment was done by using checklist for reporting in vitro studies (CRIS).

Results

The initial search resulted in a total of 297 studies. Twenty-nine were assessed for eligibility, and 23 were selected in the qualitative synthesis. According to the CRIS guidelines, all of the studies were classified as moderate risk of bias. The penetration of resin infiltration is influenced by the enamel surface treatment with hydrochloric acid, formulations containing triethylene glycol dimethacrylate (TEGDMA), the addition of ethanol, penetration time, duration of penetration time, saliva contamination, caries activity, and type of tooth. The hypermineralized surface layer needs to be removed for better resin perfusion.

Conclusion

The key to optimal resin infiltration depends on the enamel surface treatment with hydrochloric acid and application technique, infiltration duration, formulation of TEGDMA and ethanol in the resin composition, as well as the type and caries activity of involved teeth. Resin infiltration has superior penetrability compared to fissure sealant, casein phosphopeptide-amorphous calcium phosphate nanocomplexes, flowable composite, adhesive and fluoride varnish. Resin penetration depth may be a critical factor in forming a diffusion barrier and the effectiveness of infiltration in halting the progression of caries.

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.

Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials

The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.

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.

Impact of Dentistry Materials on Chemical Remineralisation/Infiltration versus Salivary Remineralisation of Enamel-In Vitro Study

The aim of this study is to evaluate salivary remineralisation versus chemical remineralisation/infiltration of enamel, using different dentistry materials. The enamel changes were studied using confocal laser scanning microscopy (CLSM), and the depth of lesions and demineralisation/remineralisation/infiltration percentage were calculated. Additionally, the macro elemental composition of the teeth was performed using atomic absorption spectroscopy (AAS). Two studies were performed: (i) demineralisation of enamel in 3% citric acid and infiltration treatment with infiltration resin (Icon, DMG), remineralisation with Fluor Protector (Ivoclar Vivadent) and artificial saliva pH 8; and (ii) enamel demineralisation in saliva at pH 3 and remineralisation at salivary pH 8. The results showed that, firstly, for the remineralisation of demineralised enamel samples, Fluor Protector (Ivoclar Vivadent) was very effective for medium demineralised lesions followed by saliva remineralisation. In cases of deep demineralisation lesions where fluoride could not penetrate, low viscosity resin (Icon, DMG, Hamburg) effectively infiltrated to stop the demineralisation process. Secondly, remineralisation in salivary conditions needed supplementary study over a longer period, to analyse the habits, diet and nutrition of patients in detail. Finally, demineralisation/remineralisation processes were found to influence the macro elemental composition of enamel demineralisation, with natural saliva proving to be less aggressive in terms of decreasing Ca and Mg content.

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.

Intercellular Matrix Infiltration Improves the Wet Strength of Delignified Wood Composites

Delignified wood (DW) represents a promising bio-based fibrous material as a reinforcing component in high-performance composites. These cellulose composites possess excellent strength and stiffness in the dry state, which are significantly higher than for natural wood. However, in the wet state, a penetrating water layer enters the intercellular regions and disrupts the stress transfer mechanisms between cell fibers in fully DW. This water layer initially facilitates complex shaping of the material but imparts DW composites with very low wet stiffness and strength. Therefore, a sufficient stress transfer in the wet state necessitates a resin impregnation of these intercellular regions, establishing bonding mechanisms between adjacent fibers. Here, we utilize a water-based dimethyloldihydroxyethylene urea thermosetting matrix (DMDHEU) and compare it with a non-water-based epoxy matrix. We infiltrate these resins into DW and investigate their spatial distribution by scanning electron microscopy, atomic force microscopy, and confocal Raman spectroscopy. The water-based resin impregnates the intercellular areas and generates an artificial compound middle lamella, while the epoxy infiltrates only the cell lumina of the dry DW. Tensile tests in the dry and wet states show that the DMDHEU matrix infiltration of the intercellular areas and the cell wall results in a higher tensile strength and stiffness compared to the epoxy resin. Here, the artificial compound middle lamella made of DMDHEU bonds adjacent fibers together and substantially increases the composites' wet strength. This study elucidates the importance of the interaction and spatial distribution of the resin system within the DW structure to improve mechanical properties, particularly in the wet state.

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.

Resin Infiltration Therapy: A micro-invasive treatment approach for white spot lesions

Purpose: The demand for esthetic dentistry has led to the development of new treatments for white spot lesions (WSLs). Microinvasive therapies, such as resin infiltration, have been used to treat demineralized enamel. Recently, resin infiltration using the active ingredient triethylene glycol dimethacrylate (TEGDMA), has been used to restore WSLs. The purpose of this narrative review is to evaluate the evidence on TEGDMA, an innovative resin that has been introduced, as an alternative dental material for treating WSLs.Methods: A review of the literature was conducted using key words pertaining to WSLs and resin infiltration including cosmetic dentistry; dental caries; dental materials; general dentistry; sealants; technology for patient care. Evidence was incorporated from biomedical data bases including PubMed and the Cochrane Library, which formed the framework for the review.Results: Based on the synthesis of the evidence, resin infiltration using TEGDMA is an effective alternative treatment option for WSLs. Studies suggest that the outcomes for micro-invasive procedures using resin infiltration may vary depending on the depth of the lesion.Conclusion: Resin infiltration, using TEGDMA, removes minimal amounts of enamel and preserves the hard tissue surrounding the WSLs. Additionally, TEGDMA restores the natural fluorescence, hardness, and texture of intact enamel. Future studies are needed to assess the long-term clinical effects of resin infiltration using this material on both permanent and primary dentition.

Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study

BACKGROUND

The purpose of this study was to compare color alterations (ΔE) of white-spot lesions (WSLs) bleached before versus after resin infiltration (RI).

METHODS

Using the facial surfaces of bovine maxillary incisors, WSLs were created and the teeth were allocated into 2 groups (n = 45/group): bleach then RI (B-RI group) and RI then bleach (RI-B group). To determine ΔE, Commission Internationale de l'Eclairage L∗ a∗ b∗ (L∗ represents lightness, ranging from black to white [0-100]; a∗ represents green to red chromaticity [-150-+100]; and b∗ represents blue to yellow chromaticity [-100-+150]) measurements were obtained at baseline, after WSL formation, and after RI and bleaching. Representative specimens were evaluated by means of scanning electron microscopy. Statistical analyses included the Mann-Whitney U and Wilcoxon signed rank tests (P ≤ .0016) and repeated measures analysis of variance (P ≤ .05).

RESULTS

No differences in ΔE were found comparing B-RI with RI-B groups or when the B-RI group was compared with bleached enamel. A statistically significant difference was found when the RI-B group was compared with bleached enamel (ΔE, 0.81; P < .001), but the difference was deemed not clinically significant. Scanning electron microscopy revealed that bleaching after RI increased surface roughness of the resin.

CONCLUSIONS

There were no clinically significant differences in ΔE of WSLs when bleach was applied before or after RI; however, applying bleaching agent after RI roughened the surface of the resin material.

PRACTICAL IMPLICATIONS

Results indicate that ΔE were not clinically significantly different between WSLs bleached before versus after RI, although it is best to sequence bleaching before RI therapy, as bleaching after RI roughened the restoration's surface.

Effect of Ageing Process and Brushing on Color Stability and Surface Roughness of Treated White Spot Lesions: An in vitro Analysis

Purpose

To evaluate the effect of ageing process and brushing on the color stability and surface roughness of white spot lesions treated with resin infiltration or remineralization.

Patients and Methods

Artificial white spot lesions were created on the facial surface of extracted bovine teeth. Specimens were divided into three main groups based on treatment received: resin infiltration (Icon), MI Paste Plus (MI) or no treatment (control). Specimens underwent pH cycling for 7 days, followed by brushing with toothbrush simulator. Specimens were then immersed in three different solutions (water, cranberry juice, or coffee) for 7 days. Surface roughness (SR) and color stability (CS) assessments were performed at baseline and after each test. One-way and two-way ANOVA were used to calculate the statistical comparisons between the groups and significance considered at P <0.05.

Results

Icon group had the least color change after pH cycling, while MI showed the least color change after brushing test. Immersion in coffee produced the highest color change in all groups, followed by cranberry juice. Icon group had the best color stability when immersed in cranberry juice or coffee. Control and the MI treated specimens showed gradual increase of SR after pH cycling and brushing test, while Icon group had improved surface properties. Brushing test alone produced less color change in comparison with immersion in cranberry juice and coffee; however, brushing increased SR.

Conclusion

Icon treatment showed superior color stability and surface roughness, compared to the control and the MI treated teeth. Brushing had less influence on color change compared to the immersion in cranberry juice or coffee.

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.

Success of resin infiltration treatment on interproximal tooth surfaces in young adults-A practice-based follow-up study

Objectives

Arresting active initial caries lesions is part of the modern caries controlling system. Resin infiltration (RI) system has been found a promising method in arresting interproximal initial lesions. The aim was to investigate whether RI arrests progression of active caries lesions.

Materials and methods

Participants (n = 20) of the retrospective study were patients in the Dental Teaching Unit, City of Oulu, Finland, mean age 26 years (SD5.2). Indication for RI was radiographically diagnosed progressing (ICDAS 1–3) interproximal lesions (n = 54). RI treatments were performed in 2015–2017. Controls were initial lesions in the same bitewing radiographs without RI or other treatment (n = 24). For analyzes teeth were categorized as lower and upper premolars and molars. The change in lesions during the follow‐up period was recorded surface wise as follows: deterioration / improvement from ICDAS score 3/improvement from ICDAS score 2/improvement per se/at follow‐up, lesion was less diffuse/no change. The changes in each tooth surface were analyzed between RI intervention and control teeth by using Chi‐square test. Proportions of successful and failed surfaces were given.

Results

The mean length of follow‐up period was 17.4 m (SD7.2). Arresting of caries lesions (ICDAS scores 2 and 3) was distinctly better in RI group (63.0%) compared with the controls (29.1%). The situation progressed among 29.2% of the controls whereas the respective proportion among the intervention group was 14.8%. Progression of lesions was more distinct in all tooth groups in the control group. Outcome was successful despite the lesion depth.

Conclusions

Resin infiltration seems effective in arresting progression of initial caries lesions with monitoring period of 1.5 years.

Investigation of the esthetic outcomes of white spot lesion treatments

Objective

The present study compared the ability of bleaching, resin infiltration and microabrasion to restore the appearance of existing white spot lesions (WSL) on tooth surfaces as close as possible to that of the original healthy enamel.

Materials and Methods

Sixty extracted human teeth with WSL were randomly assigned to three treatment groups (20/group). Prior to treatment, the colour of the surrounding healthy enamel and the WSL were measured as the baseline and pre-treatment (PreRX) colours respectively using spectrophotometer based on CIE L*A*B. The L-value was used for the statistical comparison. WSLs in each group were treated respectively by bleaching, infiltration or microabrasion following the manufacturer's instructions. Colour measurement was repeated after treatment. Both intragroup and intergroup comparisons were performed using ANOVA followed by Tukey's multiple comparison test (α=0.05).

Result

In all groups the mean L-values were significantly higher in PreRX WSL (P < 0.01; Tukey) compared to baseline (sound enamel). After treatment the difference in mean L-value between baseline and WSL increased significantly (P < 0.01, Tukey) in Bleaching and Microabrasion groups by 1.4% and 1% respectively, but decreased in Infiltration group by 3.4%. Thus resin infiltration decreased the L-value of the WSL, bringing it closer to the L-value of the sound enamel while bleaching and microabrasion increased the L-value.

Conclusions

Among the three treatment modalities investigated in this study, resin infiltration was the most effective in masking the WSLs.

Minimally invasive esthetic management of dental fluorosis: a case report

Dental fluorosis is a dental condition caused by excessive intake of fluoride during enamel formation, which can lead to color abnormalities or defects on the tooth surface. The resultant abnormal appearance ranges in severity from mildly white and opaque to dark brown, which substantially affects patients' esthetic characteristics and self-confidence. Treatment methods include tooth whitening or restoration. This clinical report describes the use of a minimally invasive esthetic technique in a 22-year-old woman with moderate dental fluorosis. The treatment plan included enamel microabrasion, at-home bleaching for 2 weeks, and subsequent resin infiltration for each tooth under a rubber dam. After 2 years of follow-up, evaluation of the patient's esthetic appearance revealed that teeth affected by dental fluorosis could be successfully treated with a minimally invasive technique involving microabrasion, at-home bleaching, and resin infiltration.

Microleakage of resin infiltration in artificial white-spot lesions

This study examined the effectiveness of resin infiltration in inhibiting microleakage from artificial white-spot lesions (AWL) in enamel. Fifty sound extracted premolars were selected and randomly divided into five groups (n = 10 each). Group 1 included sound teeth. In contrast, an AWL was created in all specimens in groups 2 to 5, as follows-Group 2: AWL with no treatment; Group 3: AWL treated with resin infiltration; Group 4: AWL treated with resin infiltration and 5,000 cycles of thermocycling; Group 5: AWL treated with resin infiltration and 10,000 cycles of thermocycling. All specimens were then coated with nail varnish, except for a 4 × 4 mm² area on the buccal surface (the measurement area), immersed in 2% methylene blue solution, and sectioned buccolingually. Microleakage was evaluated with a stereomicroscope. Data were analyzed by using the Kruskal-Wallis test and Bonferroni post-hoc correction. Application of resin infiltrant reduced microleakage in AWL. No microleakage was seen in Group 3, and differences between Groups 3, 4, and 5 were not significant (P > 0.05). The resin infiltration technique appears to aid in sealing enamel AWL and may help provide long-term protection against microleakage in enamel AWL.

Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions

OBJECTIVES

To evaluate masking effects of resin infiltration on labial white spot lesions (WSL), by comparing the latter with a remineralization approach (using hydroxyapatite and fluorides) and conventional oral care (using fluoride-free toothpaste).

METHOD AND MATERIALS

Fifteen patients with at least three WSL were enrolled for a within-person randomized controlled trial, thus allowing for intrapersonal comparisons. Each WSL per tooth in every patient was randomly assigned to one of the following groups. Group 1: lesions were resin-infiltrated with Icon (RI; DMG); Group 2: Remin Pro (RP; VOCO) was used as remineralizing agent; and Group 3 (control): affected teeth were brushed with Complete Care toothpaste (CC; Himalaya). RP and CC were applied by means of a polishing brush, using a low-speed handpiece (5 min), and these procedures were repeated chairside thrice daily for 7 consecutive days. Digital photographs were captured before and after lesion treatment under standardized conditions. The CIE L*a*b* color system was used to analyze the optical outcome, and intrapersonal color differences were statistically evaluated.

RESULTS

Compared to RP and CC, RI showed prompt and subjectively satisfactory color improvements, and this was primarily driven by L* and b* shifts. Statistical analysis of the objective color differences (ΔE*) between the three groups revealed significant differences for RI vs RP (P = .029), RI vs CC (P < .001), and RP vs CC (P = .001).

CONCLUSION

Resin infiltration is considered a time-effective treatment option for esthetically camouflaging WSL, while RP and CC failed to improve lesion appearance and oral health in the current short-term trial.

Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review

BACKGROUND

Children with first permanent molar affected by molar-incisor hypomineralization (MIH) show high treatment failure rate.

AIM

To conduct a systematic review on bonding of adhesive materials to MIH-affected enamel, so as to identify all the methods suggested to optimize it and to determine the best bonding protocol(s).

DESIGN

An exhaustive literature search was conducted on MEDLINE/PubMed, the Cochrane Library, and Web of Science databases, up to October 2018. Laboratory and clinical studies, involving adhesive restorations bonded to MIH-affected enamel, with at least a comparative group were included. Two authors independently selected studies, collected data, and assessed bias risk.

RESULTS

After title and abstract review and duplicate exclusion, 14 articles were selected on the 496 eligible papers. After full reading, 4 articles were excluded. Finally, 10 studies (6 laboratory and 4 clinical studies) were included.

CONCLUSIONS

Bond strength of composite was not significantly different when using self-etch compared with etch-and-rinse adhesives. Deproteinization after etching for etch-and-rinse adhesives enhanced bond strength; this could allow to keep MIH-affected enamel. Icon^® showed an erratic penetration; however, a preliminary deproteinization after etching could improve bond strength. A study reported no significant differences in sealant retention rate, whereas another recommended to previously apply an adhesive.

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.

Quantitative evaluation of masking effect of resin infiltration on developmental defects of enamel

OBJECTIVE

Qualitative developmental defects of enamel (DDEs) are characterized by an intact hypermineralized surface enamel layer and a porous subsurface hypomineralized layer. This structure is similar to natural early caries lesions, which are effectively arrested by resin infiltration, a micro-invasive clinical procedure. An additional reported effect in early enamel caries is recovery of enamel translucency. Due to structural similarities, a similar mechanism is expected in qualitative DDEs. The objective of the present study was to observe quantitative color masking of qualitative DDEs when subjected to resin infiltration.

METHOD AND MATERIALS

A total of 70 selected enamel defects were subjected to resin infiltration in a nonrandomized study design. Each defect was subjected to photographic imaging using a digital camera both pre- and post-intervention. Each image was assessed using ImageJ digital software (National Institutes of Health) for CIE L*a*b coordinates.

RESULTS

There were significant changes observed in L*a*b coordinates of all DDEs, when subjected to resin infiltration.

CONCLUSION

The resin infiltration intervention was successful in masking the "white" opaque discolorations of developmentally affected enamel.

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.

Interventions in management of dental fluorosis, an endemic disease: A systematic review

Objective:

Mottling and pitting of enamel due to excess fluoride consumption may affect one's self-esteem due to unaesthetic appearance and also in turn can affect the quality of life. This present study was conducted to assess various treatment approaches available for patients with dental fluorosis.

Materials and Methods:

Literatures were searched from August 1998 to August 2019 for articles in the management of dental fluorosis. The databases used were National Center for Biotechnology Information (NCBI) and Google Scholar. In NCBI, the filters were modified to randomized controlled trial, clinical trial, human trial, and free full-text articles. The following queries were used in order to search for the article: treatment for dental fluorosis, intervention of dental fluorosis, and management of dental fluorosis.

Results:

All the five studies selected after screening were randomized controlled trials. Total number of patients included in this study were 304 with the mean age of 17.7 years old. They were treated with microabrasion, bleaching, resin infiltration or combination of microabrasion with bleaching, and resin infiltration with bleaching. Microabrasion resulted in less esthetic improvement compared with bleaching. Meanwhile, resin infiltration showed a greater improvement in esthetics in comparison to bleaching. Resin infiltration with additional infiltration time and combination of resin infiltration with bleaching are the best treatment options.

Conclusion:

Based on this systematic review, resin infiltration with increased infiltration time is the best treatment approach in treating dental fluorosis.

Comparative Evaluation of Resin Infiltration and Remineralisation of Noncavitated Smooth Surface Caries Lesions: 6-month Results

PURPOSE

To compare the therapeutic effects of the resin infiltration technique, self-assembling peptide (P11-4), and fluoride varnish application on white spot lesions (WSLs) on buccal surfaces based on LF pen measurements and LAA-ICDAS scores.

MATERIALS AND METHODS

The lesions of 113 patients from a total of 319 patients with at least four visible WSL on buccal surfaces were assessed by LAA-ICDAS and laser fluoresence (LF pen). To be included in the study, participants were required to have at least 4 buccal WLSs, each in different quadrants, with an LF pen score ≥ 8. Twenty-one patients were included in the study based on the laser fluoresence values. The lesions were randomly assigned into 4 groups (n = 21): IG (Icon), CRG (Curodont Repair), DG (Duraphat), and CG (control) groups. The treatment protocols were applied, but the control group received no treatment except regular brushing. Lesions were scored by LAA-ICDAS after 3 and 6 months and LF pen after 1 week, 3 and 6 months.

RESULTS

There was a statistically significant decrease in LF pen measurements of the control and the intervention groups after 6 months when compared to baseline. The greatest lesion regression was observed with IG (-23.25 ± 18.21), which differed statistically significantly from CRG (-8.15 ± 13.89), DG (-10.1 ± 10.31) and CG (-4.15 ± 9.72), followed by DG which differed statistically significantly from CG. Statistically significant differences were observed in the activity status of the lesions between baseline and 6 months, except for the control group.

CONCLUSION

In this study, the lesion regression rates shown by mean LF pen values in all groups after six months encourages the management of non-cavitated smooth surface caries lesions with non-operative treatment approaches. Regular brushing and professional tooth cleaning seem to be effective for the management of WSLs on buccal surfaces, and resin infiltration or fluoride varnish might enhance the improvement of these lesions in moderate- to high-caries-risk individuals.

Silicone Additive Manufactured Indices Performed from a Virtual Diagnostic Waxing for Direct Composite Diastema Closure Combined with Resin Infiltration Technique on White Spot Lesions: A Case Report

The present article describes the resin infiltration technique to address white spots lesions presented on anterior and premolar teeth of a young patient after orthodontic treatment and the digital workflow for planning a diastema closure on the maxillary anterior teeth using facial photographs, an intraoral scanner, a facially driven diagnostic waxing using a dental computer-aided design (CAD) software, and 3-piece additive manufactured (AM) clear silicone indices. The virtual design of the silicone indices was completed using an open-source CAD software and included a flexible clear buccal piece, flexible clear lingual piece, and rigid clear custom tray. The unique 3-piece index design allows a horizontal path of insertion, controlled uniform thickness of the indices, flexible and rigid material properties combination, accurate translation of the diagnostic waxing into the patient´s mouth, and digital storage of the designs.

Efficacy of Resin Infiltrate in Noncavitated Proximal Carious Lesions: A Systematic Review and Meta-Analysis

Objectives:

Resin infiltration is a minimally invasive technique for treating noncavitated proximal caries. It slows/stops the carious lesion progression rate by creating a diffusion barrier inside the porous enamel lesion body. The aim was to evaluate the efficacy of resin infiltration on noncavitated proximal carious lesions in primary and permanent teeth.

Materials and Methods:

The records were obtained using electronic and other sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparent reporting. Eligible studies were randomized controlled trials evaluating the efficacy of resin infiltration for noncavitated proximal carious lesions by comparing it with control/placebo. Each included study was assessed concerning the “risk of bias” using the Cochrane Collaboration's “risk-of-bias” assessment tool. High risk-of-bias studies were excluded from the meta-analyses due to selective reporting matters. The statistics were performed by RevMan software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) utilizing the random effect model. The GRADE approach was implemented for assessing the quality of evidence.

Results:

From 106 studies identified, 17 were assessed for eligibility. After “risk-of-bias” assessment, two meta-analyses were conducted to eliminate the limitation of the significant heterogeneity between trials inspecting primary teeth (n = 2) and permanent teeth (n = 3). I² = 0% indicates the absence of statistical heterogeneity. The risk of carious lesions’ progression with resin infiltration was significantly lower in primary (risk ratio [RR]; 95% confidence interval [CI]: 0.48; 0.30–0.75, P = 0.001) and in permanent teeth (RR; 95% CI: 0.19; 0.11–0.33, P < 0.00001) compared to that of control/placebo. The GRADE approach revealed high quality of evidence.

Conclusion:

The available evidence conveys high confidence that proximal resin infiltration has superior efficacy in slowing/arresting the carious lesions’ progression rate in comparison to conventional management modalities.

Masking and Penetration Ability of Various Sealants and ICON in Artificial Initial Caries Lesions In Vitro

PURPOSE

The purpose of the present in vitro study and survey was to compare the masking ability and the penetration capacity of three resin composite sealers as well as a resin infiltrant in shallow artificial caries lesions.

MATERIALS AND METHODS

Panels of artificial initial caries lesion with an average depth of 200 µm were created on buccal and lingual surfaces of 75 extracted human molars. Specimens were randomly assigned to 5 groups: ICON (DMG America), Biscover LV (Bisco), Optiguard (Kerr Hawe), Permaseal (Ultradent), and control (no treatment). Teeth were hemi-sectioned yielding two halves, each with a panel of artificial caries lesion. Lesions on one hemi-section were used to assess the esthetic improvement following caries lesion penetration with the 4 resins based on photographs evaluated using a 100-mm visual analogue scale (VAS) by 17 raters. Lesions on opposite hemi-sections were used to measure the resin penetration area percentage (PA%) and the resin penetration depth percentage (PD%) visualized using a confocal laser scanning microscope (CLSM, Leica).

RESULTS

ICON, Optiguard, and Permaseal yielded significantly greater average VAS scores compared to Biscover. The mean PA% and PD% were significantly higher for ICON, intermediate for Optibond and Permaseal, and significantly lower for Biscover. A moderately large positive correlation was noticed between the average VAS scores and the penetration measures.

CONCLUSION

All the resin sealers (Biscover, Optiguard, and Permaseal) penetrated the artificial initial caries lesions. However, ICON resulted in the deepest penetration and the largest penetration area percentages. The masking ability of Optiguard and Permaseal of the artificial caries lesions was similar to ICON.

The efficacy of resin infiltrate on the treatment of white spot lesions and developmental opacities

Objectives

The aim of this study was to evaluate the changes in opacities by applying resin infiltrate to developmental enamel opacities and applying resin infiltrate or fluoride varnish to white spot lesions (WSLs).

Materials and Methods

A total of 132 teeth with WSLs and developmental enamel opacities were included in the study. WSLs were treated with resin infiltrate (Group 1) and fluoride varnish (Group 2), and developmental enamel opacities were treated with only resin infiltrate (Group 3). Lesions were evaluated in accordance with International Caries Detection and Assessment System (ICDAS II) criteria and DIAGNOdent Pen scores before applying the material (T0), just after the application (T1), and after 1 month (T2) and 3 months (T3).

Results

A significant decrease in DIAGNOdent Pen scores was observed in all the groups and the most important decrease was seen in Group 2 (P < 0.05). A significant decrease in ICDAS II scores was observed in Groups 2 and 3 (T0-T1) and Group 1 (T1-T2) (P < 0.05).

Conclusion

DIAGNOdent pen scores decreased and the lesion was partially masked after resin infiltrate was applied to treat developmental enamel opacities; the resin infiltrate application, however, was more successful than fluoride varnish on WSLs. Treating WSLs with resin infiltrate was a good option due to shorter term esthetic recovery and high patient satisfaction.

Four year Evaluation of Proximal Resin Infiltration in Adolescents

AIM

Resin infiltration of proximal lesions is a new approach to stopping caries progression. Therefore, the aim of the present study was to evaluate four-year efficacy of proximal infiltrates in adolescents.

MATERIALS AND METHODS

In ten adolescents, a total of 21 proximal infiltrates (ICON® (DMG, Germany) were applied to initial proximal lesions of permanent incisors and premolars according to the manufacturer's instruction. The clinical quality of resin infiltration was assessed at 1 week, 1, 2, 3 and 4 years after the treatment and the evaluation of the therapeutic effect was analyzed by radiographs.

RESULTS

Ten patients were followed up clinically for four years. The majority of the infiltrated lesions were located on permanent incisors. Teeth which were proximally infiltrated did not exhibit dental plaque and gingival bleeding in most cases. At annual recalls, plaque scores remained constant. The gingival status remained steady and no differences in tooth shape and contour were detected. Discoloration was detected in four teeth (19%) in 1st year recall and was constant at annual intervals. The radiographic evaluation of the bitewing radiographs showed no progression in 21 lesions (100%) from baseline to the 4-year recall. Overall oral hygiene of the patients was satisfactory.

CONCLUSION

In conclusion, proximal infiltration is an effective prophylactic measure in adolescents.

Resin infiltration of early carious lesion in early childhood: a case report

The treatment of white-spot lesions in infants and young children with early childhood caries is a challenge. The ideal management of the disease and subsequent remineralization of the lesions depend on the family's commitment to dietary behavior modifications to address the causes of the disease. If this proves ineffective or unlikely, resin infiltration has been developed to slow or arrest progression of white-spot lesions. In resin infiltration, the porous lesion body is penetrated by a special low-viscosity resin, blocking the diffusion of cariogenic acids into the lesion. This case report describes the use of a resin infiltrant to treat white-spot lesions in a 24-month-old boy with early childhood caries.

Resin infiltration of non-cavitated caries lesions: a systematic review

OBJECTIVE

The aim of this systematic review was to evaluate the in vivo scientific evidence of the ability of resin infiltration (RI) to arrest non-cavitated caries lesions.

MATERIALS AND METHODS

The PubMed database was searched for randomized controlled trials that evaluated the in vivo effect of RI versus placebo or other preventive treatment on the progression of caries lesions. The keywords used were 'resin infiltration, dental caries', 'resin infiltration, carious lesions', 'resin infiltration, caries lesions', 'caries infiltration' and 'Icon DMG' with the 'clinical trial' filter activated. Among the 14 articles originally identified with these keywords, only 4 (related to 3 different in vivo studies) were included for this review.

RESULTS

All 4 articles reported on proximal caries lesions. One study had been conducted on 48 high-caries-risk children while the other 3 (n = 22, 22 and 39, respectively) concerned moderate- and low-caries-risk adolescents and adults. The quality of the studies was assessed to be high with respect to randomization, split-mouth design and blinding. All the included studies showed significant differences in caries progression between test and control/placebo groups, indicating that RI may inhibit the carious process.

CONCLUSION

This systematic review revealed that RI appeared to be an effective method to arrest the progression of non-cavitated caries lesions. Additional, long-term studies are required.

[Effect of resin infiltration treatment on the colour of white spot lesions]

OBJECTIVE

This study aimed to evaluate the effect of resin infiltration and fluoride solution on masking different demineralized white spot lesions by assessing color change.

METHODS

Artificial white spot lesions were produced on 60 human molars. Each sample had at least two enamel surfaces opened (named A and B). The samples were randomly divided into groups 1, 2, and 3 according to their time of demineralization (24, 48, and 72 h). After demineralization, the A spot of each sample was treated by resin infiltration. The B spot was treated with 0.1% fluoride solution daily for 30 days. After the remineralization of the B spot, resin infiltration was used again on the B spot of each sample. Color assessment was performed by a spectrophotometer in five distinct stages: baseline, after the production of artificial caries, after resin infiltration of A spots, after 30 days of fluoride solution treatment of B spots, and after resin infiltration of remineralized B spots.

RESULTS

Before demineralization, the L* values of spots A and B in all groups were not significantly different (P > 0.05), whereas the L* values of spots A and B were significantly increased after demineralization. The L* values of A spots recovered significantly after treatment by resin infiltration (P<0.05), but only groups 1 and 2 reached the baseline. The L* values of B spots had no significant differences (P > 0.05) after fluoride treatment compared with that after demineralization. After resin infiltration on B spots, the L* values recovered but could not reach the baseline nor the level of A spots treated by resin infiltration only.

CONCLUSION

Resin infiltration is a more effective treatment for masking white spot lesions than traditional fluoride treatment. The effect of masking white spot lesions has certain relationships with the degree of demineralization and activity of the lesion.

[Effect of resin infiltration treatment on the colour of white spot lesions]

OBJECTIVE

This study aimed to evaluate the effect of resin infiltration and fluoride solution on masking different demineralized white spot lesions by assessing color change.

METHODS

Artificial white spot lesions were produced on 60 human molars. Each sample had at least two enamel surfaces opened (named A and B). The samples were randomly divided into groups 1, 2, and 3 according to their time of demineralization (24, 48, and 72 h). After demineralization, the A spot of each sample was treated by resin infiltration. The B spot was treated with 0.1% fluoride solution daily for 30 days. After the remineralization of the B spot, resin infiltration was used again on the B spot of each sample. Color assessment was performed by a spectrophotometer in five distinct stages: baseline, after the production of artificial caries, after resin infiltration of A spots, after 30 days of fluoride solution treatment of B spots, and after resin infiltration of remineralized B spots.

RESULTS

Before demineralization, the L* values of spots A and B in all groups were not significantly different (P > 0.05), whereas the L* values of spots A and B were significantly increased after demineralization. The L* values of A spots recovered significantly after treatment by resin infiltration (P<0.05), but only groups 1 and 2 reached the baseline. The L* values of B spots had no significant differences (P > 0.05) after fluoride treatment compared with that after demineralization. After resin infiltration on B spots, the L* values recovered but could not reach the baseline nor the level of A spots treated by resin infiltration only.

CONCLUSION

Resin infiltration is a more effective treatment for masking white spot lesions than traditional fluoride treatment. The effect of masking white spot lesions has certain relationships with the degree of demineralization and activity of the lesion.