1. Objectives: Non-carious enamel hypocalcifications are one of
the esthetic problems which patients seek for the treatment.
Microabrasion, macroabrasion, composite and porcelain veneers
are some treatment methods to improve the shade of the
involved tooth. Resin infiltration technique is a new
ultraconservative approach to prevent the progression of white
spot enamel lesions due to caries. The object of this clinical
study was to evaluate the effect of this new method on enamel
hypocalcifications.
Methods: In this clinical study 80 teeth in different patients will
be considered , and randomly divided into two groups of 40 as
follows: Group 1(control): No treatment, Group 2: treatment of
enamel hypocalcifications with resin infiltration technique. The
inclusion criteria were teeth with enamel hypocalcification with
no sign of caries or cavity. The baseline and final shade of the
teeth in hypocalcified area was taken with VITA 3D Master,
professional camera and photoshop software. Isolation of the
teeth was done with rubber dam or liquidam. After cleaning the
teeth, Icon kit (DMG, Germany) was applied according to the
manufacturing instructions to condition the white spot with
15% hydrochloridric acid gel followed by application of the
resin infiltrant.
Results: Preliminary results of this study on 13 hypocalcified
teeth in group 2 showed immediate improvement of the shade of
10 teeth in comparison with the control group. The shade of the
three teeth did not show an obvious improvement , because of
the overlapping of the liquidam on the hypocalcified lesion
which prevented the efficient contact of the material with the
white spot.
Conclusions: Up to this point , it seems that in specific cases of
localized and generalized enamel hypocalcifications, resin
infiltration technique could improve the shade of the teeth as a
conservative esthetic treatment in just one appointment thereby
satisfying the patient..
Keywords: resin infiltration technique, hypocalcification,
esthetic
Tooth discolorations in anterior region specially maxillary teeth are one of
the causes that needs esthetic treatments. White spot defects that is referred
to as enamel hypocalcification causes serious esthetic problem. There are
multiple causes for this status which are mostly related to prenatal
problems such as febrile episodes during infancy and high temperatures,
trauma to permanent teeth or infection of deciduous teeth. These defects
usually appear as very well demarcated white spots and affect only a few
teeth .
The reason for the appearance of white spots is the defect in natural
crystallites forms and the remaining water molecules in the microscopic
spaces provided and the further change in the scatter and the reflection of
light.
The common esthetic treatment for enamel white discolorations from
conservative to aggressive methods are oral hygiene improvement,
microabrasion, macroabrasion and in more generalized extensive cases
composite and porcelain veneers. The more extensive the involvement of a
tooth is , the more aggressive and time consuming treatment will be
required.
A new technique, Resin Infiltration Technique (RIT), was introduced in
2005 by invitro studies of Dr.Meyer and Dr. Paris as a conservative
method for the treatment of incipient caries lesions to “bridge the gap
between noninvasive and invasive methods”. In this method the lesion is
conditioned with 15% Hydrochloridric acid to erode the area and in the
next step it will be sealed by a resin infiltrant to occlude the lesion for
further progression. It is said that this technique might improve the white
spot lesions on the enamel surface after orthodontic treatments. The studies
on the resin infiltration technique has focused on the effects of this
technique on preventing further progression of the incipient caries lesions
since its introduction and there is no evidence of its application on
hypocalcified enamel lesions which can be caused by other factors than
caries and are one of the biggest reasons for the patients to request esthetic
improvement of their tooth.
The objective of this clinical study was to evaluate the effect of
this new method on enamel hypocalcification.
EFFECT OF RESIN INFILTRATION TECHNIQUE ON ENAMEL
HYPOCALCIFICATIONS: PRELIMINARY RESULTS
Fig 7. polishing of the teeth
Fig 6. Light curing of Resin infiltrant
For 40 sec
Fig 5. Resin infiltrant was applied
for 3 min
Fig 4. Icon dry was applied
for 30 sec
Fig 3. Icon etch was applied
for 2 Min
Fig 2. liquidam was applied
to protect the soft tissue
Fig 1. White spots on teeth 4-7
before treatment
Sepideh Banava1, Mohammad Safaie Yazdi 1, Maryam Elyasi 2
1) Restorative Dentistry Department, Islamic Azad University, Dental
Branch,Tehran, Iran.
2) 2) General Practitioner, Tehran, Iran.
Corresponding Author: sbanava@yahoo.com
Abstract
Introduction
1. Paris S. , Meyer-Lueckel H . Inhibition of Caries Progression by Resin Infiltration in situ Caries Res
2010;44:47–54
2. Paris S. , Meyer-Lueckel H. Masking of labial enamel white spot lesions by resin infiltration—A
clinical report . Quintessence Int 2009;40(9):257-260
3. Meyer-Lueckel H. , Paris S. , Kielbassa A.M . Improved Resin Infiltration of Natural Caries Lesions . J
Dent Res 2008; 87(12):1112-1116,
4. Paris S, Meyer-Lueckel H. Influence of aplication frequency of an infiltrant on enamel lesions. J
Dent Res 2008; 87(Spec Iss B):1585,
5. Meyer-Lueckel H. , Paris S. , Kielbassa A.M .Surface Layer Erosion of Natural Caries Lesions with
Phosphoric and Hydrochloric Acid Gels in Preparation for Resin Infiltration . Caries Res 2007;41:223–
230
6. Meyer-Lueckel H, Paris S, Kielbassa A.M Resin Infiltration of Natural Caries Lesions . J Dent Res
2007; 86(7):662-666
7. Paris S, Meyer-Lueckel H, Colfen H, Kielbassa AM. Penetration coefficients of commercially available and
experimental composites intended to infiltrate enamel carious lesions. Dent Mater. 2007; Jun;23(6):742-8
8. Mueller J, Meyer-lueckel H, Paris S, Hopfenmuller W, Kielbassa AM. Inhibition of lesion progression by
the penetration of resins in vitro: influence of the application procedure. Oper Dent. 2006 May-Jun;31 (3):
338-45
Materials & Methods
In this clinical study 80 teeth in different patients are
considered and divided randomly into two groups of 40
as follows: Group 1(control): No treatment, Group 2:
treatment of enamel hypocalcifications with resin
infiltration technique. The inclusion criteria are teeth
with enamel hypocalcification with no sign of caries or
cavity.
The clinical procedure is as follows:
1. Baseline shade of the teeth in hypocalcified area is
taken with VITA 3D Master, professional camera
( Canon , EOS 550 D ) and photoshop software (Adobe
photoshop CS4 ) .
2. Rubberdam or liquidam is applied on teeth to protect
soft tissue.
3. Teeth are etched with 15% HCL for two minutes.
4. Remnants of the etchant are rinsed off with water
spray for 30 seconds And the teeth are dried with air.
5. 99% Ethanol solution is applied on site to ease the
evaporation of remaining water molecules.
( note that in this step the final appearance of each tooth
can be seen . So the clinician can decide to apply the
etchant for the second time if more porosity is needed. )
6. The infiltrant is applied by means of a special
applicator for 3 minutes.
7. The excess material is removed by a cotton roll and
the infiltrant is cured for 40 seconds .
8. The infiltrant is applied again for 1 minute and
subsequently cured.
9. Rubberdam is removed and the teeth are polished .
10. The final shade of the teeth is taken immediately after
treatment and after one month as mentioned before.
11. The baseline and the final shades in pictures are
judged by two independent examiners besides the
patient.
The assessment criteria to score the changes in
appearance are : IMPROVED , NOT CHANGED or
GOT WORSE.
12. Lab properties of the teeth in the baseline and the
final pictures are evaluated by Photoshop software and
the difference is closely monitored.
The data are subsequently assessed by statistical tests.
Results
Conclusion
Discussion
References
CLINICAL PROCEDURE
• In this clinical study 26 teeth with hypocalcified white
spots were included in two groups of 13.
Preliminary results on 13 hypocalcified teeth in group 2
showed that based on the assessment criteria , some
immediate improvement in the shade of 10 teeth was
obtained in comparison with the control group.
• The shade of three teeth scored as NOT CHANGED.
• The difference between Lab properties of the teeth
shade will be reported in final results in the future.
It seems that the Resin infiltration technique which was
previously introduced as a conservative method for the
treatment of early white spot lesions which resulted from
caries , could also be used for esthetic treatment of
enamel hypocalcification white spots .
This could be the result of the diffusion of the infiltrant
into the porous hypocalcified enamel and its replacing
the water molecules trapped in the microscopic spaces.
The close similarity between refractive indices of enamel
and the infiltrant is the cause for the improvement in the
shade.
The failure in the improvement of the appearance of the
three teeth in this study was related to the lesions being
masked by liquidam due to their proximity to the
cervical area of the tooth.
Still further researches are needed to evaluate the effect of
this technique on the different types and depths of these
defects.
Preliminary results of this study revealed evident
improvement in the appearance of enamel
hypocalcification white spots with resin infiltration
technique in just one visit.
Fig 8. Immediate result after treatment
Before
Immediately after
treatment
After 1 month
From the beginning to the end
In close-up
Before Isolated Etched
Dried with
Ethanol
Resin
infiltrated Polished