Proximal carious lesions infiltration-a 3-year follow-up study of a randomized controlled clinical trial.

INTRODUCTION: Infiltration of carious lesion has been claimed as a promising approach for the management of non-cavitated proximal lesions (NCPL). Clinical studies have suggested that this approach may reduce NCPL progression in individuals whose caries risk was not change over the studied period. OBJECTIVE: This study aimed to assess the additional benefit of infiltration of NCPL over a 3-year period in a group of individuals who received treatment and control of carious activity. MATERIALS AND METHODS: Twenty-two caries-active subjects that possessed at least a pair of NCPL in posterior teeth were selected for this study totalizing 36 pairs of lesion. In a split-mouth design, lesions were randomly allocated to test (infiltration) or placebo treatments. At follow-up, lesions were radiographically analyzed, progression was determined by radiographic pair-wise comparison and differences in number of progressing lesions between test, and placebo-treated surfaces were compared. RESULTS: Seventeen subjects (27 pairs of lesions) were followed up. Only four subjects were caries-active at the follow-up. In the test group, 2/27 (7.4%) lesions and in the placebo group 5/27 (18.5%) lesions had progressed. No statistical difference was observed between the studied groups (p = 0.453). CONCLUSION: Subjects under treatment focusing on controlling caries activity presented low progression rates in both infiltrated and non-infiltrated NCPL. As only very few lesions progressed in both groups, no significant additional effect could be found. Further studies with larger sample sizes are necessary. CLINICAL RELEVANCE: Infiltration of NCPL may have limited additional effect if other treatments focused on controlling caries activity are successful.

Stability of two resin combinations used as sealants against toothbrush abrasion and acid challenge in vitro.

OBJECTIVE: To test the stability of two conventional adhesives when combined with a low-viscosity caries infiltrant used for sealing sound enamel against toothbrush abrasion and acid challenge in vitro. MATERIALS AND METHODS: Bovine enamel discs (Ø = 3 mm) randomly assigned to three groups (n = 10/group) were etched with 37% phosphoric acid for 30 s and treated with resins of different monomer contents forming three test groups: (1) Untreated specimens (Control); (2) Infiltrant (Icon, DMG) + conventional enamel bonding adhesive (Heliobond, Ivoclar Vivadent); and (3) Infiltrant + conventional orthodontic adhesive (Transbond XT Primer, 3M Unitek). All specimens were immersed in hydrochloric acid (pH 2.6) for up to 9 days, during which they were exposed to 1825 toothbrush-strokes per day. Calcium dissolution was assessed using Arsenazo III method at 24-h intervals. Data were analyzed by Kruskal-Wallis and Wilcoxon signed ranks tests. RESULTS: Cumulative calcium dissolution for the untreated specimens (39.75 ± 7.32 µmol/ml) exceeded the sealed groups (Icon + Heliobond: 23.44 ± 7.03 µmol/ml; Icon + Transbond XT Primer: 22.17 ± 5.34 µmol/ml). Untreated specimens presented a relatively constant calcium dissolution rate throughout the experimental period, whereas the sealed groups presented a gradual increase indicating weakening of the seal by toothbrush abrasion. Both sealed groups presented significantly lower daily calcium dissolution at all time points compared to the control, except for Group 2 on the last measurement day. CONCLUSIONS: Low-viscosity caries infiltrant application on sound enamel prior to conventional resin application provided a protective effect against enamel demineralization, but this effect was not stable when challenged mechanically by toothbrush abrasion.

Effect of Caries Infiltrant on Margin Integrity of Composite Fillings Placed Adjacent to Demineralised Primary Enamel.

PURPOSE: To investigate the influence of pretreating demineralised enamel with an infiltrant on the margin integrity of Class V like composite restorations on primary teeth bonded with different adhesives. MATERIALS AND METHODS: Forty specimens from primary molars were demineralised and circular class-V-like cavities were prepared. The cavities were treated with a universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care), applied either in self-etch (SE) or etch-and-rinse mode (ER) mode. In groups SE-I and ER-I, the demineralised margins were pretreated with a caries infiltrant (Icon, DMG) prior to adhesive application. The cavities were restored with a nanofilled composite material and thermocycled. Marginal integrity was evaluated using SEM, and the percentage of continuous margin was statistically analysed. RESULTS: Specimens treated with the caries infiltrant followed by the adhesive showed similar marginal continuity as the adhesive alone. CONCLUSIONS: Pretreatment of demineralised primary enamel with a caries infiltrant before applying a universal adhesive does not influence the marginal integrity of composite fillings.

A retrospective clinical study on the resin infiltration of proximal caries lesions: the operator's effect.

PURPOSE: This retrospective university-based study investigated the effect of operators' training and previous experience on the success of resin infiltration (RI) in arresting proximal non-cavitated caries lesions in primary and permanent teeth. METHODS: Information was collected regarding RI of proximal non-cavitated caries lesions in primary and permanent teeth with a follow-up period up to 32 months. Factors investigated were: operators' clinical experience and training, patient's age, tooth, arch, mouth-side, surface treated, tooth separation, and baseline lesion depth. Kaplan-Meier survival and Cox regression analysis with shared frailty were used (α = 5%). RESULTS: A total of 130 proximal surfaces treated on 115 teeth of 43 children (11 ± 4.4 years) were evaluated. Survival of RI was 46% up to 32 months. Lesions treated by non-trained dentists were more likely-to-present progression than those performed by non-trained dental students under supervision (HR 2.41, 95% CI: 1.00-5.80); conversely, no difference was found between non-trained dental students under supervision and trained dentists (HR 0.52, 95% CI: 0.16-1.70). Additionally, dentin lesions were 59% more-likely-to-present progression than enamel lesions (HR 0.41, 95% CI: 0.17-0.99). CONCLUSION: The operator's experience and training could influence the success of RI on proximal non-cavitated caries lesions and it should be taken into consideration when choosing this treatment modality.

The Efficacy of Resin Infiltrant and Casein Phosphopeptide-amorphous Calcium Fluoride Phosphate in Treatment of White Spot Lesions (Comparative Study).

BACKGROUND: White spot lesions (WSLs) are considered as the first sign of the progression of dental caries that can be reversed. Casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) varnish can promote remineralization process of the demineralized tooth structure. Also, WSLs can be managed by using caries infiltrant (ICON), which infiltrates etched enamel surface of the WSLs. OBJECTIVES: The main aim was to evaluate and compare the efficacy of ICON versus CPP-ACFP varnish to treat WSLs in the same oral environments. MATERIALS AND METHODS: A total of 30 participants aged 20-40 years with at least two WSLs have participated in this trial. Split-mouth technique has been used in this trial where WSLs on the left side have been treated with ICON, whereas WSLs on the right side have been treated with CPP-ACFP varnish. Clinical evaluation using DIAGNOdent was carried out at baseline, 1 week, 1, 3, 6, and 12 months after application to determine the effectiveness of these materials in treating WSLs. RESULTS: Significant differences were observed between all follow-up DIAGNOdent scores compared to baseline readings of both ICON and CPP-ACFP (P = 0.000 for all comparisons). Statistically significant differences were observed between DIAGNOdent scores of ICON compared to CPP-ACFP at all follow-up intervals (P = 0.006, 0.008, 0.045, 0.036, and 0.000). CONCLUSION: Both ICON and CPP-ACFP were effective in the treatment of WSLs of smooth surfaces but the efficacy of CPP-ACFP was better than ICON.

Shear bond strength of orthodontic brackets to enamel after application of a caries infiltrant.

OBJECTIVE: To examine differences in the shear bond strength of orthodontic brackets on differently mineralized enamel surfaces after applying a caries infiltrant or conventional adhesive. MATERIALS AND METHODS: A total of 320 bovine incisors were assigned to eight pretreated groups, and the shear force required for debonding was recorded. Residual adhesive was evaluated by light microscopy using the adhesive remnant index. Statistical analysis included Kolmogorov-Smirnov, analysis of variance (ANOVA), and Scheffé tests. RESULTS: The highest bond strength (18.8 ± 4.4 MPa) was obtained after use of the caries infiltrant. More residual adhesive and fewer enamel defects were observed on infiltrated enamel surfaces. Brackets on demineralized enamel produced multiple enamel defects. CONCLUSIONS: Acceptable bond strengths were obtained with all material combinations. A caries-infiltrant applied before bracket fixation has a protective effect, especially on demineralized enamel.