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