Penetration Depths Similar for 1 Minute and 5 Minutes

Take-Home Pearl: A 1-minute application time of infiltrant in noncavitated proximal lesions in primary molars leads to a penetration depth similar to a 5-minutes application time.

Articles Reviewed: Soviero VM, Paris S, et al. Ex Vivo Evaluation of Caries Infiltration After Different Application Times in Primary Molars. Caries Res 2013;47 (February): 110-116.

Background: The concept of sealing occlusal surfaces in order to prevent cariogenic acid attacks and starve any existing lesions has been applied to proximal lesions by DMG (Hamburg, Germany) under the product name Icon. Resin infiltration in promixal lesions can be performed in noncavitated lesions with up to radiographic extension into the outer third of dentin (DI). Currently, only laboratory and in vitro studies have been published on application time of infiltrants required for best penetration of proximal lesions.

Objective: To assess the penetration depth (PD) of an infiltrant into proximal caries lesions in primary molars after diffrent application times using an ex vivo model.

Methods: In this cx vivo, randomized design, blind assessment study, 59 proximal caries lesions from 34 children were treated. Inclusion criteria for the study were E1/E2, E2 and D1 lesions with adjacent contacts. Lesions were randomly assigned an application time of 1, 3, or 5 minutes. The lesions were then treated with Icaon infiltration by one trained investigator. The manufacturer's directions were followed with the exception of application time, and only I application of infiltrant was performed. Treated teeth were either extracted immediately if roots were completely resorbed or if needed for orthodontic treatment, or they were followed until natural exfoliation. Lesions were using the ICDAS criteria. Using polarized light microscopy, prepared sections were measured for maximum lesion depth (LD) and lesion area (LA). Scanning eletron microscopy analysis was then used to measure PD of the infiltrant and the infiltrated ares (PA).

Results: A final sample of 48 teeth was analyzed. The mean LD and LA were 596 (-+ 203 ) and 4.03 . For all lesions, the mean percentage Pd ranged from 70% to 80% and the mean percentage PA ranged from 54% to 60%. There were no significant differences in percentage PD  and percentage PA between E1/E2 lesions and D1 lesions. Longer application times did not result in deeper percentage PD of the infiltrant.

Conclusions: The authors conclude that, "Proximal caries lesions in primary molars can be infiltrated in vivo to a similar extent as observed previously in vitro. A 1-minute application of infiltrant led to a PD similar to application times up to 5 minutes."

Reviewer's Comments: Several of the studies currently available looking at resin infiltration are funded by DMG, the company who produces the Icon proximal infiltration product. This study includes two of the Icon inventors and is funded by a research grant by DMG. While proximal lesion infiltration may be indicated in low-moderate caries risk patients, high-moderate risk children (the target subject of this study) may not be good candidates for this type of restoration.

Reviewer: Timothy J. Halligan, DMD



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