Effect of Extent of White Spot Lesions on the Esthetic Outcome After Treatment by the Resin Infiltration Technique: A Clinical Trial
Abstract
Objectives: This study aimed to assess the effect of extent of white spot lesions (WSLs) on the esthetic outcome (masking effect and durability) for 6 months after treatment by the resin infiltration technique.
Materials and Methods: In this clinical trial, 79 teeth with WSLs in 18 patients were selected. The lesions were assigned to localized and generalized groups, and were all treated by resin infiltration. The color of WSLs was assessed at baseline, immediately after treatment, and 1, 3, and 6 months after treatment by using Easy Shade spectrophotometer and taking standard digital photographs. The surface area of WSLs was calculated on the photographs using MIP4Student software. Repeated Measures ANOVA was used to compare color change (∆E), and the Pearson’s correlation test was applied to analyze the association between the extent of lesions and ∆E (alpha=0.05).
Results: A significant difference was found between the two groups in ∆E at different time points (P<0.05). Also, in both localized and generalized lesions, the pretreatment ∆E was significantly different from the ∆E values at different time points after treatment (P<0.001). However, the post-treatment ∆E values were not significantly different (P>0.05). The Pearson test showed an inverse correlation between the extent of lesions and ∆E (P<0.05).
Conclusion: The resin infiltration technique is successful in masking the WSLs, with a durability of at least 6 months. Color correction by this technique is more favorable in localized lesions.
1. Ritter AV, Boushell LW, Walter R. Sturdevant's art and science of operative dentistry-e-book. 7th edition; Elsevier Health Sciences; 2019; Chapter 2:p62.
2. Stoll R, Urban-Klein B, Giacomin P, Loukas A, Jablonski-Momeni A. In vivo assessment of caries excavation with a fluorescence camera compared to direct bacteriological sampling and quantitative analysis using flow cytometry. Lasers Med Sci. 2015 Feb;30(2):843-9.
3. Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent. 2013 Apr;25(2):85-95.
4. Perdigão J. Resin infiltration of enamel white spot lesions: An ultramorphological analysis. J Esthet Restor Dent. 2020 Apr;32(3):317-324.
5. Sampson V, Sampson A. Diagnosis and treatment options for anterior white spot lesions. Br Dent J. 2020 Sep;229(6):348-352.
6. Knösel M, Attin R, Becker K, Attin T. External bleaching effect on the color and luminosity of inactive white-spot lesions after fixed orthodontic appliances. Angle Orthod. 2007 Jul;77(4):646-52.
7. Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011 Mar;81(2):206-10.
8. Meyer-Lueckel H, Paris S. Progression of artificial enamel caries lesions after infiltration with experimental light curing resins. Caries Res. 2008;42(2):117-24.
9. Kim S, Kim EY, Jeong TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. Int J Paediatr Dent. 2011 Jul;21(4):241-8.
10. Borges AB, Caneppele TM, Masterson D, Maia LC. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review. J Dent. 2017 Jan;56:11-18.
11. Kielbassa AM, Muller J, Gernhardt CR. Closing the gap between oral hygiene and minimally invasive dentistry: a review on the resin infiltration technique of incipient (proximal) enamel lesions. Quintessence Int. 2009 Sep;40(8):663-81.
12. Youssef A, Farid M, Zayed M, Lynch E, Alam MK, Kielbassa AM. Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions. Quintessence Int. 2020;51(9):696-709.
13. Rocha Gomes Torres C, Borges AB, Torres LM, Gomes IS, de Oliveira RS. Effect of caries infiltration technique and fluoride therapy on the colour masking of white spot lesions. J Dent. 2011 Mar;39(3):202-7.
14. Yuan H, Li J, Chen L, Cheng L, Cannon RD, Mei L. Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence. Angle Orthod. 2014 Mar;84(2):343-9.
15. Knösel M, Eckstein A, Helms HJ. Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomized clinical trial. Am J Orthod Dentofacial Orthop. 2013 Jul;144(1):86-96.
16. Hammad SM, El-Wassefy NA, Alsayed MA. Evaluation of color changes of white spot lesions treated with three different treatment approaches: an in-vitro study. Dental Press J Orthod. 2020 Jan-Feb;25(1):26-27.
17. Kannan A, Padmanabhan S. Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial. Prog Orthod. 2019 Jun 17;20(1):23.
18. Knösel M, Bojes M, Jung K, Ziebolz D. Increased susceptibility for white spot lesions by surplus orthodontic etching exceeding bracket base area. Am J Orthod Dentofacial Orthop. 2012 May;141(5):574-82.
19. Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, et al. Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial. J Am Dent Assoc. 2013 Sep;144(9):997-1005.
20. Torres CR, Borges AB. Color masking of developmental enamel defects: a case series. Oper Dent. 2015 Jan-Feb;40(1):25-33.
21. Neuhaus KW, Schlafer S, Lussi A, Nyvad B. Infiltration of natural caries lesions in relation to their activity status and acid pretreatment in vitro. Caries Res. 2013;47(3):203-10.
22. Denis M, Atlan A, Vennat E, Tirlet G, Attal JP. White defects on enamel: diagnosis and anatomopathology: two essential factors for proper treatment (part 1). Int Orthod. 2013 Jun;11(2):139-65. English, French.
23. Garg SA, Chavda SM. Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study. Oper Dent. 2020 Jan/Feb;45(1):1-9.
24. STRY RD. Quantitative evaluation of masking effect of resin infiltration on developmental defects of enamel. Quintessence Int. 2020 Jun;51(6):448.
25. Knösel M, Eckstein A, Helms HJ. Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo. Angle Orthod. 2019 Jan;89(1):33-39.
26. Borges A, Caneppele T, Luz M, Pucci C, Torres C. Color stability of resin used for caries infiltration after exposure to different staining solutions. Oper Dent. 2014 Jul-Aug;39(4):433-40.
27. Cohen-Carneiro F, Pascareli AM, Christino MR, Vale HF, Pontes DG. Color stability of carious incipient lesions located in enamel and treated with resin infiltration or remineralization. Int J Paediatr Dent. 2014 Jul;24(4):277-85.
28. Anderson P, Elliott JC. Rates of mineral loss in human enamel during in vitro demineralization perpendicular and parallel to the natural surface. Caries Res. 2000 Jan-Feb;34(1):33-40.
29. Jones RS, Fried D. Remineralization of enamel caries can decrease optical reflectivity. J Dent Res. 2006 Sep;85(9):804-8.
30. Paris S, Meyer-Lueckel H. Inhibition of caries progression by resin infiltration in situ. Caries Res. 2010;44(1):47-54.
31. Meyer-Lueckel H, Paris S, Kielbassa AM. Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration. Caries Res. 2007;41(3):223-30.
32. Tong LS, Pang MK, Mok NY, King NM, Wei SH. The effects of etching, micro-abrasion, and bleaching on surface enamel. J Dent Res. 1993 Jan;72(1):67-71.
33. Yazkan B, Ermis RB. Effect of resin infiltration and microabrasion on the microhardness, surface roughness and morphology of incipient carious lesions. Acta Odontol Scand. 2018 Oct;76(7):473-481.
34. Gu X, Yang L, Yang D, Gao Y, Duan X, Zhu X, et al. Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized clinical trial. Angle Orthod. 2019 May;89(3):372-377.
35. Muñoz MA, Arana-Gordillo LA, Gomes GM, Gomes OM, Bombarda NH, Reis A, et al. Alternative esthetic management of fluorosis and hypoplasia stains: blending effect obtained with resin infiltration techniques. J Esthet Restor Dent. 2013 Feb;25(1):32-9.
36. Shahroom NSB, Mani G, Ramakrishnan M. Interventions in management of dental fluorosis, an endemic disease: A systematic review. J Family Med Prim Care. 2019 Oct 31;8(10):3108-3113.
37. Gençer MDG, Kirzioğlu Z. A comparison of the effectiveness of resin infiltration and microabrasion treatments applied to developmental enamel defects in color masking. Dent Mater J. 2019 Mar 31;38(2):295-302.
38. Ertaş E, Güler AU, Yücel AC, Köprülü H, Güler E. Color stability of resin composites after immersion in different drinks. Dent Mater J. 2006 Jun;25(2):371-6.
39.Nasim I, Neelakantan P, Sujeer R, Subbarao CV. Color stability of microfilled, microhybrid and nanocomposite resins--an in vitro study. J Dent. 2010;38 Suppl 2:e137-42.
40. Chen M, Li JZ, Zuo QL, Liu C, Jiang H, Du MQ. Accelerated aging effects on color, microhardness and microstructure of ICON resin infiltration. Eur Rev Med Pharmacol Sci. 2019 Sep;23(18):7722-7731.
41. Sideridou I, Tserki V, Papanastasiou G. Study of water sorption, solubility and modulus of elasticity of light-cured dimethacrylate-based dental resins. Biomaterials. 2003 Feb;24(4):655-65.
42. Rey N, Benbachir N, Bortolotto T, Krejci I. Evaluation of the staining potential of a caries infiltrant in comparison to other products. Dent Mater J. 2014;33(1):86-91.
43.Jia L, Stawarczyk B, Schmidlin PR, Attin T, Wiegand A. Effect of caries infiltrant application on shear bond strength of different adhesive systems to sound and demineralized enamel. J Adhes Dent. 2012 Dec;14(6):569-74.
44.Yetkiner E, Wegehaupt FJ, Attin R, Attin T. Caries infiltrant combined with conventional adhesives for sealing sound enamel in vitro. Angle Orthod. 2013 Sep;83(5):858-63.
45.Borges AB, Abu Hasna A, Matuda AGN, Lopes SR, Mafetano APVP, Arantes A, et al. Adhesive systems effect over bond strength of resin-infiltrated and de/remineralized enamel. F1000Res. 2019 Oct 11;8:1743.
46.Simunovic Anicic M, Goracci C, Juloski J, Miletic I, Mestrovic S. The influence of resin infiltration pretreatment on orthodontic bonding to demineralized human enamel Appl. Sci. 2020 May 23;10(10):3619.
47.Artun J, Thylstrup A. A 3-year clinical and SEM study of surface changes of carious enamel lesions after inactivation. Am J Orthod Dentofacial Orthop. 1989 Apr;95(4):327-33.
48.Browning WD. Use of shade guides for color measurement in tooth-bleaching studies. J Esthet Restor Dent. 2003;15 Suppl 1:S13-20.
49.Chu SJ, Trushkowsky RD, Paravina RD. Dental color matching instruments and systems. Review of clinical and research aspects. J Dent. 2010;38 Suppl 2:e2-16.
50.van der Burgt TP, ten Bosch JJ, Borsboom PC, Kortsmit WJ. A comparison of new and conventional methods for quantification of tooth color. J Prosthet Dent. 1990 Feb;63(2):155-62.
51.Benson PE, Shah AA, Willmot DR. Measurement of white lesions surrounding orthodontic brackets: captured slides vs digital camera images. Angle Orthod. 2005 Mar;75(2):226-30.
2. Stoll R, Urban-Klein B, Giacomin P, Loukas A, Jablonski-Momeni A. In vivo assessment of caries excavation with a fluorescence camera compared to direct bacteriological sampling and quantitative analysis using flow cytometry. Lasers Med Sci. 2015 Feb;30(2):843-9.
3. Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent. 2013 Apr;25(2):85-95.
4. Perdigão J. Resin infiltration of enamel white spot lesions: An ultramorphological analysis. J Esthet Restor Dent. 2020 Apr;32(3):317-324.
5. Sampson V, Sampson A. Diagnosis and treatment options for anterior white spot lesions. Br Dent J. 2020 Sep;229(6):348-352.
6. Knösel M, Attin R, Becker K, Attin T. External bleaching effect on the color and luminosity of inactive white-spot lesions after fixed orthodontic appliances. Angle Orthod. 2007 Jul;77(4):646-52.
7. Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011 Mar;81(2):206-10.
8. Meyer-Lueckel H, Paris S. Progression of artificial enamel caries lesions after infiltration with experimental light curing resins. Caries Res. 2008;42(2):117-24.
9. Kim S, Kim EY, Jeong TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. Int J Paediatr Dent. 2011 Jul;21(4):241-8.
10. Borges AB, Caneppele TM, Masterson D, Maia LC. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review. J Dent. 2017 Jan;56:11-18.
11. Kielbassa AM, Muller J, Gernhardt CR. Closing the gap between oral hygiene and minimally invasive dentistry: a review on the resin infiltration technique of incipient (proximal) enamel lesions. Quintessence Int. 2009 Sep;40(8):663-81.
12. Youssef A, Farid M, Zayed M, Lynch E, Alam MK, Kielbassa AM. Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions. Quintessence Int. 2020;51(9):696-709.
13. Rocha Gomes Torres C, Borges AB, Torres LM, Gomes IS, de Oliveira RS. Effect of caries infiltration technique and fluoride therapy on the colour masking of white spot lesions. J Dent. 2011 Mar;39(3):202-7.
14. Yuan H, Li J, Chen L, Cheng L, Cannon RD, Mei L. Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence. Angle Orthod. 2014 Mar;84(2):343-9.
15. Knösel M, Eckstein A, Helms HJ. Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomized clinical trial. Am J Orthod Dentofacial Orthop. 2013 Jul;144(1):86-96.
16. Hammad SM, El-Wassefy NA, Alsayed MA. Evaluation of color changes of white spot lesions treated with three different treatment approaches: an in-vitro study. Dental Press J Orthod. 2020 Jan-Feb;25(1):26-27.
17. Kannan A, Padmanabhan S. Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial. Prog Orthod. 2019 Jun 17;20(1):23.
18. Knösel M, Bojes M, Jung K, Ziebolz D. Increased susceptibility for white spot lesions by surplus orthodontic etching exceeding bracket base area. Am J Orthod Dentofacial Orthop. 2012 May;141(5):574-82.
19. Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, et al. Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial. J Am Dent Assoc. 2013 Sep;144(9):997-1005.
20. Torres CR, Borges AB. Color masking of developmental enamel defects: a case series. Oper Dent. 2015 Jan-Feb;40(1):25-33.
21. Neuhaus KW, Schlafer S, Lussi A, Nyvad B. Infiltration of natural caries lesions in relation to their activity status and acid pretreatment in vitro. Caries Res. 2013;47(3):203-10.
22. Denis M, Atlan A, Vennat E, Tirlet G, Attal JP. White defects on enamel: diagnosis and anatomopathology: two essential factors for proper treatment (part 1). Int Orthod. 2013 Jun;11(2):139-65. English, French.
23. Garg SA, Chavda SM. Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study. Oper Dent. 2020 Jan/Feb;45(1):1-9.
24. STRY RD. Quantitative evaluation of masking effect of resin infiltration on developmental defects of enamel. Quintessence Int. 2020 Jun;51(6):448.
25. Knösel M, Eckstein A, Helms HJ. Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo. Angle Orthod. 2019 Jan;89(1):33-39.
26. Borges A, Caneppele T, Luz M, Pucci C, Torres C. Color stability of resin used for caries infiltration after exposure to different staining solutions. Oper Dent. 2014 Jul-Aug;39(4):433-40.
27. Cohen-Carneiro F, Pascareli AM, Christino MR, Vale HF, Pontes DG. Color stability of carious incipient lesions located in enamel and treated with resin infiltration or remineralization. Int J Paediatr Dent. 2014 Jul;24(4):277-85.
28. Anderson P, Elliott JC. Rates of mineral loss in human enamel during in vitro demineralization perpendicular and parallel to the natural surface. Caries Res. 2000 Jan-Feb;34(1):33-40.
29. Jones RS, Fried D. Remineralization of enamel caries can decrease optical reflectivity. J Dent Res. 2006 Sep;85(9):804-8.
30. Paris S, Meyer-Lueckel H. Inhibition of caries progression by resin infiltration in situ. Caries Res. 2010;44(1):47-54.
31. Meyer-Lueckel H, Paris S, Kielbassa AM. Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration. Caries Res. 2007;41(3):223-30.
32. Tong LS, Pang MK, Mok NY, King NM, Wei SH. The effects of etching, micro-abrasion, and bleaching on surface enamel. J Dent Res. 1993 Jan;72(1):67-71.
33. Yazkan B, Ermis RB. Effect of resin infiltration and microabrasion on the microhardness, surface roughness and morphology of incipient carious lesions. Acta Odontol Scand. 2018 Oct;76(7):473-481.
34. Gu X, Yang L, Yang D, Gao Y, Duan X, Zhu X, et al. Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized clinical trial. Angle Orthod. 2019 May;89(3):372-377.
35. Muñoz MA, Arana-Gordillo LA, Gomes GM, Gomes OM, Bombarda NH, Reis A, et al. Alternative esthetic management of fluorosis and hypoplasia stains: blending effect obtained with resin infiltration techniques. J Esthet Restor Dent. 2013 Feb;25(1):32-9.
36. Shahroom NSB, Mani G, Ramakrishnan M. Interventions in management of dental fluorosis, an endemic disease: A systematic review. J Family Med Prim Care. 2019 Oct 31;8(10):3108-3113.
37. Gençer MDG, Kirzioğlu Z. A comparison of the effectiveness of resin infiltration and microabrasion treatments applied to developmental enamel defects in color masking. Dent Mater J. 2019 Mar 31;38(2):295-302.
38. Ertaş E, Güler AU, Yücel AC, Köprülü H, Güler E. Color stability of resin composites after immersion in different drinks. Dent Mater J. 2006 Jun;25(2):371-6.
39.Nasim I, Neelakantan P, Sujeer R, Subbarao CV. Color stability of microfilled, microhybrid and nanocomposite resins--an in vitro study. J Dent. 2010;38 Suppl 2:e137-42.
40. Chen M, Li JZ, Zuo QL, Liu C, Jiang H, Du MQ. Accelerated aging effects on color, microhardness and microstructure of ICON resin infiltration. Eur Rev Med Pharmacol Sci. 2019 Sep;23(18):7722-7731.
41. Sideridou I, Tserki V, Papanastasiou G. Study of water sorption, solubility and modulus of elasticity of light-cured dimethacrylate-based dental resins. Biomaterials. 2003 Feb;24(4):655-65.
42. Rey N, Benbachir N, Bortolotto T, Krejci I. Evaluation of the staining potential of a caries infiltrant in comparison to other products. Dent Mater J. 2014;33(1):86-91.
43.Jia L, Stawarczyk B, Schmidlin PR, Attin T, Wiegand A. Effect of caries infiltrant application on shear bond strength of different adhesive systems to sound and demineralized enamel. J Adhes Dent. 2012 Dec;14(6):569-74.
44.Yetkiner E, Wegehaupt FJ, Attin R, Attin T. Caries infiltrant combined with conventional adhesives for sealing sound enamel in vitro. Angle Orthod. 2013 Sep;83(5):858-63.
45.Borges AB, Abu Hasna A, Matuda AGN, Lopes SR, Mafetano APVP, Arantes A, et al. Adhesive systems effect over bond strength of resin-infiltrated and de/remineralized enamel. F1000Res. 2019 Oct 11;8:1743.
46.Simunovic Anicic M, Goracci C, Juloski J, Miletic I, Mestrovic S. The influence of resin infiltration pretreatment on orthodontic bonding to demineralized human enamel Appl. Sci. 2020 May 23;10(10):3619.
47.Artun J, Thylstrup A. A 3-year clinical and SEM study of surface changes of carious enamel lesions after inactivation. Am J Orthod Dentofacial Orthop. 1989 Apr;95(4):327-33.
48.Browning WD. Use of shade guides for color measurement in tooth-bleaching studies. J Esthet Restor Dent. 2003;15 Suppl 1:S13-20.
49.Chu SJ, Trushkowsky RD, Paravina RD. Dental color matching instruments and systems. Review of clinical and research aspects. J Dent. 2010;38 Suppl 2:e2-16.
50.van der Burgt TP, ten Bosch JJ, Borsboom PC, Kortsmit WJ. A comparison of new and conventional methods for quantification of tooth color. J Prosthet Dent. 1990 Feb;63(2):155-62.
51.Benson PE, Shah AA, Willmot DR. Measurement of white lesions surrounding orthodontic brackets: captured slides vs digital camera images. Angle Orthod. 2005 Mar;75(2):226-30.
| Issue | Vol 20 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v20i40.13926 | |
| Keywords | ||
| Dental Caries Dental Enamel Color | ||
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How to Cite
1.
Gholami S, Boruziniat A, Talebi A, Yazdandoust Y. Effect of Extent of White Spot Lesions on the Esthetic Outcome After Treatment by the Resin Infiltration Technique: A Clinical Trial. Front Dent. 2023;20.
