CARIES INFILTRATION

PREPARED BY :AHMED SALAH ABBAS .

UNDER SUPERVISION OF :PROF . DR . NAGWA KHATTAB .HEAD OF PEDODONTICS AND

PREVENTIVE DENTISTRY DEPARTMENT .MINIA UNIVERSITY.

INTRODUCTION :DENTAL CARIES IS ONE OF THE MOST COMMON HUMAN DISEASES THAT AFFECT A VAST MAJORITY OF INDIVIDUALS. IT OCCURS AS A RESULT OF CYCLIC DEMINERALIZATION AND REMINERALIZATION OF ENAMEL DUE TO ALTERED PH LEVELS .

THE EARLIEST EVIDENCE OF THIS DEMINERALIZATION ON THE SMOOTH ENAMEL SURFACE OF A CROWN IS A “WHITE SPOT LESION.” THESE CLASSICAL AREAS OF WHITE SPOT LESIONS LOSE THEIR TRANSLUCENCY BECAUSE OF THE EXTENSIVE SUBSURFACE POROSITY CAUSED BY DEMINERALIZATION AND SHOULD BE DISTINGUISHED FROM DEVELOPMENTAL WHITE SPOT HYPOCALCIFICATIONS OF ENAMEL.

•THESE EARLY LESIONS ARE AMENABLE TO REMINERALIZATION OR ARREST BUT IF THE DEMINERALIZATION PROCESS IS NOT STOPPED, THE INTACT ENAMEL SURFACE EVENTUALLY COLLAPSES AND CAVITATES .

IF THESE LESIONS PERSIST FOR A LONG TIME, FOR EXAMPLE, AFTER ORTHODONTIC BRACKET REMOVAL, THEY REPRESENT A SEVERE ESTHETIC PROBLEM AND ARE FREQUENTLY CALLED AS ENAMEL SCARS.

CARIES INFILTRATION THEORY:

THE TREATMENT OF NONCAVITATED LESIONS SHOULD AIM UPON ARRESTING THE LESION PROGRESSION AND IMPROVING THE ESTHETICS BY DIMINISHING THE OPACITY.

WHITE OPAQUE APPEARANCE OF ENAMEL RESULTS FROM CHANGE IN REFRACTIVE INDEX BETWEEN NORMAL ENAMEL AND ENAMEL WITH INITIAL CARIOUS LESION , THIS RESULTS FROM MICROPOROSITIES OF ENAMEL WITH INITIAL CARIOUS LESION WHICH CAUSES SCATTERING OF LIGHT.

•CARIES INFILTRATION DEPENDS ON INFILTRATION OF WHITE SPOT LESIONS , WHICH AREN`T CAVITATED WITH LIGHT – CURABLE RESIN WHICH HAS HIGH , RAPID PENETRATION TO THE BODY OF NON CAVITATED CARIOUS LESIONS .

THIS RESIN ALSO HAS LOW VISCOSITY , LOW CONTACT ANGLE WITH ENAMEL , HIGH SURFACE TENSION . THIS INCREASES THE PENETRATION POWER OF THE RESIN .

THIS WILL SEALS THE MICROPORES , ENHANCES THE OPTICAL PROPERTIES OF ENAMEL TO BE NORMAL.

INDICATIONS : A ) micro-invasive treatment of incipient caries confined to enamel and outer third of dentin as determined radiographically .

B ) micro-invasive treatment of smooth surface enamel lesion as cariogenic spots after bracket removal .

CONTRA-INDICATIONS: A ) in the case of allergy to any component of the material used.

B ) if carious lesion extends beyound the outer third of dentin.

TECHNIQUE: •there is a special kit used for caries infiltration.

1 ) remove any debris on affected tooth and adjacent tooth by use of water spray.

2 ) place rubber dam for complete isolation.

3 ) introduce one of enclosed dental wedge at the interdentium.

4 ) LEAVE THE WEDGE IN THE PROXIMAL SPACE DURING THE WHOLE PROCEDURE .

5 ) SCREW THE ETCH –SYERINGE TO THE PROXIMAL TIP .

6 ) APPLY ETCH MATERIAL FOR (2) MIN .

7 ) RINSE THE ETCHANT WITH WATER FOR AT LEAST THE SAME TIME.

8 ) AFTER DRYING , THE SURFACE IS DEHYTRATED FOR (30) SEC . BY ATTACHING DRY SYERINGE TO THE PROXIMAL TIP .

9 ) USE A NEW PROXIMAL TIP AND ATTACH THE INFILTRATE SYERINGE TO THE PROXIMAL TIP .

10 ) APPLY THE INFILTRATE MATERIAL AND LEAVE IT FOR (3)MIN TO SET .

11 ) REMOVE THE PROXIMAL TIP AND REMOVE THE EXCESS MATERIAL BY DENTAL FLOSS .

12 ) LIGHT CURE THE MATERIAL FROM ALL SIDES .

13 ) REPEAT THE STEPS WHEN THE SITUATION REQUIRES.

NOTES :A ) ETCHANT USED IS ( 15%) HYDROCHLORIC ACID WHICH IS FOUND MORE EFFECTIVE THAN (37%) PHOSPHORIC ACID IN REMOVING SURFACE LAYER OF NORMAL ENAMEL LESION , PROVIDING MORE PENETRATION ABILITY OF THE INFILTRATES .

B ) THE DEHYDRATION AGENT IS (99%) ETHANOL , WHICH ALLOWS WETTING OF HYDROPHOBIC INFILTRATES.

SYSTEMATIC REVIEW OF RESIN INFILTRATION OF NON CAVITATED LESIONS

OBJECTIVE : THE AIM OF THIS SYSTEMATIC REVIEW WAS TO EVALUATE THE IN VIVO SCIENTIFIC EVIDENCE OF THE ABILITY OF RESIN INFILTRATION (RI) TO ARREST NON-CAVITATED CARIES LESIONS .

MATERIALS AND METHODS :AMONG THE 14 ARTICLES ORIGINALLY IDENTIFIED WITH THESE KEYWORDS, ONLY 4 (RELATED TO 3 DIFFERENT IN VIVO STUDIES) WERE INCLUDED FOR THIS REVIEW.

CONCLUSION : THIS SYSTEMATIC REVIEW REVEALED THAT RI APPEARED TO BE AN EFFECTIVE METHOD TO ARREST THE PROGRESSION OF NON-CAVITATED CARIES LESIONS. ADDITIONAL, LONG-TERM STUDIES ARE REQUIRED.

CONCLUSION: •When indicated, minimal invasive dentistry such as resin

infiltration technique seems to provide a good solution in dealing with early enamel lesions as recommended by many recent studies in this field.

•Such technique could also be used in combination with other enamel remineralizing agents like fluoride varnishes.

•Patient’s motivation would probably play a major role in the success of any minimal invasive dentistry technique.

•Further studies with longer periods of follow up are necessary to confirm the efficiency of this treatment modality and encourage the clinicians to use it in their dental practice.