DTUK1410

May 24-30, 201016 Clinical United Kingdom Edition C arious enamel lesions are characterised by a loss of minerals below a seem- ingly intact surface. The porosi- ties inside the lesion body result in the typically whitish appear- ance of these lesions, so-called white spots[1] . Carious enamel lesions on smooth surfaces are a frequent adverse effect of or- thodontic treatment with fixed appliances[2] . Although adhe- sively bonded brackets simplify orthodontic treatment, they in- hibit thorough cleaning of the surrounding tooth surfaces, thus promoting plaque accumulation and the formation of carious le- sions in these areas[3,4] . Even though the progression of these lesions, after removal of the brackets, may be inhib- ited with preventive measures such as topical fluoridation, the persistence of the white spot le- sions in the visible areas fre- quently lead to severe esthetic impairment[4] . Other risk factors for the formation of smooth sur- face lesions include insufficient oral hygiene, hypo salivation, or xerostomia[5] . The standard treatment for white spot lesions includes topical fluoridation and improvement of the patient’s oral hygiene in order to pro- mote the remineralisation of the demineralised enamel[6,7] . Due to the improved access of the smooth surface white spots after debonding, these non-operative measures show good results with respect to limiting the le- sion progression. However, es- pecially for deeper lesions, only a mere superficial remineralisa- tion is achieved. These lesions often have a very pronounced and mineralised surface layer[8,9] . But the lesion body under this surface layer remains porous, thus the white appearance of the lesion persists [4,10] . During the remineralisation phase, pig- ments from food, beverages, or tobacco products can also pen- etrate this lesion causing dark or brownish discolorations [9] . Many patients perceive these brown spots as even more unaesthetic. Different methods to treat these lesions have been established with varying success. The micro abrasion technique removes su- perficial enamel portions using a slurry of 18 per cent hydrochlo- ric acid and pumice[10-12] . Unfor- tunately, considerable amounts of enamel up to a depth of sever- al hundred micrometers have to be sacrificed with this procedure in order to achieve satisfactory esthetic results[13] . Other invasive restorative techniques, such as ceramic veneers or direct com- posite restorations, require the removal of extensive amounts of non-carious enamel and are very costly for the patient. The caries infiltration method is a novel, alternative therapy approach for the treatment of white spot lesions, based on the concept of sealing the micro-porosities of the lesion body and thereby inhibiting the substrate supply to inhibit the progression of the caries. For this purpose, the hy- per-mineralised surface layer is removed with a 15 per cent hy- drochloric acid gel[14] . In a next Caries infiltration in daily practice - Esthetic implications Dr Marcio Garcia dos Santos, MSc, PhD, São Paulo, Brazil ‘The standard treat- ment for white spot lesions includes topical fluoridation’ NEW Icon® – the innovative caries treatment without drilling. For incipient caries even a minimally invasive therapy will sacrifice healthy hard tissue. Icon now offers a revolutionary solution: First, the enamel surface is prepared with a specially developed HCl gel. The pore system is then filled, stabilized and sealed with a light-curing resin, thus arresting caries progression and preserving healthy hard tissue – without drilling. Icon is indicated for incipient caries with non-cavitated enamel and a radiological lesion progression into the outer third of the dentine. Treatment sets are available for proximal and smooth surface applications. DMG. A smile ahead. More information at www.drilling-no-thanks.co.uk AZ_IC_210x290_E_1004.indd 1 08.04.10 14:28

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