Icon Proximal Use in Early Enamel Lesions

Interproximal (IP) caries are cavities that develop in the tight spaces between teeth. These areas can be difficult to clean thoroughly with a toothbrush, thus increasing the risk of caries formation. Icon is a minimally invasive procedure used to treat early-stage of IP lesions, particularly those in the E1 and E2 stages. Icon can be utilized for lesions that have not yet formed cavities and have an intact surface layer. The treatment involves the use of a specific resin to penetrate the affected enamel and seal the lesion, preventing further damage. The aim of the present article is to showcase the importance of icon infiltration in the treatment of an early enamel lesion.

style italiano styleitaliano X-Ray showing E1 lesions on LR5 and LR7 and E2 lesions on LR6

Fig.1
A young male presented for a routine examination, upon taking bite wing radiographs, a number of IP lesions were detected. The X-Ray revealed E1 lesions on LR5 (distal) and LR7 (mesial), and E2 lesions on LR6 (mesial and distal).

style italiano styleitaliano initial situation

Fig.2
Occlusal view of the initial situation.

style italiano styleitaliano Insertion of orthodontic band

Fig.3
Two days prior to the Icon treatment, an orthodontic band was placed to help separating the teeth.

style italiano styleitaliano Insertion of icon wedge

Fig.4
To ensure a proper moisture control during icon treatment, isolation is achieved by placing a rubber dam, and an icon wedge to separate the dentition.

style italiano styleitaliano E2 lesion on LR6

Fig.5
E2 lesion on LR6.

style italiano styleitaliano Air abrasion using Aquacare

Fig.6
Prior to treatment, the teeth were cleaned using an ultrasonic scaler and air-abraded with 29μm aluminium oxide using Aquacare.

style italiano styleitaliano Icon etch using the proximal tip - 2 minutes

Fig.7
The Icon etch, which is 15% hydrochloric acid, was then applied using proximal tips and left on for 2 minutes.

style italiano styleitaliano Washing for 60 seconds with water and air dry

Fig.8
After washing for 60 seconds and air drying.

style italiano styleitaliano Icon dry using tip applied

Fig.9
The teeth were cleaned using ethanol (Icon dry), as shown in this image.

style italiano styleitaliano Icon infiltrant applied using proximal tip - 10 minutes

Fig.10
The ethanol was left to evaporate for 30-60 seconds before the application of Icon infiltrant using Icon proximal tip. In this case, the infiltrant was left for 10 minutes to ensure effective resin penetration within the lesion.

style italiano styleitaliano Air dry the resin infiltrant

Fig.11
Before curing, the resin was dried with air.

style italiano styleitaliano Floss between the contacts

Fig.12
Floss was used to clean the area between the contacts.

style italiano styleitaliano Cure for 40 seconds

Fig.13
Curing for at least 40 seconds with a good light curing is crucial.

style italiano styleitaliano polishing strip in use

Fig.14
Polishing strip in use.

style italiano styleitaliano Hand scaler to remove excess resin

Fig.15
The steps of Icon infiltrant application were repeated, ensuring to cure for another 40 seconds. Finally, excess resin was removed, and the tooth surface was polished using a combination of floss, polishing strips, and a Gracey scaler to achieve a smooth and polished tooth surface.

style italiano styleitaliano Post-op after infiltration. The lesion mark will disappear once the gap closes

Fig.16
Post-op after infiltration. The lesion mark will disappear once the gap closes.

Conclusions

To prevent future cavities, patients should be reminded to maintain their regular oral hygiene. Regular check-ups are also essential to monitor the treated area with bite-wing radiographs and clinical examination. Icon proximal is an effective tool for managing early enamel lesions. Accurate diagnosis is critical, and patients should be monitored after treatment. This minimally invasive approach has huge advantages including painless dentistry without the requirement of local anaesthesia or drilling. The procedure is straightforward and easy to follow.

Bibliography

  1. Cebula M, Göstemeyer G, Krois J, Pitchika V, Paris S, Schwendicke F, Effenberger S. Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials. Journal of Clinical Medicine. 2023 Jan 16;12(2):727.
  2. Elrashid AH, Alshaiji BS, Saleh SA, Zada KA, Baseer MA. Efficacy of resin infiltrate in noncavitated proximal carious lesions: a systematic review and meta-analysis. Journal of International Society of Preventive & Community Dentistry. 2019 May;9(3):211.

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