Preventative interproximal enamel lesion management using Icon proximal

Interproximal caries, are tiny cavities that form in the narrow spaces between teeth. Due to their location, these areas can be challenging to clean with a toothbrush, making them more susceptible to caries development. Icon is a minimally invasive procedure that is employed to treat small interproximal caries in their early stages, with E1 and E2 stages being the most treatable. Icon can also be used for lesions with an intact surface layer and no cavitation. The treatment involves using a specialised resin to infiltrate the enamel in the affected area and seal the lesion, preventing further harm.

style italiano styleitaliano detail of X-ray revealing proximal caries

Fig.1
Part of the X-ray that revealed E1 lesion on the upper right second premolar distally and an E2 lesion on the upper right first molar mesially.

style italiano styleitaliano occlusal view of molar and premolar contact point

Fig.2
Pre-op occlusal view on presentation.

style italiano styleitaliano orthodontic band placed to separate teeth

Fig.3
In this case, a young patient presented on a routine examination. Two days prior to the patient’s Icon treatment we placed an orthodontic band to help separate the teeth.

style italiano styleitaliano insertion of icon wedge

Fig.4
Isolation by placing a rubber dam and insertion of the Icon wedge to keep the dentition separated during treatment.

style italiano styleitaliano E2 lesion on upper right first molar

Fig.5
The E2 lesion visualised. It is important to remember that this is an adhesive procedure so moisture control is imperative.

style italiano styleitaliano air abrasion using Aquacare

Fig.6
The teeth were cleaned with an ultrasonic scaler and air abraded using 29μm aluminium oxide (Aquacare).

style italiano styleitaliano proximal e1 lesion after air-abrasion

Fig.7
The teeth are now cleaned and ready for Icon treatment.

style italiano styleitaliano Icon etch using the proximal tip

Fig.8
Icon etch (15% hydrochloric acid) is applied using the proximal tips provided, and left to sit for 2 minutes.

style italiano styleitaliano frosty enamel of washed and air dried tooth

Fig.9
The teeth are then washed for 60 seconds and air dried.

style italiano styleitaliano application of Icon Dry

Fig.10
Now the teeth must be cleaned using the ethanol solution (Icon Dry). It is advisable to let this evaporate organically (30-60 seconds). Once the ethanol has dried out, the Icon resin infiltrant is applied using the Icon proximal tip.

style italiano styleitaliano Application of Icon infiltrant using proximal tip provided

Fig.11
In this case the infiltrant was left for 10 minutes (more than advised in the manual) to ensure effective penetration of the resin within the lesion.

style italiano styleitaliano air drying after resin infiltration

Fig.12
The tooth was air dried before curing.

style italiano styleitaliano flossing before curing resin infiltrant

Fig.13
Flossing is also advised to avoid excess material to stick into the contact point.

style italiano styleitaliano light curing after resin infiltration

Fig.14
Light curing was carried out using the Eighteeth Curing Pen for 60 seconds.

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
style italiano styleitaliano after resin infiltration before polishing

Fig.15
Finally we can use a combination of floss, polishing strips and LM Gracey scaler or LM Arte Eccesso instruments to remove any excess resin tags, and ensure a smooth and well polished tooth surface.

style italiano styleitaliano lm arte anterior instruments
style italiano styleitaliano lm anterior instruments
style italiano styleitaliano polishing proximal contact with finishing strip

Fig.16
Polishing strip in use.

style italiano styleitaliano removing resin excess with scaler

Fig.17
LM Gracey scaler to remove excess resin.

style italiano styleitaliano after resin infiltration of proximal lesion

Fig.18
Post-op after infiltration.

Conclusions

Patients should be reminded to maintain their regular oral hygiene to prevent future cavities from forming. Additionally, the patient should schedule regular check-ups to monitor the treated area with bite wing radiographs and clinical examination. Icon proximal can be a useful tool for managing and preventing early enamel lesions. Correct diagnosis is crucial, and patients should be followed up after treatment. The benefits of Icon proximal include pain-free dentistry without the need for local anaesthesia or drilling. The procedure is simple and easy to follow.

Bibliography

1. Kantovitz KR, PasCon Fm, noBRe-dos-santos m, PuP- Pin-Rontani Rm. Review of the effects of infiltrants and sealers on non-cavitated enamel lesions. Oral Health Prev Dent 2010; 8: 295-305.
2. Torres, CRG, Borges, AB, Torres, LMS, Gomes, IS, Simões de Oliveira, R. Effect of caries infiltration technique and fluoride therapy on the colour masking of white spot lesions. Journal of dentistry 2011, 39 (3), 202-207.
3. Attal J P, Atlan A, Denis M, Vennat E, Tirlet G . White spots on enamel: treatment protocol by superficial or deep infiltration (part 2). Int Orthod 2014; 12: 1–31.
4. Paris S, Schwendicke F, Keltsch J, Dorfer C, Meyer-Lueckel H . Masking of white spot lesions by resin infiltration in vitro. J Dent 2013; 41: 28–34.
5. Paris S, Meyer-Lueckel H, Cölfen H, Kielbassa AM. Penetration coefficients of commercially available and experimental composites intended to infiltrate enamel carious lesions.

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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