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.
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.
Fig.2
Pre-op occlusal view on presentation.
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.
Fig.4
Isolation by placing a rubber dam and insertion of the Icon wedge to keep the dentition separated during treatment.
Fig.5
The E2 lesion visualised. It is important to remember that this is an adhesive procedure so moisture control is imperative.
Fig.6
The teeth were cleaned with an ultrasonic scaler and air abraded using 29μm aluminium oxide (Aquacare).
Fig.7
The teeth are now cleaned and ready for Icon treatment.
Fig.8
Icon etch (15% hydrochloric acid) is applied using the proximal tips provided, and left to sit for 2 minutes.
Fig.9
The teeth are then washed for 60 seconds and air dried.
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.
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.
Fig.12
The tooth was air dried before curing.
Fig.13
Flossing is also advised to avoid excess material to stick into the contact point.
Fig.14
Light curing was carried out using the Eighteeth Curing Pen for 60 seconds.
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.
Fig.16
Polishing strip in use.
Fig.17
LM Gracey scaler to remove excess resin.
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
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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.
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