New Techniques for Early Caries Intervention: Two Cases

William Johnston Rowe, Jr., DDS

Disclosures

January 19, 2011

New Techniques for Minimally Invasive Treatment: Two Cases

Conservative biomimetic restoration of teeth results in a restoration that is compatible with the mechanical, biologic, and optical properties of underlying dental tissues.[1] Demineralized, but noncavitated, enamel lesions can be arrested or remineralized in many situations. Research suggests that combining a microinvasive, conservative restorative approach with aggressive caries remineralization provides therapeutic benefits and significantly reduces long-term restorative needs and costs for patients.[2]

Demineralization, particularly at the cervical area of teeth, after orthodontic treatment is a common clinical finding for which minimally invasive approaches may be useful.[3,4] Use of a caries infiltrant may be an effective restorative procedure to avoid more costly invasive surgical options.[5] Manufacturer's directions for the use of the infiltrant Icon® (DMG America; Englewood, New Jersey) are for treatment of proximal carious lesions extending no deeper than the outer third of the dentin layer radiographically, with demineralized "white spots" on the facial surfaces of teeth without visible cavitation. Two cases are presented for use of a minimally invasive technique, one case with a diagnosis of orthodontic white spots anteriorly, and another case with a diagnosis of minimal interproximal lesions posteriorly.

Treatment Options for Dental Demineralization

The minimally invasive treatment options for dental demineralization or early caries include the following:

  • Treatment with topical fluoride and/or other remineralizing agents with repeated applications[3];

  • Surgical removal of demineralized enamel and placement of resin bonded restorative material;

  • Use of microinvasive infiltration resin[4]; or

  • No treatment with possible progression.

Case #1: Anterior Postorthodontic Demineralization

A 17-year-old girl presents with a chief complaint of "white rings" on her front teeth following removal of orthodontic brackets. She had maintained good oral health with routine visits to the dentist for prophylaxis and examination and had completed a 24-month course of orthodontic treatment. In the past, the patient has used carbamide peroxide over-the-counter preparations to whiten her teeth. Demineralized enamel was present on the facial surfaces of maxillary anterior teeth surrounding the area where the orthodontic brackets had previously been placed (Figure 1). Mild demineralization was localized to the enamel of the teeth.

Figure 1a. Demineralized, "white spot" lesions, post orthodontic treatment, full mouth view. 1b. "White spot" lesions, maxillary anterior close-up.

After reviewing her treatment options, the patient chose to pursue treatment with microinvasive infiltration resin (Figure 2).

Figure 2a. Post treatment of "white spot" lesions, full mouth view. 2b. Post treatment of "white spot" lesions, maximally anteriorclose-up.

Case #2: Early Interproximal Posterior Lesions

A 24-year-old woman presented for routine dental prophylaxis. She had no significant dental history; she reported that she had whitened her teeth with carbamide peroxide whitening gel in the past. Several interproximal early carious lesions were noted upon radiographic examination. Digital radiographs reveal early interproximal caries on teeth numbers 4, 5, 29, and 30 (Figure 3).

Figure 3. Digital radiograph showing interproximal caries on teeth numbers 4, 5, 29, and 30.

Following discussion of treatment options, the patient chose to pursue treatment with microinvasive infiltration resin.

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