Resin Infiltrations Reduce White Spot Tooth Lesions

Laird Harrison

September 13, 2013

Resin infiltrations appear to reduce white spot lesions on teeth, a randomized controlled trial shows.

Lesions treated with resin infiltration shrunk by a mean of 60.9% 8 weeks after treatment, whereas lesions in an untreated control group grew by 3.3%.

Seth V. Senestraro, DDS, from the Department of Orthodontics, School of Dentistry, Oregon Health & Science University, Portland, and colleagues published the results of their trial in the September issue of the Journal of the American Dental Association.

"Resin infiltration, a minimally invasive restorative treatment, was shown to be effective for [white spot lesions] that formed during orthodontic treatment," the authors write.

White spot lesions result from enamel demineralization and may be caused by poor oral hygiene. Because orthodontic appliances make brushing difficult, the lesions occur frequently in patients who wear them. Estimates of the prevalence of white spot lesions in this population range from 4.9% to 97%, the authors report.

White spot lesions are sometimes described as incipient cavities, but prior studies suggest they are stable in the long term and do not usually lead to caries. Still, the lesions are worth treating because they look bad, the authors note.

They also note that previous research has shown "minimal and often clinically insignificant" responses to topical treatments such as casein phosphopeptide amorphous calcium phosphate and low concentration fluoride. Moreover, bleaching can weaken enamel, and traditional restorations and microabrasion both require removing enamel.

In contrast, resin infiltration requires removing only the outer layer of enamel with an etchant. After exposing the demineralized lesion body this way, the clinician fills the lesion with a low-viscosity resin.

Resins Reduced White Spots in Treated Teeth

To test the effectiveness of this approach, the researchers recruited 30 patients aged 12 to 30 years who had extensive white spot lesions after orthodontic treatment. Of these patients, 10 did not keep appointments. The researchers chose 66 teeth with white spot lesions from the remaining 20 patients and randomly assigned 46 teeth to be treated with resin infiltration and 20 to serve as untreated controls.

In contrast to the typical infiltration technique, the researchers used a fine-grit polishing disk to abrade the lesions with a slow-speed handpiece before applying the resin. They did this because the lesions were relatively old. For newer lesions, this step might not be necessary, they note.

They photographed the teeth before and after treatment and showed the photographs to 5 orthodontists who did not know which teeth had been treated and which had not. The orthodontists rated improvement in the teeth using a visual analog scale, with 0 being no improvement and 100 being complete improvement.

Eight weeks after treatment, the infiltrated teeth had a mean visual analogue scale rating of 65.9 compared with 9.2 for the control teeth. The difference was statistically significant (P < .001).

In addition, the lead investigator measured the sizes of the lesions before and after the treatment, using an image analysis program (ImagJ, National Institutes of Health, Bethesda, Maryland) to assess any changes. The difference in the change in size was statistically significant (P < .001).

The authors have disclosed no relevant financial relationships.

JADA. 2013;144:997-1005. Abstract

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