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DOI: 10.4172/2332-0702.1000234
Health
ISSN: 2332-0702
Oral Hygiene & Health
Research Article
Review Article Open
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Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature

Review
Omar Abd El Sadek El Meligy1,2*, Shimaa Tag Eldin Ibrahim1 and Najlaa Mohammed Alamoudi1
1
King Abdulaziz University, Jeddah, Saudi Arabia
2
Alexandria University, Alexandria Governorate, Egypt

Abstract
Background: Noninvasive measures involving fluoridation, dietary control, and oral hygiene instruction, as well
as invasive restorative methods, are the standard treatment options for interproximal caries. Intermediate treatment
options, similar to pit-and-fissure sealing on occlusal surfaces that has been shown to be effective in preventing
and inhibiting caries, have not yet been established on interproximal surfaces. Recently, the application of resins
on interproximal caries lesions has been studied and improved, leading to the development of new materials, which
infiltrate and seal the carious lesion, improving the inhibition of caries progression.
Aim: The aim of this literature review was to revise the in vivo and in vitro scientific evidence of the ability of resin
infiltration (RI) to arrest non-cavitated proximal caries lesions.
Materials and methods: Electronic search of English scientific papers from 2007 to 2017 was accomplished
using Pub Med search engine. The keywords used were ‘resin infiltration, dental caries’, ‘resin infiltration, carious
lesions’, ‘resin infiltration, caries lesions’, ‘caries infiltration’ and ‘Icon DMG’ with the ‘clinical trial’ filter activated.
Results: One hundred and forty articles were reviewed as well as some references of selected articles. Fifty
studies described the ability of resin infiltration to arrest non-cavitated caries lesions. Conclusion: Data show this new
technique complements existing treatment options for interproximal caries by delaying the time point for a restoration
and consequently closing the gap between noninvasive and invasive treatment options.

Keywords: Resin infiltration; Dental caries; Carious lesions; Caries
infiltration; Icon DMG
Introduction
Dental caries is a major public health concern commonly affecting
children in their early childhood. It has a negative impact on children’s’
oral as well as general health [1]. The caries prevalence rate in the
Jeddah city has ranged from 70 to 76% in 6-year-old children [2].
Special attention has been devoted to early proximal carious
lesions, with maximum preservation of tooth structure [3]. This is
mainly because restorative therapy for interproximal lesions requires
removal of a substantial amount of sound tissue and this brings tooth
into a circle of treatment and retreatment [4]. Therefore, early detection
and treatment of such lesions will limit the need for invasive treatment
in the future.
Restoring the tooth structure by dental filling and restoration
was the first choice for treating dental caries [5], but in the last years,
the treatment has been changed from the large invasive technique to
noninvasive or minimal invasive preventive techniques [6].
Several noninvasive techniques have been developed to treat early
caries lesions [7]. Smooth surfaces caries, have benefited from the
preventive effects of fluoride agents, such as fluoride toothpaste and
fluoridated water. Fluoride application improves the re-mineralization
process of the demineralized tooth structure [8]. It was reported that the
application of Duraphat fluoride varnish twice per year with 6 months’
interval, significantly reduces the incidence of proximal caries [9].
Sealants were first introduced to protect the pit and fissure surfaces
in the 1960s by Cueto and Buonocore [10], as a part of preventive
programs to protect pits and fissures on the occlusal tooth surfaces
from dental caries. Such sealants prevented dental decay by preventing
the growth of bacteria that cause dental caries [11].
The prevalence of decay was decreased in the industrialized
countries between 1970 and 1980 due to the use fluoride and fissure
sealant [12]. In addition, sealant prevents caries on both occlusal and
proximal teeth surfaces [13], but due to the low penetration ability of
the resin material, the resin infiltration (RI) material with less viscosity
was needed [14] to penetrate to the lesion base, arrest the lesion,
providing mechanical support and also improving the aesthetics of the
enamel [15].
Infiltration Concept (ICON®) is a relatively new resin product
developed in Germany and used in the treatment of incipient lesions
[16]. It improves the retention and prevents caries on smooth surfaces,
but not pit and fissure surfaces [17].
Resin infiltration is a micro-invasive method that fills the incipient
lesion pores via capillary action [18], which blocks further diffusion
of the bacteria by creating barriers and stops lesion development,
restoring the tooth without anaesthesia and drilling to preserve the
natural anatomy of the tooth form [19].
The ICON® infiltrates the lesion, make the bacteria inactive and
prevents caries progression [19] compared to the sealant which only
work as mechanical barrier between the tooth structure and the oral
environment [11].
*Corresponding author: Omar Abd El Sadek El Meligy, Professor of Pediatric
Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of
Saudi Arabia, Tel: +966122871660; Fax: +966126403316; E-mail: omeligy@kau.
edu.sa.
Received: December 12, 2017; Accepted: December 18, 2017; Published:
January 10, 2018
Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of
Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral Hyg Health 6:
234. doi: 10.4172/2332-0702.1000234
Copyright: © 2018 Meligy OAESE, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.

J Oral Hyg Health, an open access journal

ISSN: 2332-0702 Volume 6 • Issue 1 • 1000234
Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
The ICON® is available on the market as two products according to
their use; the first one is known as ICON caries infiltrate-proximal and
is used in early interproximal caries lesions. The second one is known
as Icon - Caries Infiltrate smooth surface and is used to treat all other
smooth surfaces [20].
The commercial ICON® kit contains 15% hydrochloric acid as
etchant, ethanol for drying and the infiltrate resin material [21]. The
ICON® system contains 15% hydrochloric acid etchant [21], while the
sealants system contains 37% phosphoric acid etchant [22].
When applying RI in etched demineralized enamel, resin will fill
the porosities of demineralized enamel surface [23]. This technique will
mask the opaque white spot lesions [24], in smooth buccal or lingual
surfaces and inter-proximal surfaces [20].
The aim of this literature review was to revise the in vivo and in vitro
scientific evidence of the ability of RI to arrest non-cavitated proximal
caries lesions.
Materials and Methods
Electronic search of English scientific papers from 2007 to 2017 was
accomplished using Pub Med search engine. The keywords used were
‘resin infiltration, dental caries’, ‘resin infiltration, carious lesions’, ‘resin
infiltration, caries lesions’, ‘caries infiltration’ and ‘Icon DMG’ with the
‘clinical trial’ filter activated.
Results
One hundred and forty articles were reviewed as well as some
references of selected articles. Fifty studies described the ability of RI to
arrest non-cavitated caries lesions.
Discussion
Bonding in dentistry
Bonding of different materials to the enamel and dentin is one
of the most important developments in the dentistry [25]. Many
improvements have been made in this field since its development in
the 1950s [26]. Etching techniques for bonding to enamel have changed
the practice of dentistry. Although bonding to the dentin has been
challenge, ongoing developments are improving the reliability of dentin
bonding agents [26].
Understanding the history of bonding agents is very important, as
bonding has become a base of modern dentistry. In the previous 50
years, there has been development in the bonding agents. New concepts
on restorative and adhesive dentistry have been advanced during this
period. In 1955, Buonocore developed the principles of adhesive
dentistry when he used the techniques of bonding and acids for
surface treatment before application of the restorative material. Several
options were discovered to maintain bonding between filling material
and the tooth structure. This discovery included the improvements of
resin materials which controlled adhesive properties, development of
available materials, adhesive material between the tooth and the filling
and chemical treatment of the tooth surface to create a new surface
to which the materials adhere [25]. Later, Buonocore recommended
that the formation of the resin tags was the phenomenon that allows
the adhesion of resin to the acid etched enamel. The micromechanical
bonding is widely accepted today.
The main aim of dental adhesives is retention of fillings. Etching
to enamel development was another challenge in bringing bonding of
materials to the tooth structure. Different acids, as phosphoric acid,
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with dissimilar etching times were tested for etching of the enamel [27].
The ability to bond to enamel is reliable and widely accepted today.
Bonding to dentin has been more difficult than to enamel, because
enamel contains less protein than dentin and the dentin pores contain
fluid which inhibits bonding to dentin [28].
Preventing the leakage along the restoration’s margins is an
advantage of a good adhesive. Most of the esthetic resin restorative
materials are using adhesive systems and the major limitation of the
earlier filling materials is the lack of adhesion to the tooth structure
[25]. Acid treatment is a significant method used to accomplish
adhesion of bonded restorations to the tooth structure [25]. Buonocore,
in 1955 found that conditioning enamel with 85% phosphoric acid for
30 seconds help the resin bond to the tooth enamel. Also, this new
bonding technique can be used for different restorative materials as pit
and fissure sealants [26].
Buonocore, in 1955 suggested the formation of resin tags as the
primary attachment mechanism of resin to phosphoric acid-etched
enamel. The acid etching mechanism removes about 10 micrometers
(um) of enamel and creates a porous layer of 5-50 um deep to allow for
the resin penetration into the porous layer [26]. Etching increases the
surface area of the enamel substrate by exposing the organic material of
the enamel, which can then serve as a network to which the resins can
adhere [26]. In other words, etching creates spaces deep along the inter-
prismatic areas to which the resin can penetrate. When the low viscosity
resin is applied to the etched area, it flows into the micro-porosity
channels of this layer and polymerizes to form a micromechanical bond
with the enamel surface [26]. Conventional adhesive systems consist of
three components: an acid conditioner, a primer and an adhesive resin
[29].
Adhesion is being defined as the attraction between molecules
of different materials at the interface [30]. Several factors must be
considered in bonding between the restorative material and the tooth
structure, as adhesive properties, the use of adhesive interface and the
alteration of the tooth surface to help adhesion [25]. Adhesion can be
categorized by three different mechanisms, chemical adhesion, which
includes covalent, ionic and metallic bonds, physical adhesion, which
includes secondary valence forces such as Vander Waals forces, hydrogen
bonds and London dispersion forces and mechanical adhesion which is
defined as penetration of one material into a different material [31].
The dentin bonding agents usually consists of conditioner, primer
and adhesives. Conditioner (etchant) which is used to prepare the
dentin surface and applied before the primer, the etchant is usually
washed off before the application of the primer, etchant as phosphoric
acid, citric acid, nitric acid or oxalic acid are always used. Primer are
the bi-functional molecules, of which one functional group contains a
hydrophilic component to facilitate wetting and adhesion to the dentine
and the opposite end is the hydrophobic group which readily bonds
to the bonding resin. Different primers are used as HEMA (Hydroxy-
Ethyl Methacrylate), PMDN (Pyromellitic diethylmethacrylate),
NPG-GMA (N-phenylglycine glycidyl-methacrylate), NTG-GMA
(N-tolylglycine glycidyl-methacrylate), PENTA (Phosphonated penta-
acrylate ester) and glutaraldehyde. Adhesives chemically bond to
the primers and provide an increase in additional micro-mechanical
and macro-mechanical surface retention. Different types are used
that bond to the primed dentinal surface as Bis-GMA (Bisphenol-
glycidyl methacrylate), UDMA (Urethane-dimethacrylate), TEGMA
(Triethylene glycol-methacrylate), and 4-META (4-Methacryloxy-ethyl
trimellitate anhydride) [29].
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Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
In 1955, Buonocore introduced the concept of acid etching. Acid
etching step is used to achieve adhesion to enamel. Acid etching of
the enamel removes the inter-prismatic mineral crystals, increase the
surface energy, surface area, and create micro-porosities on the enamel
surface into which the bonding agents can flow, resulting in reliable
enamel bond strengths. There are three types of etching patterns, Type
1 etching pattern is the most common type, and it involves preferential
removal of enamel prism cores, but the prism peripheries remain
intact, Type 2 etching pattern is the reverse of the type 1, in which the
peripheries are removed and the core remains intact and Type 3 etching
pattern is less distinct and includes areas resembling both of the other
patterns and also etching patterns that appear unrelated to the prism
morphology [26].
Pits and fissure sealants
Sealants are coatings applied to the pits and fissures of mainly molar
teeth which prevent the growth of bacteria that promote decay in pit
and fissure surfaces of molar teeth [32].
In 2002, Simonsen said that ‘the term pit and fissure sealant is
used to describe a material that is introduced into the occlusal pit and
fissures of caries susceptible teeth, thus forming a micro-mechanically
bonded, protective layer cutting access of caries producing bacteria
from their source of nutrients’. Hyatt in early 1923 introduced pits and
fissure and suggested a technique called prophylactic odontotomy,
which involved a minimal operative procedure of restoring sound
fissures with amalgam. The idea was not fully accepted, which led to the
using of Blacks’ extension for prevention cavity preparation [33]. The
prophylactic odontotomy was done on sound teeth to prevent cavities,
whereas Black’s principle was applied on teeth with caries.
Early before the fluoride, various chemicals as zinc chloride and
ammoniacal silver nitrate were used on the tooth surface, but it wasn’t
successful [33]. After the introduction of fluoride into the practice of
dentistry, development of preventive materials started specifically for
pit and fissure surfaces [33]. The revolution came in 1955 by Buonocore,
when he developed the acid etching technique. Cyanoacrylates were
used as sealant materials in the 1960s, but did not last long. In the late
1960s, a new successful material was developed known as the Bisphenol
A and glycidyl methacrylate (BIS-GMA) with methyl methacrylate
monomer. The American Dental Association (ADA) issued an initial
acceptance for the first Bis-GMA material in 1972 and gave it full
acceptance in 1976. Bis-GMA sealant materials are the mostly used
today resins and urethane-based resins and considered a basis for
development of other products [34]. In 1960, sealants were developed
for the protection of pits and fissures of occlusal surfaces and buccal and
lingual pits from dental caries as they prevent the growth of bacteria in
pits and fissures and therefore prevent dental caries. Now, there are two
types of sealants available, the resin based sealants, composites and the
glass ionomer sealants [32].
Four different generations were developed from resin sealants
based on the mechanism of polymerization and the material content.
The first-generation products were activated with an ultraviolet light,
the second and third generations were auto-polymerized and visible-
light activated, respectively and finally the fourth generation contained
fluorides [32].
In 1974, McLean and Wilson presented the glass ionomer sealant
[32]. Glass ionomer sealants contain fluoride and prevent caries
through the release of fluoride but it has inadequate retention [32].
In 1990, a combination of composites and glass ionomer cements
known as compomers were developed. The battle against decay has a
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long history, which includes the preventive innovations such as early
physical blocking of fissures with zinc phosphate cements, mechanical
fissure eradication, prophylactic odontotomy and chemical treatment
with silver nitrate [35].
Acid etch bonding technique was a new technology in the use
of bonding in prevention of pit and fissure caries. New methods of
caries prevention have focused on the pit and fissure surfaces, as
the smooth surfaces have become less susceptible to decay with the
advent of fluoride. The disproportional occurrence of caries on pit
and fissure surfaces continues to date, with these surfaces accounting
for approximately 91% of dental decay. The high risk of pit and fissure
caries on almost all the molars has driven the dental profession to view
sealants as a highly advantageous procedure [35].
Dental sealants have become an essential part of contemporary
restorative dentistry. The advent of the acid etch technique, availability
of new restorative material and a better understanding of the caries
process has helped clinicians make better recommendations [36].
The resin-based sealants are divided into categories based on
their polymerization as auto-polymerizable, which polymerize by
themselves/ without any source for activation, photo-polymerizable,
which polymerize after exposure to a source of light of a particular
wavelength, and the combination of both [37]. Another category of
material is a composite that incorporates particles of glass hardened
glass ionomer cements within its mass. The other two types of glass
ionomer are those with light-polymerized liquid and those modified
with inclusion of metal [38]. Glass ionomer cements were developed
in 1974 by Wilson and Kent and consisted of calcium or strontium
alumino-fluorosilicate glass powder (base) combined with water
soluble polymer (acid) [38]. The term ‘glass ionomer cement’ is applied
to materials that involve an acid-base reaction as a part of the setting
reaction. As the cements contain fluoride ions, significant amounts
of these ions are released during this reaction, without affecting the
physical properties of the hardened cement [33]. Since development of
sealant material in 1960s it has been used widely by clinicians.
Resin infiltration
Superficial sealing of caries lesion is introduced as a safe method
for controlling caries progression in non-cavitated enamel caries [21].
The ICON® (infiltration concept) were developed using a microinvasive
technique. The material concept is based on infiltration into the
porosity of the tooth structure and stopping further progression of the
lesions. On the other hand, it shows many drawbacks such as difficulty
in retention and high flowability when applied, in addition to the need
for smooth proximal surfaces [39].
A method of treating caries has been introduced, by using RI
materials that infiltrate and fill the pores of the early interproximal
caries [40]. The idea of treating early caries lesions was established in
1970. Through years, this technique was developed to become easier
and more effective in penetrating caries [41]. From there, RI was
developed [42].
The research group led by Buonocore conducted the first
experiments to penetrate low viscosity resins into carious lesions.
After the advent of bonding agents and development of sealants, very
few studies on infiltration of early carious lesions were conducted. In
1976, Robinson et al. published their earliest study on the concept of
infiltration using adhesive compound called resorcinol formaldehyde
on carious lesion, they found that the penetration of the resin greatly
increased when etched with HCl for 5-10 seconds. An effort was
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Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
made to develop a new infiltration material with better properties
such as having low viscosity, bactericidal, hydrophilic, mechanically
supportive and cosmetically acceptable. Also, another material known
as Chlornaphthalene was tested on the surface of the lesion and showed
gradual penetration into the caries porosity, were 60±10% of the lesions
pore volume had been occupied by the resin [43].
Robinson et al. conducted an in vitro study that compared resorcinol
formaldehyde and other commercially available resins including Scotch
bond TM (3M Dental products), All-bond (Bisco Inc., Ill), Amalgam
bond (Parkell Biomaterials, NY) and Cyanoacrylates. The study showed
that all the polymers reduced the available pore volume significantly
after the first and second application and after the third application only
resorcinol-formaldehyde and scotch-bond further reduced the pore
volume significantly. The resin material had the potential to infiltrate
into lesions and protect them from caries attack [44]. White spot lesions
showed resistance to acid attack when etched with phosphoric acid
and sealed with a resin material when compared to none treated white
lesions [45].
Using an unfilled resin for sealing white spot lesions show its
effectiveness in preventing further demineralization [46]. Evaluating the
effectiveness of sealing active proximal caries lesions with an adhesive
system after one year using the McNemar’s test showed regression on
lesion and no further progression was seen [47]. Various RI materials
showed promising results in terms of infiltration into the lesions and
prevention from acid attack [47].
ICON® is an abbreviation for Infiltration Concept, introduced into
the field of dentistry in 2008 for treating white spot lesions. It depends
on a micro-invasive technique that is used for the treatment of white
spot carious lesions on the buccal, lingual and proximal surface of the
teeth [48].
Nowadays the RI material became commercially available as kits
that contain all the material needed during the procedure, such as
ICON® (DMG, Hamburg, Germany) [21].
Minimally invasive treatment of white spot lesion has been
proposed in the past as using combination of micro-abrasion paste
containing silicon carbide micro-particles in soluble water paste and
6.6% hydrochloric acid and enamel remineralization paste containing
casein phospho-peptide amorphous calcium phosphate complexes
(CCP-ACP) [49].
The major disadvantage of using this technique is the high amount
of enamel that is eroded as part of micro-abrasion. The infiltration
technique has several advantages over other techniques. First, deeper
lesions can be improved by infiltration techniques which can’t induce
remineralization and the esthetic improvement [49]. Secondly, when it
is compared to other techniques, the infiltration is much less invasive
[50].
ICON® caries infiltration technique is an alternative therapeutic
technique to prevent the further progression of enamel lesions. The
aim of this treatment is to block the porosities within the body of the
white spot lesion with a low viscosity light-cured resin that has been
improved to penetrant the porous enamel [50]. Infiltrates are light-
curable and have low viscosity, low contact angles to the enamel and
a high surface tension to complete penetration into the lesion porosity
[50]. Before the applying RI material, the enamel is conditioned using
15% hydrochloric acid gel. The resin penetrates into the lesion driven
by a capillary force. The ICON® infiltrate resin material was developed
after pilot studies done at the University of Kiel, Germany, where
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they had experimented various mixtures of resin materials such as
TEGDMA, BisGMA and ethanol using various mixing ratios [50]. A
mixture of highest penetration coefficient was preferred as an infiltrate
[51], so as to create a diffusion barrier within the lesion and not on
the lesion surface. Once the resin material is infiltrated, excess material
was removed from the surface of the lesion using a cotton swab and
the material infiltrated. Curing was done using a ultra-violet light [51].
ICON® is available on the market as two products according to their
use. The first one is known as ICON® caries infiltrant-approximal and
is used in early interproximal caries lesions. The second one is known
as ICON® caries infiltrate-vestibular and is used after removing the
orthodontics appliances [52].
A single ICON® package consists of an infiltrate which is a
composed of tetra ethylene glycol di-methacrylate, additives and
initiator, an acid conditioner to etch the enamel surface made of 15%
hydrochloric acid and ethanol. ICON® works on the principle of the
light-scattering phenomenon. The sound enamel has a refractive index
of 1.62. The porosities of a white spot carious lesion are usually filled
with either a watery medium or air, which have refractive indices of
1.33 and 1, respectively. The whitish appearance of the lesion is because
of the difference in the refractive index between the enamel crystals
and the medium within causing scattering of the light. The micro-
porosities on lesion body are infiltrated with the resin material which
has a refractive index of 1.46, thus making the differences between the
enamel and porosities negligible, so that the lesion appears similar to
the surrounding enamel [50].
After the ICON® infiltration material was developed; many in vitro
studies investigated the efficacy of the RI in penetrating and infiltrating
the artificial caries lesions. They found that teeth treated with RI were
more resistant to caries progression and had good prognosis compared
to non-treated teeth [53].
An in vitro study done by Paris et al. [42] evaluated the penetration
co-efficient of four experimental resin materials, to evaluate the effect
of infiltrate composition and penetration co-efficient (PC cm/sec) on
inhibition of progression of proximal caries lesions. They found that
the four experimental resins have different penetration co-efficient and
that there is no significant different in the mineral loss between the four
types.
Also, Meyer-Lueckel et al. [40] conducted an in vitro study to
evaluate the penetration coefficient of ICON® in comparison to a
commercially available adhesive using confocal microscopy and
transverse microradiography. They found that that the maximum
penetration depth and penetration percentage was significantly higher
for the ICON® compared to the adhesive. Penetration of the resin
infiltrating material is hampered by the mineralized surface layer of the
white spot lesion. Etching should be done to remove this surface layer
[17]. Different types of etching gels were used in removing the surface
layer. Studies showed that using 15% HCl for 90 to 120 seconds is highly
effective compared to 37% phosphoric acid [17].
The caries infiltration technique has mostly been tested on non-
cavitated lesions; the effect of RI in cavitated lesions is unknown.
Testing ICON® infiltrating technique on cavitated lesions on the
proximal surface of premolars was done to evaluate infiltration patterns
of proximal caries lesions differing in International Caries Detection
and Assessment System (ICDAS) codes 2, 3, 4 or 5. Evaluation using
microscopes measured the lesion depth, area of demineralized
enamel, cavity depth, cavity width, cavity area, and extent of the resin
penetration, also called as infiltration depth, and infiltrated area in
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Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
demineralized enamel and area of the cavity filled with infiltration. The
resin infiltration penetrated deeply in all the demineralized parts but
lesions with ICDAS codes 3, 4 and 5 had no infiltration. The depth of
infiltration in ICDAS 4 and 5 was significantly lower compared to code
2 [54].
Few clinical studies were done to assess the efficacy of the ICON®
material. Kim and his colleagues conducted a clinical study in 2011 at
the Department of Pediatric Dentistry at Pusan National University to
evaluate the effectiveness of the resin infiltration technique in masking
white spot lesions on the maxillary anterior teeth following orthodontic
treatment white spot lesions with ICDAS code 2, teeth with enamel
defect were completely masked [55].
Through times, management of early proximal caries was a challenge
[56], sealing early proximal lesions is very effective on stopping caries
progression [57]. Resin infiltration would be the future of treating early
caries lesions, since it’s easily used non-invasive and painless technique.
Before etching and infiltration, deproteinization is recommended
to improve surface roughness achieving a better outcome [58]. Also,
treating early caries lesions with a combination of resin-infiltrated
and fluoride varnish showed promising results compared to fluoride
varnish only [59].
Treating proximal lesions with resin infiltration was more effective
than non-operative measures. ICON® was effective in preventing the
progression of the caries lesion when compared to no treatment [42].
Several clinical methods have been used for caries diagnosis, such
as visual, tactile and radiographic methods. In addition, scanning
electronic microscope (SEM) is an effective method of examining the
surface changes in incipient caries in vitro [60].
Arnold et al. [61] used both light and electron microscope to study
the infiltration of resin in initial caries lesions. They found that using
different types of microscopes are effective in studying the pathways of
infiltration of the resin into initial caries lesions.
Initial caries has several zones and each zone has different pore
volumes. The superficial layer had low pore volume, while bodies
of the caries lesion had 25% pore volume and finally the translucent
zone at a depth of the lesion had 1% pore volume. The normal enamel
contains only 0.1% pore volume [61]. So, low viscosity resins have been
developed to infiltrate the initial caries lesions [62].
Acute caries cannot be infiltrated with RI, while chronic lesions
show inhomogeneous infiltration with resin [61].
The RI technique has many advantages such as providing mechanic
stabilization for the demineralized enamel structure, no structure loss of
the affected or neighboring teeth, occlusion of the micro pore structures
in the body of the lesion, arresting or decreasing lesion progression,
reducing secondary caries, delaying the need for a restoration, no
postoperative sensitivity or pulp inflammation, reduction of gingivitis
and periodontitis risk and good esthetic results in masking white spot
lesions [19].
Taher et al. [63], compared the surface roughness values of ICON®
with healthy enamel using a profilometer. Contrary to the current study,
no statistically significant difference was found between the infiltrate
and healthy enamel, indicating that this material might be suitable for
the treatment of enamel subsurface lesions.
Pyne et al. [64] conducted a study using AFM where they saw a
generally smooth surface and some shallow depressions in healthy
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bovine enamel, which were thought to be caused by polishing. When
compared to the Icon group, the control group showed much smoother
surfaces visually and lower surface roughness values numerically. The
Icon group showed non-homogenous surfaces with small granular
particle mounds showing amount and distribution differences.
Hashizume et al. [65] stated that mature human dental enamel has a
high degree of mineralization making structural studies somewhat less
straight forward than for other tissues, particularly for mode of imaging
involving transmission electron microscopy. Despite the variety of
available in vitro tests for measuring surface changes, the most common
form of reporting roughness average (Ra) within dental studies has
been the surface profile Ra (Ra, arithmetic average) or the root mean
square (Rq, geometric average). Profilometric means are usually used to
evaluate surface roughness. Roughness is a measure of surface texture.
It is often quantified by the deviations of the surface from its ideal form.
If the deviations are large, then the surface is considered to be rough,
meanwhile, the surface is considered smooth if they are small [66].
There are many studies in the literature which investigate the
properties of the infiltrate [67], only one study aimed to evaluate the
material at a Nano-scale using AFM [68]. This study evaluated the
effect of water storage on surface Ra of healthy human enamel after
application of ICON® and Seal-Rite™ using AFM and tridimensional
micro computed topography. They found that fissure sealant group
revealed the lowest Ra values and the Seal-RiteTM material was less
affected by water storage than ICON® [68].
In RI technique, the infiltrant must be applied twice to decrease
polymerization shrinkage and for the micro pore structure to be
occluded [55]. When the demineralized enamel micro porosities are
successfully infiltrated by RI, a decrease in surface roughness is expected
[19]. The surface roughness caused by dental treatments is dependent
on the materials being used. While some dental materials result in a
smooth surface, some materials can create a relatively rough surface.
Rough surfaces have an increased risk of bacterial adhesion and plaque
accumulation compared to smoother surfaces and as a result rougher
surfaces increase the risk of demineralization [69].
Qualitative methods such as SEM, and quantitative methods such
as contact and non-contact profilometry as well as confocal laser
scanning microscopy are other alternative methods to investigate
surface roughness [70]. Unlike these other methods, the probe of the
AFM device has the ability to determine the surface topography of the
material vertically (X and Y axis) and horizontally (Z axis) on the Nano-
scale. Thus, the images establish the topographic profile of the scanned
surface accurately and numeric data obtained provides a reflection of
these images. In addition, AFM provides higher resolution images and
lacks the disadvantages and limitations of SEM such as vacuum and
coating [71].
In a study by Ulrich et al. [58], ICON® was applied to natural lesions
to investigate the surface roughness parameter Sa using a 3D scanning
microscope, it was found that the ICON® samples had a higher surface
roughness value compared to healthy enamel.
According to Paris et al. [72] before curing the resin, the excess
infiltrate material should be removed because the remaining thin resin
layer will increase the plaque accumulation and caries development.
They found that the instruction manual provided by the manufacturer
stated that the excess material was wiped off using a cotton roll before
curing. Following the AFM analysis, it was observed that even after
polishing a small amount of resin remained and rough areas were
detected on the scanned samples’ surfaces. The Sq values of the ICON®
Volume 6 • Issue 1 • 1000234
Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
group were significantly higher than the control group consisting of
healthy enamel.
Previous studies stated that if a surface has a roughness value less
than 200 nm (0.2 lm), then this roughness will not contribute to plaque
accumulation, but if the value is higher, then plaque accumulation will
be unavoidable [73].
Characteristic parameters as micro-hardness of infiltrated
lesions might be influenced by monomer and solvent composition
of infiltrates. Furthermore, repeated application of the infiltrate is
recommended as it may influence such parameters. The commercially
available infiltrate (ICON®) is based on TEGDMA. The addition of
Bis-GMA in experimental infiltrates was intended to increase micro-
hardness of infiltrated lesions, since Bis-GMA molecules have a more
rigid molecular structure due to their aromatic backbone Thus, Bis-
GMA resins show higher flexural strength and elastic modulus than
TEGDMA, thereby increasing the hardness of the polymer [74].
Furthermore, Bis-GMA was shown to decrease both polymerization
shrinkage and contraction stress of TEGDMA-based composite resins
[75]. Bis-GMA has a higher viscosity, thus reducing the penetration
coefficient of the resin [62].
Paris et al. [76] conducted a study to evaluate micro-hardness
and demineralization resistance of artificial enamel lesions infiltrated
with various experimental infiltrates in vitro. Experimental infiltrates
differed in their monomer composition and solvent content: Adding
Bis-GMA to the usually TEGDMA based infiltrates may reduce
polymerization shrinkage due to higher molecular weight, but might
concurrently reduce penetration depth. Adding ethanol as solvent may
improve penetrability due to increased penetration coefficient of the
resin, but reduce lesion hardness. The influence of such altered infiltrate
composition and penetration coefficients on penetration depth and
lesion progression of natural caries lesions has been investigated
previously by Meyer-Lueckel in 2010 [62]. The influence of infiltrated
composition on micro-hardness as well as the influence of once or twice
application of infiltrates on micro-hardness and lesion progression was
also investigated and the result showed significant increase in the micro-
hardness and reduced mineral loss after demineralization compared
with untreated lesions and the addition of Bis-GMA or ethanol solvent
did not improve physico-chemical resistance of infiltrated lesions.
Repeated resin application improves lesion micro-hardness and seems
to also have beneficial effects on demineralization resistance [76].
Resin infiltration is currently indicated as its increase micro-
hardness compared to untreated or remineralied carious lesions
[77]. Hardness measurements of restorative materials were shown to
correlate with other mechanical properties, like fracture resistance,
elasticity, yield and compressive strength or abrasion resistance [78].
Reported surface micro-hardness for sound human enamel is 352 HVN
[79] and for carious enamel is 0.29-3.29 GPa [80], while for the lesion
infiltrated by resin is 33 HVN-0.32 GPa [76].
Infiltrated proximal lesions do not need to resist masticatory forces,
but reinstate proximal surfaces, thus resisting proximal abrasion or
attrition to preventing cavitation of lesions [76].
Conclusion
Data show this new technique complements existing treatment
options for interproximal caries by delaying the time point for a
restoration and consequently closing the gap between noninvasive and
invasive treatment options.
J Oral Hyg Health, an open access journal
ISSN: 2332-0702
Page 6 of 8
References
1. Finucane D (2012) Rationale for the restoration of carious primary teeth: A
review. Eur Arch Paediatr Dent 13: 281-292.
2. Al-Malik MI, Rehbini YA (2006) Prevalence of dental caries, severity, and
pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia.
J Contemp Dent Pract 7: 46-54.
3. Gomez SS, Basili CP, Emilson CG (2005) A 2-year clinical evaluation of sealed
noncavitated approximal posterior carious lesions in adolescents. Clin Oral
Investig 9: 239-243.
4. Fejerskov O, Kidd E (2008) Dental caries: The disease and its Clinical
Management (2nd edn.). Blackwell Munksgaard, Oxford, UK. pp: 444-445.
5. Yengopal V, Harneker SY, Patel N, Siegfried N (2009) Dental filling for the
treatment of caries in the primary dentition. Cochrane Database Syst Rev 15:
CD004483.
6. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, et al. (2012) Minimal
intervention dentistry for managing dental caries- a review: report of a FDI task
group. Int Dent J 62: 223-243.
7. Doméjean S, Ducamp R, Léger S, Holmgren C (2015) Resin infiltration of non-
cavitated caries lesions: A systematic review. Med Princ Pract 24: 216-221.
8. Cury JA, Tenuta LM (2009) Enamel remineralization: Controlling the caries
disease or treating early caries lesions. Braz Oral Res 23: 23-30.
9. Bergström EK, Birkhed D, Granlund C, Moberg SU (2014) Approximal caries
increment in adolescents in a low caries prevalence area in Sweden after a 3.5-
year school-based fluoride varnish programme with Bifluorid 12 and Duraphat.
Community Dent Oral Epidemiol 42: 404-411.
10. Ripa, LW (1983) Occlusal sealants: An overview of clinical studies. J Public
Health Den 43: 216-225.
11. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, et al. (2013) Sealants
for preventing dental decay in the permanent teeth. Cochrane Database Syst
Rev 2013 28: CD001830.
12. Marthaler T (2004) Changes in dental caries 1953-2003. Caries Res 38: 173-
181.
13. Splieth C, Ekstrand K, Alkilzy M, Clarkson J, Meyer-Lueckel H, et al. (2010)
Sealants in dentistry: outcomes of the ORCA Saturday Afternoon Symposium
2007. Caries Res 44: 3-13.
14. Bidarkar A (2011) In vitro prevention of secondary demineralization by icon
(infiltration concept). University of Iowa, Iowa Research Online.
15. Kumar H, Palamara J, Burrow MF, Manton DJ (2012) Resin infiltration-taking
the first steps to filling the holes in cheese molars. AR Australas Coll Dent Surg
21: 120-123.
16. Heymann GC, Grauer D (2013) A contemporary review of white spot lesions in
orthodontics. J Esthet Rest Dent 25: 85-95.
17. Meyer-Lueckel H, Paris S, Kielbassa AM (2007) Surface layer erosion of
natural caries lesions with phosphoric and hydrochloric acid gels in preparation
for resin infiltration. Caries Res 41: 223-230.
18. Bergstrand F, Twetman S (2011) A review on prevention and treatment of
post-orthodontic white spot lesions-evidence-based methods and emerging
technologies. Open Dent J 5: 158-162.
19. Kielbassa AM, Muller J, Gernhardt CR (2009) Closing the gap between oral
hygiene and minimally invasive dentistry: a review on the resin infiltration
technique of incipient (proximal) enamel lesions. Quintessence Int 40: 663-681.
20. Güvenç Başaran İV, EG Başaran (2011) Non-Cavitated approach for the
treatment of white spot lesions: a case report. International Dental Research.
21. Gugnani N, Pandit IK, Gupta M, Josan R (2012) Caries infiltration of non-
cavitated white spot lesions: A novel approach for immediate esthetic
improvement. Contemp Clin Dent 3: 199-202.
22. Silverstone L, Saxton C, Dogon I, Fejerskov O (1975) Variation in the pattern
of acid etching of human dental enamel examined by scanning electron
microscopy. Caries Res 9: 373-387.
23. Subramaniam P, Babu KG, Lakhotia D (2014) Evaluation of penetration depth
of a commercially available resin infiltrate into artificially created enamel
lesions: An in vitro study. JCD 17: 146-149.
Volume 6 • Issue 1 • 1000234
Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234
24. Shivanna V, Shivakumar B (2011) Novel treatment of white spot lesions: A
report of two cases. J Conserv Dent 14: 423-426.
25. Buonocore MG (1955) A simple method of increasing the adhesion of acrylic
filling materials to enamel surfaces. J Dent Res 34: 849-853.
26. Swift EJ, Perdigao J, Heymann HO (1995) Bonding to enamel and dentin: A
brief history and state of the art. Quintessence Int 26: 95-110.
27. Buonocore MG, Matsui A, Gwinnett AJ (1968) Penetration of resin dental
materials into enamel surfaces with reference to bonding. Arch Oral Biol 13:
61-70.
28. Kugel G, Arsenault P, Papas A (2009) Treatment modalities for caries
management, including a new resin infiltration system. Compend Contin
Educat Dent 3: 1-10.
29. van der Vyver PJ, de Wet FA (2000) The current state of dentine bonding
systems: A review of materials and techniques. SADJ 55: 475-485.
30. von Fraunhofer JA (2012) Adhesion and cohesion. Int J Dent 2012: 951324.
31. Driessens FCM (1977) Chemical adhesion in dentistry. Int Dent J 27: 317-323.
32. Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Makela M (2008) Pit and
fissure sealants for preventing dental decay in the permanent teeth of children
and adolescents. Cochrane Database Syst Rev 2008 8(4): CD001830.
33. Burt BA, Eklund SA (2005) Dentistry, Dental Practice and the Community (5th
ed.). Elsevier Saunders, St. Louis, MO. pp: 366-379.
34. Kervanto-Seppala, Lavonius E, Pietila I, Pitkaniemi J, Meurman JH, et al.
(2008) Comparing the caries-preventive effect of two fissure sealing modalities
in public health care: A single application of glass ionomer and a routine resin-
based sealant programme. A randomized split-mouth clinical trial. Int J Paediatr
Dent 18: 56-61.
35. Feigal RJ (2002) The use of pit and fissure sealants. Pediatr Dent 24: 415-422.
36. Donly KJ (2002) Sealants: Where we have been; where we are going. Gen
Dent 50: 438-440.
37. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, et al. (2008) Evidence
based clinical recommendations for the use of pit-and-fissure sealants: A report
of the American Dental Association Council on Scientific Affairs. JADA 139:
257-268.
38. Croll TP, Nicholson JW (2002) Glass ionomer cements in pediatric dentistry:
Review of the literature. Pediatr Dent 24: 423-429.
39. Schmidlin PR, Gohring TN, Roos M, Zehnder M (2006) Wear resistance and
surface roughness of a newly devised adhesive patch for sealing smooth
enamel surfaces. Oper Dent 31: 115-121.
40. Meyer-Lueckel H, Paris S (2008) Progression of artificial enamel caries lesions
after infiltration with experimental light curing resins. Caries Res 42: 117-124.
41. Paris S, Meyer-Lueckel H, Kielbassa AM (2007) Resin infiltration of natural
caries lesions. J Dent Res 86: 662-666.
42. Paris S, Hopfenmuller W, Meyer-Lueckel H (2010) Resin infiltration of caries
lesions: An efficacy randomized trial. J Dent Res 89: 823-826.
43. Robinson C, Hallsworth AS, Weatherell JA, Kunzel W (1976) Arrest and control
of carious lesions: a study based on preliminary experiments with resorcinol-
formaldehyde resin. J Dent Res 55: 812-818.
44. Robinson C, Brookes SJ, Kirkham J, Wood SR, Shore RC (2001) In vitro
studies of the penetration of adhesive resins into artificial caries-like lesions.
Caries Res 35: 136-141.
45. Goepferd SJ, Olberding P (1989) The effect of sealing white spot lesions on
lesion progression in vitro. Pediatr Dent 11: 14-16.
46. Garcia-GodoyF, Summitt JB, Donly KJ (1997) Caries progression of white spot
lesions sealed with an unfilled resin. J Clin Pediatr Dent 21: 141-143.
47. Abuchaim C, Rotta M, Grande RH, Loguercio AD, Reis A (2010) Effectiveness
of sealing active proximal caries lesions with an adhesive system: 1-year
clinical evaluation. Braz Oral Res 24: 361-367.
48. Gray GB, Shellis P (2002) Infiltration of resin into white spot caries-like lesions
of enamel: An in vitro study. Eur J Prosthodont Restor Dent 10: 27-32.
49. Ardu S, Castioni NV, Benbachir N, Krejci I (2007) Minimally invasive treatment
of white spot enamel lesions. Quintessence Int 38: 633-636.
J Oral Hyg Health, an open access journal
ISSN: 2332-0702
Page 7 of 8
50. Paris S, Meyer-Lueckel H (2009) Masking of labial enamel white spot lesions
by resin infiltration-a clinical report. Quintessence Int 40: 713-718.
51. Martignon S, Ekstrand KR, Ellwood R (2006) Efficacy of sealing proximal
early active lesions: An 18-month clinical study evaluated by conventional and
subtraction radiography. Caries Res 40: 382–388.
52. Basaran G, Veli I, Basaran EG (2011) Non-cavitated approach for the treatment
of white spot lesions: A case report. IDR 1: 65-69.
53. Meyer-Lueckel H, Paris S, Mueller J, Colfen H, Kielbassa (2006) Influence
of the application time on the penetration of different dental adhesives and a
fissure sealant into artificial subsurface lesions in bovine enamel. Dent Mater
22: 22-28.
54. Paris S, Bitter K, Naumann M, Dorfer CE, Meyer-Lueckel H (2011) Resin
infiltration of proximal caries lesions differing in ICDAS codes. Eur J Oral Sci
119: 182-186.
55. Kim S, Kim EY, Jeong, TS, Kim JW (2011) The evaluation of resin infiltration
for masking labial enamel white spot lesions. Int J Paediatr Dent 21: 241-248.
56. Braga MM, Mendes FM, Ekstrand KR (2010) Detection activity assessment
and diagnosis of dental caries lesions. Dent Clin North Am 54: 479-493.
57. Martignon S, Tellez M, Santamaría R, Gomez J, Ekstrand K (2010) Sealing
Distal Proximal Caries Lesions in First Primary Molars: Efficacy after 2.5 Years.
Caries Res 44: 562-570.
58. Ulrich I, Mueller J, Wolgin M, Frank W, Kielbassa AM (2015) Tridimensional
surface roughness analysis after resin infiltration of (deproteinized) natural
subsurface carious lesions. Clin Oral Investig 19: 1473-1483.
59. Ekstrand KR, Bakhshandeh A, Martignon (2010) Treatment of proximal
superficial caries lesions on primary molar teeth with resin infiltration and
fluoride varnish versus fluoride varnish only: Efficacy after 1 year. Caries Res
44: 41-46.
60. Worawongvasu R (2015) A scanning electron microscopic study of enamel
surfaces of incipient caries. Ultrastruct Pathol 39: 408-412.
61. Arnold W, Gaengler P (2012) Light and electronmicroscopic study of infiltration
of resin into initial caries lesions-a new methodological approach. J Microsc
245: 26-33.
62. Meyer-Lueckel H, Paris S (2010) Infiltration of natural caries lesions with
experimental resins differing in penetration coefficients and ethanol addition.
Caries Res 44: 408-414.
63. Taher NM, Alkhamis HA, Dowaidi SM (2012) The influence of resin infiltration
system on enamel microhardness and surface roughness: An in vitro study.
Saudi Dent J 24: 79-84.
64. Pyne A, Marks W, Picco L, Dunton P, Ulcinas A, et al. (2009) High speed atomic
force microscopy of dental enamel dissolution in citric acid. Arch Histol Cytol
72: 209-215.
65. Hashizume LN, Shinada K, Kawaguchi Y, Yamashita Y (2002) Sequence of
ultra-structural changes of enamel crystals and streptococcus mutans biofilm in
early enamel caries in vitro. J Med Dent Sci 49: 67-75.
66. Field J, Waterhouse P, German M (2010) Quantifying and qualifying surface
changes on dental hard tissues in vitro. J Dent 38: 182-190.
67. Paris S, Soviero VM, Seddig S, Meyer-Lueckel H (2012) Penetration depths
of an infiltrant into proximal caries lesions in primary molars after different
application times in vitro. Int J Paediatr Dent 22: 349-355.
68. Taher NM (2013) Atomic force microscopy and tridimensional topography
analysis of human enamel after resinous infiltration and storage in water. Saudi
Med J 34: 408-414.
69. Gurdogan EB, Ozdemir-Ozenen D, Sandalli N (2017) Evaluation of surface
roughness characteristics using atomic force microscopy and inspection of
microhardness following resin infiltration with icon. J Esthet Restor Dent 29:
201-208.
70. Kakaboura A, Fragouli M, Rahiotis C, Silikas N (2007) Evaluation of surface
characteristics of dental composites using profilometry, scanning electron,
atomic force microscopy and gloss-meter. J Mater Sci Mater Med 18: 155-163.
71. Cerci BB, Roman LS, Guariza-Filho O, Camargo ES, Tanaka OM (2012) Dental
enamel roughness with different acid etching times: atomic force microscopy
study. Eur J Gen Dent 1: 187-191.
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Citation: Meligy OAESE, Ibrahim STE, Alamoudi NM (2018) Resin Infiltration of Non-Cavitated Proximal Caries Lesions: A Literature Review. J Oral
Hyg Health 6: 234. doi: 10.4172/2332-0702.1000234

Page 8 of 8

72. Paris S, Meyer-Lueckel H, Mueller J, Hummel M, Kielbassa AM (2006) resins: Influence of infiltrant composition and application frequency in vitro. J
Progression of sealed initial bovine enamel lesions under demineralizing Dent 41: 543-548.
conditions in vitro. Caries Res 40: 124-129.
77. Torres CR, Rosa PC, Ferreira NS, Borges AB (2012) Effect of caries infiltration
73. Teughels W, Van Assche N, Sliepen I, Quirynen M (2006) Effect of material technique and fluoride therapy on microhardness of enamel carious lesions.
characteristics and/or surface topography on biofilm development. Clin Oral Oper Dent 37: 363-369.
Implants Res 17: 68-81.
78. Mahoney E, Holt A, Swain M, Kilpatrick N (2000) The hardness and modulus
74. Asmussen E, Peutzfeldt A (1998) Influence of UEDMA, BisGMA and TEGDMA of elasticity of primary molar teeth: an ultramicro- indentation study. J Dent 28:
on selected mechanical properties of experimental resin composites. Dent 58-94.
Mater 14: 51-56.
79. Maupome G, Diez-de-Bonilla J, Torres-Villasenor G, Andrade-Delgado LC,
75. Gonçalves F, Pfeifer CS, Ferracane JL, Braga RR (2008) Contraction stress Castano VM (1998) In vitro quantitative assessment of enamel microhardness
determinants in dimethacrylate composites. J Den Res 87: 367-371. after exposure to eroding immersion in a cola-drink. Caries Res 32: 148-153.

76. Paris S, Schwendicke F, Seddig S, Muller W, Rfer C, et al. (2013) Micro- 80. Huang TTY, He LH, Darendeliler MA,Swain MV (2010) Nano-indentation
hardness and mineral loss of enamel lesions after infiltration with various characterization of natural carious white spot lesions. Caries Res 44: 101-107.

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Volume 6 • Issue 1 • 1000234
ISSN: 2332-0702