Modern methods of prevention and treatment of early carious lesions

Abstract

Introduction: Despite ihe high rate of science development and intensive research in preventive dentistry, tooth decay remains the most common dental disease. The nowadays market offers a large variety of products that help dentists worldwide to prevent caries, but the dilemma is which product to choose: a modern one, or one with many years' proven results? In this paper I will refer to the prevention and treatment of incipient caries - a major problem in caries - prone and post-orthodontic patients with both aesthetic and functional implications. Objectives: To evaluate the clinical efficiency of the two methods proposed in this study in the treatment of early carious lesions: a two week therapy with Flor-Opal versus immediate infiltration with Icon. Methods: For this study a number of patients with early carious lesions were selected and divided into two groups. For the first group we will use topical applications of fluoride varnishes and for the second we will use the infiltration method of demineralized enamel. Both groups received professional scaling and brushing. The first group received treatment with Flor-Opal from Ultradent company, which is sustained-release source of 0.5% fluoride ion (1.1% Neutral NaF) in a sticky, viscous gel. The product was designed for at-home use when fluoride application is needed and is available in syringes or disposable trays. Due to the necessity of repeated appliance (a 2-week therapy) we decided to manufacture multiuse individual trays. The second group received treatment with the caries infiltrant- Icon from DMG America. The working technique is quite simple and requires no more than 15 min: after isolating the required sector (preferably with rubber dum) the demineralized (white) spots are etched with Icon-Etch (hydrochloric acid gel) for 120 sec, washed, dried, and then desiccated with Icon-Dry (99% ethanol). On the so-prepared surface is applied the Icon-Infiltrant for 3 min setting and then it is light-cured for 40 sec. After the procedure is repeated one more time, the surface is finished with polishing cups. Results: After a 2 week 6 and 12 months recall we evaluated the former regions with early carious lesions by aesthetic and functional criteria. In the first group we observed the persistence of white spot lesions and in one patient the caries progressed and needed common treatment of cavities. The second group showed neither aesthetic modifications nor caries evolution. Conclusions: The results were conclusive, but the decision to use one or other treatment strategies is to be made by the doctor and the patient's consent. The choice will rely on the criteria: cost effectiveness / improvement of aesthetics/ efficiency to stop decay.