Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

Andrej M Kielbassa,Vanessa D Werth,Rita Schmidl,Christoph Schüller,Ina Ulrich,Wilhelm Frank

doi:10.1038/ijos.2017.15

Abstract

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin (RI/CR) when used with deproteinised and etched occlusal subsurface lesions (International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin (CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using NaOCl (2%). After etching with HCl (15%), 10 premolar and 10 molar lesions were infiltrated (Icon/DMG; rhodamine B isothiocyanate (RITC)-labelled) followed by fissure sealing (G-ænial Flo/GC; experimental group, RI/CR). In the control group (CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation (DIAGNOdent pen, KaVo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar (57.9%±23.1%) and molar lesions (35.3%±22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences (P=0.034). Moreover, microleakage (n=1) and the occurrence of voids (n=2) were reduced in the RI/CR group compared with the CR group (5 and 17 specimens, respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.

Highlights

It is generally accepted that the occlusal surfaces of premolars and molars are caries-prone and account for a majority of all carious lesions
Regarding Group 1, the mean ± standard deviation (SD) of the infiltrated areas was 81 684.1px ± 89 020.8 px, and which corresponds to 45.9% ±24.8% of the entire lesion extension (% ILAEnamel). These results indicate that resin infiltration filled major parts but did not completely occlude the carious lesions
Flowable composite resins (CRs) are widely used for fissure sealing[13,35,36,37] and exhibit increased retention rates and better physical properties compared with conventional fissure sealants.[37]

Summary

Introduction

It is generally accepted that the occlusal surfaces of premolars and molars are caries-prone and account for a majority of all carious lesions. Adhesive sealing of fissures using (un-)filled composite resins (CRs) has proven to be a preventive strategy with high efficacy[1] and highly significant caries reduction rates.[2] In specimens sealed clinically, bacteria located in the fissures were entrapped or explicitly reduced[3] by the sealing procedure, indicating that any microbial activities will be stopped With their pioneering clinical studies, Handelman et al.[4] revealed as early as 1976 that sealing of incipient lesions decreased the number of cultivable microorganisms to a scattering fraction, and these authors did not observe progression of the sealed carious lesions radiographically nor clinically. The same hypothesis applies to sealing of carious areas (demineralised and weakened enamel, softened dentine)

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