Title	Resin Infiltration of White Spot Lesions is a Minimally Invasive Treatment to Improve Esthetic Appearance
Clinical Question	In teenagers with white spot lesions, does the use of resin infiltration improve esthetics over the duration of a year as compared to no treatment?
Clinical Bottom Line	In patients with white spot lesions the use of resin infiltration improves the patients esthetics but the duration of time of the esthetic improvement still needs further research.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 23810050 Knösel/ 2013 Twenty one subjects between 12 and 19 years of age with a total of 231 WSL's received resin infiltration of noncavitated postorthodontic WSLs. Patients were assessed before treatment, after 1 day, 1 week, 4 weeks, 3 months and 6 months Randomized Clinical Trial Key results Twenty one subjects with a total of 231 WSL's received resin infiltration or no treatment of noncavitated postorthodontic WSLs. Patients were assessed before treatment, after 1 day, 1 week, 4 weeks, 3 months and 6 months. Data found that there was an overall significant decrease in ΔE where p<.05. The data also concluded that the treatment was durable overtime and the ΔE stayed relatively consistent throughout each follow up. The depth and duration of the lesion seemed to have an effect on treatment; the research suggests the treatment of the WSLs earlier provides an even better esthetic result. Overall the evidence lead to the conclusion that resin infiltration esthetically improves demineralized teeth with WSLs. 25126675 Eckstein/ 2015 Twenty subjects (111 teeth) between the ages of 13-19 years old received resin infiltration of noncavitated postorthodontic WSLs. Patients were contacted for a 1 year follow up assessment Randomized Controlled Trial Key results The patients were contacted for a six-month and one-year follow up after their treatment of white-spot lesions (WSLs) with resin infiltration. The author compared the camouflage effects of WSLs to sound adjacent enamel (ΔE) using spectrophotometric recordings. The data showed there was a significant decrease in ΔE at the six-month follow-up where p<0.001. When comparing the six-month follow up to the one-year follow there was an additional decrease in ΔE of no significance. The study showed that the camouflage effects of WSLs treated with resin infiltration was not significantly altered after 12 months; further stating that resin infiltration can be a recommended treatment for the esthetic improvement of white spot lesions
Evidence Search	(("resins, plant"[MeSH Terms] OR ("resins"[All Fields] AND "plant"[All Fields]) OR "plant resins"[All Fields] OR "resin"[All Fields]) AND infiltration[All Fields] AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR ("white"[All Fields] AND "spot"[All Fields]) OR "white spot"[All Fields]) AND lesion[All Fields]) AND (systematic[sb] OR Randomized Controlled Trial[ptyp] OR Controlled Clinical Trial[ptyp] OR Meta-Analysis[ptyp])
Comments on The Evidence	Validity: In the 2013 randomized clinical trial done by Knösel the patients were chosen for the study if they showed WSLs after multibracket treatment. The study did not further differentiate the subjects based on the severity of the lesion or age, though the age range was within teenagers. Of the 21 patients with WSLs that got resin infiltration only one did not show up to any further follow-up sessions. All patients were given the ICON DMG resin infiltration per the producer’s instruction sheet. This project was supported by a grant from DMG to the University of Göttingen which adds bias and competing interests to the study. In the 2015 randomized controlled trial done by Eckstein the patients were chosen for the study if they showed evidence of having a white-spot lesion (WSL) on the enamel surface. The study did not further differentiate the patients based on severity of the lesion or age. Of the twenty patients with WSLs that got the resin infiltration treatment only nine of the original twenty were available for the one-year follow up. All patients were given the ICON DMG resin infiltration per the producer’s instruction sheet. The study was supported by DMG, which adds bias and competing interests to the study. Perspective: I believe more long term studies need to be performed. Since the majority of patients being treated are younger, it raises the question of how many times a patient would have to be treated within his or her lifetime to be able to obtain the same level of esthetics as when the initial treatment was performed. In addition, the Knösel article made a claim that treatment of WSLs with resin infiltration produces a more esthetic effect if done soon after bracket removal, more evidence needs to be provided for the validity of this claim to hold true.
Applicability	The studies focused on treatment of white spot lesions with a resin infiltration technique. The evidence suggests that resin infiltration is a feasible option to improve the esthetic appearance of enamel discoloration caused by white spot lesions. The longevity of the esthetic appearance requires further investigation.
Specialty	(General Dentistry) (Orthodontics) (Restorative Dentistry)
Keywords	resin infiltration, esthetics, white spot lesions, minimally invasive
ID#	3213
Date of submission	05/02/2017
E-mail	KohlerD@livemail.uthscsa.edu
Author	Dori Kohler
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Issa Sasa, BDS, MS
Faculty mentor e-mail	sasa@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Jason Do Nguyen (San Antonio, TX) on 09/30/2022 Based on new information from a recent systematic review on this topic (PMID: 34106348, 2021), there is increased support for using resin infiltration to improve esthetics of white spot lesions.