Resin-Infiltration Of Early Caries Lesions Supplementary To F-Varnish In HCR-Population

As new alternatives to caries management are validated, the operative management of early, non-cavitated caries lesions will become sub-optimal practice.  Resin-infiltration, demonstrating a potential to non-invasively inhibit lesion progression suggests an alternative choice. A clinical protocol for lesion-infiltration proposes a more informed, less-invasive management approach; minimizing possible harms, while conserving tooth-structure and healthcare resources. Utilizing split-mouth design, adjunct proactive lesion-management by resin-infiltration combined with multiple fluoride–varnish applications is investigated and compared to the historically reactive “watch-wait-and-recall” standard-of-care (SOC).  Objective: Evaluation of approximal lesion-infiltration effects, supplementary to SOC-management of High Caries Risk (HCR)-patients.  Methods: 42 consented HCR-subjects (20.1+0.9 yrs old; 6.9+3.0 DMFT) enrolled for management of two interproximal lesions. All patients received oral hygiene instructions, diet-counseling, dental prophylaxis, fluoride-varnish, and fluoride-dentifrice. Orthodontic separators were placed for 5-7 days permitting optimized visual diagnosis and impression of lesion-surfaces prior to infiltration-management.  Two affected E2/D1-surfaces were randomly treated by resin-infiltration (ICON, DMG) or mock-infiltration (control). Individually-standardized digital radiographs provided visual determination of lesion-size distribution at baseline and follow-up evaluations.  Results: Tooth separation aided visual assessment of approximal lesion-surfaces. Diagnosis of pre-separation clinical assessment of ‘intact surface-lesion’ (N=84) was confirmed post-separation in 100% of the cases, both visually and by assessment of the impression-intaglio.  ICDAS-scores (1,2) differed slightly pre- (55,29) vs post-separation (52,32).  Radiographic image sets (BL-6mo) were analyzed for changes in lesion-surface and density. After 6-months (97.6% recalled) visual radiographic assessment showed 0% lesion-progression in both groups. Preliminary results of digital subtraction of image sets confirmed this early data. In-depth 6-months results will be presented.  Conclusions: Tooth-separation facilitates surface-assessment of approximal early caries lesions, clinically confirming the surface integrity of radiographically diagnosed lesions in this study.  Visual assessment of paired radiographs (BL vs 6-mo) reveals no early lesion-changes. Longer-term follow-up will evidence definitive treatment effects of resin infiltration combined with SOC HCR-regimen including fluoride-varnish.