Proper diagnosis and treatment of approximal lesions radiographically located around the enamel-dentin-junction (EDJ) have been a challenge for the clinician. A 3-year split-mouth study on approximal-posterior surfaces is being conducted to compare the efficacy of three preventive procedures (flossing-instructions, sealing-technique, infiltrating-technique) on such lesions.
Objectives: To describe: 1.-A novel infiltration technique. 2.-The ICDAS-II-criteria and the activity-status of approximal lesions in this sample.
Methods: Forty 16- to 31-year-olds participated each with three approximal lesions (n=120) [radiographic scores 3-radiolucency in the EDJ (65%) and 4-outer dentinal third (35%)] in posterior teeth. After a 2-day elective temporary tooth separation elastic bands were removed and the proximal spaces cleaned. Lesions were scored with ICDAS-II criteria (0-sound, 1-first-visual-enamel-change, 2-distinctive-visual-enamel-change, 3-enamel-breakdown, 4-underlying-shadow, 5/6-distinctive/extensive-cavity) and activity criteria: -visual appearance (0-brown-opacity, 1-white-opacity, 2-surface-rupture); -plaque-stagnation area (0-no, 1-yes); -tactile findings (0-smooth/hard, 1-rough/soft). Forty lesions received no clinical treatment (only flossing instructions), 40- sealing (described in: Martignon et al., Caries Res 2006), and 40- infiltration. The infiltration procedure was conducted as follows: rubber-dam isolation, plastic-wedge placement between lesion- and neighboring-surface, positioning of a 50m-transparent applicator between teeth, etching of lesion-surface with 15%-HCl-gel (120s), water-spray (30s), 100%-etanol application (30s), air-drying (30s), infiltrant application (applicator; 5min), air-drying (excesses removal, 30s), light-curing (60s), infiltrant reapplication (1min), light-curing (60s), and surface polishing (polishing strips).
Results: Lesions were scored as first-visual-enamel-change (0.8%), distinctive-visual-enamel-change (89.2%), enamel-breakdown (5.8%), and no assessment possible (4.2%). Regarding activity visual appearance corresponded to white-opacity (65.8%), surface-rupture (25.0%), brown-opacity (4.2%), and no assessment possible (4.2%); tactile findings corresponded to rough (46.7%), smooth (23.3%) and no assessment possible (30.0%). All lesions (100.0%) were located in plaque stagnation areas.
Conclusion: Most radiolucencies around the EDJ were visually classified as distinctive-visual-enamel-change (white opacities) in plaque-stagnation areas and rough. The infiltration technique has been described as a clinically feasible method for treating these lesions.