We’ve all seen the white spot lesions on our patient’s teeth. By any measure they’re not particularly aesthetic, and most patients would love for them to disappear. So why is it that most dentists don’t seem to be addressing them? Perhaps they don’t realize that a simple and remarkably effective solution exists: resin infiltration.

Irene Iancu, a Canadian RRDH (Restorative Registered Dental Hygienist), international speaker, educational content producer, key opinion leader and owner of a startup dental practice in Toronto, has extensive experience with resin infiltration. We spoke with her to learn more about using resin infiltration to address unsightly white spots.

What is resin infiltration?

Resin infiltration is a procedure that uses an unfilled resin to infiltrate white spot lesions, thereby causing the color of the lesion to mimic the color of the rest of the tooth. To the naked eye, that white spot lesion becomes virtually invisible. Resin infiltration can be successfully used to address all types of white spot lesions, from enamel lesions, E1 lesions and D1 lesions all the way to developmental lesions and fluorosis.

It is probably because the procedure is very minimally-invasive – there’s no drilling, mechanical removal of structure or manipulation of the hard tissue other than etching – that it is growing in popularity.

Plus, patients are thrilled with the way that resin infiltration makes their white spots disappear, and are equally excited about how long lasting this solution is.

Although the unfilled resin does not have any real resistance strength, Ms. Iancu points out that “it also has nowhere to go. It’s infiltrated into the tooth. It’s not a composite veneer that we’re putting on the front of the tooth and just fingers crossed hoping that it sticks. So, I haven’t seen any changes to my patients. I had one yesterday. We took a post-op photo and it’s been two and a half years and it looks the same as it did on the first day.”

How do you do a resin infiltration procedure?

Here are the steps that Ms. Iancu recommends for addressing white spot lesions:

1. Isolate – Ms. Iancu prefers a rubber dam. “I’ve seen clinicians not use a rubber dam,” she reports, “and have a really hard time controlling moisture. And, of course, that etch tastes horrible. So does the resin, and so does ethanol in its purest form. So a rubber dam is really important.”

For interproximal lesions, unless you have a great deal of experience with this procedure, Ms. Iancu strongly recommends that you work on just one surface at a time. The device that allows you to go interproximal has a little wedge to it, to separate the teeth. Placing orthodontic separator rings about 15 minutes prior (or up to a few days prior) can also help provide proper separation.

2. Etch – Comprised of 15% hydrochloric acid. “Not to be mistaken,” Ms. Iancu clarifies, “with the phosphoric etch that we use.” Use the etch for two to three minutes, agitating the etch into the lesion and then rinse. Depending on the lesion’s depth you may have to do the etching procedure two or three times; this is especially the case for interproximal lesions.

3. Ethanol – Next, use an ethanol solution. This dries out the tooth and the tubules, and allows you to visualize a white spot lesion.

4. Infiltrate – Ms. Iancu recommends Icon from DMG. “The infiltrant itself is then used,” explains Ms. Iancu, “sometimes for up to 20 or 30 minutes, to allow the tooth to pull in or suck in that resin. It can go all the way to around 400 microns if you’re dealing with a lesion that’s quite deep.” For interproximal surfaces, allow the resin to infiltrate for 5 to 10 minutes, depending on the depth of the lesion.

5. Remove excess – “If you’re using the device that’s provided correctly,” asserts Ms. Iancu, “then you shouldn’t have excess flash. The only time I see excess flash is if I’ve infiltrated for a long period of time and then the tooth just has no more space to suck in any of that resin.” In that case you can use a scalpel blade to remove the excess.

6. Polish – For a smooth surface, use your discs to polish. Sometimes Ms. Iancu also uses a little white stone. On an interproximal surface, take a soft flex disc and gently polish around the surface.

7. Floss – For interproximal lesions, be sure to floss.

8. Provide post-op instructions –To minimize the opportunity for any internal or intrinsic staining to happen, instruct your patient to stick to a white diet, avoiding anything that is dark, for the first 48 hours after the procedure. This is the time frame during which the dental tubules will be open.

The learning curve for this procedure is not steep, and the basic steps are written on the product’s packaging.

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How do you deal with voids and shrinkage in a resin infiltration procedure?

The good news is, neither of these potential problems is an issue here.

Because the Icon infiltrant material is a completely viscous material, you don’t have to worry about voids. “It’s not a compactable material,” Ms. Iancu notes. “The tooth is sucking in this liquid resin all on its own without your assistance. There won’t be any voids.”

What about marginal shrinkage or polymerization shrinkage? “The longer you infiltrate for, the less opportunity there is for shrinkage,” Ms. Iancu states. “There’s no physical prep margin, so there’s no cavitation. The beauty of these lesions is that they’re cavitation free. So, essentially, you should have virtually no shrinkage at all.”

How can this resin infiltration procedure be a practice builder?

Many patients have been told that there’s nothing to be done about their unsightly white spots. Some have seen providers that tried other techniques that were not successful. When patients realize that there’s an easy, painless, minimally-invasive way to get rid of these white spots, they’re thrilled.

To use this as a practice builder, think in terms of reaching out to the following:

· Orthodontists – Contact your local orthodontists, let them know you do this procedure, and share some of your “before” and “after” cases of white spot lesion management.

· Parents of young children – This procedure is safe to use to address developmental white spots as early as a child’s first tooth. Whenever Ms. Iancu’s office completes a successful treatment on a child she finds that the positive word of mouth leads to additional patients as well.

· Young adults – A lot of people in their twenties and thirties have lived with white spots for years, often because white spot lesion management was not provided as part of previous orthodontic treatment. For many in this demographic, they are at a point in their lives where they want to do something about it and they are excited to learn that there is a non-invasive solution for their unsightly white spots.

“It’s really changed my practice!” Ms. Iancu exclaims.