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Almost all modern dental clinics today use the latest scientific achievements and developments in their practice. Now it becomes possible to carry out dental treatment quickly and painlessly. The new technology eliminates the treatment of caries-affected areas of the tooth with a drill. In connection with this approach, healthy tissue practically does not suffer during the preparation of the tooth for filling. We owe the appearance of such a unique method of treating caries in the daily practice of dentists to the German company DMG. Its employees developed and patented drug "ICON". The words Infiltration Concept, which are translated as infiltration and concept folded into an abbreviation "ICON".

Treatment of superficial caries with the ICON infiltration method is considered an alternative technique. Its purpose is to eliminate all the unpleasant stages of standard caries treatment. Every person who has treated a tooth at least once in his life considers drilling a carious cavity to be such an unpleasant moment. Especially this procedure causes fear in children. Instead of a drill, dentists successfully use chemicals. However, it should be noted that no alternative technology is yet able to completely replace the mechanical treatment of the carious cavity. Therefore, such methods of treatment are used in the initial stages of the disease. In addition, a stable result can not always be achieved.

Of course, before applying any new technique, it is advisable to carefully familiarize yourself with it and study all its features. Therefore, we will consider in more detail what the treatment of superficial caries is with the ICON infiltration method.

As mentioned above, this technology allows you to do without the preparation of the tooth cavity. The procedure itself takes place in three stages:

1. Gel "Icon-Etch" is designed to clean the surface layer of enamel. With this drug, the dentist treats the diseased tooth.
2. Alcohol "Icon-Dry" is used in the second stage of the procedure. It dries the surface of the tooth.
3. Icon-Infiltrant is a composite material designed to seal the pores of the enamel layer.

As a result of treatment, a diseased tooth cannot be outwardly distinguished from healthy units. There is a blocking of the development of pathogenic microbes, after hermetically sealing the enamel pores in the affected area. The procedure is quick and, most importantly, pain-free.

In European clinics, this technique has been practiced since 2009. In the territory of the Russian Federation, not all clinics have mastered the ICON technology yet.

Expert evaluation indicates the expediency of filling only shallow lesions with the preparation. The technology under consideration should not be used to treat advanced caries. It means - at the stage of formation of a carious cavity. The drugs are effective only at the stage of the initial spot. Also, "ICON" is not used for preventive purposes. These factors are attributed to the disadvantages of the ICON method.

There are much more positive aspects of the method of alternative treatment of caries:

1. The ability to stop caries at the stain stage.
2. Effective treatment without tooth preparation.
3. No need for anesthesia.
4. The ability to preserve healthy tooth tissue as much as possible.
5. The technique does not form fear in children for dental procedures.

Treatment of superficial caries by the infiltration method "ICON" is carried out for children from the age of three. This is because the procedure involves sitting still for 15 to 20 minutes. And it is difficult to persuade small patients to fulfill this condition.

ICON (ICON) is a new technology in the treatment of the most common disease of the oral cavity, that is, caries, which appears as brown spots on the surface of the teeth, indicating the activity of harmful bacteria. It is on them that the action of the ICON methodology (ICON) is focused and it is called “infiltration”.

Treatment of caries by the ICON method (ICON) consists in filling the affected areas with a polymer composition that clogs the carious cavity and completely stops the reproduction of bacteria. In addition, ICON (ICON) restores the previous density to the tissues of the tooth, which is disturbed during the course of the disease, they become more resistant to the action of acids, while their natural composition is not disturbed.

Features of caries treatment by the ICON method

• Small destruction of dental tissues during treatment, which occurs without preparation.
• The speed of the procedure, which lasts 20-25 minutes.
• The drill and anesthesia are not used, and the patient does not feel pain.
• Healthy areas of the tooth are not subjected to stresses that occur during classical treatment.
• The area treated using the ICON technology (ICON) does not visually stand out against the background of other teeth.
• The surface of the teeth retains its original shape.
• The technique helps only if the disease has not passed into the stage of deep caries. Otherwise, the technology will be powerless, and the use of the classical format of caries treatment cannot be avoided. That is why it is necessary to visit the dentist regularly.

How is caries treated without a drill using the ICON method?

First, the surface of the affected tooth is cleaned with dental products, after which the dentist treats the surface of the tooth with a special gel. Next, a special ICON infiltrate is applied to the affected area, blocking the pathological process.
After that, illumination is carried out with a polymerization lamp to harden the liquid, and the tooth surface is polished to achieve perfect smoothness and shine.

Clinical case 1.

Clinical case 2.

The article considers a fundamentally new method of microinvasive treatment of cavityless enamel caries by the method of infiltration.

The constancy of ultrastructural and microcrystalline architectonics of tooth enamel is ensured by remineralization processes in the oral cavity. Superficial caries is a process of irreversible demineralization of enamel. In the enamel affected area, 25–35% of pores and microspaces filled with cariogenic microorganisms are found. The state of a stabilized carious process is described, when a protective zone is formed behind the enamel lesion zone, delimiting the carious process from healthy enamel. In all cases of superficial caries, both in active form and in the form of a suspended process, a large number of cariogenic organisms are found in the zone of the enamel lesion and often on its surface, the product of which is lactic acid.

In the 2000s, a fundamentally new method for microinvasive treatment of cavityless enamel caries was proposed using the infiltration method. The method of enamel infiltration is based on achieving a cariesstatic effect by closing the enamel pores, which are the "entrance gates" for the penetration of acids and the release of dissolved minerals.

The technique was developed by Prof. H. Meyer-Lueckel and Dr. S. Paris. It is based on the removal of a pseudo-intact layer of enamel with 15% hydrochloric acid, followed by filling the lesion with a mixture of synthetic resins that have certain rheological properties (low viscosity) and, accordingly, a higher penetrating ability (high penetration coefficient). The table shows the radiological classification of proximal carious lesions according to their depth (Mejare I., 1999).

Table. X-ray classification of proximal carious lesions according to their depth (Mejare I., 1999)

According to S. Paris and H. Meyer-Lueckel (2009), the progression of the carious process 18 months after enamel infiltration using the Icon material (DMG, Germany) is observed only in 10% of teeth with proximal carious lesions of the E2–D1 level (in the comparison group - in 38% of the teeth, respectively).

The main provisions of the concept of minimally invasive caries treatment:

Timely diagnosis of carious lesions (measurement of the degree of demineralization of hard tissues of the tooth using laser fluorescence, enamel electrical conductivity, optical coherence tomography, occlusal radiography, transillumination, and other methods);

Remineralization of initial carious lesions with fluorine and calcium preparations;

Control of cariogenic microflora (rational oral hygiene, reducing the frequency and amount of refined carbohydrates consumed, the use of fluoride preparations, etc.);

Surgical intervention with minimally invasive treatment of cavity caries (manual preparation, slot- and bat cave-preparation, tunnel preparation, etc.).

Indications for enamel infiltration:

Enamel caries in the stain stage on the vestibular surfaces of the teeth;

Enamel caries and dentine caries with lesions up to half of its thickness (levels E1–D1 according to radiographic classification) on the proximal surfaces of the teeth while maintaining a pseudo-intact layer.

Contraindications for enamel infiltration:

Treatment of caries of dentin with damage to more than half of its thickness (levels D2–D3 according to radiological classification);

Cavitary caries of enamel and dentin;

Enamel discoloration due to trauma;

Individual intolerance to the components of the material.

Visual diagnosis of carious lesions and determination of the possibility of non-invasive therapy is preferably carried out using optical devices (monocular, binocular magnifier and intraoral video camera), which allow to observe the surgical field in detail.

The Icon system for the non-invasive treatment of early caries was developed by DMG in collaboration with the Charite Clinic Berlin and the University of Kiel. The manufacturer recommends using it for E1, E2, D1 lesions.

The Icon System (DMG) includes the following components:

Interdental wedges for separation of proximal areas;

Etching agent - 15% hydrochloric acid gel;

Vestibular and proximal nozzles with one-sided perforation for the introduction of an etching agent and an infiltrant;

Infiltrant Icon-Infiltrant.

Two variants (sets) of the Icon system are offered: for proximal surfaces (Icon Cariesinfiltrant-approximal) and for the treatment of vestibular surfaces of teeth (Icon Cariesinfiltrant-vestibular). They differ in the types of nozzles and the presence or absence of wedges.

The syringes included in the proximal lesion treatment kit contain material for treatment of two surfaces. In the case of treatment of multiple lesions of the proximal surfaces during one session, the treatment of lesions is performed sequentially.

The syringes included in the vestibular surface kit contain material for a single treatment of two to three lesions. In the case of treatment of adjacent vestibular areas during one session, the treatment of lesions can be carried out in parallel.

In Belarus, in particular, at the Department of Therapeutic Dentistry of BelMAPO, experience has been gained in working with the Icon system.

Clinical case 1.

Patient E., 24 years old, applied to the clinic of the Department of Therapeutic Dentistry of BelMAPO with complaints of a cosmetic defect in teeth 21 and 22. For an objective assessment of the diagnosis of foci of the carious process, we used laser fluorescence microscopy (KaVO "Diagnodent"), which allows us to determine the volume of cariogenic metabolic products. microorganisms, especially lactic acid. In this clinical situation, enamel caries of teeth 21 and 22 (E1) was diagnosed (Fig. 1.1).

Defect sizes were determined using an LI-2-8x monocular, which allows measurements to be made with an accuracy of 0.1 mm. After the diagnosis was made, it was decided to apply a minimally invasive method for the treatment of tooth enamel caries using the Icon material (DMG).

Before carrying out the infiltration of approximal caries, the tooth was cleaned with a brush, polishing paste and floss. They put on a rubber dam (Fig. 1.2).

After applying the rubber dam, the teeth were separated with a plastic wedge from the set (Fig. 1.3).

In order for the wedge to better enter the proximal section, its handle can be turned at an angle. The wedge handle was disconnected by turning it. The separating wedge was left in the proximal section during the entire treatment session (Fig. 1.4).

The proximal tip was screwed onto the Icon-Etch syringe and inserted into the interdental space with the perforated side facing the affected tooth surface (Fig. 1.5).

With its help, Icon-Etch, an etching gel of 15% hydrochloric acid, was applied to the contact surface (1.5 - 2 piston turns correspond to the required amount of material) (Fig. 1.6).

Icon-Etch was left to act for 2 minutes.

The application film was removed from the interdental space and rinsed with Icon-Etch water for at least 30 seconds (Fig. 1.7).

The affected area was dried with dry air from an oil-free compressor (Fig. 1.8).

To create optimal conditions for the adhesion of polymer resins, it is necessary to completely remove moisture that is present in the pores of the enamel after washing with water and subsequent drying. For this purpose, ethanol was applied to the treated areas and dried. The application cannula was then screwed onto the Icon-Dry syringe. Approximately half of the contents of the syringe were applied to the lesion and left to act for 30 seconds (Fig. 1.9). Then dried again with dry air from an oil-free compressor.

The next stage of treatment is direct infiltration of the lesion. For its implementation, a special proximal nozzle was screwed onto the Icon-Infiltrant syringe and the application film was inserted into the interdental space. The green side of the nozzle should be directed towards the surface to be treated, since the material exits only through the perforations (Fig. 1.10).

Turn off the lamp of the dental unit before applying the infiltrant!

Icon-Infiltrant was applied with a slight excess to the lesion (1.5–2 piston turns approximate the required amount of material). The material was left to act for 3 minutes. Icon-Infiltrant was illuminated from all sides for at least 40 seconds (Fig. 1.11).

To reduce polymerization shrinkage and increase microhardness, the material was applied a second time by screwing a new approximate nozzle onto the Icon-Infiltrant syringe. The material was left to act for 1 minute and the material was illuminated from all sides for at least 40 seconds. (Fig. 1.12 - after repolymerization.)

The separating wedge and rubber dam were removed. The structure was polished using polishing strips and disks (Fig. 1.13, 1.14).

Clinical case 2.

Patient A., 27 years old, applied to the clinic of the Department of Therapeutic Dentistry of BelMAPO with complaints of a cosmetic defect in the area of ​​teeth 11 and 12.

For an objective diagnosis of the state of hard tissues, we used the method of laser fluorescence microscopy (KaVO "Diagnodent"). The dimensions of the defects were determined using an LI-2-8x monocular, which makes it possible to carry out measurements with an accuracy of 0.1 mm. After the examination, the patient was diagnosed with caries of the enamel of teeth 11 and 12 (Fig. 2.1).

For the treatment of cavityless caries, the carious lesion infiltration technique using the Icon system was used in this case.

Before treatment, the treated tooth and adjacent teeth were cleaned. After removing the plaque, the oral cavity was rinsed with water and a rubber dam was applied (Fig. 2.1). To apply the etching gel, the vestibular tip was screwed onto the Icon-Etch syringe. With the plunger turned, Icon-Etch was gently applied to the lesion and left to act for 2 minutes.

In the treatment of caries in the white spot stage, a 2 mm area around the lesion was also etched.

For better dissolution of the pseudo-intact layer, the manufacturer is allowed to etch the lesion with a 15% hydrochloric acid gel three times, for 2 minutes each time.

Icon-Etch was flushed with water for at least 30 seconds and dried with dry air from a malt-free compressor. On fig. 2.2 photograph of the affected area of ​​the tooth with a carious process after etching with 15% hydrochloric acid gel, washing and drying. The moisture remaining in the enamel pores after washing with water was dried with ethanol. To do this, the application cannula was screwed onto the Icon-Dry syringe. Approximately half of the contents of the syringe were applied to the lesion and left to act for 30 seconds. Dry with dry air from an oil-free compressor.

Before the actual infiltration, the vestibular tip was screwed onto the Icon-Infiltrant syringe. By turning the piston, Icon-Infiltrant was applied with a slight excess to the etched surface and left to act for 3 minutes (Fig. 2.3). Excess material was removed with air from an oil-free compressor.

The next step was to re-apply Icon-Infiltrant to the affected surface: a new vestibular nozzle was screwed onto the Icon-Infiltrant syringe and the material was applied a second time. Left to act for 1 minute and shone from all sides for at least 40 seconds. For the treatment of caries of the enamel of the proximal surfaces of teeth 12 and 11, the proximal nozzle was used. The sequence of manipulations was similar to the clinical case described above. On fig. 2.4 shows the stage of treatment of caries of the proximal surfaces of teeth 12 and 11 and the vestibular surface of tooth 21 after repeated application of the Icon infiltrator and its illumination before final polishing. With the rubber dam removed, the surface of the restoration was polished using discs and polishing heads.

Rice. 2.5. - after finishing.

On fig. 2.6 shows the result of treatment after 3 months.

On fig. 3.1 - 3.3 shows the Icon system and types of nozzles.

After the infiltration of the enamel with the Icon material, dynamic monitoring is necessary (at least once a year) with regular X-ray control. Since Icon is not a radiopaque material, it is mandatory to fill out a special passport for each treated tooth.

Enlargement of the object of study using a monocular, binocular loupe and intraoral video camera, as well as examinations using laser fluorescence significantly improve the quality of caries diagnosis and allow you to determine the boundaries of non-invasive therapy.

The atraumaticity and relative speed of the treatment method (in one visit) determine the high potential for the use of the drug in the clinic of therapeutic dentistry. Based on the experience with the materials of the Icon system, it can be concluded that the microinvasive treatment of superficial caries by infiltration is highly effective. An additional advantage of the technology is the restoration of enamel fluorescence in most cases.

The drill always causes a feeling of fear in everyone. Of course, who is pleased to hear the buzzing and drilling in the tooth, which is sometimes accompanied by more unpleasant sensations. But technology has long gone far ahead, so now there is a unique way of restoration, which does not use standard methods of cleaning the cavity of the teeth. One of these is Icon caries treatment technology. Due to the fact that during this method of treatment a drill is not used, it has become quite popular among many patients. But still, before applying this method, you need to carefully study its features.

The name of the medical technology Icon comes from the abbreviation Infiltration Concept, in translation it means “the concept of infiltration”. It was first invented in Germany by DMG, then it was introduced into the practice of European dentists, and then it began to be used in Russia. In Russia, e began to be used not so long ago, only 6 years ago. But, despite the short period of existence, it has become a fairly popular technology, the thing is that during it there is low interference in the work of the human body.

Attention! The principle of Icon technology is based on the fact that during it, a doctor injects a special polymer composition into the affected area. The main task of this composition is that it completely closes the open cavity and stops the process of further spread of bacteria.

Also, using this technique, you can completely restore the density of the structure of the dental tissue, make it more durable and resistant to the effects of acidic environments that can be observed in the oral cavity.
With the help of infiltration, it is possible to stop the process of spreading a carious lesion at the “white spot” stage without the use of a drill. Due to the fact that drilling is not carried out during the treatment, a large amount of dental tissue can be saved.

ICON is a modern technique for the treatment of superficial caries without anesthesia and without a drill. The essence of the technique is to seal the tooth enamel damaged by caries with a special innovative material.

Characteristics

The Icon infiltration method has a number of features:

• this method of treatment is effective when the carious lesions of the teeth are not yet in a deep stage. If it is used already at advanced stages, then its use will not give any results and will be ineffective;
• using this method, an increased strengthening of the structure of the dental tissue is provided, which in the future can protect against acid exposure.

  Important! It should be borne in mind that during this technology, a thin layer of dental tissue is burned out, but still it is much less than when using a drill.

  After the Icon infiltration method, the enamel does not crack and retains its original structure;

• this method of treatment cannot always stop the spread of a carious lesion, sometimes it continues to spread. In these cases, the tooth structure is restored and treated according to the classical method.

Impregnation of the enamel with a colorless monobond is Icon infiltration. This method allows you to get rid of caries at the stain stage. With its help, a natural remineralization of the carious lesion occurs.

Advantages

Icon infiltration technology has a number of advantages, among which are the following:

1. During its implementation, a small level of destruction of the structure of the dental tissue is observed, while the treatment is carried out without preparation;
2. Fast execution of the procedure, the period of which is about 20-25 minutes;
3. During this method of treatment, a drill and anesthesia are not used, so the patient does not feel pain;
4. During the Icon method, there is no stress on healthy areas of the teeth, which are often observed with the classical method of treatment;
5. The area treated using Icon technology does not visually stand out and does not differ in any way from the structure of healthy teeth;
6. After this method of treatment, the structure of the teeth retains its original state.

The preparation for the treatment of dental caries by the Icon method allows you to treat teeth without using a burr machine. Drill-free treatment helps preserve healthy tooth tissue by minimizing mechanical intervention, and the absence of anesthesia makes the procedure more comfortable.

Flaws

The disadvantages include the following nuances:

• this method will be effective only with superficial caries. At severe stages of caries, methods of preparation and removal of dental tissues are used;
• Icon technology compared to other classical methods costs almost twice as much;
• the use of this method requires a highly qualified doctor and the development of innovative technologies;
• many dentists believe that this procedure is not effective in the treatment of carious lesions.

The result of dental treatment using the infiltration method is the compaction of the porous part of the damaged enamel, the creation and maintenance of a more resistant tooth tissue to aggressive stimuli.

How is the procedure carried out

The technology of the Icon method is carried out in several stages:

1. At the first stage, a thorough cleaning is performed, and dental deposits are also removed. First of all, soft plaque is removed;
2. It is important that the infiltration area is completely dry, which is why many dentists use rubber dams. During treatment, a latex base plate is installed, which provides isolation of the treated teeth from the oral cavity for the period of medical therapy;
3. Next, the teeth are wedged using special wedges. This procedure is quite unpleasant, but it can be tolerated. Tools are used to move the teeth away from each other;
4. After that, the hard tissues of the tooth are prepared for infiltration.

   Important! A special gel with an etching structure is applied to the area with a lesion, this agent contains sodium hypochlorite and amino acids.

   This remedy is left for a couple of minutes, after which a porous surface opens, on which the doctor performs the rest of the therapeutic manipulations;

5. The gel is washed off with a water-air spray, then the tooth surface is thoroughly dried;
6. Next, a special nozzle is used, which was developed by DMG. Two different polymers are applied to the tooth surface in two stages. The first polymer is applied and left for 3 minutes, then lightening is carried out. The second type of polymer is applied for 1 minute. After the defect is completely sealed and filled, the carious lesion is sealed with an infiltrate;
7. The result is visible immediately after this procedure. The tooth becomes white, and it does not differ from other healthy teeth.

The main stages of the procedure: isolation of the tooth with a rubber dam - treatment of the affected surface with a special gel - drying of the pores using an alcohol solution - applying an infiltrate to the tooth surface - polymerization - polishing the surface.

Contraindications

Despite the fact that this procedure has a gentle effect, allows you to restore the damaged structure of the teeth without the use of cavity preparation with a drill, its use has some contraindications.
You should not use Icon teeth infiltration if you have the following contraindications:

• the presence of medium or deep carious lesions;
• if the patient has an individual intolerance to the components that are used during this procedure;
• the presence of fluorosis or enamel hyperplasia.

In other cases, the Icon procedure is not prohibited. This treatment technology can be used even during pregnancy, in early childhood, because it has a gentle effect.

Attention! The preparations that are used during this procedure are absolutely hyperallergenic. But before using them, it is still recommended to conduct the necessary examination and pass the appropriate tests.