Cariology 1 Final Study Guide 2024 D1T1 PDF

Lecture 15 - CAMBRA/ Caries Risk I. Caries Balance A. Protective Factors (SAFER) 1. Saliva/Sealants, Antibacterials, Fluoride, Effective Habits, Risk-based reassessment B. Risk Factors (BAD) 1. Bad bacteria, absence...

Lecture 15 - CAMBRA/ Caries Risk I. Caries Balance A. Protective Factors (SAFER) 1. Saliva/Sealants, Antibacterials, Fluoride, Effective Habits, Risk-based reassessment B. Risk Factors (BAD) 1. Bad bacteria, absence of saliva, destructive habits C. Disease Indicators (WREC) 1. White Spots, Restorations < 3 yrs, Enamel Lesions, Cavities in Dentin II. High-Risk Areas - Pits/Fissures, Root, Cervical, Interproximal III. Plaque Stagnation Areas - restorations/ orthoappliances IV. Caries Detection Methods A. Sensitivity - true positive rate B. Specificity - true negative rate C. Note* magnification could cause increase in sensitivity (more false negatives) while decreasing specificity (less false positives) Method Description Sensitivity Specificity Visual Visual examination 0.12 0.93 Visual + Perio Probe Visual examination with probing 0.14-0.80 0.93 Visible Light Can be added to valolight, uses 0.5-0.85 0.95 visible light spectrum Transillumination / NIDIT IR Light - 780 nm 0.68 0.93 Impedance Uses closed circuit, AC Impedance 0.67-0.96 0.71-0.98 Spectroscopy Technique (ACIST) Radiography Xrays 0.45-0.7 0.70-0.97 Dyes Stains demin. dentin, not bacteria, eg 0.71-0.74 1.00 methylene blue, fuchsin red Fluorescence Method Wavelength Caries Detection Notes Diagnodent Red Light - 655 nm 0-10: Sound Reacts to Porforins 11-20: Outer Half of which are byproducts Enamel of biofilm 21-30: Inner 1/2 of Enamel beeps faster with 31-40: Dentin Caries caries detection Quantitative Light Blue Light Healthy = green Expensive, modified Fluorescence (QLF) Caries = no camera fluorescence SIROInspect Laser Light - 405 nm w/ 530 nm filter Caries Assessments 1) ICDAS Stage 0 1 2 3 4 5 6 ICDAS Descrip. Sound First Distinct Enamel Visible Visible Extensive visual Enamel gone, dentin Dentin dentin enamel opacity/ no shadow visible, change discolor visible >1/2 of dentin tooth or surface shadow 2) Radiographic E0 E1 E2 D1 D2 D3 Stage Radiographic Sound Small Large Dentin Affected Dentin Dentin Descrip. enamel enamel funnel funnel cavitati wedge shadow shadow on shadow to pulp 3) ADA Stage Sound Initial Moderate Advanced ADA Descrip. Sound Cavitated enamel Possible dentin Definite dentin infection infection RISK ASSESSMENT *** KNOW THIS SHIT High Risk (D0603) (WREC) Medium Risk (D0602) (BADEA) Low Risk (D0601) (SAFER) White Bad Bacteria heavy plaque - Saliva flow - Spots/Demineralization - Can use agar to culture 1) Enzymes (Disease Indicator) biofilm 2) Moistens food - White Spots - Strep 3) Rinses oral cavity Mutans - Dentinal Caries/Tubule Infection - Lactobacillus - Root Caries - Actinomycin Deep pits/fissures Restorations < 36 m prior Appliances Present - ortho/ Antibacterials ie Xylitol 4x (Disease Indicator) restorations daily in last 6m Chlorhexidine in last < 6m Enamel/ Dentin Lesions Destructive Habits Fluoride use (Disease Indicator) Recreational Drugs Frequent Big Backing - - >3x between meals - Sugary diet - Enamel demin. < 5.5 pH - Dentin demin. < 6.5 pH Cavities (Disease Indicator) Exposed Roots Effective Habits Reduced Salivary Function Absence of Saliva - Risk-based Reassessment (aka xerostomia) - - Old Age Daily - 0.5 L - 1.5 L - Female Sex Unstimulated - 0.3 ml/min, - Anticholinergic/ abnormal < 0.1-0.2 ml/min sympathomimetic Stimulated - 0.5-2ml/min, - Xerostomia Frequency abnormal < 0.5 ml/min - No med: 17% Test - chew on straw 3 min - 3 med: 33.5% and check volume, test pH - >7 med: 67% - Endocrine disease *EXTREMELY HIGH RISK - - Neurologic disease if pt has one disease indicator - Psychogenetic disease AND xerostomia - Infections Low moderate high extreme ^ prescription drugs Prescription as well Lecture 17 - Polymerization I. Polymerization Definition - chemical rxn that transforms small molecules into large polymer chains or networks (monomer + monomer +... w/ photoinitiator = polymer) A. Required for glass ionomers, telio onlay, resin composite II. Photoinitiators - chemicals that activate polymerization w/ exposure to specific wavelength and intensity of light A. Violet light - 380-420 nm 1. UV - 100-400 nm B. Blue light - 420-490 nm Group 1 - no coinitiators needed Lucirin TPO - trimethylbenzoyl - Peak 381-390 nm (380-410 nm) diphenylphosphine oxide - Requires UV light - Less yellow than PPD Group 2 - coinitiators needed CQ - Camphorquinone*** - Peak 468 nm (425-495 nm) - Most common - Requires tertiary amine coinitiator - Yellow - Very unstable, sets quickly, sensitive to ambient light - Mechanism of Action: 1) Exposure to blue light (468 nm) 2) CQ decomposition 3) Reacts with tert. Amine 4) Produces free radicals 5) FRs split carbon DBs 6) Oxidized carbon propagates further DB breakage PPD - 1-phenyl 1,2-propanedione - Peak 398 nm (390-460 nm) - Less yellow than CQ - Used w/ CQ Other Photoinitiators to Know  Ivocerin UV Irgacure 819 UV PQ - Phenanthrenequinone Bluelight C. *KNOW THE FULL NAMES OF ALL PHOTOINITIATORS III. Polymerization Steps (remember APT) A. Activation/Initiation - Creation of FR which oxidizes initial monomer DBs B. Propagation - Oxidized monomers break C. Termination - Two Free Radicals/Oxidized Monomers Collide IV. Determinants of Effectiveness of Polymerization A. Resin-Based Composites 1. Types and concentrations of fillers/monomers/photoinitiators/other a) Refractive Index of each component b) Want RI of filler = matrix to allow for better penetration of light c) Shade Match - uncured resin different from cured, so place ball of resin near prepared area and cure prior to restoration 2. Shade of RBC (pigments) a) Dentin shade darker than enamel shade, so cure dentin longer 3. Type and concentration of photoinhibitors a) BHT - most common photoinhibitor B. Light Cure Unit (LCU) 1. Type of Curing Unit Clinical LCUs LED Curing Units *** - LED = light emitting diode - WHAT WE USE - Gen I - 450-480 nm - SMALL SPECTRA, blue only - Gen II - 430-480 nm, 500 mW/cm2 - Replaced LED bulbs w/ chips to increase irradiance - Gen III - Dual Peak aka polywave 390-420 nm, 420-490 nm - Produces bluelight AND UV w/ dual spectra - WHAT WE USE - note* wired is better because the battery in wireless option can reduce irradiance over time Halogen Curing Unit - Spectra: 390-520 nm  - Irradiance: 150-1600 mW/cm2 - Uses quartz-tungsten-halogen (QTH) - Emits white light, requires filter for blue/ UV - OLD, bulb needs to frequently be replaced - HIGH TEMP so requires heat filter Plasma Curing Unit - Spectra: 420-490 nm - Irradiance: 2400 mW/cm2 - Emits white light, requires filter for blue/ UV Lab Setting LCUs Argon Laser - Technically used in both settings Pulsed Blue Laser Blue Diode Laser Blue text indicates NOT requiring filter to produce UV/bluelight 2. Irradiance aka Intensity aka Power Density 𝑃𝑜𝑤𝑒𝑟 𝑜𝑓 𝑊𝑎𝑣𝑒𝑙𝑒𝑛𝑔𝑡ℎ a) 𝐼𝑟𝑟𝑎𝑑𝑖𝑎𝑛𝑐𝑒 = 𝐴𝑟𝑒𝑎 𝑜𝑓 𝑂𝑝𝑡𝑖𝑐𝑎𝑙 𝐺𝑢𝑖𝑑𝑒 units: mW/cm2 b) 𝑅𝑎𝑑𝑖𝑎𝑛𝑡 𝐸𝑥𝑝𝑜𝑠𝑢𝑟𝑒 = 𝐼𝑟𝑟𝑎𝑑𝑖𝑎𝑛𝑐𝑒 * 𝐸𝑥𝑝𝑜𝑠𝑢𝑟𝑒 𝑇𝑖𝑚𝑒 units J/cm2 3. Exposure Time 4. Size of LCU tip/geometry/beam profile a) Smaller tip increase irradiance profile b) Beam Profile - indicates different irradiance depending on region of tip  c) Tip Placement Considerations (1) Access to preps/LCU design - elbow shape not ideal, affects TMJ, pen-shape is better (2) Direction of Light Guide Tip - make sure to hold tip perpendicular to restoration (3) Distance - hold 1-2 mm to ensure light permeates through entire restoration d) Measurements of Irradiance (1) Radiometer - place tip on sensor and cure (2) MARC (Managing Accurate Resin Curing) - sensor in tooth of a manikin to assess actual time, irradiance, peak wavelength, radiant exposure, total energy 5. Effect of Autoclaving and Protective Barrier a) Autoclaving and disinfecting solutions can damage LCU tip b) Protective Barrier must be placed properly to avoid beam profile disruption C. Procedural Factors D. Environmental Factors 1. Ambient and operating light 2. Surrounding atmosphere V. Degree of Conversion and Polymerization Considerations A. Three Gel Phases (correlates w/ polymerization stages) Gel Stage Polymerization Stage Details Pre-gel Activation/Initiation - Radicals form - Molecules (matrix, filler, PIs) are loose and capable of moving around - WANT TO EXTEND PRE-GEL PHASE** - Done by using soft-start/discontinuous LCU setting Gel Propagation - Molecules can’t move around anymore Post-gel Termination - Molecules shrink - C-Factor = bonded surface/unbonded surface - Types of Shrinkage Fracturing - 1) Cohesive Fracture - between a material itself (tooth or composite) - 2) Adhesive Fracture - between tooth and composite VI. Other Considerations A. Oxygen Inhibiting Layer - oxygen binds to free radicals to form peroxide radicals which inhibit polymerization 1. Initiation efficiency is reduced 2. Place glycerin gel to counteract B. Temperature Increases - can burn soft tissues and pulp tissue (ie Class V) C. Cytotoxicity - uncured RC matrix monomers are cytotoxic D. Eye Protection - 1. Blue Light - damages retina 2. Violet Light - damages cornea Lecture 18 - Non-Invasive Caries Management (emphasis on diet/sugars) I. Sugar Types A. Sources - crushed/juiced > refined > becomes tables sugar 1. Tropical Climates - sugar cane 2. Colder Climates - sugar beets B. Types of Sugars Polysaccharide Source Ring Size Chain Orientation/ Chain Length Fiber Plants Hexose Networked, undigestable but aids in digestion Glycogen Human Body Sugar Hexose Branched Storage Starch Plant (potato) Hexose Straight Amylose Amylose + Hexose Straight, 100+ monos Amylopectin = starch Amylopectin Amylose + Hexose Branched, 20-30 monos Amylopectin = starch Disaccharide Composition Details Sucrose Glucose (6C) + Fructose (5C) Table sugar** Lactose Glucose (6C) + Galactose (6C) Milk Sugar Maltose 2x Glucose (6C) Market Sugars Composition Details Table Sugar/ 50% Fructose + 50% Glucose Sucrose High-Fructose HFCS 55 - 55% fructose + 45% glucose - Cheaper Corn Syrup HFCS 90 - 90% fructose + 10% glucose - Used in sodas - Fructose is metabolized by liver, can induce damage Agave Nectar 70-90% fructose + 10-30% glucose  C. Sweetness: monosaccharide > disaccharide > polysaccharide II. Sugar Metabolism Pathway - Note that glucans and fructans are what compose sticky matrix for biofilm and acids - Resulting glucose and fructose go into glycolysis III. Cariogenic Challenge associated with Diet A. Stephan Curve - takes ~1 hour to restore neutral pH 1. Enamel Demineralizes: 5.5 pH 2. Dentin Demineralizes: 6.5 pH 3. Greater CAMBRA Risk = greater time under critical pH demineralization level 4. Frequent snacking = ^ freq. of pH lowering = ^ demineralization 5. FREQUENCY OF SUGAR CONSUMPTION is more damaging than QUANTITY OF SUGAR CONSUMPTION B. Vipeholm Study - positive correlation between consumption of sugar and caries 1. UNETHICAL - conducted at mental hospital, fed copious amounts of “extra sticky toffee” IV. Sugar Consumption A. Fast Facts 1. 1 teaspoon = 4 g sugar 2. Children (2-19 y/o) - girls 15 teaspoons, boys 18 teaspoons 3. Adults (20+ y/o) - girls 15 teaspoons, boys 19 teaspoons 4. Daily Average Intake: 17 teaspoons/71.14 g a) 25.96 kg or 57.23 lb/ year 5. Free Sugar Guidelines a) WHO - < 10% total energy intake, ie 50 g assuming 2000 kcal daily b) AHA - 6 teaspoons for girls, 9 teaspoons for boys B. American Sugar Consumption by Source 1. 24% - Sugary Beverages a) 16% - Soft Drinks b) 5% - Fruit Juices c) 2% - Sports/Energy Drinks d) 1% - Other Sweet Beverages 2. 19% - Dessert/Sweet Snacks a) 6% - Cookies/ Brownies b) 5% - Ice Cream/ Frozen Dairy Desserts c) 4% - Cakes/ Pies d) 3% - Pastries e) 1% - Other 3. 11% - Coffee/Tea 4. 9% - Candy/Sugars 5. 7% - Breakfast Cereals/Bars 6. 7% - Sandwiches 7. 4% - high fat milk/yogurt 8. 19% - OTHERS C. Examples Beverage Sugars Other Details Coke 39 g ~ 10 teaspoons Contains phosphoric acid Vitamin Water 28 g ~ 7 teaspoons Naked Fruit Juice 68 g ~ 17 teaspoons Juicing isolates sugars bound to fiber, JUICING BAD V. Sugar Alcohols A. Structurally similar to sugars but with -OH group B. Typically not as prone to caries C. Can cause bloating/diarrhea VI. Artificial Sweeteners A. Much more powerful than sugars and sugar alcohols * could possibly be carcinogenic VII. Oral Hygiene - Biofilm Management A. Plaque Control 1. Mechanical Disturbance Mechanisms a) Brushing, flossing, interdental brushing 2. Chemical Actions a) Tooth paste, rinse, spray, varnish, chewing gum Risk Caries Risk Management Prescription Low OTC: 0.15%/1,500 Moderate ppm NaF OTC: In Office: Prescriptions toothpaste 6-10 g 5%/22,600 : High Xylitol/day ppm 0.12% CHX 0.05%/230 NaF varnish 1x/day for 1 Extreme High Ca-P ppm NaF (D1206) week/month Toothpaste Nutritional use OTC NaF Baking-Soda Counseling Rinse on off Rinse (D1310) days Oral Hygiene 1.1%/5,000 Instruction ppm NaF (D1330) toothpaste VIII. Silver Diamine Fluoride (38% SDF) ADA approved for cavitated lesions A. Desensitizing, arrests caries by precipitating surface and plugging tubules B. Can result in black staining from silver particle residue C. Composition 1. Silver - antimicrobial 2. Fluoride - remineralizes 3. Ammonia - stabilizes solution D. Protocol: 1. Field Isolation 2. Use Spoon Excavator #6418 to remove superficial soft caries 3. Rinse and dry 4. Apply SDF with microbrush 5. Wait 60s then air dry 6. Apply Fluoride Varnish (5%/22,600 ppm) 7. Restore with Glass Ionomer before staining occurs Lecture 19 - Caries Excavation I. Caries Management Goals - Prevent new lesions, Prevent advancement of existing lesions, Preserve tooth structure with conservative treatment (use smaller burs) II. Lesion Progression into Dentin A. Zone of Destruction - induced by lactic acid produced by acidogenic bacteria which activates MMPs to eat away exposed dentin B. Demineralized Dentin - softer dentin C. Sclerotic Dentin - formed due to occlusion and hypermineralization of superficial tubules, peritubular dentin grows inwards on itself 1. Air pushes odontoblasts down exposed tubules, increases calcification 2. Brannstrom’s Hydrodynamic Theory - air/temp/pressure moves odontoblasts in tubules, triggering main response in pulp o D. 3 Dentin - reactive/reparative dentin formation 1. Reactionary Dentin - mild, odontoblast/Hoehl’s cell calcification response to anything (caries, prep, abrasion, erosion, attrition, toxicity etc...), produced by odontoblasts from dentinal tubules 2. Reparative Dentin - severe, formed in response to pulp exposure (eg. rapid caries progression or loss of salivary flow due to cancer), produced by odontoblast-like cells from pulp  E. ICDAS Stages of Lesion Formation Stages 1 2 3 4 5 6 Image > 1/2 tooth surface, cavitation to dentin ZD, DD SD, 3o DD, SD, 3o DD, SD, 3o ZD, DD o SD DD, SD, 3 SD, 3o Class. White Spot White/ Microcavitation Cavitation Brown Spot Desc. First visual Distinct Enamel Visible Visible Extensive enamel Enamel gone, no dentin Dentin dentin change opacity/ visible shadow visible, >1/2 discolor dentin or of tooth shadow surface *** - Caries Infected, remove, leathery texture *** - Caries Affected, DON’T remove fully in order to avoid PULP EXPOSURE F. Hardness Progression of Dentin Demineralization Stages III. Caries Detection Refresher A. Sensitivity - true positive rate B. Specificity - true negative rate C. Note* magnification could cause increase in sensitivity (more false negatives) while decreasing specificity (less false positives) Method Description Sensitivity Specificity Visual Visual examination 0.12 0.93 Visual + Perio Probe Visual examination with probing 0.14-0.80 0.93 Visible Light Can be added to valolight, uses 0.5-0.85 0.95 visible light spectrum Transillumination / NIDIT IR Light - 780 nm 0.68 0.93 Impedance Uses closed circuit, AC Impedance 0.67-0.96 0.71-0.98 Spectroscopy Technique (ACIST) Radiography Xrays 0.45-0.7 0.70-0.97 Dyes Stains demin. dentin, not bacteria 0.71-0.74 1.00 (eg. methylene blue or fuchsin red in propylene glycol) Fluorescence Method Wavelength Caries Detection Notes Diagnodent Red Light - 655 nm 0-10: Sound Reacts to Porforins 11-20: Outer Half of which are byproducts Enamel of biofilm 21-30: Inner 1/2 of Enamel beeps faster with 31-40: Dentin Caries caries detection Quantitative Light Blue Light Healthy = green Expensive, modified Fluorescence (QLF) Caries = no camera fluorescence SIROInspect Laser Light - 405 nm Can detect remnants w/ 530 nm filter of old restorations IV. Caries Excavation Protocol (example in slides used ICDAS class 6 as example) A. Outline: open access/remove adjacent restorations w/ #330/245 at 200,000 under water irrigation B. Remove soft/decayed tissue with excavator (EXC6418, 1.3 mm width) 1. Start from margins to not damage pulp C. Circumferentially go along DEJ w/ #2 RA Round Carbide @ 8,000 rpm to remove peripheral decay 1. Exposed dentin should be hard and shiny, indicating sound dentin D. Clean margins w/ #2 Round Carbide (1.0 mm width) @ 8,000 rpm or #8888 (diamond 1.2 mm width, 9.0 mm length) @ 200,000 rpm E. Check hardness of newly exposed circumscribed dentin with explorer (EPD1359) F. Remove caries infected dentin from pulpo-axial walls with #4 (1.4 mm width) or #6 (1.8 mm) Round Carbide bur @ slower 4,000 rpm 1. AGAIN FROM PERIPHERY TO CENTER to not damage pulp V. Caries Management by Lesion Depth A. Shallow/Moderate - not reaching inner 1/3 or 1/4 of dentin and no risk of pulp exposure 1. Selective removal to firm non-restorative cavity control fissure sealant if non-cavitated 2. Note that radiographs typically underestimate dentin infection depth B. Deep - Inner 1/3 or 1/4 of dentin w/ risk of pulp exposure 1. Stepwise Removal - BETTER, helps prevent RCT w/ 3o Dentin development a) Remove peripheral Inf. Dentin b) Temp  c) 6m wait to allow 3o Dentin to develop d) Finish Removal 2. or Selective Removal to Soft a) Doing everything in one visit VI. Pulp Exposure Responses Indirect Pulp Capping Direct Pulp Capping Pulpotomy Pulpectomy Pulpal Tissue Not Pulpal Tissue Exposed Exposed No Pulpal Tissue Partial Pulpal Tissue Overall Pulpal Tissue Inflammation Inflammation Inflammation Possible Hemostasis No Hemostasis RMGI Liner + CaOH, RMGI Liner + CaOH + Removal of coronal Removal of coronal but not employed MTA (mineral trioxide pulp to preserve pulp and RCT as large anymore because aggregate), CaOH and uninflamed nerves in pulp inflammation research does not MTA under RMGI roots followed up suggests periapical support benefits and liner stimulates restoration lesion liners also reduce odontoblast future bonding production of capabilities reparative 3o Dentin, forming a Dentin bridge which seals exposure in roughly 60 days A. Pulp Capping Materials 1. Stimulates Reparative 3o Dentin Growth a) Bioceramics b) CaOH (Calcium Hydroxide) c) MTA (mineral trioxide aggregate) 2. Not good for pulp exposure site a) Zinc Oxide-Eugenol (1) Inhibits polyermization!!! (2) Can soothe teeth but increased internal tooth inflammation b) GI/ RMGIs c) Adhesive Systems VII. Pulp Exposure Response Protocol w/ Direct Capping A. Direct Pulp Capping 1. Clean Dentin around the exposure site 2. Stop bleeding w/ cotton pellet/ CHX/ sterile water/ saline 3. Mix equal amounts CaOH-based Dycal base and catalyst with spatula with placement tip (SP3074) 4. Dab on Dycal with placement tip end of SP3074 onto the exposed site 5. Mix and apply GC Fuji Liner (GIC, dual-cured, mixed) over Dycal 6. Light cure for 20s and wait 5-6 minutes to harden B. Place matrix band and wedge C. Clean surface with GC Cavity Conditioner for 10s D. Rinse and remove excess water E. Mix and apply GC Fuji IX (GIC) 1. Mixing Time - 10s (although we do 7s in lab to extend working time) 2. Working Time - 2 min/ 120 s 3. Setting Time - 6 min/ 360 s 4. Powder to Liquid Ratio - 0.4/0.11 F. Shape occlusal surface with composite instruments G. Let material set and remove wedge/matrix band H. Re-shape with Soflex disks and burs I. Polish with composite polishers Lecture 20 - Resin Infiltration I. When to use Resin Infiltration (CODE D2990***) 1) ICDAS Stage 0 1 2 3 4 5 6 ICDAS Descrip. Sound First Distinct Enamel Visible Visible Extensive visual Enamel gone, dentin Dentin dentin enamel opacity/ no shadow visible, change discolor visible >1/2 of dentin tooth or surface shadow 2) Radiographic E0 E1 E2 D1 D2 D3 Stage Radiographic Sound Small Large Dentin Affected Dentin Dentin Descrip. enamel enamel funnel funnel cavitati wedge shadow shadow on shadow to pulp 3) ADA Stage Sound Initial Moderate Advanced ADA Descrip. Sound Cavitated enamel Possible dentin Definite dentin infection infection A. Only use for: 1. ICDAS: Stages 1-4 2. Radiographic Stages: E1, E2, D1 B. Sealant - physical barrier 1. Issues: can debond and difficult interproximally C. Infiltration - diffuses between porous enamel  D. Note* only micro-invasive treatment II. Demineralized Enamel (aka white spots, ICDAS 1/2) A. Sub-surface lesion under pseudo-intact surface layer B. Increased pore volume by 30% C. Pore act as diffusion path for microorganisms and substrate 1. USE RESIN INF. TO SEAL D. Light scattering causes white spots E. Ca and Phosphate cations are replaced by H+ III. Resin Infiltration for Enamel Demineralizations A. Removal of Surface Layer with 15% Hydrochloric Acid (15% HCL) 1. Average thickness of enamel surface is 30-40 um 2. 37.5% Phosphoric Acid is TOO WEAK B. Pore are Filled with Resin - Factors 1. Time: ^time ^ penetration 2. Contact Angle: ^ contact angle ^ hydrophobicity ^ penetration 3. Surface Tension: ^ penetration 4. Viscosity: ^ viscosity v penetration 5. Radius: ^ radius ^ pore size ^ penetration 6. note* dentin is hydrophilic while enamel is hydrophobic C. Occlusion of Diffusion Paths D. Inhibition of Lesion Progression E. Stabilization of Lesion 1. 90% drop in hardness for demineralized enamel 2. More applications of Resin Inf. increases hardness IV. Indications for Interproximal Resin Infiltration A. V. Resin Infiltration Protocol A. RD and wedge to widen the contact point B. Insert green face of 15% etchant (Icon-Etch) applicator facing target proximal surface C. Acid Etch for 120s (until hypomineralized enamel pores are exposed) D. Rinse E. Dry for 30s with 100% Ethanol (Icon-Dry) 1. Allows hydrophobic resin infiltrant to penetrate F. Insert green face of Resin Infilitrant (Icon-Infilitrant, made of TEGDMA) and leave for 3-5 minutes G. LC 40s H. Apply second coat of Resin Infiltrant for 1 min I. LC 40s VI. Refractive Indices (RI) A. Want RI of infiltrant to be similar to RI of enamel to avoid contrast Material RI Apatite 1.62 Microporosities (Air) 1.0 Microporosities (Water) 1.33 Infiltrant 1.46