Icon Smooth Surface: Minimally Invasive Treatment With Maximal Results

Peter Auster, DMD


Resin infiltration is a revolutionary addition to the growing trend of minimally invasive dentistry. This conservative restorative technique is used to arrest incipient carious lesions early on and treat white spot lesions aesthetically without the need for local anesthesia or mechanical removal of tooth structure.
Currently, Icon (DMG America) is the only resin infiltration system available in the United States. This unique, micro-invasive treatment creates a diffusion barrier not just on the surface of the tooth but also within the hard tissue that stabilizes and blocks further carious activity. The innovative technology strengthens, stabilizes, and limits lesion progression, offering successful treatment of facial and interproximal lesions up to a depth of D1.
Icon bridges the gap between prevention and surgical procedures. Fueled by capillary action, it non-surgically fills the caries lesion without having the need to compromise the tooth. The result is a protected, resin-filled lesion that halts caries progression.
Saving tooth structure when treating incipient lesions with minimally invasive dentistry truly provides great satisfaction for both the patient and clinician. Since using Icon, I have had absolutely profound results on white spot facial lesions—teeth are continually restored back to their natural states and shades. With a hint of hesitation and doubt, I recently used Icon Smooth Surface on a very unusual and difficult case.

Figure 1. Preoperative image of dark staining in tooth Nos. 7 to 10. Figure 2. OptraGate lip retractor (Ivoclar Vivadent) and dental dam used for surface lesion removal and Icon-Etch application (DMG America).
Figure 3. Significantly decreased lesion after use of Icon-Etch and Icon-Dry. Figure 4. Dental dam removal post Icon technique.
Figure 5. Final restorations after polishing.

A 28-year-old female presented with dark yellow stains on teeth Nos. 7 to 10, with teeth Nos. 8 and 9 grossly stained (Figure 1). All other teeth were a beautiful light shade in the whitening shade range. Unlike healthy enamel, the texture of the stained surface areas was rough and scratchy.
The patient had no obvious decay, no discomfort, and only a few small restorations overall. The lingual enamel was healthy. Dental history revealed that the patient had a lemon-sucking habit for many years. She would place a piece of cut lemon between her upper teeth and lips and leave it there until the flavor disappeared. The treatment plan was to eliminate the resulting unsightly staining, prevent any further carious activity, and restore the teeth back to their natural texture and shade using Icon Smooth Surface (DMG America).
Treatment begins with the placement of an OptraGate lip retractor (Ivoclar Vivadent) and paint-on dental dam to protect the gingival tissue. A rubber dam can also be used here. It is important to remove the surface layer of the lesion in order for Icon to gain access, so the lesions are first treated with a medium grit abrasive disc and scrubbed with Consepsis Astringent (Ultradent Products).
The next step is the application of Icon-Etch (15% HCL) for 2 minutes (Figure 2). The etchant is then rinsed off for 30 seconds and dried with oil/water-free air. For complex cases like this, this procedure (etch, rinse, and dry) is repeated up to 2 more times and inspected after each process to see if surface discoloration has diminished.
The next step is the application of Icon-Dry (99% ethanol) for 30 seconds. This is a good time to observe the aesthetic response. If the lesion has decreased significantly, it is time to move on to the next step (Figure 3). If not, repeat the etching process. The treatment was repeated one more time for this case.
Once the tooth is desiccated, the infiltration procedure can take place. Icon-Infiltrant (the resin matrix) is applied with the direct operatory light turned off. The infiltrant is applied for 3 minutes to allow full penetration of the surface. This material is continuously placed to ensure that the surface remains wet for the full 3 minutes. (This can be increased to 5 minutes in more complicated lesions).
Any excess material can be removed with cotton pellets. The contacts are flossed, and the teeth are light cured for 40 seconds each.
The infiltration step is then repeated for one additional minute, and the teeth are each light cured again for 40 seconds. At this point, the paint-on dam (or rubber dam) is removed (Figure 4). The restoration is now treated like a composite restoration and polished with polishing cups and discs.
The Icon Smooth Surface resin infiltration treatment for this patient with lemon erosion damage was clearly successful (Figure 5). What’s more, this quick, easy-to-use technique was completed in one 45-minute visit. A year later, the stain has not returned. I have not yet seen a comparable product on the market that treats mild to severe stains without a far more invasive and expensive approach.
For more information, call DMG America at (800) 662-6383 or visit dmg-america.com.

Dr. Auster has spent 30 years in private practice with a focus on high-end reconstructive and cosmetic dentistry. He completed 2 terms as director for the American Academy of Cosmetic Dentistry (AACD) and one term as AACD leadership committee chair. He has received the AACD Humanitarian of the Year award. He is a Fellow of the American College of Dentists. Dr. Auster is founder and past-president of the Greater New York Academy of Cosmetic Dentistry. He is a Dawson Academy Scholar and an ADA Certificate for International Voluntary Service winner.