SOCIETY OF COLOR

Color Properties of Demineralized Enamel Surfaces

Treated with a Resin Inf|ltration System
KEVIN HALLGREN, DDS, MSD*, SERCAN AKYALCIN, DDS, MS, PhD†, JERYL ENGLISH, DDS, MS‡,
ESER TUFEKCI, DDS, MS, PhD§, RADE D. PARAVINA, DDS, MS, PhD{

ABSTRACT
Objective: To assess color properties of white spot lesions (WSLs) following resin inf|ltration treatment in vitro.
Materials and Method: WSLs were artif|cially created on 30 extracted human teeth.Two groups were formed: (a)
control, and (b) resin inf|ltrant group (n 515, each).Instrumental color measurements were performed using a
spectrophotometer and visual color evaluation was performed by three independent evaluators.Color assessment
was determined atthree time points: baseline (T0), after WSL formation (T1), and after resin inf|ltrant or control
treatment (T2).CIELAB color coordinates were determined and the resultant color difference (DE*) was calculated
between the time points.Two-way repeated measures analysis of variance (ANOVA) and One-way ANOVA analyses
were used to evaluate the color changes.Pearson chi-square analysis was performed to evaluate the visual ratings
between treatment and control groups.Level of signif|cance was set p <0.05.
Results: After treatment of WSLs there was a signif|cant color change (DE*) between treatment and control groups (p
<0.05).Resin inf|ltration group showed a regression of all values toward the pretreatment levels.There was a
signif|cant difference in visual evaluation ratings between groups after treatment; treatment group had all surfaces
receive a rating of being clinically acceptable, with 73% of these surfaces having no perceptible color difference to
adjacent sound enamel.Meanwhile, control group received ratings of all surfaces having a visual color difference that
was deemed as unacceptable (p < 0.05).
Conclusion: In-vitro resin inf|ltration for the treatment of enamel WSLs produced a signif|cant improvement in color,
reverting L*, a*, and b* values back toward baseline values.

CLINICAL SIGNIFICANCE
Resin inf|ltration of enamel white spot lesions on teeth is capable of managing the esthetic problem by reverting the
L*, a*, and b* color coordinates back to their baseline values. (J Esthet Restor Dent 00:000^000, 2016)

INTRODUCTION both an increase in the incidence and the severity of

Over the past 30 years, numerous studies have
reported an increase in white spot lesions (WSLs)
following orthodontic treatment.1–4 While a large
portion of the non-orthodontically treated population
experiences some form of demineralization,
orthodontically treated patient populations have shown
pre-existing enamel opacities.3 Approximately 50% of
orthodontically treated patients develop WSLs in one
or more teeth, compared with only 24% of those not
undergoing orthodontic treatment.1–4 The
development of these unsightly lesions, thus, presents a
significant clinical predicament and may also lead to
patient dissatisfaction.

*Orthodontist, Private Practice, Kalamazoo, MI, USA


Associate Professor and Program Director,Tufts University, School of Dental Medicine, Department of Orthodontics, Boston, MA, USA
`
Professor and Chair,The University of Texas at Health Science Center at Houston, School of Dentistry, Department of Orthodontics, Houston,TX, USA
‰
Associate Professor,Virginia Commonwealth University, School of Dentistry, Department of Orthodontics, Richmond,VA, USA

Professor and Director, Department of Restorative Dentistry and Prosthodontics, Houston Center for Biomaterials & Biomimetics, University of Texas School of
Dentistry at Houston, Houston,TX

C 2016 Wiley Periodicals, Inc.

V DOI 10.1111/jerd.12207 Journal of Esthetic and Restorative Dentistry Vol 00  No 00  00^00  2016 1
 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.
While appliance removal followed by diligent oral
hygiene and elimination of other cariogenic factors
may halt white spot formation, incipient lesions may
or may not undergo regression over time.5–7 Complete
elimination of lesions is unlikely due to the rapid
remineralization of the enamel surface with high
concentration fluorides, which restricts passage of ions
into the deeper, more affected layers. Therefore,
immediate application of high concentration of fluoride
is not recommended.8 Decreased enamel discolorations
may occur with time due to further remineralization,
but regression is primarily credited to gradual surface
abrasion of tooth structure.5
A multitude of preventative measures for WSLs exist,
which range from routine oral hygiene instructions,
fluoride application, and antimicrobial mouth rinses, to
antimicrobial biomaterials engineered to fight the
development of WSLs by inhibiting biofilm formation
around the appliances. However, lack of patient
compliance hinders many of these efforts,9–11 and thus
despite the vast number of preventative measures
aimed to limit post-treatment enamel demineralization,
the incidence of WSLs remains high.
The literature clearly shows that orthodontic therapy
increases the prevalence of WSLs when compared with
untreated controls, especially when oral hygiene is
poor.1,3,4 For this reason, it is pertinent to investigate
therapies aimed at restoring these lesions. Treatment
modalities including remineralization therapy,
conventional restoration, and more recently, resin
infiltration are all options that the clinician must weigh
when deciding how to best restore these unsightly
lesions.
A modern minimally invasive approach to treat post-
orthodontic WSLs with resin infiltration has been
advocated due to its reported esthetic superiority
compared with remineralization treatment.12–16 The
treatment of enamel demineralization with resin
infiltration begins with the application of hydrochloric
acid etch to the lesion surface, which erodes the
pseudo-intact surface layer of a WSL. This allows the
low viscosity resin (infiltrant) to penetrate the
subsurface porosities of the lesion via capillary forces.
2 Vol 00  No 00  00^00  2016 Journal of Esthetic and Restorative Dentistry
The infiltrated resin contains a refractive index (RI)
similar to that of enamel, which limits the light
scattering normally experienced within a lesion,
thereby reducing the visual color differences between
the WSL and healthy enamel. The ability of the resin
infiltrant to permeate and occlude the subsurface
porosities of the WSL would then be expected to
achieve higher esthetic outcomes compared with
remineralization therapy, particularly when surface
layer caries arrest has occurred, leaving subsurface
demineralization inaccessible.
The purpose of this study is to assess the effectiveness
of a resin infiltrant (Icon, DMG, Hamburg, Germany)
in masking WSLs by comparing both quantitative and
qualitative tooth surface esthetic properties before and
after resin infiltrant application. Delineating the visual
properties that resin infiltration modulates within a
WSL may aid the clinician in making treatment
decisions regarding post-orthodontic WSLs. The null
hypothesis is that treatment of WSLs with resin
infiltration will not produce differences in the color
improvement of WSLs compared with non-treated
WSLs.
MATERIALS AND METHOD
Procedure
Sample
About 30 extracted human premolars and molars with
exclusion criteria as follows: presence of stain,
demineralization, decay, fluorosis, enamel defects, or
restorations. Extracted teeth were kept in 0.5%
Chloramine T (Sigma Aldrich, St. Louis, MO, USA)
prior to the study. WSLs were produced in-vitro
through immersion in a demineralization solution over
a 4-day period (2.2 mM calcium chloride, 2.2 mM
monopotassium phosphate, 0.05 mM acetic acid
having pH adjusted to 4.4 and 1 M potassium
hydroxide).17 Two groups were evaluated: a control
group (n 5 15) exposed to distilled water, and an Icon
resin infiltrant application group (n 5 15).
DOI 10.1111/jerd.12207 V
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 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.
Two coats of clear, acid resistant nail polish (Revlon,
New York, NY, USA) were applied to the right half of
the buccal surface of each tooth, extending from the
right interproximal surface to the vertical midline of the
buccal surface. This left exposed enamel on the left half,
and enamel protected by acid resistant nail polish on the
right half. After this, the teeth underwent a 4-day
exposure to an acidic demineralizing solution for the
creation of WSLs. Then, Icon resin infiltrant was applied
per manufacturer’s recommendations (n 5 15). The
WSLs were etched for 2 minutes with 15% hydrochloric
acid (Icon Etch, DMG) and then rinsed with air-water–
spray for 30 seconds. The WSLs were desiccated by air-
blowing for 10 seconds followed by application of
ethanol (Icon Dry, DMG, Hamburg, Germany) for 30
seconds, and air-blowing again for 10 seconds. The resin
infiltrant (Icon Infiltrant, DMG) was then applied to the
WSLs with a sponge applicator provided by the Icon
resin infiltration system and was left in place for 3
minutes. Excess resin was removed with a cotton roll.
The resin was light cured for 40 seconds from the
buccal. The resin infiltration step was repeated once with
a penetration time of 60 seconds to allow resin to
infiltrate the remaining porosities. The resin was again
light cured for 40 seconds from the buccal. The prepared
specimens were polished at 11,000 rpm with fine, and
superfine polishing discs for 5 seconds each (Shofu
Dental, San Marcos, CA, USA). Control group specimens
(n 5 15) were stored in distilled water following T1
measurements. Same operator performed these tasks in
order to standardize the procedure.
Color Assessment
Spectrophotometric color measurements were
performed using the SpectroShade Micro
spectrophotometer (MHT Optic Research, Niederhasli,
Switzerland). Visual color evaluation was performed by
three qualified evaluators. Spectrophotometric and
visual color assessments were performed at baseline
(T0) to record the color characteristics of the pre-
treatment enamel (prior to WSL production), after 4
days of immersion in an acidic demineralizing solution
that created WSLs (T1), and after Icon had been
applied to the treatment group, and the control and
C 2016 Wiley Periodicals, Inc.
V DOI 10.1111/jerd.12207
Icon treated teeth had been immersed in distilled
water for 24 hours (T2).
The instrumental color measurements were performed
using the Commission International de I’Eclariage
(CIE) L*a*b* color notation system (CIELAB).1 The
SpectroShade was calibrated according to
manufacturer instructions. A custom positioning table
was fabricated which positions the SpectroShade
relative to the buccal surface of each tooth in a fixed,
standardized, and repeatable position for each
measurement. The base of the positioning table
allowed the spectrophotometer to be oriented in the
same position each time it is placed on the table
(Figure 1). The upper member of the table contained a
fixed asymmetrically indexed holding cup, into which
customized tooth positioning jigs were inserted and
removed with identical orientation, between time
points. The customized silicone tooth positioning jigs
(ClearBite, DenMat, Lompoc, CA, USA) were
fabricated so that the buccal surface of each tooth was
centered within the focal target box of the
SpectroShade, at an angle where a tangent line from
the center of the buccal surface runs parallel to the
lens of the focal box, ensuring that positioning was
both optimized and repeatable for each measurement.
A standardized millimetric grid was affixed to the
viewing screen of the SpectroShade. The grid was used
to identify and record coordinates of a point located
halfway between the center line of the buccal surface
and the left proximal surface of each tooth (exposed
enamel), which served as the precise location at which
all instrumental color measurements were recorded at
each time point. Three images were captured for each
specimen at each time point, and the average values
for L* (lightness, achromatic color coordinate), a*
(green/red coordinate), b* (blue/yellow coordinate),
and the resultant color difference (DE*) over the three
measurements was calculated as follows:18
h i1=2
DE  5 ðL 1 2L 2 Þ2 1 ða1  2 a2  Þ2 1ðb1  –b2  Þ2
Spectrophotometric color assessments and
comparisons were made between T0 and T1, T1 and
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 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.

FIGURE 1. Custom tooth positioning to obtain color measurements.

T2, and T0 and T2. In addition to the RESULTS

spectrophotometric measurements, a visual color
assessment was performed by three independent and
Instrumental Color Differences
calibrated evaluators at T0, T1, and T2. Each evaluator
passed the dental color matching competency test and
The color difference (DE*) after completion of WSL
demonstrated superior color matching competency,
formation (T0 ! T1) did not differ significantly between
according to the International Organization for
groups (p > 0.05, Table 1). The mean color difference
Standardization, which means that they correctly
for the resin infiltration group was 16.1 6 5.0, while the
matched at least 85% of the tabs from the Vita
corresponding value for control group was 15.4 6 3.8.
Classical Shade Guide.19 Each evaluator was asked to
After the treatment of WSLs (T1 ! T2) there were
determine whether there was a perceivable difference
significant color differences between treatment and
in color between the two surfaces (exposed enamel vs.
control groups. The resin infiltration group showed a
protected enamel), and if there was, whether this
regression of all values toward pre-treatment levels, with
difference would be considered clinically acceptable.
significant decrease in lightness, increase in a* value and
increase in b* value after resin infiltration. The DE* for
the resin infiltration group from T1 ! T2 was
Statistical Analysis
15.7 6 5.3, while the DE* for the control group was
0.9 6 0.4 (p < 0.05, Table 1). Significant color differences
Independent samples T-test was performed to analyze
were also found between baseline and after treatment
DE* values between time points. Two-way repeated
(T0 ! T2). The resin infiltration group had a DE* of
measures analysis of variance (ANOVA) was performed
2.0 6 1.3, while the control group had a DE* of
to analyze group-time interactions. One-Way ANOVA
15.2 6 4.3 (p < 0.05, Table 1).
with Bonferonni Post Hoc multiple comparison test was
performed to analyze the L*, a*, and b* values within
each group between the three time points. Pearson chi-
square analysis was performed to determine the
Color Coordinates
distribution of the visual ratings between treatment and There was a significant difference in group-time
control groups. Statistical analysis was performed using interaction for the L* (p < 0.001), a* (p 5 0.016), and
SPSS 21.0 for Mac (SPSS Inc, Chicago, IL, USA). Level b* (p < 0.001) values. L* values increased significantly
of significance was set at of p < 0.05. in both groups between baseline and WSL formation

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 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.

TABLE 1. Mean DE* for the groups between the evaluation periods
Time periods Resin infiltration (N 5 15) Control (N 5 15)

Mean Std. Dev Err. Mean Mean Std. Dev Err. Mean p value
T0^T1 16.1 5.0 1.3 15.4 3.8 1.0 0.701

T1^T2 15.7 5.3 1.4 0.9 0.4 0.1 <0.001

T0^T2 2.0 1.3 0.3 15.2 4.3 1.1 <0.001

TABLE 2. Multiple comparisons Bonferroni analysis of change in L*, a*, and b* values within the groups between time points
Time point Resin infiltration group Control group

Mean difference Std. error p Mean difference Std. error p

L*

T0 ! T1 27.8 1.4 <0.001 27.8 1.2 <0.001

T0 ! T2 20.1 1.4 1.000 28.0 1.2 <0.001

T1 !T2 7.7 1.4 <0.001 20.2 1.2 1.000

a*

T0 ! T1 1.1 0.6 0.20 1.0 0.4 0.036

T0 ! T2 0.1 0.6 1.00 1.0 0.4 0.039

T1 !T2 21.0 0.6 0.24 20.0 0.4 1.000

b*

T0 ! T1 13.8 1.2 <0.001 13.1 1.3 <0.001

T0 ! T2 0.4 1.2 1.000 12.8 1.3 <0.001

T1 !T2 213.4 1.2 <0.001 0.3 1.3 1.000

(p < 0.05). The L* value decreased significantly in the
treatment group between WSL formation and resin
infiltration treatment. There was no significant
difference between baseline and post-treatment L*
values for the treatment group (p > 0.05) while a
significant increase in L* values remained between
baseline and post-treatment for the control group
(p < 0.005, Table 2). The a* values decreased
significantly (p < 0.05) in the control group between
baseline and post-treatment, while there was no
significant difference in a* values in the treatment
group between baseline and post-treatment (p > 0.05,
Table 2). The b* values decreased significantly in both
groups between baseline and WSL formation (p < 0.05,
Table 2). The b* value increased significantly in the
treatment group between WSL formation and resin
infiltration treatment. There was no significant
difference between baseline and post-treatment b*
values for the treatment group (p > 0.05) while a
significant decrease in b* values remained between
baseline and post-treatment for the control group
(p < 0.05, Table 2).
Visual Evaluation
Intraclass correlation analysis showed that inter-rater
agreement was above 98%. Therefore, the ratings from
the three evaluators were combined. There were no
significant differences between the groups after WSL

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 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.
TABLE 3. Visual Analysis following WSL formation (T1) and after treatment (T2)
Time Resin infiltration (N 5 15)
periods
No Perceptible Clinically
difference difference acceptable
T1 0 15 0 15
T2 11 4 15
formation, as all surfaces in both groups received a
rating of having a visual difference that was clinically
unacceptable (p > 0.05, Table 3). There was a
significant difference between groups after treatment,
where the treatment group received significantly less
ratings of having a visual color difference, while having
no surfaces receiving a rating of being clinically
unacceptable. Meanwhile, the control group received
ratings of all surfaces having a visual color difference
that was clinically unacceptable (p < 0.05, Table 3).
DISCUSSION
This study investigated the color improvement of
WSLs following resin infiltration treatment. Based on
the results, resin infiltration performed better than the
control in improving the esthetic appearance of WSLs.
The null hypothesis was rejected.
The results showed an average DE* of 2.0 6 1.3 for the
resin infiltration treatment group between baseline and
post-treatment. The CIELAB 50:50% perceptibility
threshold and 50:50% acceptability threshold in
dentistry were found to be DE* 5 1.2, DE* 5 2.7,
respectively.20 This means that 50% of observers will
note a perceptual difference between two colors when
the DE* is 1.2. Similarly, 50% of observers will
determine a color difference to be acceptable at a DE*
of 2.7, while the other 50% will consider this color
difference unacceptable. Therefore results of the
present study indicate that the average color change of
WSLs treated with resin infiltrant is at an acceptable
level. This finding is supported by the results of the
visual color assessment, where each evaluator rated the
color difference of all resin infiltrated surfaces as
clinically acceptable, while rating all control group
6 Vol 00  No 00  00^00  2016 Journal of Esthetic and Restorative Dentistry
Control (N 5 15)
Clinically No Perceptible Clinically Clinically
unacceptable difference difference acceptable unacceptable
0 15 0 15
0 0 15 0 15
teeth as having a visual color difference that was
clinically unacceptable.
Icon resin infiltrant has been previously shown to have
a refractive index of 1.51, which is similar that that of
enamel, which possesses a refractive index of 1.62.16
Resin infiltrant has also been shown to penetrate
subsurface demineralization up to 400 mm.21 This deep
penetration of resin, which contains a similar refractive
index to that of enamel, decreases the light scattering
which normally occurs when the demineralized pores
of a WSL are filled with water (RI 5 1.33) or air
(RI 5 1.00). The light scattering that occurs at these
interfaces between materials with differing refractive
indices is what gives a WSL its opaque, whitish
appearance. Resin infiltration has also been shown to
stabilize WSLs by reinforcing the weakened enamel
prism structure with polymerized resin.16 These effects
are likely factors which resulted in the improvement of
color, and average DE* of 2.0 6 1.3 for the resin
infiltration treatment group between baseline and post-
treatment.
The results of this study are in accordance with recent
results obtained by Yuan et al.14 where they found
resin infiltration treatment yielded a resultant average
DE* of 2.9 6 1.2. Resin infiltration treatment produced
a smaller resultant DE* between baseline and post-
treatment; taking a higher average pre-treatment DE*
(16.1 6 5.0 compared with 12.9 6 3.4 in the Yuan
study) to a lower post-treatment DE* (2.0 6 1.3
compared with 2.9 6 1.2), indicating that resin
infiltration had the ability to mitigate a larger color
difference than found in the aforementioned study.
The larger pre-treatment (T1) DE* was likely due to
differences in protocol for WSL creation between the
two studies.
DOI 10.1111/jerd.12207 V
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 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.
In this study, etching of the enamel surface was
performed with one application of 15% hydrochloric
acid gel (Icon Etch) for 120 seconds. Manufacturer’s
instructions state that unless white spots are treated
early, that is, 1–2 months after bracket removal, it is
recommended to repeat the etching step. A third
etching process is recommended if a white spot is still
visible after Icon-Dry is applied. While samples in this
study completed WSL formation 24 hours prior to
resin infiltration treatment, it may be necessary to
ascertain the effects of additional etching procedures
on the resultant color improvement of in-vitro created
WSLs in future studies. This aim is further supported
by a study in which they concluded that a mineralized
surface layer of a natural WSL significantly hampered
the penetration of light-curing resin, and that 120
seconds of etching with 15% hydrochloric acid gel did
not lead to complete surface layer removal in 67% of
cases.22 With mean resin penetration depths being
lower in specimens without complete surface layer
removal, the ability of resin infiltration to significantly
improve the color properties in these samples may be
limited.
The strengths of the present study include
standardized creation of WSLs to human enamel with
objective measurement of the samples with
spectrophotometric analysis and subjective analysis by
three calibrated independent evaluators. The study is
limited by its in-vitro nature and thus future clinical
trials delineating the long-term effects of resin
infiltration treatment should be sought to corroborate
the findings of this study and the use of resin
infiltration in clinical practice.
CONCLUSION
In-vitro resin infiltration treatment of WSLs
significantly reduced discoloration caused by these
lesions compared with controls. The infiltration
treatment produced a significant improvement in color
difference, significantly reverting L*, a*, and b* values
back toward baseline values, with a resultant color
difference that falls within the perceived acceptability
threshold. The color competent visual evaluators found
C 2016 Wiley Periodicals, Inc.
V DOI 10.1111/jerd.12207
color differences between surfaces treated with resin
infiltrant and adjacent untreated control surfaces were
clinically acceptable.
DISCLOSURE AND ACKNOWLEDGEMENT
The authors do not have any financial interest in the
companies whose materials are included in this article.
REFERENCES
1. Melrose CA, Appleton J, Lovius BBJ. A scanning electron
microscopic study of early enamel caries formed in vivo
beneath orthodontic bands. Br J Orthod 1196;23:43–7.
2. Mizrahi E. Enamel demineralization following orthodontic
treatment. Am J Orthod 1982;82:62–7.
3. Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white
spot formation after bonding and banding. Am J Orthod
1982;81:93–8.
4. Banks PA, Burn A, O’Brien K. A clinical evaluation of the
effectiveness of including fluoride into an orthodontic
bonding adhesive. Eur J Orthod 1997;19:391–95.
5. Artun J, Thylstrup A. Prevalence of carious white spots
after orthodontic treatment with multibonded appliances.
Scand J Dent Res 1986;94:193–201.
6. Marcusson A, Norevall L-I, Persson M. White spot
reduction when using glass ionomer cement for bonding in
orthodontics: a longitudinal and comparative study. Eur J
Orthod 1997;19:233–42.
7. Al-Khateeb S, Forsberg C-M, de Josselin de John E, et al. A
longitudinal laser fluorescence study of white spot lesions in
orthodontic patients. Am J Orthod Dentofac Orthop 1998;
113:595–602.
8. Ogaard B, Rolla G, Arends J, ten Cate, JM. Orthodontic
appliances and enamel demineralization. Part II: prevention
and treatment of lesions. Am J Orthod Dentofac Orthop
1988;94:123–8.
9. Geiger AM, Gorelick L, Gwinnett AJ, et al. The effect of a
fluoride program on white spot formation during
orthodontic treatment. Am J Orthod Dentofac Orthop
1988;93:29–37.
10. Geiger AM, Gorelick L, Gwinnett AJ, et al. Reducing white
spot lesions in orthodontic populations with fluoride
rinsing. Am J Orthod Dentofac Orthop 1992;101:403–7.
11. Stratemann MW, Shannon IL. Control of decalcification in
orthodontic patients by daily self-administered application
of a water-free 0.4 percent stannous fluoride gel. Am J
Orthod 1974;66:273–79.
Journal of Esthetic and Restorative Dentistry Vol 00  No 00  00^00  2016 7
 COLOR PROPERTIES OF A RESIN INFILTRATION SYSTEM Hallgren et al.
12. Borges A, Caneppele T, Luz M, et al. Color Stability of Resin
Used for Caries Infiltration After Exposure to Different
Staining Solutions. Oper Dent. 2014;39:433–40.
13. Paris S, Meyer-Lueckel H, Colfen H, et al. Penetration
coefficients of commercially available and experimental
composites intended to infiltrate enamel carious lesions.
Dent Mater 2007;23:742–8.
14. Yuan H, Li J, Chen L, et al. Esthetic comparison of white-
spot lesion treatment modalities using spectrometry and
fluorescence. Angle Orthod 2014;84:343–9.
15. Rocha Gomes Torres C, Borges AB, Torres LM, et al. Effect of
caries infiltration technique and fluoride therapy on the colour
masking of white spot lesions. J Dent 2011;39(3):202–7.
16. Paris S, Schwendicke F, Keltsch J, et al. Masking of white
spot lesions by resin infiltration in vitro. J Dent 2013;41
Suppl 5:e28–34.
17. Kumar V, Itthagarun A, King N. The effect of casein
phosphopeptide-amorphous calcium phosphate on
remineralization of artificial caries-like lesions: an in vitro
study. Aust Dent J 2008;53:34–40.
8 Vol 00  No 00  00^00  2016 Journal of Esthetic and Restorative Dentistry
18. Commission International de I-Eclairage 1986 Colorimetry
Publication No. 15, Supplement 2.
19. International Organization for Standardization. ISO/TR
28642 dentistry—guidance on color measurement.
Geneva: International Organization for Standardization;
2011.
20. Paravina RD, Ghinea R, Herrera LJ, et al. Color
difference thresholds in dentistry. J Esthet Restor Dent
2015;27:S1–9.
21. Neuhaus S, Schlafer A, Lussi B, et al. Infiltration of natural
caries lesions in relation to their activity status and acid
pretreatment in vitro. Caries Res 2013;47:203–10.
22. Paris S, Meyer-Leuckel H, Kielbassa AM. Resin infiltration
of natural caries lesions. J Dent Res 2007;86:662–6.
Reprint requests: Sercan Akyalcin; Associate Professor and Program
Director,Department of Orthodontics,Tufts University School of
Dental Medicine,1Kneeland Street,Boston MA 02111,USA;Tel.:
617-636 -6887; Fax: 617-636 -2740; email: sercan.akyalcin@tufts.edu
DOI 10.1111/jerd.12207 V
C 2016 Wiley Periodicals, Inc.