Dentistry

Cite as: Archiv EuroMedica. 2026. 16; 5. DOI 10.35630/2026/16/Iss.5.24

Received 15 July 2026;
Accepted 01 October 2026;
Published 02 October 2026

EFFECTIVENESS OF ICON RESIN INFILTRATION IN THE TREATMENT OF WHITE SPOT LESIONS – A NARRATIVE REVIEW OF CLINICAL STUDIES, META-ANALYSES, AND IN VITRO RESEARCH

Zuzanna Jeziorska¹ , Izabela Migdał¹ ,
Justyna Polko¹ , Bartosz Szymajda¹ ,
Maja Witek² , Zuzanna Galicka¹ ,
Jakub Artur Czapkiewicz¹ , Weronika Kwaśnica³ ,
Katarzyna Raczek⁴ , Tomasz Horodniczy⁵

¹ Medical University of Silesia, Katowice, Poland
² Medical University of Warsaw, Poland
³ Poznan University of Medical Sciences, Poznan, Poland
⁴ Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
⁵ Ortho.pl Dental Office, Wrocław, Poland

download article (pdf)

  zuza.jeziorska8@gmail.com

ABSTRACT

Background

White spot lesions (WSLs) and other non-cavitated enamel lesions may present both clinical and esthetic challenges. Resin infiltration with ICON has been investigated as a minimally invasive approach for masking enamel discoloration and modifying the progression of early carious lesions. Its potential applications have also been explored in selected developmental enamel defects.

Aim

The aim of this narrative review was to critically summarize current evidence regarding the biological basis, clinical effectiveness, esthetic outcomes, laboratory findings, and clinical applications of ICON resin infiltration in non-cavitated enamel lesions, with particular emphasis on white spot lesions, comparisons with alternative treatment modalities, and its potential role in developmental enamel defects.

Materials and Methods

A structured literature search was conducted using PubMed and Google Scholar, with PubMed Central used as a full-text archive for relevant publications. The search primarily covered publications from January 2009 to June 2026, with earlier landmark studies included when relevant. The final literature search was conducted in June 2026. Studies were selected according to their relevance to the review objectives and included clinical studies, systematic reviews, meta-analyses, and in vitro investigations. Publications for which the full text was unavailable were excluded.

Results

The reviewed evidence indicates that ICON resin infiltration can improve the visual appearance of selected white spot lesions, with the magnitude and durability of esthetic improvement varying according to lesion characteristics, treatment protocols, and follow-up duration. Clinical and laboratory studies also suggest that resin infiltration may reduce lesion progression in early carious lesions. Evidence regarding developmental enamel defects, including fluorosis and molar-incisor hypomineralization, is more limited and heterogeneous. Comparisons with remineralization and other minimally invasive approaches indicate potential clinical benefits, although treatment outcomes are dependent on lesion type and clinical circumstances.

Conclusions

ICON resin infiltration represents a minimally invasive treatment option for selected non-cavitated enamel lesions. The most consistent clinical evidence concerns the esthetic masking of white spot lesions and the management of early carious lesions, whereas evidence for developmental enamel defects remains more limited. Treatment outcomes depend on lesion characteristics, clinical protocol, and follow-up duration. Further well-designed clinical studies with standardized outcome measures and longer follow-up are needed to clarify the long-term effectiveness and applicability of resin infiltration across different types of enamel lesions.

Keywords: resin infiltration; ICON; white spot lesions; enamel demineralization; minimally invasive dentistry; orthodontics

INTRODUCTION

White spot lesions (WSLs) are the earliest clinically detectable manifestation of enamel caries and are characterized by subsurface mineral loss beneath an apparently intact enamel surface. Increased enamel porosity alters light transmission, producing the characteristic opaque white appearance of affected areas. WSLs may occur on any tooth surface; however, they are particularly common following fixed orthodontic treatment due to prolonged plaque retention around brackets and bands, making them one of the most frequent iatrogenic complications of orthodontic therapy [1-6,37-40].

The formation of WSLs reflects an imbalance between enamel demineralization and remineralization. Organic acids produced by cariogenic biofilm diffuse into enamel, dissolve hydroxyapatite crystals, and enlarge interprismatic spaces while the superficial enamel layer remains relatively intact. If the cariogenic challenge persists, progressive mineral loss may eventually result in cavitation requiring restorative intervention [11-14,39-43].

The prevalence of post-orthodontic WSLs remains high despite advances in preventive dentistry, with reported incidence ranging from approximately 25% to over 70%, depending on oral hygiene, treatment duration, fluoride exposure, dietary habits, and diagnostic criteria [5,9,37,38]. Besides representing an early stage of dental caries, these lesions frequently compromise the esthetic outcome of orthodontic treatment and may reduce patient satisfaction, particularly when located on the labial surfaces of anterior teeth [5,15-20].

Conventional management of non-cavitated enamel lesions has traditionally relied on remineralization strategies, including topical fluorides, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and other calcium phosphate-based agents. Although these therapies may arrest lesion progression, their ability to restore the optical appearance of enamel is limited because remineralization occurs predominantly within the superficial lesion layer [2,4-9,42,43]. Consequently, increasing attention has been directed toward minimally invasive techniques capable of combining biological preservation with esthetic improvement.

Among these approaches, resin infiltration has become an important development in contemporary minimally invasive dentistry. Unlike restorative procedures, resin infiltration does not require mechanical removal of sound dental tissues. Instead, a low-viscosity TEGDMA-based resin penetrates enamel microporosities after hydrochloric acid conditioning and ethanol dehydration, forming a diffusion barrier that inhibits lesion progression while improving enamel translucency through modification of its refractive properties [10-24,31-33,44].

Since the introduction of the ICON resin infiltration system (DMG, Hamburg, Germany), numerous laboratory investigations, randomized clinical trials, prospective studies, systematic reviews, and meta-analyses have evaluated its clinical performance. Current evidence supports its effectiveness in arresting non-cavitated enamel lesions and improving the esthetic appearance of post-orthodontic WSLs. More recently, resin infiltration has also been investigated as a minimally invasive treatment for developmental enamel defects, including dental fluorosis and molar-incisor hypomineralization (MIH), although evidence in these indications remains less robust [1-9,15-36,45-49].

Despite the growing body of evidence, several issues remain unresolved, including long-term color stability, the influence of lesion depth on treatment outcomes, optimal patient selection, and the role of resin infiltration relative to emerging remineralization technologies and bioactive materials [3-8,34-36,45-49]. Addressing these questions is essential for optimizing clinical protocols and expanding the indications for this micro-invasive technique.

AIM

The aim of this narrative review was to critically summarize current evidence regarding the biological basis, clinical effectiveness, esthetic outcomes, laboratory findings, and clinical applications of ICON resin infiltration in non-cavitated enamel lesions, with particular emphasis on white spot lesions, comparisons with alternative treatment modalities, and its potential role in developmental enamel defects.

Objectives

1. To characterize the biological mechanisms of ICON resin infiltration and summarize laboratory evidence regarding resin penetration, enamel microhardness, permeability, resistance to demineralization, and optical properties.
2. To evaluate the clinical effectiveness and esthetic outcomes of ICON resin infiltration in white spot lesions and compare its effects with remineralization therapies, microabrasion, and bleaching.
3. To assess the available evidence for resin infiltration in developmental enamel defects, particularly dental fluorosis and molar incisor hypomineralization, and to examine factors affecting treatment predictability and long term durability.

MATERIALS AND METHODS

Literature Search Strategy

This narrative review was based on a structured literature search designed to identify and critically evaluate evidence regarding the clinical application of ICON resin infiltration in non-cavitated enamel lesions. The primary literature search was conducted using PubMed and Google Scholar, with PubMed Central (PMC) used as a full-text archive for relevant publications. Publications identified between January 2009 and June 2026 were considered. The final literature search was conducted in June 2026. Earlier publications were included when they represented landmark studies describing the biological principles of resin infiltration, enamel demineralization, or the development of resin infiltration techniques.

The search strategy combined Medical Subject Headings (MeSH) and free-text terms using Boolean operators (AND, OR). The main search terms included ICON, resin infiltration, white spot lesions, enamel demineralization, initial caries, non-cavitated caries, orthodontic white spot lesions, fluorosis, molar-incisor hypomineralization (MIH), clinical trial, systematic review, meta-analysis, and in vitro study.

Eligibility Criteria

Eligible publications included peer-reviewed articles published in English, comprising randomized controlled trials, prospective and retrospective clinical studies, systematic reviews, meta-analyses, relevant narrative reviews providing background information, and in vitro investigations evaluating the physicochemical properties, biological effects, or clinical performance of resin infiltration.

Studies were considered relevant when they addressed at least one of the following aspects: the mechanism of resin infiltration, penetration into enamel lesions, esthetic outcomes, caries arrest or lesion progression, long-term clinical performance, comparison with alternative treatment modalities, or applications in developmental enamel defects such as dental fluorosis and molar-incisor hypomineralization.

Conference abstracts, editorials, case reports, duplicate publications, and studies lacking sufficient methodological information or full-text availability were excluded.

Study Selection and Data Extraction

The literature identified through the search strategy was assessed for relevance according to the predefined eligibility criteria. Publications addressing the biological basis, clinical effectiveness, esthetic outcomes, laboratory performance, and expanding clinical applications of resin infiltration were prioritized for inclusion.

Because this review was designed as a narrative review rather than a systematic review or meta-analysis, the selection process was based on clinical relevance and contribution to the objectives of the review.

The final literature synthesis included 49 publications selected for their relevance to the objectives of the review. The included literature comprised clinical studies, systematic reviews, meta-analyses, narrative reviews, and in vitro investigations published primarily between 2009 and 2026.

Data Synthesis

The selected literature was synthesized narratively according to the principal clinical and scientific aspects of resin infiltration. The synthesis focused on: (1) the pathogenesis and clinical significance of white spot lesions; (2) the composition and mechanism of action of the ICON system; (3) clinical effectiveness and esthetic outcomes; (4) evidence from in vitro investigations; (5) comparisons with conventional remineralization, microabrasion, bleaching, and restorative treatment; and (6) applications in developmental enamel defects, particularly dental fluorosis and molar-incisor hypomineralization.

Methodological Considerations

As a narrative review, this study did not follow a formal systematic review protocol and no quantitative meta-analysis was performed. The available evidence was interpreted according to study design, clinical relevance, consistency of findings, and methodological limitations. Particular attention was given to the distinction between clinical evidence and laboratory findings, especially when evaluating the long-term durability and esthetic stability of resin infiltration.

RESULTS

Clinical Effectiveness of ICON Resin Infiltration

The clinical literature indicates that resin infiltration may provide clinically relevant esthetic improvement and support the arrest of non-cavitated enamel lesions, with the strongest evidence available for post-orthodontic white spot lesions (WSLs). Randomized clinical trials, prospective studies, split-mouth investigations, and longer-term clinical evaluations have reported immediate reductions in lesion visibility and improved color matching between affected and adjacent sound enamel following resin infiltration [5,10,15-20,25-30,45,46,49].

The esthetic effect appears to be related to penetration of the infiltrant into the porous lesion body and subsequent modification of enamel optical properties. Clinical studies comparing resin infiltration with conventional remineralization strategies have reported greater improvement in lesion masking following infiltration, while also demonstrating inhibition or stabilization of lesion progression [10,15-20,25-30,45,46,49].

Clinical follow-up studies have reported persistence of esthetic improvement over periods extending from several months to approximately four years. The degree and durability of masking vary according to lesion characteristics, particularly lesion depth and activity, as well as treatment technique and clinical maintenance. More superficial lesions generally demonstrate more predictable esthetic improvement, whereas deeper lesions may show incomplete masking because of limited resin penetration [17,18,25-31].

Resin infiltration has also demonstrated clinical effectiveness in arresting proximal non-cavitated caries lesions. Clinical investigations indicate that infiltration reduces lesion permeability and restricts diffusion pathways, allowing stabilization of early lesions without removal of sound dental tissues [13,24-28,44-46].

Evidence from Systematic Reviews and Meta-Analyses

Systematic reviews and meta-analyses generally support the use of resin infiltration for the esthetic management of WSLs. Pooled analyses indicate greater improvement in lesion appearance following resin infiltration than with conventional remineralization approaches, including fluoride-based treatment and calcium phosphate-based therapies [1-6,34-36,45,46,49].

The available evidence is strongest for post-orthodontic WSLs. Across systematic reviews, resin infiltration has been associated with immediate and clinically detectable improvement in lesion appearance together with evidence of lesion arrest. The magnitude and durability of the effect, however, vary among studies because of differences in lesion characteristics, treatment protocols, follow-up periods, and outcome assessment methods [1-6,25-36,45-49].

Evidence comparing resin infiltration with microabrasion is more heterogeneous. Both approaches can improve enamel appearance, but their mechanisms differ: microabrasion removes a superficial layer of enamel, whereas resin infiltration acts within subsurface porosities. Consequently, the clinical effect of each treatment depends substantially on lesion depth and morphology [18-20,29,34-36,48].

In Vitro Findings

Laboratory investigations provide consistent evidence regarding the physicochemical effects of resin infiltration. Studies using microscopic and imaging techniques have demonstrated penetration of low-viscosity TEGDMA-based resin into porous enamel lesions following hydrochloric acid conditioning. The removal of the relatively hypermineralized superficial layer facilitates access to the lesion body and improves resin penetration [8,11-14,21-24,31,32].

Experimental studies have also demonstrated increased enamel microhardness and reduced lesion permeability following resin infiltration. Polymerization of the infiltrant within the porous lesion structure provides mechanical reinforcement and reduces pathways available for diffusion of acids and dissolved minerals. In pH-cycling models, infiltrated lesions have shown greater resistance to subsequent demineralization than untreated lesions [13,21-24,31,32,44].

Spectrophotometric investigations have demonstrated reductions in color difference following resin infiltration. Replacement of air- and water-filled microporosities with resin reduces light scattering and accounts for the optical masking observed clinically [10,14,15,21,30].

Laboratory studies have also identified limitations related to long-term color stability. TEGDMA-based infiltrants demonstrate water sorption and may undergo discoloration after prolonged exposure to chromogenic substances such as coffee, tea, and red wine. These findings should be interpreted in the context of the experimental design because continuous immersion models do not fully reproduce the oral environment [8,29-36,47-49].

Experimental investigations of modified infiltrants containing antibacterial monomers, bioactive fillers, calcium phosphate compounds, or nanoparticles have reported potentially improved mechanical, antibacterial, and degradation-related properties. However, these materials remain predominantly at the experimental stage, and the available clinical evidence continues to concern primarily the conventional TEGDMA-based ICON system [32-36,47,48].

Comparison with Alternative Treatment Modalities

Clinical and laboratory evidence indicates that resin infiltration differs from conventional remineralization therapies in both mechanism and clinical effect. Fluoride and calcium phosphate-based treatments primarily promote mineral deposition, whereas resin infiltration penetrates the lesion body and modifies its optical and diffusion properties. Consequently, systematic reviews generally report greater esthetic improvement following resin infiltration than after conventional remineralization alone [2-6,34-36,42,43,45,46].

Microabrasion is effective for superficial enamel discolorations and selected developmental defects but involves controlled removal of the outer enamel layer. Its effectiveness decreases with increasing lesion depth. Resin infiltration, in contrast, preserves the enamel surface and acts within subsurface porosities, making it particularly applicable to non-cavitated post-orthodontic WSLs [18-20,29,34-36,48].

Tooth bleaching can reduce the color contrast between affected and unaffected enamel but does not directly modify the porous structure responsible for the WSL. Available studies therefore describe bleaching primarily as an adjunctive procedure, including in combination with resin infiltration or microabrasion in selected esthetic cases [18,29,48].

Direct composite restoration remains relevant for cavitated lesions and defects associated with substantial structural loss. For non-cavitated lesions, resin infiltration provides a micro-invasive alternative that may delay or avoid restorative intervention while preserving sound dental tissues [41,44-46].

Emerging studies have also investigated combined protocols involving resin infiltration with microabrasion or bleaching. These approaches may improve esthetic outcomes in selected cases, although the available evidence remains heterogeneous and standardized protocols have not yet been established [29,34-36,48].

Applications Beyond Conventional White Spot Lesions

The literature indicates that the potential application of resin infiltration extends beyond conventional caries-related WSLs to selected developmental enamel defects, particularly dental fluorosis and molar-incisor hypomineralization (MIH). However, the evidence base for these indications is smaller and less consistent than that available for post-orthodontic WSLs [5,7,29,30,47,48].

Clinical studies of dental fluorosis have reported esthetic improvement following resin infiltration, particularly in mild and moderate superficial lesions. Treatment predictability appears to depend on lesion depth and the distribution of mineral alterations within the enamel [5,29,34-36,47,48].

For MIH, available evidence suggests greater variability in treatment response. Resin infiltration appears most applicable to mild lesions with intact white or cream-colored opacities, whereas deeper yellow or brown lesions and teeth with posteruptive enamel breakdown demonstrate less predictable outcomes and may require alternative or additional treatment [30,47,48].

Systematic reviews addressing developmental enamel defects emphasize the limited quality and heterogeneity of the available evidence. Small study populations, differences in treatment protocols, subjective esthetic outcome assessment, and relatively short follow-up periods limit direct comparison between studies and prevent definitive conclusions regarding long-term effectiveness in fluorosis and MIH [5,34-36,47,48].

Overall, the analyzed literature demonstrates the most consistent clinical evidence for resin infiltration in non-cavitated post-orthodontic WSLs. Evidence for proximal caries lesions and developmental enamel defects is also supportive, but the available studies are more heterogeneous. Laboratory research consistently supports the proposed mechanism of action by demonstrating resin penetration, increased microhardness, reduced permeability, and improved optical properties, while also identifying potential concerns regarding long-term staining and material stability [8,11-14,21-36,44-49].

Table 1 summarizes representative clinical trials, prospective studies, and evidence syntheses evaluating ICON resin infiltration for post-orthodontic white spot lesions, proximal caries, and enamel defects, highlighting its esthetic masking effects, caries-arresting potential, and generally sustained clinical benefits across follow-up periods of up to 3 years.

Overall, the available evidence suggests that resin infiltration may provide both esthetic and lesion-arresting effects in selected non-cavitated enamel lesions; however, the magnitude and durability of these effects vary according to lesion type, treatment protocol, and study design.

DISCUSSION

The findings of this narrative review indicate that ICON resin infiltration has a well-established role in the minimally invasive management of non-cavitated enamel lesions, with the most consistent evidence available for post-orthodontic white spot lesions (WSLs). Across clinical studies, systematic reviews, meta-analyses, and laboratory investigations, resin infiltration demonstrates a characteristic combination of lesion stabilization and esthetic improvement while preserving sound dental tissues [1-6,10-20,25-36,44-49].

The clinical benefit of resin infiltration is particularly evident in post-orthodontic WSLs. Conventional remineralization strategies may reduce lesion activity and promote mineral recovery, but their ability to reverse the optical changes associated with subsurface porosity is limited. Resin infiltration addresses this limitation by replacing air- and water-filled microporosities with a polymeric material whose optical properties more closely approximate those of sound enamel. This mechanism explains the rapid masking effect consistently reported in clinical studies [10,14,15,21,30].

The available evidence also indicates that clinical effectiveness is strongly influenced by lesion characteristics. Superficial non-cavitated lesions generally demonstrate more predictable esthetic improvement because the infiltrant can penetrate the porous lesion body more effectively. In contrast, deeper lesions may exhibit incomplete masking despite technically adequate treatment. Lesion depth and morphology should therefore be considered important determinants of treatment outcome rather than assuming a uniform response across all WSLs [17,18,25-31].

An important distinction emerging from the reviewed literature concerns the difference between clinical and laboratory evidence. In vitro studies consistently demonstrate resin penetration, increased enamel microhardness, reduced permeability, and improved resistance to demineralization. These findings provide strong mechanistic support for resin infiltration; however, artificially produced lesions and controlled laboratory conditions cannot fully reproduce the complex biological environment of the oral cavity. Consequently, laboratory findings should support, rather than replace, clinical evidence when determining treatment effectiveness [8,11-14,21-24,31-36,44].

Long-term esthetic stability remains one of the most relevant unresolved issues. Laboratory studies demonstrate susceptibility of TEGDMA-based infiltrants to water sorption and staining following prolonged exposure to chromogenic substances. Clinical studies, however, generally report satisfactory esthetic stability during available follow-up periods. The discrepancy may partly reflect differences between continuous laboratory immersion protocols and the dynamic oral environment, where saliva, oral hygiene, dietary behavior, and surface maintenance influence pigment accumulation [8,29-36,47-49]. Longer prospective clinical studies are therefore necessary to determine the extent to which laboratory staining findings translate into clinically relevant discoloration.

The comparison with alternative treatment modalities further clarifies the clinical position of resin infiltration. Fluoride and calcium phosphate-based therapies remain important approaches for controlling early caries activity and supporting remineralization, particularly when lesions are diagnosed at an early stage. Their principal limitation in relation to esthetic WSL management is the less predictable reversal of the optical changes produced by subsurface porosity. Resin infiltration offers a complementary mechanism by physically modifying the porous lesion structure and consequently improving its optical appearance [2-6,34-36,42,43,45,46].

Microabrasion and bleaching remain useful in selected clinical situations but address different aspects of enamel discoloration. Microabrasion is particularly applicable to superficial defects because it relies on controlled removal of the external enamel layer, whereas resin infiltration is capable of addressing subsurface porosity without sacrificing additional sound enamel. Bleaching may reduce color contrast but does not directly eliminate the structural basis of a WSL. These differences support an individualized approach in which treatment selection is determined by lesion depth, morphology, activity, and esthetic requirements rather than by the use of a single universal technique [18-20,29,34-36,48].

The reviewed evidence also suggests that the application of resin infiltration to developmental enamel defects requires greater caution. Fluorosis and MIH differ substantially from post-eruptive caries-related WSLs in their etiology, mineral composition, and structural organization. Although increased enamel porosity may permit resin penetration, the heterogeneity of developmental defects contributes to greater variability in clinical response. The available evidence is therefore encouraging but considerably less mature than the evidence supporting post-orthodontic WSL treatment [5,29,30,34-36,47,48].

For MIH in particular, treatment predictability appears to depend on the severity and morphology of the defect. Mild, intact white or cream-colored lesions may be amenable to resin infiltration, whereas deeper yellow or brown lesions and teeth with posteruptive enamel breakdown may require alternative or combined treatment approaches. This variability emphasizes the importance of accurate diagnosis and careful case selection before infiltration is undertaken [30,47,48].

An additional consideration is the development of next-generation infiltrating materials. Experimental studies incorporating antibacterial monomers, bioactive fillers, calcium phosphate compounds, and nanoparticles suggest potential improvements in mechanical properties, antibacterial activity, and resistance to degradation. However, these materials remain largely supported by laboratory evidence, and clinical validation is required before their potential advantages can be translated into routine clinical practice [32-36,47,48].

Overall, the evidence supports resin infiltration as an important component of contemporary minimally invasive dentistry, particularly for appropriately selected non-cavitated post-orthodontic WSLs. Its main clinical advantage lies in combining biological preservation with immediate esthetic improvement. At the same time, the variability associated with lesion depth, developmental enamel defects, material staining, and differences between study protocols indicates that treatment outcomes should not be considered universally predictable. Continued research should therefore focus on standardized clinical protocols, validated outcome measures, long-term follow-up, and patient-reported outcomes [1-6,25-36,45-49].

Limitations

This review has several limitations that should be considered when interpreting its findings. First, the narrative-review design introduces a potential risk of selection bias. Although a structured search strategy and predefined eligibility criteria were applied, the identification, selection, and interpretation of the literature involved an element of author judgment. Unlike a systematic review with a registered protocol and a fully reproducible screening process, a narrative review may be influenced by the availability, relevance, and perceived methodological value of individual publications. Consequently, the included evidence may not represent the entire body of available literature, and studies with different or less favorable findings may be relatively underrepresented.

Second, substantial heterogeneity exists among the included studies with respect to study design, lesion characteristics, treatment protocols, outcome measures, and follow-up periods. Clinical studies differed in the location and severity of white spot lesions, methods of lesion assessment, and criteria used to evaluate esthetic improvement or lesion progression. This heterogeneity limits direct comparison between individual studies and prevents reliable quantitative synthesis of the available evidence.

Third, part of the available evidence originates from in vitro and laboratory-based investigations. These studies provide important information regarding resin penetration, microhardness, permeability, color changes, and material properties, but their findings cannot be directly equated with clinical outcomes. Factors present in the oral environment, including saliva, dietary exposure, biofilm activity, mechanical abrasion, and repeated staining, may influence the long-term behavior of infiltrated lesions.

Another limitation concerns the relatively limited duration of follow-up in a substantial proportion of clinical studies. Although several investigations have demonstrated persistent esthetic improvement and lesion stabilization over extended observation periods, evidence regarding very long-term color stability, resistance to staining, and durability across different types of enamel defects remains limited. This is particularly relevant for developmental enamel defects such as fluorosis and molar-incisor hypomineralization, for which the evidence base is smaller and less homogeneous than for post-orthodontic white spot lesions.

Finally, differences in treatment protocols, including etching procedures, infiltration time, application technique, and polishing protocols, may contribute to differences in treatment outcomes. Further well-designed prospective clinical studies using standardized diagnostic criteria, treatment protocols, objective outcome measures, and longer follow-up periods are needed to improve the comparability and clinical interpretation of the available evidence.

An additional limitation was the exclusion of publications for which the full text was unavailable, which may have resulted in the omission of potentially relevant evidence.

CONCLUSIONS

ICON resin infiltration is a minimally invasive approach applicable to selected non-cavitated enamel lesions. The available evidence supports its use primarily for the esthetic masking of white spot lesions and for the management of early carious lesions, including selected proximal lesions. Laboratory studies provide biological support for resin penetration and lesion modification, whereas evidence concerning developmental enamel defects such as fluorosis and molar-incisor hypomineralization remains more limited and heterogeneous. Clinical outcomes depend on lesion characteristics, treatment protocol, and follow-up duration. Further prospective clinical studies with standardized outcome measures and longer follow-up are warranted to determine the durability of treatment effects and to better define the indications for resin infiltration across different types of enamel lesions.

DISCLOSURE

The authors declare that they have no conflicts of interest related to this manuscript. No external funding was received for the preparation of this review.

Author Contributions

Conceptualization: Bartosz Szymajda.
Methodology: Bartosz Szymajda, Zuzanna Jeziorska, Katarzyna Raczek.
Literature search: Zuzanna Jeziorska, Justyna Polko, Bartosz Szymajda, Maja Witek, Zuzanna Galicka, Jakub Artur Czapkiewicz, Weronika Kwaśnica, Izabela Migdał.
Data extraction: Bartosz Szymajda, Zuzanna Galicka.
Data curation: Zuzanna Jeziorska, Justyna Polko, Bartosz Szymajda, Weronika Kwaśnica.
Data analysis: Maja Witek, Jakub Artur Czapkiewicz.
Writing original draft: Zuzanna Jeziorska.
Writing review and editing: Zuzanna Jeziorska, Justyna Polko, Bartosz Szymajda, Maja Witek, Zuzanna Galicka, Jakub Artur Czapkiewicz, Weronika Kwaśnica, Tomasz Horodniczy, Izabela Migdał.
Critical revision of the manuscript: Bartosz Szymajda, Katarzyna Raczek, Tomasz Horodniczy.
Supervision: Katarzyna Raczek, Tomasz Horodniczy, Izabela Migdał.
Project administration: Izabela Migdał.
Final approval: All authors.

Use of Artificial Intelligence

Generative AI tools were used during the preparation of this manuscript for language editing, refinement of wording, and organizational support. All changes made with the assistance of these tools were reviewed by the authors. The authors take full responsibility for the final content of the manuscript.

REFERENCES

1. Prada AM, Potra Cicalău GI, Ciavoi G. A review of white spot lesions: development and treatment with resin infiltration. Dent J (Basel). 2024;12(12):375. https://doi.org/10.3390/dj12120375
2. Lopes PC, Carvalho T, Gomes ATP, Veiga N, Blanco L, Correia MJ, et al. White spot lesions: diagnosis and treatment - a systematic review. BMC Oral Health. 2024;24:58. https://doi.org/10.1186/s12903-023-03720-6
3. Lamorgese M, Veiga N, Correia MJ, Gomes ATPC, Lopes S, Lopes-Rocha L, et al. White spot lesion treatment options: a systematic review of different techniques for masking these lesions. Gels. 2025;11(5):371. https://doi.org/10.3390/gels11050371
4. Puleio F, Fiorillo L, Gorassini F, Iandolo A, Meto A, D’Amico C, et al. Systematic review on white spot lesions treatments. Eur J Dent. 2022;16(1):41-48. https://doi.org/10.1055/s-0041-1731931
5. Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(8):4711-4719. https://doi.org/10.1007/s00784-021-03931-7
6. Xie Z, Yu L, Li S, Li J, Liu Y. Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. BMC Oral Health. 2023;23:346. https://doi.org/10.1186/s12903-023-03076-x
7. Dziaruddin N, Zakaria ASI. Resin infiltration of non-cavitated enamel lesions in paediatric dentistry: a narrative review. Children (Basel). 2022;9(12):1893. https://doi.org/10.3390/children9121893
8. Ibrahim DFA, Venkiteswaran A, Hasmun NN. The penetration depth of resin infiltration into enamel: a systematic review. J Int Soc Prev Community Dent. 2023;13(3):194-207. https://doi.org/10.4103/jispcd.JISPCD_36_23
9. Yazarloo S, Arab S, Mirhashemi AH, Gholamrezayi E. Systematic review of preventive and treatment measures regarding orthodontically induced white spot lesions. Dent Med Probl. 2023;60(3):527-535. https://doi.org/10.17219/dmp/140964
10. Paris S, Meyer-Lueckel H. Masking of labial enamel white spot lesions by resin infiltration-a clinical report. Quintessence Int. 2009;40(9):713-718.
11. Meyer-Lueckel H, Paris S. Improved resin infiltration of natural caries lesions. J Dent Res. 2008;87(12):1112-1116. https://doi.org/10.1177/154405910808701201
12. Meyer-Lueckel H, Paris S, Kielbassa AM. Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration. Caries Res. 2007;41(3):223-230. https://doi.org/10.1159/000099323
13. Paris S, Meyer-Lueckel H. Inhibition of caries progression by resin infiltration in situ. Caries Res. 2010;44(1):47-54. https://doi.org/10.1159/000275917
14. Paris S, Schwendicke F, Keltsch J, Dörfer CE, Meyer-Lueckel H. Masking of white spot lesions by resin infiltration in vitro. J Dent. 2013 Nov;41 Suppl 5:e28-e34. https://doi.org/10.1016/j.jdent.2013.04.003
15. Kim S, Kim EY, Jeong TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. Int J Paediatr Dent. 2011;21(4):241-248. https://doi.org/10.1111/j.1365-263X.2011.01126.x
16. Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, et al. Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial. J Am Dent Assoc. 2013;144(9):997-1005. https://doi.org/10.14219/jada.archive.2013.0225
17. Knösel M, Eckstein A, Helms HJ. Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomized clinical trial. Am J Orthod Dentofacial Orthop. 2013;144(1):86-96. https://doi.org/10.1016/j.ajodo.2013.02.029
18. Gu X, Yang L, Yang D, Gao Y, Duan X, Zhu X, et al. Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: a split-mouth, randomized clinical trial. Angle Orthod. 2019;89(3):372-377. https://doi.org/10.2319/041218-274.1
19. Giray FE, Durhan MA, Haznedaroglu E, Durmus B, Kalyoncu OI, Tanboga I. Resin infiltration technique and fluoride varnish on white spot lesions in children: preliminary findings of a randomized clinical trial. Niger J Clin Pract. 2018;21(12):1564-1569. https://doi.org/10.4103/njcp.njcp_209_18
20. Kannan A, Padmanabhan S. Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial. Prog Orthod. 2019;20:23. https://doi.org/10.1186/s40510-019-0276-y
21. Meyer-Lueckel H, Paris S. Progression of artificial enamel caries lesions after infiltration with experimental light curing resins. Caries Res. 2008;42(2):117-124. https://doi.org/10.1159/000118631
22. Meyer-Lueckel H, Paris S. Infiltration of natural caries lesions with experimental resins differing in penetration coefficients and ethanol addition. Caries Res. 2010;44(4):408-414. https://doi.org/10.1159/000318223
23. Meyer-Lueckel H, Chatzidakis A, Naumann M, Dörfer CE, Paris S. Influence of application time on penetration of an infiltrant into natural enamel caries. J Dent. 2011;39(7):465-469. https://doi.org/10.1016/j.jdent.2011.04.003
24. Paris S, Meyer-Lueckel H, Kielbassa AM. Resin infiltration of natural caries lesions. J Dent Res. 2007;86(7):662-666. https://doi.org/10.1177/154405910708600715
25. Paris S, Hopfenmuller W, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy randomized trial. J Dent Res. 2010;89(8):823-826. https://doi.org/10.1177/0022034510369289
26. Paris S, Bitter K, Naumann M, Dörfer CE, Meyer-Lueckel H. Resin infiltration of proximal caries lesions differs in relation to lesion depth: long-term clinical evaluation. Caries Res. 2010;44(4):400-407.
27. Peters MC, Hopkins AR Jr, Zhu L, Yu Q. Efficacy of proximal resin infiltration on caries inhibition: results from a 3-year randomized controlled clinical trial. J Dent Res. 2019;98(13):1497-1502. https://doi.org/10.1177/0022034519876853
28. Bagher SM, Hegazi FM, Finkelman M, Ramesh A, Gowharji N, Swee G, et al. Radiographic effectiveness of resin infiltration in arresting incipient proximal enamel lesions in primary molars. Pediatr Dent. 2018;40(3):195-200.
29. Zotti F, Albertini L, Tomizioli N, Capocasale G, Albanese M. Resin infiltration in dental fluorosis treatment-1-year follow-up. Medicina (Kaunas). 2021;57(1):22. https://doi.org/10.3390/medicina57010022
30. Kim E-Y, An U-J, Kim S, Jeong T-S. Resin infiltration for the esthetic improvement of anterior teeth with developmental defects and post-orthodontic decalcification. J Korean Acad Pediatr Dent. 2010;37(2):218-224.
31. Neuhaus KW, Schlafer S, Lussi A, Nyvad B. Infiltration of natural caries lesions in relation to their activity status and acid pretreatment in vitro. Caries Res. 2013;47(3):203-210. https://doi.org/10.1159/000345654
32. Paris S, Meyer-Lueckel H, Cölfen H, Kielbassa AM. Resin infiltration of artificial enamel caries lesions with experimental light curing resins. Dent Mater J. 2007;26(4):582-588. https://doi.org/10.4012/dmj.26.582
33. Gugnani N, Pandit IK, Gupta M, Josan R. Caries infiltration of non-cavitated white spot lesions: a novel approach for immediate esthetic improvement. J Conserv Dent. 2012;15(4):391-395.
34. Manoharan V, Kumar AS, Arumugam SB, Anand V, Krishnamoorthy S, Methippara JJ. Is resin infiltration a microinvasive approach to white lesions of calcified tooth structures? A systemic review. Int J Clin Pediatr Dent. 2019;12(1):53-58. https://doi.org/10.5005/jp-journals-10005-1579
35. Doméjean S, Ducamp R, Léger S, Holmgren C. Resin infiltration of non-cavitated caries lesions: a systematic review. Med Princ Pract. 2015;24(3):216-221. https://doi.org/10.1159/000371709
36. Lin GSS, Chan DZK, Lee HY, Low TT, Laer TS, Pillai MPM, et al. Effectiveness of resin infiltration in caries inhibition and aesthetic appearance improvement of white-spot lesions: an umbrella review. J Evid Based Dent Pract. 2022;22(3):101723. https://doi.org/10.1016/j.jebdp.2022.101723
37. Ogaard B, Rolla G, Arends J. Orthodontic appliances and enamel demineralization. Part 1: lesion development. Am J Orthod Dentofacial Orthop. 1988;94(1):68-73. https://doi.org/10.1016/0889-5406(88)90453-2
38. Sundararaj D, Venkatachalapathy S, Tandon A, Pereira A. Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: a meta-analysis. J Int Soc Prev Community Dent. 2015;5(6):433-439. https://doi.org/10.4103/2231-0762.167719
39. Featherstone JDB. The continuum of dental caries-evidence for a dynamic disease process. J Dent Res. 2004;83(Spec No C):C39-C42. https://doi.org/10.1177/154405910408301S08
40. Featherstone JDB. Dental caries: a dynamic disease process. Aust Dent J. 2008;53(3):286-291. https://doi.org/10.1111/j.1834-7819.2008.00064.x
41. Kidd EAM. How ‘clean’ must a cavity be before restoration? Caries Res. 2004;38(3):305-313. https://doi.org/10.1159/000077770
42. Ten Cate JM. Current concepts on the theories of the mechanism of action of fluoride. Acta Odontol Scand. 1999;57(6):325-329. https://doi.org/10.1080/000163599428562
43. Ten Cate JM, Featherstone JDB. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol Med. 1991;2(3):283-296. https://doi.org/10.1177/10454411910020030101
44. Meyer-Lueckel H, Paris S. Resin infiltration in the management of initial caries lesions. Quintessence Int. 2010;41(10):841-846.
45. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database Syst Rev. 2015;(11):CD010431. https://doi.org/10.1002/14651858.CD010431.pub2
46. Wierichs RJ, Abou-Ayash B, Kobbe C, Esteves-Oliveira M, Wolf M, Knaup I, Meyer-Lueckel H. Evaluation of the masking efficacy of caries infiltration in post-orthodontic initial caries lesions: 1-year follow-up. Clin Oral Investig. 2023;27(5):1945-1952. https://doi.org/10.1007/s00784-022-04843-w
47. El Meligy OAES, Alamoudi NM, Eldin Ibrahim ST, Felemban OM, Al-Tuwirqi AA. Effect of resin infiltration application on early proximal caries lesions in vitro. J Dent Sci. 2021;16(1):296-303. https://doi.org/10.1016/j.jds.2020.04.005
48. Borges AB, Caneppele TMF, Masterson D, Maia LC. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review. J Dent. 2017;56:11-18. https://doi.org/10.1016/j.jdent.2016.10.010
49. Youssef A, Farid M, Zayed M, Lynch E, Alam MK, Kielbassa AM. Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions. Quintessence Int. 2020;51(9):696-709. https://doi.org/10.3290/j.qi.a45104

back