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Samples - Caries treatment without drilling

‘Drilling and filling’ is the usual dentist’s approach to caries. In the early stages, however, caries progression can be halted with a new infiltrant fluid. This fast, painless technique leaves the healthy tooth tissue intact. The German company DMG has perfected the technology, which was invented at Charité-University Medicine in Berlin, and brought it to the worldwide market.


Imagine a dentist who doesn’t reach for his drill as soon as he identifies a caries lesion between two of your teeth. Imagine that he sticks an ultrathin device between the two teeth and applies a tiny bit of fluid, exactly in the right spot – and voilà, you’re done. No anaesthetic, no drilling, no filling and no pain and sensitivity in the weeks to come. If you ask dental scientist Hendrik Meyer-Lückel, this will become the preferred routine in dental practices around the world. “The technology’s achievements are even better than we expected,” he says. “Now the main challenge is to change the ‘drilling and filling’ paradigm that still prevails among dentists.”


Together with his colleague Sebastian Paris, Meyer-Lückel developed this new caries treatment, called Icon, at Charité-University Medicine in Berlin. “Caries lesions are porous,” he explains. “When left untreated, they will quite often progress due acids that are secreted by the bacteria situated in biofilms on the teeth. We are now able to halt this process by applying an infiltrant that penetrates into the porous structure of dental enamel. This fluid hardens and forms a protective layer that prevents further demineralization.” The treatment is suitable for lesions in the early and medium stages, Meyer-Lückel clarifies, when there is no actual hole in the tooth yet. When the lesion is cavitated or has penetrated deep into the dentin, drilling will still be necessary.


Icon is applicable on all smooth surfaces of teeth, but the technique offers most advantages for the so-called proximal surfaces: the sides of teeth that touch each other. “These spaces are notoriously difficult to reach, both for everyday cleaning and for treatment,” says Meyer-Lückel. “When dentists drill to treat an early lesion in this area, they will have to destroy a lot of healthy material to get to the affected tissue. This is obviously uncomfortable for the patient, and it definitely shortens the lifetime of the tooth.”


Meyer-Lückel and his colleague Paris experimented with various combinations of etching gels and infiltrants, and eventually found an ideal combination. “We use hydrochloric acid to etch the surface of the lesion,” he elaborates, “which opens up the pore structure. Then we apply a resin, consisting of low-viscous organic monomers, which flows into the capillaries of the lesion.” This resin only attaches itself to the affected tissue, he clarifies, and hardens quickly. Clinical studies have shown the effectiveness of the treatment for up to five years, but the scientist is optimistic that the benefits persist much longer.


Product developer Hans-Dieter Höhnk at the German company Dental Material Gesellschaft (DMG) was enthusiastic about the Icon concept as soon as he heard about it. “One of my colleagues, who is a dentist, told me about this invention,” he says, “and said it was quite remarkable. We wanted to see this for ourselves, and invited the scientists to present their technology to a team of experts at DMG. We immediately realized that this was the kind of thing we are always looking for: it was new and inventive, and it filled the gap between prevention and invasive treatment.”


Höhnk and his colleagues, however, identified some challenges in the application system. The scientists had been working with small strips that contained the infiltrant, a bit like filter paper. DMG developed a more advanced system: a pouch made out of very thin foil. The pouch is inserted between the teeth with the help of a special holder, which resembles a simple floss tool. A syringe is then used to insert the liquid. The pouch has tiny holes on just one side, bringing the fluid into contact with the affected tooth only. “This application system is completely new,” Höhnk emphasises. “Our engineers at DMG have developed it in close cooperation with the inventors at the university.”


Although the initial contacts were made directly between the Charité-University and DMG, a third party was involved in negotiating the contracts: ipal, a German commercialization agency for academic inventions. “As the exclusive service provider we are in charge of all inventions coming from the university,” says Janin Hofmann, Head of Acquisition and Commercialization at ipal. “Following a detailed assessment of the marketability and patentability of the invention, we filed the patents for the Charité. These patents still lie with the university. We acquired an exclusive licence for the technology, and we in turn have negotiated a licencing agreement with DMG.” Beside ipal’s expertise in identifying an invention’s potential, highlights Hofmann,  the added value of this triangle construction is the fact that ipal can play a neutral part in the process of technology transfer. “We have an objective perspective on the market value of the technology,” she says, “which allows us to serve the interests of the inventors as well as those of the licensee. We always keep the success of the future product in mind.”


Icon has been on the market since 2009 and is now available in many  countries around the world, including Germany, the US and Russia. “The main challenge,” says inventor Meyer-Lückel, “is to change the persistent drilling paradigm. Dentists often believe that if you don’t drill and fill, bacteria will infiltrate the tooth and cause damage from within. This, however, is a misconception. If there is no cavitation in the teeth, the bacterial film is limited to the outside of the tooth, and the acids are blocked very effectively by our hardened resin.”


Höhnk at DMG agrees that dentists’ trust in the product remains a stumbling block. “Dentists don’t easily change their established methods,” he underlines. “This product is something new for them, and they will have to invest time in acquiring the routine.” Also, as both professionals point out, some dentists may be hesitant to employ a technique that protects a tooth for as much as a decade – fearing that this may hamper business. There is another side to this, though. The scientists have also developed a tool that allows dentists to identify the early stages of lesions much easier on X-rays. “This should make dentists happy, because it allows them to find more lesions to treat,”  laughs Meyer-Lückel. “In any case, if they really want to act in their patient’s best interest, dentists should opt for the preventive approach.”


Höhnk is optimistic: he too is convinced that the preventive approach will prevail. “Although sales are not meeting our expectations yet,” he indicates, “we definitely have a business case and sales are rising steadily. Surprisingly a new, aesthetic market has opened up: besides halting proximal caries, our product is also effective against certain discolorations of the teeth.” People with dental braces, for example, are often left with ‘white spots’ on their teeth after brackets have been removed. Applying Icon will restore the tooth’s original colour and also protect from demineralization. “Clearly this is not what the infiltration method was originally developed for,” says Höhnk, “but we are of course more than happy with this additional application.”





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Name of product:Icon

Research institute:Charité-University Medicine, Berlin (Germany)

Marketed by:DMG Dental Material Gesellschaft mbH, Hamburg (Germany)

On the market since: 2009

Noteworthy:DMG won the 2010 German Innovation Award in the category ‘medium-sized company’ for Icon.



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In the spotlight:


Dental caries is a very common phenomenon. An average person has around eight proximal (in-between teeth) caries lesions throughout his or her life. Caries, also known as tooth decay or a dental cavity, is characterised by demineralisation of the hard tissues of the tooth: enamel, dentin and cementum. When left untreated, the decay can reach the underlying dental nerves, causing excessive pain and even loss of the tooth.

Caries is caused by the acids that are released by bacteria situated in a biofilm on the tooth surface. These bacteria live on sugar residues. This is why adequate mouth care (i.e. biofilm removal) helps to prevent caries. Tooth surfaces are constantly demineralized under the influence of acids, but remineralization also takes place, promoted by substances in our saliva and fluoride in our toothpaste. Only when this balance is disturbed will caries get a chance to develop. Some people are more susceptible to caries than others, due to the composition of their saliva, oral hygiene, eating habits and even the shape of their teeth.

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