Effects of repeated etching cycles using 15% hydrochloric acid on enamel loss and relative attenuation coefficient in resin infiltration

BACKGROUND: Resin infiltration is used to mask enamel opacities and the recommended etching cycles are three. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles.

AIM: To determine the incremental and total enamel loss when enamel surfaces are exposed to multiple etching cycles and to assess the relative attenuation coefficient after multiple etching cycles and resin infiltration treatment.

METHODS: Ninety extracted sound human premolars teeth were divided into 9 groups (n = 10); with each consecutive group having one additional etching cycle up to 9 cycles. The teeth were scanned with optical coherence tomography and enamel loss and attenuation coefficient were measured with MATLAB software. Enamel loss (one-way ANOVA, p ≤ 0.05) and attenuation coefficient (two-way ANOVA, p ≤ 0.05) were statistically analyzed.

RESULTS: There was a significant total enamel loss of more than 33% found at the 7th etching cycle and more. There was no statistically significant difference in the incremental mean depth of penetration of resin between various etching cycles (F(8, 134) = [2.016], one-way ANOVA, p = 0.185).

CONCLUSION: This study recommends that etching should not be repeated more than seven cycles to prevent excessive enamel loss. Following eight etching cycles, resin infiltration penetration appears approximately equal to that of healthy enamel.