One of the most useful articles I've put into practice from Spear Digest is Dr. Andy Cohens on reduction of white spot lesions using MI paste. To date, it's been the most effective treatment modality I've had for dealing with fluorosis stains, white spot lesions and decalcified spots.

Recently I started implementing DMG's ICON treatment. It's resin infiltration that “fills in” the de-calcified areas leading to the white spots. I haven't been this excited about an easy procedure with impressive results in a long time. It uses micro-invasive infiltration technology to treat smooth surface and proximal carious lesions, and I recently used it on my dental assistants white spot lesions on 8 and 9 with impressive results.

This product has been around for a while, so I was surprised I hadn't heard of it sooner. I came across it via Instagram, and contacted my DMG rep. I'll walk you through the protocol and show you an example of the impressive results I achieved on my assistant.

micro etch for white spot lesions

Use either a latex rubber dam (if the lesions are close to the gingiva, as is the case with many post-ortho lesions) or an Optragate. Do not use a non-latex dam. If you place an Optragate, you can use a liquid rubber dam and light cure if needed to protect the tissue. 

white spot lesion treatment tips

In order to prepare the surfaces for infiltration, micro-air abrade the surface of the lesions or polish with a disk. Use pummice to clean the lesions to be treated.

Youll then use the 15 percent HCL etchant that comes in the ICON kit for a 2 minute etch. With fluorosis stains, you can etch up to 3 minutes. This seems like a lot, but you havent drilled into the teeth, so you are in enamel and in a safe zone for extended etching.

Rinse for a full 30 seconds, then dry thoroughly.

You are going to repeat the above steps and again disk or air abrade, etch, rinse and dry.

After the second etch, the teeth should be very chalky. 

etching for white spot lesions

Youll then place ethanol on the lesions, (Icon dry in the kit) which gives you a “preview” of the final result. If you have good esthetics with the Icon dry, you are good to go with the infiltration. If there isn't a change, or you see a suboptimal change, you havent accessed the lesion and you need to etch again.

conservative approach to treating white spot lesions

After you have placed the Icon dry, if you are proceeding with the infiltration, dry the area, then use the infiltration resin in the kit to wet the area for a three-minute infiltration. If, during the three minutes, the resin is no longer visible and shiny, add additional resin. The resin is being absorbed during this time and you may need to apply it additional times, especially for larger lesions.

After the three minutes have passed, remove the excess with cotton pellets and light cure for 40 seconds per tooth.

After resin infiltration is completed, floss the proximal contacts to remove any flash.

Before wetting the teeth, do an additional minute of resin infiltration. This is your “insurance policy” to be sure that your initial infiltration fills all of the micropores in the tooth. You will then need an additional 40 second cure. 

tips for treating white spot lesions effectively

After the resin is complete, youll need to finish and polish with the same tools you would use to smooth and finish a typical anterior composite.

This should be a fantastic new treatment to implement in your practice if you arent already using it. The typical cost of this treatment seems to run around the price of a single surface composite on one tooth, and you can determine a “case fee” depending on how many teeth are involved.

The total treatment is only around 15 minutes for two teeth in my office, and we book 30 minutes start-to-finish for the patient. You can order the product through your regular supply rep, and its very inexpensive for how many teeth can be treated with one kit. Happy white spot removal!

dmg icon kit for treating white spot lesions
best tools for white spot lesion removal

(Click this link for more dentistry articles by Dr. Courtney Lavigne.)

Courtney Lavigne, D.M.D. is a member of Spear Visiting Faculty and a contributing author to Spear Digest.


Commenter's Profile Image Alex B.
July 29th, 2017
I love the results too! But how long does it last? I'm wondering if brushing removes it over time. I had a patient return for a touch up after a few months.
Commenter's Profile Image Courtney L.
August 5th, 2017
Hey Alex! This technique is new to me so I can't share with you years of follow up. However, based on the way the technique works via infiltration, the only reason you should need to do a second round of treatment is if you didn't get complete results the first time and when the teeth rehydrate you see discrepancies. The best way I think you can evaluate the success of it is to use water after etching to see a preliminary result and decide if an additional etching round is necessary. I contacted DMG and when applied correctly there shouldn't need to be touch ups unless it's improvement of the results! Hope that helps!
Commenter's Profile Image Stephen S.
October 16th, 2017
I was wondering if you had any experience with patents who tried to whiten after this procedure, or any information about post-treatment whitening? Thanks!
Commenter's Profile Image Courtney L.
October 18th, 2017
Hi Stephen! Because it is a clear resin infiltration, you may bleach like normal and the treated lesion will reflect the color of the the rest of the tooth and remain consistent with the surrounding dentition!
Commenter's Profile Image Elizabeth C.
January 17th, 2018
Hi Courtney, I am excited to use this more in my office! How do you code this procedure at your office.. and do you know if there's any way insurance would cover part of it since it's not a traditional "filling"?
Commenter's Profile Image Courtney L.
January 21st, 2018
Hi Elizabeth! I recommend talking to the DMG rep in your area. Our rep walked us through what codes to use and suggested prices. It's usually an out of pocket expense but there are some codes you can try to submit. Hope that helps!
Commenter's Profile Image Inna C.
September 27th, 2019
I got great results with the product but after a Zoom treatment, some spots returned. Any experiences like this? Thanks
Commenter's Profile Image Courtney L.
October 1st, 2019
Hi Inna! I haven't had results like that using Kor whitening in my office post-treatment, but I also haven't tried Zoom. My recommendation would be to talk to DMG about it directly; it's a good data point for the product and they may have some feedback as well!