Quantitative Radiographic Assessment of Proximal Caries Lesions Treated with Resin Infiltration

Quantitative Radiographic Assessment of Proximal Caries Lesions Treated with Resin Infiltration | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quantitative Radiographic Assessment of Proximal Caries Lesions Treated with Resin Infiltration Sinem Özdemir, Nimet Ünlü, Bilgün Çetin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7875571/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective Resin infiltration is widely used for non‑cavitated proximal caries lesions, yet evidence from standardised, quantitative radiographic monitoring is limited. This study evaluated short‑term outcomes using a reproducible, image‑based workflow. Methods In this observational cohort, adults (n = 23; 118 proximal lesions) were managed with resin infiltration (Icon) plus oral-hygiene instruction (10 patients; 53 lesions) or oral-hygiene instruction alone (13 patients; 65 lesions). Standardised bitewing radiographs were obtained at baseline, 6, and 12 months. Lesion length and area were measured in ImageJ following a reproducible calibration protocol. Between-group and longitudinal effects were tested using repeated-measures analyses and generalised linear mixed models (GLMMs) with patient-level random intercepts. Results Over 12 months, mean lesion-length increase was 0.14 mm with infiltration versus 0.26 mm in controls. GLMMs showed significant effects of group, time, and baseline caries level, and a significant group×time interaction ( p < 0.001; large effect), indicating diverging trajectories. The protective effect was most evident at enamel level; dentine-involving lesions were stabilised relative to controls. DMF-T was not independently significant ( p ≥ 0.05). Conclusions Within a standardised quantitative radiographic workflow, resin infiltration was associated with less short-term radiographic progression than no treatment. Findings support lesion-level quantitative monitoring to inform micro-invasive management and follow-up scheduling. ImageJ Proximal caries Radiographic monitoring Resin infiltration Statistics: GLMM Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Dental caries is a biofilm‑mediated, diet‑modulated disease arising from an imbalance between demineralisation and remineralisation at the tooth–biofilm interface, primarily driven by acidogenic bacteria metabolising dietary carbohydrates [ 1 , 2 ]. Below a critical pH of ~ 5.5, hydroxyapatite begins to dissolve, initiating progressive subsurface mineral loss. Clinically, early changes appear as non‑cavitated enamel lesions (white‑spot opacities) before frank cavitation develops [ 3 , 4 ]. Proximal surfaces are diagnostically challenging as they cannot be inspected directly; radiography is therefore indispensable for detection and monitoring [ 5 ]. Reliance on operative thresholds can delay care or prompt unnecessary removal of sound tissue, potentially entraining teeth into the restorative cycle [ 6 ]. Contemporary caries management emphasises micro‑invasive strategies that arrest progression before cavitation. Resin infiltration (RI) was introduced to occlude lesion porosities and arrest non‑cavitated proximal lesions [ 7 , 8 ]. Clinical and laboratory studies indicate that RI reduces permeability, slows progression and can improve the appearance of white‑spot lesions [ 9 – 11 ]. Systematic reviews and meta‑analyses support clinical efficacy, with outcomes influenced by lesion depth, particularly where dentine is involved [ 12 – 14 ]. Despite wide uptake, most evidence relies on categorical radiographic scores, which are less sensitive to subtle temporal change. Few studies have quantified proximal lesion dynamics using standardised image‑based metrics, and robust evidence remains scarce [ 15 , 16 ]. This gap limits understanding of post‑infiltration behaviour and hinders objective, reproducible follow‑up protocols. This study evaluated short‑term outcomes of resin infiltration for non‑cavitated proximal enamel lesions using a standardised quantitative radiographic workflow. The null hypothesis (H0) was that quantitative image analysis would detect no significant difference in progression between infiltrated and untreated lesions. 2. Materials and methods 2.1. Study design and ethics This two‑group, lesion‑level observational cohort (retrospective–prospective mixed design) was conducted at the Department of Restorative Dentistry. The protocol was approved by the Non‑Interventional Research Ethics Committee of Selçuk University (Decision No: 2022/37). Written informed consent was obtained from all prospectively enrolled participants. 2.2. Patient selection and sample size Adults attending routine examinations were consecutively screened. Records were reviewed to identify cases with documented proximal resin infiltration and standardised bitewings in the hospital information management system (HIMS). In total, 23 patients with 118 non‑cavitated proximal lesions met eligibility criteria and were included following consent. An a priori sample size calculation for a two‑group, three‑time‑point repeated‑measures design (group×time interaction; moderate effect size Cohen’s f = 0.25; α = 0.05; ε = 1.00; within‑subject correlation = 0.70) indicated 18 participants would provide ≥ 80% power; our sample exceeded this threshold. Inclusion criteria: At least one non‑cavitated proximal lesion (E1, E2 or D1) on bitewing radiographs Vital tooth with intact marginal ridge and no cavitation Ability to attend 6‑ and 12‑month follow‑ups Exclusion criteria: Pregnancy Inability to cooperate with treatment Absence of proximal contact Contraindications to radiography Lesions were confirmed clinically under ×3 magnification using a mouth mirror, dental floss and an explorer without pressure. Doubtful cases were excluded. 2.3. Study groups Lesions were allocated by treatment: Icon : 53 proximal lesions (10 patients) treated with resin infiltration plus oral-hygiene instruction Control : 65 proximal lesions (13 patients) managed with oral-hygiene instruction alone The unit of analysis was the lesion. Multiple lesions per patient were included, with analyses adjusted for within-patient clustering. 2.4. Clinical protocol (Icon resin infiltration) A single trained operator (S.Ö.) used a resin infiltrant (Icon; DMG, Hamburg, Germany) per manufacturer protocol: rubber dam isolation; contact separation with wedges; cleaning with pumice and floss; 15% hydrochloric acid gel etching (2 min); thorough water rinse (30 s) and air-dry; ethanol desiccation (Icon Dry, 30 s); initial infiltration (3 min) and light polymerisation (40 s at 1100 mW/cm²); second application (1 min) to compensate for polymerisation shrinkage; final light curing (40 s). 2.5. Demographic and clinical data Age, sex, caries extent (enamel/dentine), DMF‑T, lesion location (mesial/distal), tooth group (anterior/premolar/molar) and arch (maxillary/mandibular) were recorded. Non‑cavitated proximal lesions under observation or infiltration were excluded from DMF‑T scoring. 2.6. Radiographic assessment Standardised digital bitewings were obtained at baseline, 6 and 12 months using the paralleling technique with a positioning holder (Kerr Dental, Orange, CA, USA). Individualised wax bite registrations (Polywax; Bilkim, Izmir, Turkiye) were fabricated, stored and reused to ensure reproducibility. Exposure parameters, collimation and focus–sensor distance were constant. Radiographs were exported as 32‑bit PNG files and analysed in ImageJ v1.54g (NIH, Bethesda, MD, USA). Images were spatially calibrated using the known dimensions of the bite block. Images with projection mismatch or positioning error were excluded. Figure 1 illustrates the measurement workflow. A pilot reliability study on 50 images was performed by a postgraduate student (S.Ö.) and a professor of Oral and Maxillofacial Radiology (B.Ç.). Inter‑examiner agreement was excellent (κ = 0.91). All subsequent blinded measurements were performed by the postgraduate student (S.Ö.), each repeated twice; inter‑rater correlation was high ( r = 0.891) and means were used for analysis. 2.7. Statistical analysis Data were analysed in SPSS v27 (IBM; Armonk, NY, USA). Normality was assessed with Shapiro–Wilk. Parametric variables were analysed with independent‑samples t‑tests and repeated‑measures ANOVA; non‑parametric data with Mann–Whitney U and Friedman tests. To address within‑patient clustering and longitudinal structure, lesion‑level outcomes were modelled using GLMMs with a random intercept for Patient ID. Fixed effects were group, time, lesion depth, tooth group and the group×time interaction. An AR(1) covariance structure accommodated temporal correlation; Satterthwaite approximation was used for degrees of freedom. Maximum‑likelihood estimation with robust covariance was applied. Effect sizes were expressed as Cohen’s f with 95% CIs where applicable. Multiple comparisons used Bonferroni adjustment. Statistical significance was set at p < 0.05. There were no missing measurements for the primary radiographic outcomes at scheduled time points; images with projection mismatch were excluded a priori per protocol. Post hoc robustness checks yielded consistent inferences: using a simpler working correlation structure and model specification gave a borderline group×time p = 0.049, whereas the final GLMM with a patient‑level random intercept (AR(1) covariance) yielded a stronger group×time effect (p < 0.001); results were similar when compound symmetry was used as the working correlation. 3. Results Assessments were conducted at baseline, 6 months, and 12 months; mean follow‑up duration was 12 months. Demographic and clinical characteristics are summarised in Table 1. Groups were comparable by age, but differed in sex ratio, lesion depth and DMF‑T ( p <0.05). Lesion location, tooth group and arch did not differ ( p ≥0.05). Mean lesion lengths were consistently lower in the Icon group at all time points (Table 2). Both groups showed time‑dependent change, but progression was markedly reduced with Icon. From baseline to 12 months, lesion growth averaged ~0.14 mm with Icon versus ~0.26 mm in controls ( p <0.05). Lesion area showed similar trends (Table 3), with controls exhibiting significantly larger areas at 6 and 12 months ( p <0.05). GLMM confirmed a significant group×time interaction ( p <0.001; Cohen’s f =0.44, large), indicating divergent trajectories (Figure 3). Enamel and dentine lesions responded differently (Figure 4): enamel lesions progressed in both groups, but less with infiltration; dentine lesions progressed in controls but were largely stabilised with Icon (Cohen’s f =0.47, large). DMF‑T had no independent main effect ( p ≥0.05). However, interaction analyses indicated greater progression in patients with higher DMF‑T, especially in controls ( p <0.05; Figure 5), while lesions in low‑DMF‑T patients remained stable after infiltration (Cohen’s f =0.74, very large). Three‑way interaction terms (lesion type×group×time and DMF‑T×group×time) were excluded from the final GLMM for parsimony; however, because they offer comparable information, the findings are presented graphically (Figures 4 and 5). Overall, resin infiltration was associated with significantly reduced progression compared with oral‑hygiene instruction alone, with the protective effect most pronounced at enamel level and in patients with lower baseline caries experience. 4. Discussion This non‑interventional cohort evaluated Icon resin infiltration in initial proximal lesions (E1, E2, D1) using standardised quantitative radiographic measurements at 6 and 12 months. The null hypothesis was rejected: infiltration consistently slowed progression. Randomised trials provide the highest evidence [17] but can be constrained by ethical and practical considerations [18]. Prospective observational designs offer complementary insights for micro‑invasive techniques requiring extended follow‑up [19]. Our mixed retrospective–prospective approach captured real‑world outcomes under standardised radiography, enabling assessment of individual risk factors alongside treatment effects [20]. Icon (DMG; Hamburg, Germany) is engineered for early proximal lesions [9]. Its mechanism involves penetrating demineralised enamel micropores to create a diffusion barrier [21,22]. While effective on proximal surfaces, limitations include surface smoothness and retention [23]. Three‑dimensional topography indicates incomplete smoothing, leaving defects and exposed prisms susceptible to demineralisation [24], which may contribute to biofilm accumulation. Thus, RI’s promise is accompanied by intrinsic limitations. Effectiveness varies across ages and risk profiles [15,25,26]. In this study of adults aged 18–51 years, participants were stratified by DMF‑T. Radiographic parameters were tightly standardised in line with ALARA: 60 kVp tube voltage, consistent geometry and individualised bitewing holders with red baseplate wax [27,28]. ImageJ enabled quantitative lesion measurements. Prior in vivo Icon studies often used categorical visual assessments [26,29–32] or digital subtraction radiography [33–35]. Few studies have demonstrated quantitative proximal measurements with ImageJ, predominantly in vitro [36,37]. Our work therefore provides methodological innovation. Lesion progression control in the Icon group paralleled area findings (Tables 2–3; Figure 3). Baseline lesion areas did not differ statistically between groups. Categorical baseline comparisons showed a greater proportion of dentine lesions in controls and more low‑DMF‑T patients in Icon. These differences were not independently significant in GLMM once group and time were modelled, underscoring the centrality of the group×time interaction. Our results align with evidence that infiltration slows progression relative to no treatment [15,16,38,39]. D1 lesions carry higher cavitation potential [40,41]. In our cohort, three D1 lesions in controls progressed to cavitation by 6 months and were retained in analyses using fixed lesion‑length values. Although complete three‑dimensional penetration has been demonstrated [24], clinical outcomes are influenced by enamel heterogeneity, dynamic de‑/re‑mineralisation, and lesion microporosity [43–46]. Infiltration success varies with ICDAS code, pore volume and enamel structure [46,47]. When analysed separately, dentine lesions progressed rapidly, but Icon significantly slowed the rate. Some studies have reported contrasting enamel‑level findings [30,31,34,48–50]. In high‑risk patients (DMF‑T 5–10 and 11–20), progression continued over 12 months in both groups (Figure 5), indicating that restorative or micro‑invasive care alone may be insufficient and should be paired with behaviour change and remineralisation. Pairwise GLMM contrasts showed significant increases only in high‑risk strata. Within 12 months, infiltration was associated with short‑term control relative to routine care. As RI was developed for non‑cavitated enamel on smooth/proximal surfaces [9], and evidence for dentine‑involving lesions is mixed [30,31,48–51], durable effectiveness for D1 cannot be assumed. Longer follow‑up with lesion‑level stratification is warranted. In summary, over 12 months, resin infiltration significantly slowed progression of initial proximal lesions compared with no treatment, with benefits most evident at the enamel level. Standardised ImageJ‑based radiographic monitoring provided reliable in vivo quantification. Resin infiltration is an effective micro‑invasive strategy that may defer restorative intervention while preserving tooth structure. Larger cohorts with extended follow‑up are required to clarify durability, particularly in high‑risk patients and in lesions extending into dentine. Strengths include: (1) standardised, quantitative radiographic measurement using ImageJ; (2) enhanced reproducibility via individualised positioning guides; (3) prospective 6‑ and 12‑month evaluations under routine conditions; (4) modelling that accounts for within‑patient clustering (GLMM); and (5) educational relevance for training in micro‑invasive care. Limitations include: (1) a modest sample; (2) a one‑year horizon; (3) potential minor geometric variation despite standardisation; and (4) absence of deproteinisation/delipidation pretreatment, which may enhance etching and penetration and could partly explain progression in some enamel lesions. Declarations Ethics approval statement : The protocol was approved by the Non‑Interventional Research Ethics Committee of Selçuk University (Decision No: 2022/37). Written informed consent was obtained from all prospectively enrolled participants. Patient consent statement All participants provided informed consent for participation and radiographic follow‑up. No identifiable images are included. Conflict of interest disclosure: The authors declare no competing interests. Clinical trial registration Not applicable. Funding statement: This research was supported by the Selçuk University Scientific Research Projects Coordination Unit (Project No. 23132001). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Contribution S.Ö. performed software development, formal analysis, investigation, visualisation, drafted the original manuscript, and curated resources. N.Ü. provided supervision, methodology, project administration, conceptualisation, validation, and writing—review and editing. B.Ç. contributed to methodology, supervision, data curation, software, and conceptualisation. All authors reviewed and approved the manuscript. Data Availability The data underlying this article are available from the corresponding author upon reasonable request. References Goldberg M (2020) Enamel and dentin carious lesions. JSM Dent 8:1120. https://doi.org/10.47739/2333-7133/1120 Pitts NB, Zero DT (2016) White paper on dental caries prevention and management. FDI World Dent Federation 2016:3–9 Featherstone JD (2004) The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent 2:259–264 Paula ABP, Fernandes AR, Coelho AS et al (2017) Therapies for white spot lesions—a systematic review. 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Icon Control p Tests Age, median (IQR) 22 (20-24) 25 (21-28) 0.252 Mann-Whitney U Sex, n(%) 0.001 Yates correction Male 22(41.50) 8(18.30) Female 31(58.50) 57(87.70) Caries level, n(%) 0.006 Yates correction Enamel 24(45.30) 13(20) Dentin 29(54.7) 52(80) DMF-T n(%) 0.007 Pearson chi-square 1-4 27(50.95) 18(27.70) 5-10 9(16.95) 27(41.50) 11-20 17(32.10) 20(30.80) Lesion location, n(%) 0.579 Pearson chi-square Distal (D) 28(52.80) 31(47.70) Mesial (M) 25(57.2) 34(52.3) Tooth group, n(%) 0.614 Pearson chi-square Anterior 7(13.2) 5(7.7) Premolar 34(64.2) 44(67.7) Molar 12(22.6) 16(24.9) Jaw (arch), n(%) 0.624 Yates correction Maxillary 31(58.50) 42(64.60) Mandibular 22(41.50) 23(35.40) Table 2. Lesion‑length measurements (mm) by group and time. Means ± SD; ranges shown. Time Icon mean ± SD Control mean ± SD p * T0 1.21 ± 0.52 A,B 1.51 ± 0.47 A <0.001 T1 1.25 ± 0.50 A 1.72 ± 0.49 B <0.001 T2 1.35 ± 0.53 B 1.77 ± 0.54 B 0.001 p** 0.010 0.001 Footnotes. p*: between-group comparison at each time point by independent samples t-test. p** : within-group time effect by repeated measures ANOVA. T0: baseline; T1: 6 months; T2: 12 months. A-B : Within columns, values sharing the same uppercase superscript letter (A, B) do not differ significantly (Bonferroni–adjusted p≥ 0.05). Different letters indicate p <0.05. Table 3. Lesion area (mm²) by group and time. Medians (IQR); ranges shown. Time Icon median (IQR) Control median (IQR) p * T0 1 (0.66-1.67) A 1.13 (0.89-1.62) B 0.262 T1 1.13 (0.74-1.83) AB 1.52 (1.17-2.04) A 0.002 T2 1.30 (0.86-1.79) B 1.62 (1.19-2.05) A 0.004 P ** 0.035 <0.001 Footnotes. * Mann–Whitney U test (between groups at that time point). ** Friedman test (within-group comparison across T0–T2). T0 = baseline; T1 = 6 months; T2 = 12 months. A–B: Within columns, values sharing the same uppercase superscript letter (A, B) do not differ significantly (Bonferroni–adjusted p ≥0.05). Different letters indicate p <0.05. Table 4. GLMM results for lesion-length measurements in proximal lesions. Model term F df1 df2 p Group 7.733 1 11 0.018 Time 15.620 2 109 <0.001 Caries level 103.113 1 63 <0.001 Group × Time 8.505 2 86 <0.001 Tooth group 6.069 2 67 0.004 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7875571","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530523024,"identity":"40f9c023-9f9b-4d2d-9db2-598359072f9c","order_by":0,"name":"Sinem Özdemir","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYDACZijJxsB8AMiQkCFFC1sCSAsPKXbxGIBYhLXIt/MefHTjj3U0n/SZz69u1FjwMLAfProBnxaDw3zJxjk86bltfLnbrHOOAR3Gk5Z2A68WZh4z6RyJw7ltPLzbjHPYgFokeMzwapFv5jH/nWMA0sLzzDjnHxFaGA7zmDHnJIC1MD/ObSNCi8FhHmPpnANAv/CwmTHn9knwsBHyi3z/GcPPOX+sc+f3MD/+nPOtTo6f/fAx/A5DAmwSYJJY5SDA/IEU1aNgFIyCUTByAADBgD3iLcrYsQAAAABJRU5ErkJggg==","orcid":"","institution":"Selçuk University, Faculty of Dentistry","correspondingAuthor":true,"prefix":"","firstName":"Sinem","middleName":"","lastName":"Özdemir","suffix":""},{"id":530523025,"identity":"7a444c70-67e7-4a6c-933f-46e7fcdabf1e","order_by":1,"name":"Nimet Ünlü","email":"","orcid":"","institution":"Selçuk University, Faculty of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Nimet","middleName":"","lastName":"Ünlü","suffix":""},{"id":530523026,"identity":"ae662128-cdce-49a4-9a18-dece991bd613","order_by":2,"name":"Bilgün Çetin","email":"","orcid":"","institution":"Selçuk University, Faculty of Dentistry","correspondingAuthor":false,"prefix":"","firstName":"Bilgün","middleName":"","lastName":"Çetin","suffix":""}],"badges":[],"createdAt":"2025-10-16 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12:55:41","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":120184,"visible":true,"origin":"","legend":"","description":"","filename":"ce169bace8264adfa8b9ee55f4cbb0101structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/2db7741e5c7c53a60d4a0f0d.xml"},{"id":93778612,"identity":"0ca7bab8-83b2-4fb3-af9c-31f60187b601","added_by":"auto","created_at":"2025-10-17 12:47:41","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135335,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/1d07fbfb94fb43b58eee249a.html"},{"id":93778604,"identity":"8ae09f89-ca3c-4086-863d-13d1215eea8a","added_by":"auto","created_at":"2025-10-17 12:47:41","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":399542,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImageJ workflow.\u003c/strong\u003e In sequence: calibration, length measurement, and area measurement.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/f5ba9c7ad3ccb292a4b9e0a1.jpeg"},{"id":93780340,"identity":"ce4041cf-25ed-4855-b435-c7ab41cb0d5c","added_by":"auto","created_at":"2025-10-17 13:03:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":76623,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plots showing the correlation between lesion length (mm) and lesion area (mm²) at baseline (T0, blue), 6 months (T1, green), and 12 months (T2, red). Spearman correlation analysis revealed strong positive correlations at all time points (T0: \u003cem\u003er\u003c/em\u003e=0.806, T1: \u003cem\u003er\u003c/em\u003e=0.836, T2: \u003cem\u003er\u003c/em\u003e=0.877; all \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). Regression lines are shown as dashed lines.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/56b7429ae60b093367f13444.png"},{"id":93779955,"identity":"c12995e8-343a-4b87-aab1-62cef82cebb1","added_by":"auto","created_at":"2025-10-17 12:55:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":43470,"visible":true,"origin":"","legend":"\u003cp\u003eGroup × Time interaction for lesion length (mm, Mean ± SE). Lesion progression was monitored at baseline (T0), 6 months (T1), and 12 months (T2) in Icon and Control groups. Error bars represent standard error of the mean. Values derived from GLMM. Significant differences between groups at corresponding time points are marked with red asterisks (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, Sequential Bonferroni adjusted).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/0ad869dad92dcf0e1e4be961.png"},{"id":93778602,"identity":"901bfb38-1fd0-4d14-a568-17ce9292b98e","added_by":"auto","created_at":"2025-10-17 12:47:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":101857,"visible":true,"origin":"","legend":"\u003cp\u003eMean lesion length (mm) ± SE for enamel and dentin lesions in the Icon and Control groups at baseline (T0), 6 months (T1), and 12 months (T2). Values represent estimated marginal means ± SE derived from GLMM. Asterisks denote significant differences between groups at the respective timepoints (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, Sequential Bonferroni adjusted).\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/0318bce9cb1f64dafdd6ef1e.png"},{"id":93778600,"identity":"bca9a2c5-1157-4725-967b-bcf76fd3d5be","added_by":"auto","created_at":"2025-10-17 12:47:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":111003,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated marginal means (mm) ± SE of lesion length by group and DMFT categories (1-4, 5-10, 11-20) at baseline (T0), 6 months (T1), and 12 months (T2). Values derived from GLMM. Asterisks denote significant group differences at the respective timepoints (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, Sequential Bonferroni adjusted).\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/af88fe66863ebaf4009d65d7.png"},{"id":93903938,"identity":"d9a7f743-f98f-4e94-882d-b157b1d9b194","added_by":"auto","created_at":"2025-10-20 06:32:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1545497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7875571/v1/6bba18ba-9221-4457-97be-d1b39f020ba0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quantitative Radiographic Assessment of Proximal Caries Lesions Treated with Resin Infiltration","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDental caries is a biofilm‑mediated, diet‑modulated disease arising from an imbalance between demineralisation and remineralisation at the tooth\u0026ndash;biofilm interface, primarily driven by acidogenic bacteria metabolising dietary carbohydrates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Below a critical pH of ~\u0026thinsp;5.5, hydroxyapatite begins to dissolve, initiating progressive subsurface mineral loss. Clinically, early changes appear as non‑cavitated enamel lesions (white‑spot opacities) before frank cavitation develops [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eProximal surfaces are diagnostically challenging as they cannot be inspected directly; radiography is therefore indispensable for detection and monitoring [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Reliance on operative thresholds can delay care or prompt unnecessary removal of sound tissue, potentially entraining teeth into the restorative cycle [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContemporary caries management emphasises micro‑invasive strategies that arrest progression before cavitation. Resin infiltration (RI) was introduced to occlude lesion porosities and arrest non‑cavitated proximal lesions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Clinical and laboratory studies indicate that RI reduces permeability, slows progression and can improve the appearance of white‑spot lesions [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Systematic reviews and meta‑analyses support clinical efficacy, with outcomes influenced by lesion depth, particularly where dentine is involved [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite wide uptake, most evidence relies on categorical radiographic scores, which are less sensitive to subtle temporal change. Few studies have quantified proximal lesion dynamics using standardised image‑based metrics, and robust evidence remains scarce [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This gap limits understanding of post‑infiltration behaviour and hinders objective, reproducible follow‑up protocols.\u003c/p\u003e\u003cp\u003eThis study evaluated short‑term outcomes of resin infiltration for non‑cavitated proximal enamel lesions using a standardised quantitative radiographic workflow. The null hypothesis (H0) was that quantitative image analysis would detect no significant difference in progression between infiltrated and untreated lesions.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1. Study design and ethics\u003c/h2\u003e\n \u003cp\u003eThis two‑group, lesion‑level observational cohort (retrospective\u0026ndash;prospective mixed design) was conducted at the Department of Restorative Dentistry. The protocol was approved by the Non‑Interventional Research Ethics Committee of Sel\u0026ccedil;uk University (Decision No: 2022/37). Written informed consent was obtained from all prospectively enrolled participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2. Patient selection and sample size\u003c/h2\u003e\n \u003cp\u003eAdults attending routine examinations were consecutively screened. Records were reviewed to identify cases with documented proximal resin infiltration and standardised bitewings in the hospital information management system (HIMS). In total, 23 patients with 118 non‑cavitated proximal lesions met eligibility criteria and were included following consent. An a priori sample size calculation for a two‑group, three‑time‑point repeated‑measures design (group\u0026times;time interaction; moderate effect size Cohen\u0026rsquo;s \u003cem\u003ef\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25; \u003cem\u003e\u0026alpha;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05; \u003cem\u003e\u0026epsilon;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.00; within‑subject correlation\u0026thinsp;=\u0026thinsp;0.70) indicated 18 participants would provide\u0026thinsp;\u0026ge;\u0026thinsp;80% power; our sample exceeded this threshold.\u003c/p\u003e\n \u003cp\u003eInclusion criteria:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAt least one non‑cavitated proximal lesion (E1, E2 or D1) on bitewing radiographs\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eVital tooth with intact marginal ridge and no cavitation\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAbility to attend 6‑ and 12‑month follow‑ups\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eExclusion criteria:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePregnancy\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eInability to cooperate with treatment\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAbsence of proximal contact\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eContraindications to radiography\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eLesions were confirmed clinically under \u0026times;3 magnification using a mouth mirror, dental floss and an explorer without pressure. Doubtful cases were excluded.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3. Study groups\u003c/h2\u003e\n \u003cp\u003eLesions were allocated by treatment:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eIcon\u003c/strong\u003e: 53 proximal lesions (10 patients) treated with resin infiltration plus oral-hygiene instruction\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e: 65 proximal lesions (13 patients) managed with oral-hygiene instruction alone\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe unit of analysis was the lesion. Multiple lesions per patient were included, with analyses adjusted for within-patient clustering.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e2.4. Clinical protocol (Icon resin infiltration)\u003c/h2\u003e\n \u003cp\u003eA single trained operator (S.\u0026Ouml;.) used a resin infiltrant (Icon; DMG, Hamburg, Germany) per manufacturer protocol: rubber dam isolation; contact separation with wedges; cleaning with pumice and floss; 15% hydrochloric acid gel etching (2 min); thorough water rinse (30 s) and air-dry; ethanol desiccation (Icon Dry, 30 s); initial infiltration (3 min) and light polymerisation (40 s at 1100 mW/cm\u0026sup2;); second application (1 min) to compensate for polymerisation shrinkage; final light curing (40 s).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.5. Demographic and clinical data\u003c/h2\u003e\n \u003cp\u003eAge, sex, caries extent (enamel/dentine), DMF‑T, lesion location (mesial/distal), tooth group (anterior/premolar/molar) and arch (maxillary/mandibular) were recorded. Non‑cavitated proximal lesions under observation or infiltration were excluded from DMF‑T scoring.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.6. Radiographic assessment\u003c/h2\u003e\n \u003cp\u003eStandardised digital bitewings were obtained at baseline, 6 and 12 months using the paralleling technique with a positioning holder (Kerr Dental, Orange, CA, USA). Individualised wax bite registrations (Polywax; Bilkim, Izmir, Turkiye) were fabricated, stored and reused to ensure reproducibility. Exposure parameters, collimation and focus\u0026ndash;sensor distance were constant.\u003c/p\u003e\n \u003cp\u003eRadiographs were exported as 32‑bit PNG files and analysed in ImageJ v1.54g (NIH, Bethesda, MD, USA). Images were spatially calibrated using the known dimensions of the bite block. Images with projection mismatch or positioning error were excluded. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the measurement workflow.\u003c/p\u003e\n \u003cp\u003eA pilot reliability study on 50 images was performed by a postgraduate student (S.\u0026Ouml;.) and a professor of Oral and Maxillofacial Radiology (B.\u0026Ccedil;.). Inter‑examiner agreement was excellent (\u0026kappa;\u0026thinsp;=\u0026thinsp;0.91). All subsequent blinded measurements were performed by the postgraduate student (S.\u0026Ouml;.), each repeated twice; inter‑rater correlation was high (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.891) and means were used for analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e2.7. Statistical analysis\u003c/h2\u003e\n \u003cp\u003eData were analysed in SPSS v27 (IBM; Armonk, NY, USA). Normality was assessed with Shapiro\u0026ndash;Wilk. Parametric variables were analysed with independent‑samples t‑tests and repeated‑measures ANOVA; non‑parametric data with Mann\u0026ndash;Whitney U and Friedman tests. To address within‑patient clustering and longitudinal structure, lesion‑level outcomes were modelled using GLMMs with a random intercept for Patient ID. Fixed effects were group, time, lesion depth, tooth group and the group\u0026times;time interaction. An AR(1) covariance structure accommodated temporal correlation; Satterthwaite approximation was used for degrees of freedom. Maximum‑likelihood estimation with robust covariance was applied. Effect sizes were expressed as Cohen\u0026rsquo;s \u003cem\u003ef\u003c/em\u003e with 95% CIs where applicable. Multiple comparisons used Bonferroni adjustment. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n \u003cp\u003eThere were no missing measurements for the primary radiographic outcomes at scheduled time points; images with projection mismatch were excluded a priori per protocol. Post hoc robustness checks yielded consistent inferences: using a simpler working correlation structure and model specification gave a borderline group\u0026times;time \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049, whereas the final GLMM with a patient‑level random intercept (AR(1) covariance) yielded a stronger group\u0026times;time effect (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); results were similar when compound symmetry was used as the working correlation.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eAssessments were conducted at baseline, 6 months, and 12 months; mean follow‑up duration was 12 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDemographic and clinical characteristics are summarised in Table 1. Groups were comparable by age, but differed in sex ratio, lesion depth and DMF‑T (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Lesion location, tooth group and arch did not differ (\u003cem\u003ep\u003c/em\u003e\u0026ge;0.05).\u003c/p\u003e\n\u003cp\u003eMean lesion lengths were consistently lower in the Icon group at all time points (Table 2). Both groups showed time‑dependent change, but progression was markedly reduced with Icon. From baseline to 12 months, lesion growth averaged ~0.14 mm with Icon versus ~0.26 mm in controls (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). Lesion area showed similar trends (Table 3), with controls exhibiting significantly larger areas at 6 and 12 months (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eGLMM confirmed a significant group\u0026times;time interaction (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; Cohen\u0026rsquo;s \u003cem\u003ef\u003c/em\u003e=0.44, large), indicating divergent trajectories (Figure 3). Enamel and dentine lesions responded differently (Figure 4): enamel lesions progressed in both groups, but less with infiltration; dentine lesions progressed in controls but were largely stabilised with Icon (Cohen\u0026rsquo;s \u003cem\u003ef\u003c/em\u003e=0.47, large). DMF‑T had no independent main effect (\u003cem\u003ep\u003c/em\u003e\u0026ge;0.05). However, interaction analyses indicated greater progression in patients with higher DMF‑T, especially in controls (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05; Figure 5), while lesions in low‑DMF‑T patients remained stable after infiltration (Cohen\u0026rsquo;s \u003cem\u003ef\u003c/em\u003e=0.74, very large). Three‑way interaction terms (lesion type\u0026times;group\u0026times;time and DMF‑T\u0026times;group\u0026times;time) were excluded from the final GLMM for parsimony; however, because they offer comparable information, the findings are presented graphically (Figures 4 and 5).\u003c/p\u003e\n\u003cp\u003eOverall, resin infiltration was associated with significantly reduced progression compared with oral‑hygiene instruction alone, with the protective effect most pronounced at enamel level and in patients with lower baseline caries experience.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis non‑interventional cohort evaluated Icon resin infiltration in initial proximal lesions (E1, E2, D1) using standardised quantitative radiographic measurements at 6 and 12 months. The null hypothesis was rejected: infiltration consistently slowed progression.\u003c/p\u003e\n\u003cp\u003eRandomised trials provide the highest evidence [17] but can be constrained by ethical and practical considerations [18]. Prospective observational designs offer complementary insights for micro‑invasive techniques requiring extended follow‑up [19]. Our mixed retrospective\u0026ndash;prospective approach captured real‑world outcomes under standardised radiography, enabling assessment of individual risk factors alongside treatment effects [20].\u003c/p\u003e\n\u003cp\u003eIcon (DMG; Hamburg, Germany) is engineered for early proximal lesions [9]. Its mechanism involves penetrating demineralised enamel micropores to create a diffusion barrier [21,22]. While effective on proximal surfaces, limitations include surface smoothness and retention [23]. Three‑dimensional topography indicates incomplete smoothing, leaving defects and exposed prisms susceptible to demineralisation [24], which may contribute to biofilm accumulation. Thus, RI\u0026rsquo;s promise is accompanied by intrinsic limitations.\u003c/p\u003e\n\u003cp\u003eEffectiveness varies across ages and risk profiles [15,25,26]. In this study of adults aged 18\u0026ndash;51 years, participants were stratified by DMF‑T. Radiographic parameters were tightly standardised in line with ALARA: 60 kVp tube voltage, consistent geometry and individualised bitewing holders with red baseplate wax [27,28]. ImageJ enabled quantitative lesion measurements. Prior in vivo Icon studies often used categorical visual assessments [26,29\u0026ndash;32] or digital subtraction radiography [33\u0026ndash;35]. Few studies have demonstrated quantitative proximal measurements with ImageJ, predominantly in vitro [36,37]. Our work therefore provides methodological innovation.\u003c/p\u003e\n\u003cp\u003eLesion progression control in the Icon group paralleled area findings (Tables 2\u0026ndash;3; Figure 3). Baseline lesion areas did not differ statistically between groups. Categorical baseline comparisons showed a greater proportion of dentine lesions in controls and more low‑DMF‑T patients in Icon. These differences were not independently significant in GLMM once group and time were modelled, underscoring the centrality of the group\u0026times;time interaction.\u003c/p\u003e\n\u003cp\u003eOur results align with evidence that infiltration slows progression relative to no treatment [15,16,38,39]. D1 lesions carry higher cavitation potential [40,41]. In our cohort, three D1 lesions in controls progressed to cavitation by 6 months and were retained in analyses using fixed lesion‑length values.\u003c/p\u003e\n\u003cp\u003eAlthough complete three‑dimensional penetration has been demonstrated [24], clinical outcomes are influenced by enamel heterogeneity, dynamic de‑/re‑mineralisation, and lesion microporosity [43\u0026ndash;46]. Infiltration success varies with ICDAS code, pore volume and enamel structure [46,47]. When analysed separately, dentine lesions progressed rapidly, but Icon significantly slowed the rate. Some studies have reported contrasting enamel‑level findings [30,31,34,48\u0026ndash;50].\u003c/p\u003e\n\u003cp\u003eIn high‑risk patients (DMF‑T 5\u0026ndash;10 and 11\u0026ndash;20), progression continued over 12 months in both groups (Figure 5), indicating that restorative or micro‑invasive care alone may be insufficient and should be paired with behaviour change and remineralisation. Pairwise GLMM contrasts showed significant increases only in high‑risk strata.\u003c/p\u003e\n\u003cp\u003eWithin 12 months, infiltration was associated with short‑term control relative to routine care. As RI was developed for non‑cavitated enamel on smooth/proximal surfaces [9], and evidence for dentine‑involving lesions is mixed [30,31,48\u0026ndash;51], durable effectiveness for D1 cannot be assumed. Longer follow‑up with lesion‑level stratification is warranted.\u003c/p\u003e\n\u003cp\u003eIn summary, over 12 months, resin infiltration significantly slowed progression of initial proximal lesions compared with no treatment, with benefits most evident at the enamel level. Standardised ImageJ‑based radiographic monitoring provided reliable in vivo quantification. Resin infiltration is an effective micro‑invasive strategy that may defer restorative intervention while preserving tooth structure. Larger cohorts with extended follow‑up are required to clarify durability, particularly in high‑risk patients and in lesions extending into dentine.\u003c/p\u003e\n\u003cp\u003eStrengths include: (1) standardised, quantitative radiographic measurement using ImageJ; (2) enhanced reproducibility via individualised positioning guides; (3) prospective 6‑ and 12‑month evaluations under routine conditions; (4) modelling that accounts for within‑patient clustering (GLMM); and (5) educational relevance for training in micro‑invasive care.\u003c/p\u003e\n\u003cp\u003eLimitations include: (1) a modest sample; (2) a one‑year horizon; (3) potential minor geometric variation despite standardisation; and (4) absence of deproteinisation/delipidation pretreatment, which may enhance etching and penetration and could partly explain progression in some enamel lesions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003estatement\u003c/strong\u003e: The protocol was approved by the Non‑Interventional Research Ethics Committee of Sel\u0026ccedil;uk University (Decision No: 2022/37). Written informed consent was obtained from all prospectively enrolled participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent for participation and radiographic follow‑up. No identifiable images are included.\u003c/p\u003e\n\u003ch2\u003eConflict of interest disclosure:\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eClinical trial registration\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding statement:\u003c/h2\u003e\n\u003cp\u003eThis research was supported by the Sel\u0026ccedil;uk University Scientific Research Projects Coordination Unit (Project No. 23132001). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eS.\u0026Ouml;. performed software development, formal analysis, investigation, visualisation, drafted the original manuscript, and curated resources. N.\u0026Uuml;. provided supervision, methodology, project administration, conceptualisation, validation, and writing\u0026mdash;review and editing. B.\u0026Ccedil;. contributed to methodology, supervision, data curation, software, and conceptualisation. All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data underlying this article are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGoldberg M (2020) Enamel and dentin carious lesions. 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Sci Rep 14:12444. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-024-63289-0\u003c/span\u003e\u003cspan address=\"10.1038/s41598-024-63289-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eComparison of demographic and clinical characteristics (categorical variables) between groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIcon\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTests\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge,\u0026nbsp;\u003c/strong\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e22 (20-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e25 (21-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eMann-Whitney U\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex,\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 82px;\"\u003e\n \u003cp\u003eYates correction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e22(41.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e8(18.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e31(58.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e57(87.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaries level,\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 82px;\"\u003e\n \u003cp\u003eYates correction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eEnamel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e24(45.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e13(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eDentin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e29(54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e52(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDMF-T\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePearson chi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e1-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e27(50.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e18(27.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e9(16.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e27(41.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e11-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e17(32.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e20(30.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLesion location,\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePearson chi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eDistal (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e28(52.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e31(47.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMesial (M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e25(57.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e34(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth group,\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePearson chi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e7(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e5(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003ePremolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e34(64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e44(67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMolar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e12(22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e16(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJaw (arch),\u0026nbsp;\u003c/strong\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 82px;\"\u003e\n \u003cp\u003eYates correction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMaxillary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e31(58.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e42(64.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMandibular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e22(41.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e23(35.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eLesion‑length measurements (mm) by group and time. Means \u0026plusmn; SD; ranges shown.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"482\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIcon\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.21 \u0026plusmn; 0.52\u003csup\u003eA,B\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.51 \u0026plusmn; 0.47\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.25 \u0026plusmn; 0.50\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.72 \u0026plusmn; 0.49\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.35 \u0026plusmn; 0.53\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e1.77 \u0026plusmn; 0.54\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFootnotes.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ep*:\u0026nbsp;\u003c/strong\u003ebetween-group comparison at each time point by independent samples t-test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e: within-group time effect by repeated measures ANOVA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT0:\u0026nbsp;\u003c/strong\u003ebaseline; \u003cstrong\u003eT1:\u003c/strong\u003e 6 months; \u003cstrong\u003eT2:\u003c/strong\u003e 12 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-B\u003c/strong\u003e: Within columns, values sharing the same uppercase superscript letter (A, B) do not differ significantly (Bonferroni\u0026ndash;adjusted \u003cem\u003ep\u0026ge;\u003c/em\u003e0.05). Different letters indicate \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eLesion area (mm\u0026sup2;) by group and time. Medians (IQR); ranges shown.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"412\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIcon\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1 (0.66-1.67)\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.13 (0.89-1.62)\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.13 (0.74-1.83)\u003csup\u003eAB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.52 (1.17-2.04)\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.30 (0.86-1.79)\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.62 (1.19-2.05)\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFootnotes.\u003cbr\u003e\u003c/strong\u003e* Mann\u0026ndash;Whitney U test (between groups at that time point).\u003c/p\u003e\n\u003cp\u003e** Friedman test (within-group comparison across T0\u0026ndash;T2).\u003cbr\u003e\u0026nbsp;T0 = baseline; T1 = 6 months; T2 = 12 months.\u003cbr\u003eA\u0026ndash;B: Within columns, values sharing the same uppercase superscript letter (A, B) do not differ significantly (Bonferroni\u0026ndash;adjusted \u003cem\u003ep\u003c/em\u003e\u0026ge;0.05). Different letters indicate \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eGLMM results for lesion-length measurements in proximal lesions.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"482\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e15.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaries level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e103.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup \u0026times; Time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTooth group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ImageJ, Proximal caries, Radiographic monitoring, Resin infiltration, Statistics: GLMM","lastPublishedDoi":"10.21203/rs.3.rs-7875571/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7875571/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eResin infiltration is widely used for non‑cavitated proximal caries lesions, yet evidence from standardised, quantitative radiographic monitoring is limited. This study evaluated short‑term outcomes using a reproducible, image‑based workflow.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this observational cohort, adults (n\u0026thinsp;=\u0026thinsp;23; 118 proximal lesions) were managed with resin infiltration (Icon) plus oral-hygiene instruction (10 patients; 53 lesions) or oral-hygiene instruction alone (13 patients; 65 lesions). Standardised bitewing radiographs were obtained at baseline, 6, and 12 months. Lesion length and area were measured in ImageJ following a reproducible calibration protocol. Between-group and longitudinal effects were tested using repeated-measures analyses and generalised linear mixed models (GLMMs) with patient-level random intercepts.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOver 12 months, mean lesion-length increase was 0.14 mm with infiltration versus 0.26 mm in controls. GLMMs showed significant effects of group, time, and baseline caries level, and a significant group\u0026times;time interaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; large effect), indicating diverging trajectories. The protective effect was most evident at enamel level; dentine-involving lesions were stabilised relative to controls. DMF-T was not independently significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026ge;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eWithin a standardised quantitative radiographic workflow, resin infiltration was associated with less short-term radiographic progression than no treatment. Findings support lesion-level quantitative monitoring to inform micro-invasive management and follow-up scheduling.\u003c/p\u003e","manuscriptTitle":"Quantitative Radiographic Assessment of Proximal Caries Lesions Treated with Resin Infiltration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 12:47:36","doi":"10.21203/rs.3.rs-7875571/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ffed1c59-cd7b-45bf-ba2a-75672945caab","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T06:23:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 12:47:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7875571","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7875571","identity":"rs-7875571","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}