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Objectives For deep carious lesions, selective or stepwise carious tissue removal (SE, SW) seem advantageous compared with non-selective removal. For primary molars, there is insufficient evidence comparing SE against SW. This randomized pilot trial compared SE and SW over 12 months. Methods A two-arm superiority trial was conducted comparing SE and SW in primary molars with deep lesions but without pulpal symptoms. We recruited 74 children (one molar/child) aged 3–9 years. In both groups, peripheral carious tissue removal was performed at T1 to hard dentin. In proximity to the pulp, leathery dentin was left followed by an adhesive compomer restoration. Blinded re-examination was performed after six months (T2). Molars allocated to SW were re-entered, removal to firm dentin carried out pulpo-proximally, and again restored. After another 6 months, all molars were re-examined (T3). Our primary outcome was success, defined as no restorative/endodontic complications (including pulp exposure) leading to reinterventions. Secondary outcomes included total treatment and opportunity costs. Patients’, dentists’ and parents’ subjective assessments were recorded. This trial was registered (ClinicalTrials.gov/NCT02232828). Results After 12 months a total of 72 children (36 SE, 36 SW) were analyzed. Three failures occurred (2 exposures in SW, 1 pulpal complication leading to extraction in SE) (p > 0.05). The subjective evaluation by patients, parents or dentists did not differ significantly. Combined treatment and opportunity costs were significantly higher in SW (mean;SD: 186;61 Euro) than SE (100;59) (p Conclusions The significantly increased costs for performing SW instead of SE in deep carious lesions in primary molars may not be justified. Clinical significance For primary molars with deep lesions, but vital pulps, SE was less costly at similar efficacy compared with SW. Dentists’ decision-making should consider this alongside further clinical aspects.

Objectives Dentists have a range of options for managing molars with severe molar-incisor hypomineralization (MIH), each with different long-term implications. The cost-effectiveness of managing molars with severe MIH was assessed. Methods A mixed public-private-payer perspective within German healthcare was adopted. Individuals with one to four severely MIH-affected molars were followed over their lifetime. We compared: (1) removal of the tooth/teeth and orthodontic alignment of the second and third molars (Ex/Ortho); (2) restoration of the tooth using resin composite (Comp); (3) restoration using an indirect metal crown after temporizing it using a preformed metal crown (PMC/IR). The health outcome was tooth retention years. Transition probabilities were estimated based on the best available evidence. Cost calculations were based on German dental fee catalogues. Monte-Carlo microsimulations were performed for cost-effectiveness-analysis. Results If extraction was performed at the optimal age (9.5/11 years for maxillary/mandibular molars), Ex/Ortho was most cost-effective (67 years, 446–938 Euro). Comp (51 years, 1911 Euro) and PMC/IR were dominated (50 years, 2033 Euro). This cost-effectiveness ratio was also determined when >1 molar was treated. If extraction was performed later, assuming no spontaneous alignment, Ex/Ortho was more costly than Comp, at least when only 1 molar was treated. Conclusions For molars with severe MIH, extraction at the optimal age and, if needed, orthodontic alignment can be cost-effective, especially when >1 molar is affected. For single molars where the chance of spontaneous alignment is low, Comp might also be considered. These findings apply to German healthcare and within the limitations of this study only. Clinical significance: When deciding how to manage molars with severe MIH, both tooth retention, with lower costs but higher needs for re-treatments, and tooth removal, with possible need for orthodontic alignment, can be considered. Considering cost-effectiveness, the latter may be preferable, especially if the age of extraction is chosen correctly, or several molars are affected.

Objectives The aim of this in vitro study was to evaluate three treatment modalities [infiltrant resin (IR), micro-filled infiltrant resin (MFIR), infiltrant-sealant-combination (ISC)] regarding both their abilities to penetrate lesions differing in ICDAS-codes and to fill fissures and cavities. Materials and methods Extracted human molars (n = 90) showing fissure caries lesions with and without cavitations were etched with 15% hydrochloric acid (HCl) that was mixed with abrasives and a 15% HCl-solution (1:1). The etching gel was rubbed for 30 s within the fissure and, if eligible, within the cavity using a brush. After this pretreatment an infiltrant (Icon; DMG; IR) or an infiltrant mixed with microfillers (MFIR) was applied. ISC included the application of an infiltrant followed by a fissure sealant (Helioseal; Ivoclar Vivadent) From each tooth slices showing a non-cavitated (based on ICDAS-2) or cavitated lesion part (based on ICDAS-3/5) were prepared. Lesion (LA) and penetration areas (PA) as well as the completeness of fissure and cavity filling were analyzed using dual staining and confocal laser scanning microscopy. Results Percentage penetration (PP) was calculated as 100 × PA/LA. PP [median (25th/75th)] did not differ significantly between IR [95 (86/100)%], MFIR [93 (62/100)%] or ISC [89 (67/97)%] (p > 0.05; Kruskal-Wallis test). All three materials filled about 90% of the dimensions of fissures and cavities (p > 0.05; Kruskal-Wallis test). Conclusion It can be concluded that MFIR seems to be suitable to fill fissures and cavities like a fissure sealant and that it penetrates fissure caries lesions similarly deep as the conventional infiltrant after an experimental etching regime. Clinical significance The MFIR seems to combine advantages of the fissure sealing and the caries infiltration procedure.

Objectives The risk of ‘caries adjacent to restorations’ (CAR) might depend on the used restorative materials. In situ studies are often used to compare the risk of caries adjacent to different materials. We aimed to review in situ studies to evaluate how different materials contribute to risk of CAR. Data sources We included in situ controlled trials comparing directly placed restorative materials, reporting on caries (mineral loss, measured via radiography or micro-hardness) adjacent to these materials. Medline, Embase and Cochrane CENTRAL were systematically searched. Screening and data extraction was performed independently by two authors. Materials were classified according to the used adhesive and restorative materials. Fixed-effects pairwise and frequentistic network meta-analyses were performed Study selection Nine studies (132 patients, 8 materials) were included, yielding inconsistent results. We could not identify underlying reasons, as confounders were only limitedly reported. The resulting material rankings come with great uncertainty, and raise doubts as to the validity and transferability of in situ studies as well as the applicability of their findings. Conclusions The current body of evidence of in situ studies is insufficient for firm conclusions as to the caries risk adjacent to different materials. The validity and applicability of included studies remain uncertain. Clinical significance While single in situ studies seem to convey consistent and applicable information, the overall body of evidence is inconsistent, limiting the conclusions which can be drawn from it.

Probiotics might be beneficial to prevent or treat caries, gingivitis or periodontitis. We aimed to appraise trials assessing probiotics for managing caries and periodontal disease.We included randomized controlled trials comparing the efficacy of probiotics versus (placebo) control with regards to Streptococcus mutans [SM], lactobacilli [LB], periodontal pathogens numbers, gingivitis, oral hygiene, caries incidence/experience increment, or periodontitis. Meta-analysis and trial-sequential-analysis were performed.Three electronic databases (Medline, Embase, Central) were screened.50 studies (3247 participants) were included. Studies were mainly performed in children and used lactobacilli (45); bifidobacteria (12) or other genus (3). Probiotics significantly increased the chance of reducing SM (OR: 2.20, 95% CI: 1.23/3.92) or LB (OR: 2.84; 1.34/6.03)10(4)CFU/ml. Such reduction was confirmed for SM counts (standardized mean differences: -1.18, 95% CI: -1.64/-0.72), but not LB (SMD: 0.33; 0.15/0.52). For periodontal pathogens, no significant difference was found. Probiotics significantly reduced bleeding-on-probing (SMD: -1.15; -1.68/-0.62) and gingival index (SMD: -0.86; -1.52/-0.20), but not plaque index (SMD: -0.34; -0.89/0.21). Caries incidence was not significantly reduced (OR: 0.60; 0.35/1.04), neither was caries experience (SMD: -0.26; -0.55/0.03) or CAL (SMD: -0.46; -0.84/0.08). In contrast, probing-pocket depths (SMD: -0.86; -1.55/-0.17) were significantly reduced. Data was quantitatively insufficient for conclusive findings, and risk of bias was high.Current evidence is insufficient for recommending probiotics for managing dental caries, but supportive towards managing gingivitis or periodontitis. Future studies should only record bacterial numbers alongside accepted disease markers or indicators.Probiotic therapy could be used for managing periodontal diseases. For caries, further studies should ascertain both efficacy and safety.

The choice of trial comparators might impact on the validity of the available evidence. We aimed at evaluating dental restorative trial networks and the underlying comparisons made, hypothesizing that certain comparators are disproportionally preferred or avoided.A systematic review was performed via Medline, CENTRAL and EMBASE. Randomized controlled trials on dental restoration or adhesive materials published 2005-2015 were included. Social network analysis techniques were used to assess trial networks.114 studies on 15321 restorations placed in 5232 patients were included. 57 and 53 trials investigated restoration of cervical and load-bearing cavities, respectively. Four trials on non-cervical, non-load-bearing cavities did not form a network and were not evaluated. The most frequently assessed material combination was hybrid composites placed using 2-step etch-and-rinse adhesives. In cervical cavities, the majority of trials compared adhesives, not restorative materials. In load-bearing cavities, testing other restorative materials (ormocers, compomers) was common, too. In both networks, comparisons within material classes were frequent. There was significant homophily (p0.001), i.e. certain material classes were preferred as comparators, while this preference seemed to change with time. Only very few comparisons yielded significant differences between materials.The disproportional use of certain material classes as comparator might be due to their perceived role as gold standard. Compared with other scientific disciplines, dental restorative trial networks seem less prone for bias by comparator choice. Factors underlying the network geometry should be assessed to understand drivers of the research agenda.

Objectives In this pilot study, we applied deep convolutional neural networks (CNNs) to detect caries lesions in Near-Infrared-Light Transillumination (NILT) images. Methods 226 extracted posterior permanent human teeth (113 premolars, 113 molars) were allocated to groups of 2 + 2 teeth, and mounted in a pilot-tested diagnostic model in a dummy head. NILT images of single-tooth-segments were generated using DIAGNOcam (KaVo, Biberach). For each segment (on average 435 × 407 × 3 pixels), occlusal and/or proximal caries lesions were annotated by two experienced dentists using an in-house developed digital annotation tool. The pixel-based annotations were translated into binary class levels. We trained two state-of-the-art CNNs (Resnet18, Resnext50) and validated them via 10-fold cross validation. During the training process, we applied data augmentation (random resizing, rotations and flipping) and one-cycle-learning rate policy, setting the minimum and maximum learning rates to 10−5 and 10-3, respectively. Metrics for model performance were the area-under-the-receiver-operating-characteristics-curve (AUC), sensitivity, specificity, and positive/negative predictive values (PPV/NPV). Feature visualization was additionally applied to assess if the CNNs built on features dentists would also use. Results The tooth-level prevalence of caries lesions was 41%. The two models performed similar on predicting caries on tooth segments of NILT images. The marginal better model with respect to AUC was Resnext50, where we retrained the last 9 network layers, using the Adam optimizer, a learning rate of 0.5 × 10−4, and a batch size of 10. The mean (95% CI) AUC was 0.74 (0.66-0.82). Sensitivity and specificity were 0.59 (0.47-0.70) and 0.76 (0.68-0.84) respectively. The resulting PPV was 0.63 (0.51-0.74), the NPV 0.73 (0.65-0.80). Visual inspection of model predictions found the model to be sensitive to areas affected by caries lesions. Conclusions A moderately deep CNN trained on a limited amount of NILT image data showed satisfying discriminatory ability to detect caries lesions. Clinical significance CNNs may be useful to assist NILT-based caries detection. This could be especially relevant in non-conventional dental settings, like schools, care homes or rural outpost centers.

Objectives This systematic review aimed at evaluating the accuracy of radiographic caries detection for different lesions at different locations. Data Studies reporting on the accuracy (sensitivity/specificity) of radiographic detection of natural primary caries lesions under clinical or in vitro conditions were included. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity and diagnostic odds ratios (DORs) were calculated using random-effects meta-analysis. Analyses were performed separately for occlusal and proximal lesions, with further discrimination between any kind of lesions, dentine lesions, and cavitated lesions. Sources Electronic databases (Medline, Embase, Cochrane Central) and grey literature were systematically searched, complemented by cross-referencing from bibliographies. Study selection From 947 identified articles, 442 were analyzed full-text. 117 studies (13,375 teeth, 19,108 surfaces) were included, the majority of them reporting on permanent teeth and having high risk of bias. The detection of any kind (i.e. also initial) lesions had low sensitivities (pooled DOR [95% CI]: 0.24 [0.21/0.26] to 0.42 [0.31/0.34]), but moderate to high specificities (0.70 [0.76/0.84] to 0.97 [0.95/0.98]). For dentine lesions, sensitivities were higher (from 0.36 [0.24/0.49] for proximal to 0.56 [0.53/0.59] for occlusal lesions), and specificities ranged between 0.87 [0.85/0.89] and 0.95 [0.94/0.96]. No studies reported on cavitated occlusal lesions, whilst for cavitated proximal lesions, sensitivities increased above 0.60, whilst sensitivities remained high (above 0.90). Conclusions Radiographic caries detection is highly accurate for cavitated proximal lesions, and seems also suitable to detect dentine caries lesions. For detecting initial lesions, more sensitive methods could be considered in population with high caries risk and prevalence. Clinical significance Radiographic caries detection is especially suitable for detecting more advanced caries lesions, and has limited risks for false positive diagnoses. For groups with high caries risk and prevalence, alternative detection methods with higher sensitivity for initial lesions might be considered.

Selective (incomplete) caries excavation reduces the risk of pulpal complications, but might compromise the properties of teeth or restorations. Different restorative approaches might be required after selective instead of complete excavation. We compared margin integrity, micro-leakage and fracture resistance of selectively excavated and differently restored premolars in vitro.In 72 extracted human premolars, artificial residual lesions were induced on pulpo-axial walls of standardized cavities. Teeth were restored using one of three bonding systems (OptiBond FL, Clearfil SE Bond, G-aenial Bond) and a fibre-enforced (EverX) or standard hybrid composite resin (Filtek Z250). After thermo-mechanical cycling, groups (n = 12) were compared regarding their gingivo-cervical margin integrity (proportion of acceptable margins), microleakage depth, and fracture resistance, with statistical evaluation using generalized linear modelling.Margin integrity was significantly influenced by the bonding system (p0.001), but not by the composite (p = 0.105). Proportions of acceptable margins were increased in teeth restored with OptiBond FL (median [25th/75th percentiles]: 93 [78/100%]) or Clearfil SE (82 [60/94]%) compared with G-aenial Bond (43 [15/74%]; p0.05). Neither bonding systems nor composites significantly influenced leakage depth in enamel (p = 0.749/0.569) or dentine (p = 0.112/0.909). Fracture resistance was significantly influenced by bonding system (p = 0.008) and composite (p = 0.001), and was higher in teeth restored using OptiBond FL (mean [SD]: 1210 [336]N) compared with Clearfil SE (1007 [208]N) or G-aenial Bond (1023 [281]N, p0.05), and using EverX (1182 [314]N) instead of Filtek Z250 (979 [228]N; p0.01).Bonding systems which perform well in completely excavated teeth also yielded good results for selectively excavated teeth in vitro. Using fibre-enforced composites to restore selectively teeth increased fracture resistance.Bonding systems which perform well in completely excavated teeth are also suitable for restoring selectively excavated teeth. Using fibre-enforced composites seems suitable for increasing the fracture resistance of selectively excavated teeth and their restorations.

Objectives Conventionally, caries excavation is performed until only hard dentine remains, while more selective and reliable criteria might be available. We aimed at systematically comparing the effects of using different excavation criteria via network meta-analysis. Sources Electronic databases were searched for randomised or non-randomised clinical trials (RCTs/NRCTs) evaluating excavation of cavitated lesions. Data Criteria were divided into six groups: Excavation until pulpo-proximal dentine on the cavity floor was (1) either hard on probing, (2) slightly softened on probing, (3) not stainable by caries-detector-dye, or until (4) self-limiting polymer burs, (5) fluorescence-assisted devices or (6) chemo-mechanical gels indicated termination of the excavation. Evaluation of risk of complications, risk of pain/discomfort, excavation time, and number of remaining bacteria were then undertaken using Bayesian network meta-analysis. Study selection 28 studies (19 RCTs, 9 NRCTs) with 1782 patients (2555 lesions), most of them investigating primary teeth, were included. Risk of complications was highest when excavating until only non-stainable dentine remained, and lowest when not attempting to remove all softened dentine. Risk of pain significantly decreased if self-limiting chemo-mechanical excavation or fluorescence-assisted lasers were used instead of excavating until all dentine was hard. When not attempting to remove all softened dentine, the time required for excavation was shortest, whilst the greatest number bacteria remained. Conclusions Not attempting to remove all softened or stainable dentine might reduce the risk of complications. Data regarding self-limiting excavation is insufficient for definitive conclusions. Excavation criteria should be validated against clinically relevant outcomes. Clinical significance Given current evidence, dentists might not need to attempt excavation until only hard dentin remains in proximity to the pulp. Instead, their choice of excavation criterion or method should be guided by clinical requirements and outcomes.

Since some probiotic bacteria are cariogenic themselves, their suitability for caries management is questionable. Inactivated bacteria or their supernatants have been found to exert probiotic effects, whilst having several advantages compared with living bacteria. We hypothesized that viable and heat-inactivated Bifidobacterium animalis BB12 reduces the cariogenicity of Streptococcus mutans (SM) in vitro.We assessed mono- and mixed species biofilms of SM and viable or heat-inactivated BB12. Biofilms were grown in a continuous-culture-system under cariogenic conditions on smooth proximal enamel or cavitated dentine. For each of eight experimental subsets (4 biofilms×2 hard-tissue conditions), a total of 32 specimens was used. After 10 days, bacterial numbers of 12 biofilms per group were analysed, and all specimens submitted to transversal microradiography.Mineral loss was higher in cavitated dentine than smooth enamel for all biofilms (p0.001, t-test). BB12-monospecies biofilms induced significantly less mineral loss than SM in both enamel (p0.05) and dentine (p0.001). Viable BB12 did not significantly reduce cariogenicity of SM (p0.05), whilst heat-inactivated BB12 decreased cariogenicity of SM in dentinal cavities (p0.01). Bacterial numbers were higher on dentine than enamel (p0.05), but not significantly influenced by biofilm species (p0.05).Heat-inactivated BB12 reduced the cariogenicity of SM in dentinal cavities in vitro. Inactivated probiotics might be suitable for caries control.

The aim of this in vitro study was to evaluate the penetration of an infiltrant and a sealant, when applied as recommended, into fissure caries lesions.The fissure systems of extracted human teeth were classified according to the international caries detection and assessment system (ICDAS, codes: 0, 1, 2). Within each ICDAS-code ten teeth were either etched with 37% H3PO4-gel for 60s and subsequently sealed ('Fissure Sealing'; Helioseal; Ivoclar Vivadent) or etched with 15% HCl-gel for 120s and subsequently infiltrated ('Resin Infiltration'; Icon; DMG). Additionally, ten teeth with ICDAS-code 2 were etched with 37% H3PO4-gel for 120s and infiltrated ('Soft-Etch-Infiltration'). Specimens were cut perpendicular to their surfaces, polished, and confocal microscopic images were obtained. Lesion depths (LDmax) and penetration depths (PDmax) were measured and percentage penetration was calculated as PPmax=PDmax/LDmax×100.Baseline LDmax [median (interquartile range)] for ICDAS-code 2 lesions was 1192 (805-1512)μm. In ICDAS-code 2 lesions PPmax was significantly higher for specimens treated with 'Resin Infiltration' [41 (30-78)%] compared to 'Soft-Etch-Infiltration' [11 (0-21)%] or 'Fissure Sealing' [5 (0-9)%] (p0.05; Mann-Whitney test). PPmax did not differ significantly between groups in ICDAS-code 0 and 1 lesions (p0.05).The fissure sealant when applied after etching with H3PO4-gel only penetrates superficially into non-cavitated fissure caries lesions. Penetration of an infiltrant is superior in particular after etching with HCl-gel.Compared with sealing, infiltration of fissure caries lesions leads to more deeply infiltrated lesions, which might in turn result in superior abilities to hamper caries progression.

Objectives The aim of this in vitro study was to evaluate the ability of one commercial and five experimental infiltrating resins (infiltrants) to camouflage enamel white spot lesions immediately after resin infiltration and after a staining period. Methods In each of 120 bovine enamel samples, two artificial caries lesions were created (windows A and C; pH = 4.95, 50 days), whereas two windows were protected serving as sound controls (B and D). After etching windows C and D (37% phosphoric acid), specimens were randomly allocated to 6 groups. Either one of 5 experimental infiltrants or a commercial infiltrant (Icon, DMG) (refractive indices 1.50–1.55) was applied and light cured. After half of each specimen was polished, samples were remineralized (pH = 7.0) and stained with tea and red wine for 50 days. Photographic images after various treatment steps were obtained. Color differences (Δ E ) of untreated (A) and treated lesions (C) as well as infiltrated sound enamel (D) were compared with untreated enamel (B). Results All infiltrants showed significantly better color match with sound enamel (median Δ E [25th/75th percentile]: 2.2 [1.5/3.1]) than untreated controls (9.3 [8.0/10.9]) ( p E of infiltrated lesions was demonstrated ( R 2 = 0.43, p > 0.05). Staining was significantly reduced for polished infiltrated lesions compared to untreated or infiltrated unpolished lesions ( p Conclusions Resin infiltration is suitable to mask artificial white spot lesions. Polished infiltrated lesions are resistant to staining in vitro. Clinical significance Resin infiltration is a micro-invasive approach to camouflage post-orthodontic white spot lesions.

Objective Caries infiltration is an innovative approach to treat medium stages of caries that bridges the gap between preventive and invasive measures, whereby hard tissues are preserved. Special low viscosity resins (infiltrants) showed almost complete penetration into natural lesions when applied for 5 min. Since shorter application times seem to be clinically more feasible, the aim of this in vitro study was to compare the penetration of an infiltrant (Icon pre-product; DMG, Hamburg, Germany) into natural caries lesions after various application times. Methods Extracted permanent human posterior teeth showing non-cavitated proximal caries lesions were infiltrated for either 0.5, 1, 3, or 5 min ( n = 20) and light-cured. Specimens were prepared and lesion (LD) as well as penetration depths (PD) were analysed using dual fluorescence confocal microscopy. Results PD [median (Q25;Q75)] at maximum LD after 0.5 min [159 (27;340) μm] and 1 min [152 (69;375) μm] were significantly lower compared to those after 3 min [414 (338, 518) μm] and 5 min [407 (332;616) μm] ( p 500 μm) could be penetrated almost completely after 3 min [98 (88;100)%] and 5 min [100 (81;100)%] application. Conclusions Thus, 3 min application of an infiltrant seems to be sufficient to achieve an almost complete penetration of enamel caries.

Objectives Arresting of enamel lesions by infiltration with light curing composite resins might be a treatment alternative of future micro-invasive dentistry. So far only commercially available adhesives and fissure sealants have been used to infiltrate enamel lesions. Since these products have been optimized for adhesive purposes, the aim of this study was to develop optimized resins for the infiltration of enamel lesions and to measure their physical properties. Methods The penetration coefficients (PCs) of five adhesives and a fissure sealant as well as 66 experimental composite resins were determined. To establish the resins’ PCs the viscosities, surface tensions, and contact angles to bovine enamel were measured. Results For the commercially available products PCs from 4.0 to 278.9 cm/s were measured. Four of these materials showed a good correlation with penetration depths obtained in a previous study. Experimental composites showed PCs from 0.2 to 474.9 cm/s. The addition of ethanol significantly increased the PCs due to a decrease of viscosity and contact angle. Highest PCs were found for mixtures containing TEGDMA, HEMA and 20% ethanol. Significance The knowledge about the PC of resin composites seems to be useful for the development of new materials optimized to infiltrate enamel lesions.

Sealing of approximal enamel lesions by infiltration with low viscous resins seems to be a promising approach in non-operative dentistry and should bear advantages compared to remineralization or invasive treatment.The aim of this in vitro study was to evaluate the penetration ability of five dental adhesives and a fissure sealant into initial enamel lesions for an application time of either 15 s or 30 s.In each of 54 specimens of bovine enamel, three windows were demineralized for 14 days. Subsequently, two windows were etched with phosphoric acid for 5s in order to degrade the surface layer, whereas one window served as untreated control. The specimens were randomly divided into six groups and a fissure sealant as well as five different adhesives were applied onto the subsurface lesions and allowed to penetrate for either 15 or 30 s. Overlying material was wiped away and the resins were light cured. To visualize the penetrated resins and the remaining pore structures, the specimens were infiltrated with a low viscous fluorescent resin and studied using a Confocal Laser Scanning Microscope (CLSM).For Helioseal, Heliobond, Resulcin Monobond, and Excite an application time of 30s resulted in significantly higher (p0.05; t-test) penetration depths (47-105 microm) compared to 15s (29-49 microm).Helioseal, Heliobond, Resulcin Monobond, and Excite are suitable for sealing artificial subsurface enamel lesions in vitro. After an application time of 30 s a significant deeper penetration could be observed for these materials.