전치부의발육결함및교정후탈회병소의심미적개선을위한 resin infiltration 김은영 안울진 김신 정태성 부산대학교치의학전문대학원소아치과학교실 국문초록어린이영구전치의법랑질발육결함이나고정성장치에의한교정치료후탈회병소는흔히심미적문제를유발한다. 본연구는상악전치부에위원인에의한탈회로인하여백반양병소를보이는 21명어린이의 38개치아를대상으로, 최근비침습적인방법으로소개된 resin infiltration 기법을적용하고, 병소의색조의임상적개선효과를비교, 분석하여다음과같은결과를얻었다. 1. 1주후색조가개선된병소는발육결함병소의 25%, 교정탈회병소의 61% 로나타났다. 2. 발육결함병소의 40%, 교정치료후탈회병소의 6% 에서는시술전후의색조변화를관찰할수없었다. 3. 법랑질발육결함병소에서는시술직후보다 1주후에더많은색조변화를관찰할수있었다. 결과적으로일부증례에서는색조의극적인개선이관찰되었으나, 또일부증례에서는변화가거의나타나지않았는데, 이는병소깊이의차이에기인한것으로사료되었다. 주요어 : Resin infiltration, 최소침습, 색조, 탈회, 법랑질발육결함 Ⅰ. 서론소아치과임상에서는영구전치법랑질의발육결함이나우식성탈회에의한백반양병소를비교적흔히보게된다. 법랑질발육결함병소 (developmental defects of enamel, 이하 DDE) 의특수한형태인대구치-전치저석회화증 (Molar Incisor Hypomineralization) 은 3.6~25% 의유병률을보인다 1). 교정치료에의해기인된백반양병소의유병율은 2~96% 로다양하게보고되고있는데, 그이유는평가방법, 치료전탈회병소존재, 교정치료시불소도포여부에따라달라지기때문이다 2). 이병소들은심부로의확대가능성뿐아니라, 심미적인측면에서문제가된다 3). 고정성장치를사용한교정치료로인한법랑질탈회병소는장치제거후부분적으로는재광화되나백반양색조는거의비가역적이며 4-6), 교정치료완료후 5년이지난뒤에도지속됨이보고되었다 7). 이러한백반양병소의치료법으로여러가지방법들이제시 되고있다. 지금까지다음과같은 4가지방법들이비교적흔히사용되어오고있다. 첫째, 불소나 CPP-ACP와같은제제를이용하여재광화를촉진하는방법을들수있다 5,8,9). 그러나이와같은재광화술식은어느정도효과적이기는하나, 병소내부로침투하지못해백반양탁색을제거하는데는한계가있다 8,10). 따라서이방법이효과적이기위해서는장시간이소요되며우식의초기단계에적용이이루어져야하고, 환자의협조에의존해야하는단점이있다 8). 둘째, 미백을들수있는데 11,12), 이방법역시심미적개선에는한계가있고술후과민증등의부작용이흔히나타나며, 탈회법랑질뿐아니라건전한법랑질의미세경도도감소시키는문제가있다 13-15). 셋째로, 미세연마술이백반양병소의치료에흔히사용되고있는데 16-20), 그러나이것은적용시간과횟수, 강도에따라법랑질의과도한삭제를초래할수있고 21), 얕은병소에서만효과적이다 22). 마지막으로치질삭제에이은수복치료를하는방법도적지않게사용되고있다. 하지만이방법은매우침습적인방법으로서 23,24), 치질이과도히희생되고치아파괴를가속화한다는측면에서, 그리고백 교신저자 : 김신경상남도양산시물금읍범어리 / 부산대학교치의학전문대학원소아치과학교실 / 055-360-5180 / shinkim@pusan.ac.kr 원고접수일 : 2010 년 01 월 11 일 / 원고최종수정일 : 2010 년 04 월 07 일 / 원고채택일 : 2010 년 04 월 19 일 218
대한소아치과학회지 37(2) 2010 반양병소의치료를필요로하는환자의대부분이소아, 청소년또는젊은성인이라는점을감안한다면, 지양되어야할것으로사료된다. 최근소개된 resin infiltration 개념은산과용해된무기물의확산통로역할을하는미세구멍들을저점도의광중합레진으로폐쇄함으로써병소의진행을정지시키는방법이다 25). 또한레진기질이법랑질구조를강화시킴으로써, 초기우식표층의파괴를예방하는효과가있다 26). 그간일부연구에서이미시판되고있는레진접착제나치면열구전색제를인공우식내로침투시키려는시도를하였으나 27-29), 이들재료는병소의표층에국한하여침투하는등 30) 별성과를거두지못하였다. 최근에들어이와같은목적을위해, 높은침투계수를가진저점도의광중합레진이개발되었다. 이방법은부수적인효과로서, 병소의불투명한색조가사라지고원래의법랑질색조를회복한다는주장이있다. 따라서본연구는 resin infiltration에의한백반양병소의색조변화의유무와그정도를임상적으로평가해볼목적으로시도되었다. Ⅱ. 연구재료및방법 1. 연구대상부산대학교병원소아치과에서정기검진을받고있는어린이중상악전치부에백반양병소를가진어린이 21명으로부터 DDE를가진 20개의치아 (12명, 평균연령 12.5세 ) 와고정성장치에의한교정치료후탈회병소를가진 18개의치아 (9명, 평균연령 15.1세 ) 를대상으로하였다. 이중고정성장치에의한교정치료후탈회치아는교정치료완료후최소 3개월 (9개월 ~3년 8개월, 평균 21개월 ) 이지난치아를대상으로하였다. 본실험은생명윤리위원회 (IRB) 규정에의해서면실험동의서를확보한후시행하였다. 2. Resin infiltration 시술환아의보호를위해보안경을씌우고, 러버댐과치간이개용고무링을장착하여연조직과인접치를보호하였다. 러버컵과세마제를이용하여치면을세마하고세척하였다. 15% 염산 (ICON -Etch, DMG, Germany) 을 2분간적용하여표층법랑질을제거해병소본체의다공성구조를노출시키고, 30초간세척후압축공기로건조시켰다. 99% 에탄올 (ICON -Dry, DMG, Germany) 을 30초간적용하여병소를탈수시킨후, 압축공기로건조시키고, infiltrant 레진 (ICON -Infiltrant, DMG, Germany) 을 3분간적용하여병소내부로스며들게하였다. 표면에남아있는잉여레진을면구로닦아내고, 치간부의레진을제거하였다. 40초간광중합을시행한후, 레진을 1분간적용, 잉여레진제거, 40초간광중합을 1회더반복시행하였다. 수복용레진연마디스크 (Sof-lex disk, 3M ESPE) 를사용하여거칠어진법랑질표면을연마하였다. 3. 임상사진촬영치료전 (T1), 치료직후 (T2), 1주후 (T3) 에치면세마를시행하고임상사진을촬영하였다. 촬영조건을표준화하기위하여두부고정장치를제작하고, 카메라를일정한위치에고정시켜촬영거리와각도를일정하게유지하였다. 디지털카메라 (EOS 450d camera, Canon, Japan), 매크로렌즈 (SP AF90mm F/2.8 Di 1:1 Macrolens, Tamron, USA), 그리고플래쉬 (MT 24-EX twinlight, Canon, Japan) 를사용하여디지털이미지를얻었다. 카메라를수동모드 ( 셔터스피드 1/200, F29, ISO 400, Auto white balance, spot 측광 ) 로설정을일정하게유지하였다. 주변환경의빛을차단하기위해암실에서촬영하였으며, 플래시의광도를일정하게유지하기위해광도계를사용하였다. 또한치면에대한빛의반사를최소화하기위해편광필터와트윈라이트를사용하였다. 그래도반사광이잡힌부분은시료에서제외시켰다. 4. 이미지분석이미지편집프로그램 (Adobe Photoshop CS3 extended ver 10.0, Adobe, USA) 을이용하여백반양병소의경계선을그리고, 정상치면을임의로선택한후, 이미지분석프로그램 (I-solution, IMT technology, Korea) 을사용하여임상사진을분석하였다. 치료전사진에서지정한경계선의레이어를치료후와 1주후사진으로옮겨동일한부위에서색조분석이이루어지도록하였다. 대상치아의백반양병소와정상치면의 RGB값을측정한후 CIE L*a*b* 값으로변환하였다. 본연구에서적용한 CIE L*a*b* 색공간은측색으로얻어진값을표시하는방법으로, 1976년국제조명위원회 (CIE) 에서제정한것이다. CIE L*a*b* 색표계에서 L* 값은명도를나타내는데, 0 은완전한검정을나타내고값이증가할수록명도가증가함을의미한다. a* 와 b* 는색상을나타내며 a* 의양의값은적색, 음의값은녹색, b* 의양의값은황색, 음의값은청색방향을의미한다. 이들 3차원색표계를이용하면색의상호관계를인간의색감각에가까운균등지각색공간으로나타내는것이가능하다 31). 측정된 CIE L*a*b* 값으로아래의공식을이용하여각시기별정상치면과백반양병소의색조차 (ΔE) 를계산하였다. ΔE = (L 1-L 2) 2 + (a 1-a 2) 2 + (b 1-b 2) 2 L1 : 정상치면의 L값 L2 : 백반양병소의 L값 a1 : 정상치면의 a값 a2 : 백반양병소의 a값 b1 : 정상치면의 b값 b2 : 백반양병소의 b값 ΔE는두색조사이의불일치를정량화하는값으로임상적으로색조차이나색변화를감지할수있는임계값은 3.7이다 32). 219
즉정상치면과백반양병소의색조차인 ΔE가 3.7 미만인경우백반양병소를임상적으로인지할수없으며, 3.7 이상인경우백반양병소를임상적으로인지할수있다. 또한임상적으로백반양병소가관찰되더라도치료전과후 ΔE 값의차이가 3.7 이상인경우에는색조변화를감지할수있다. 치료 1주후색조변화정도에따라다음과같이 type 1, 2, 3로구분하였다 ; Type 1 : 치료 1주후정상치면과비교하여백반양탁색이거의완전히사라진경우 ( 정상치면과백반양병소사이의 Δ E 값이 3.7 미만인경우 ), Type 2 : 치료 1주후백반양탁색이어느정도개선되기는하였으나, 아직남아있는경우 ( 정상치면과백반양병소사이의 ΔE 값이 3.7 이상이나, 치료전과 1주후 ΔE 값의차이가 3.7 이상인경우 ), Type 3 : 치료 1주후백반양탁색의색조가거의변하지않은경우 ( 정상치면과백반양병소사이의 ΔE 값이 3.7 이상이고, 치료전과 1주후 ΔE 값의차이가 3.7 미만인경우 ) 5. 통계학적분석윌콕슨의부호순위검정법을이용하여치료전과직후, 치료전과 1주후, 치료직후와 1주후색조차의통계학적유의성에대해검정하였다. Ⅲ. 연구성적 DDE 병소 20개중, 25% 인 5개에서 type 1의결과를보였고, 35% 인 7개에서 type 2, 40% 인 8개에서 type 3의결과를보였다 (Table 1, Fig. 1, 2). 그리고고정성장치에의한교정치료후탈회병소의 18개중, 61% 인 11개, 33% 인 6개, 6% 인 1개에서각각 type1, 2, 3 의결과를나타내었다 (Table 1, Fig. 3, 4). 전반적으로 DDE 병소와교정치료후탈회병소모두치료전과직후, 치료전과 1주후정상치면과백반양병소사이의색조차가유의하게감소하였다 (p<0.05). DDE 병소에서는치료직후에비해 1주후색조차가유의하게감소하였다 (p<0.05, Table 2). Table 1. Color changes of white spot lesions Type 1 Type 2 Type 3 (disappeared) (progressed) (little changed) sum DDE* 5(25%) 7(35%) 8(40%) 20 ODL** 11(61%) 6(33%) 1(6%) 18 * DDE : developmental defects of enamel ** ODL : orthodontic decalcified lesions Fig. 1. Type 1 color changes in maxillary left central incisor showing DDE. Compared with T1(before treatment), enamel color was recovered much in T2(immediately after treatment), and still more in T3(1 week after treatment), showing almost normal. Fig. 2. Type 2 color changes in maxillary left lateral incisor showing DDE. Although enamel color was recovered slightly in T2(immediately after treatment), and still more in T3(1 week after treatment) compared with T1(before treatment), the white spot remained. Fig. 3. Type 1 color changes in maxillary left lateral incisor showing orthodontic decalcified lesion. Compared with T1(before treatment), enamel color was recovered much in T2(immediately after treatment), and still in T3(1 week after treatment), showing almost normal. Fig. 4. Type 3 color changes in maxillary right canine showing orthodontic decalcified lesion. Compared with T1(before treatment), no change in enamel color was visible either in T2(immediately after treatment) or in T3(1 week after treatment). 220
대한소아치과학회지 37(2) 2010 Table 2. Statistical analysis of color changes T1 - T2 T1 - T3 T2 - T3 DDE* p < 0.05 p < 0.05 p < 0.05 ODL** p < 0.05 p < 0.05 p = 0.09 T1 - T2 : color change between T1(before the treatment) and T2(after the treatment) T1 - T3 : color change between T1 and T3(1 week after the treatment) T2 - T3 : color change between T2 and T3 * DDE : developmental defects of enamel ** ODL : orthodontic decalcified lesions Ⅳ. 총괄및고찰 백반양초기우식병소와 DDE 병소의불투명도는법랑질표층하방에서다공성이증가된데에기인한다 33,34). 이러한불투명도는치면을건조시켰을때더명확한데, 이는법랑질과수분, 공기의광굴절률이다르기때문이다. 건전한법랑질의광굴절률은 1.62인반면, 다공성법랑질은타액등의수분에의해채워질경우물의광굴절률인 1.33에근접하여불투명해보이게된다. 치면이건조되었을때에는미세구멍내의수분이공기로대체되어공기의광굴절률인 1.0과가까워지므로병소가더명확해진다 35). 반면 infiltrant resin으로다공성법랑질을채우게되면광굴절률은 1.46으로증가하여건전한법랑질과근접해짐으로써색조가개선되는효과를나타내게된다. Infiltrant resin은불소나 CPP-ACP 등을이용한재광화치료와는달리, 병소내부로깊게침투하므로상대적으로깊은병소에서도색조가개선되며, 그효과또한치료후즉시나타난다 8,10,36). 그리고미세연마술이나수복치료에비해덜침습적인방법이다 23,24,37,38). Resin infiltration의개발목적은다공성우식병소를제거하는대신, 산과용해된무기물의확산통로역할을하는미세구멍들을폐쇄해우식진행을정지시키고자하는것이다 25). 또한이방법은비와동성초기법랑질우식병소에기계적인지지도제공한다 27). Infiltrant resin은침투계수가높은저점도광중합레진으로법랑질에대한접촉각이낮고표면장력이높다 39). 이러한특성으로인해병소본체내부로깊은침투가가능하다. 그러나병소표층이장벽으로작용해병소본체로의침투를방해한다. 따라서표층의완전한제거와병소본체의노출이산부식의목적이다 30). 염산사용으로인한표층의완전한제거로병소구조를더약하게하지않을까하는의문이있을수있으나, Meyer-Lueckel 등 38) 은 40 μm 의과광화된표층을완전히제거하기위해서는 15% 염산의사용이가장적절하고, 표층이완전히부식된뒤에도와동이형성되지않았으며또한이후침투된레진이병소구조를강화시킬수있음을주장하였다. 또한백반양병소의치료로흔히선택되는미세연마술의경우, 18% 염산을사용하여법랑질을 360 μm 까지제거함을고려한다면 37), 40 μm 정도는많은양은아니라고할수있다. 99% 에탄올은미세구멍내부를완전히탈수시켜레진이모세관현상에의해 병소내로빨려들어가도록할목적으로사용한다 40). 본질적으로 infiltration 기법은병소내부에장벽을형성하는것이기때문에 infiltrant resin 적용후표면에남아있는잉여레진을닦아내고광중합을시행한다. 병소본체내로균일하게레진이침투해들어간다면병소표면의레진층은없어도무방하고, 오히려표면의레진을제거함으로써표면의이상적인형태를얻을수있다 28). 레진의중합수축으로인한공간을폐쇄하기위해레진을두번반복적용한다 27). 본연구에서사용한디지털표준임상사진술은병소크기와색의정량화를위해가장간단하고임상적으로접근이쉬운방법으로, 이미여러연구에서카메라와조명이동일한위치에있다면객관적이고재현성이있으며정확한방법이라고보고되고있다 41-44). 본연구에서는표준임상사진술과영상분석프로그램으로부터얻은결과를바탕으로색의차이를확인할수있는정량적인수치인 ΔE를이용하였다. 인간의눈은표준화된실험실환경에서 1 ΔE 값까지색조차를구분할수있을만큼효과적이다. 하지만광원을표준화할수없는구강내에서는 3.7 ΔE 값이상인경우색조차이를구분할수있다. 몇몇연구에서는그임계값을 3.0 ΔE로주장하고있지만, 색안정성에대한대부분의연구에따르면 3.7 ΔE를임계값으로정하고있다 32,45,46). 본연구에서고정성장치에의한교정치료완료후 3개월이상경과한환자를선택한것은교정장치제거후단지구강위생관리만철저히하여도어느정도의탈회병소는타액에의해 2-3개월동안스스로재광화되기때문이다. 어느정도의탈회병소는수주내에사라지고, 대부분의병소는 2-3개월동안그임상적크기가감소된다 47,48). 따라서본연구에서는교정치료완료후병소가자발적으로개선되는기간인 3개월이지난후에도남아있는병소를대상으로하였다. 본연구결과 DDE 병소의 60%, 교정치료후탈회병소의 94% 에서색조가유의하게개선되었고, 백반양탁색이거의사라진경우는 DDE 병소에서 25%, 교정치료후탈회병소에서 61% 를보였다. 따라서 DDE 병소보다는교정치료후탈회병소에서색조개선효과가더큼을알수있었다. 이처럼일부증례에서는극적인색조개선이나타난반면, 색조변화가거의없었던병소도발육결함병소의 40%, 교정치료후탈회병소의 6% 로관찰되었다. 이것은병소의깊이차이에기인한것으로해석되었다. 즉, infiltrant resin의침투깊이를넘어서는깊은병소에서는색조개선효과를거둘수없는것으로판단되었다. 그러나 resin infiltration의원래목적은확산통로를폐쇄해내부병소를보호하는것으로, 심미적개선효과는그에따른부수적인효과이므로색조가개선되지않더라도병소의진행을차단한다는점에서는의미가있다고할수있다. 그러나법랑질색조개선을목적으로한 resin infiltration의적응증을판별하기위해서는병소깊이를정밀하게계측할방법의개발이절실하며, 아울러장기적인색조안정성을위한지속적인연구가필요할것으로생각되었다. 또한일부 DDE 병소에서시술직후에비해 1주후에색조변화가더많이진행된이유에대해서는추가적인연구가있어야할것이다. 221
Ⅴ. 결론소아치과임상에서자주접하게되는 DDE 나교정치료후탈회에의한백반양법랑질병소에대한 resin infiltration의색조개선효과를평가할목적으로 38개의영구전치를대상으로시술전후의색조변화를분석하여다음과같은결과를얻었다. 1. 1주후색조가개선된병소는발육결함병소의 25%, 교정탈회병소의 61% 로나타났다. 2. 발육결함병소의 40%, 교정치료후탈회병소의 6% 에서는시술전후의색조변화를관찰할수없었다. 3. 법랑질발육결함병소에서는시술직후보다 1주후에더많은색조변화를관찰할수있었다. 색조개선을목적으로하는 resin infiltration 기법의적응증판별을위하여병소깊이의정밀한측정방법이절실하며, 장기적인색조안정성에대한연구가필요할것으로생각되었다. 또한일부증례에서나타난 1주후색조개선효과에대한추가적인연구가필요할것이다. 참고문헌 1. Weerheijm KL : Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update, 31:9-12, 2004. 2. Benham AW, Campbell PM, Buschang PH : Effectiveness of pit and fissure sealants in reducing white spot lesions during orthodontic treatment. A pilot study. Angle Orthod, 79:338-345, 2009. 3. Suzuki M, Jordan RE, Skinner DH, et al. : Clinical management of non-carious enamel defects. Int Dent J, 32:148-158, 1982. 4. Artun J, Brobakken BO : Prevalence of carious white spots after orthodontic treatment with multibonded appliances. Eur J Orthod, 8:229-234, 1986. 5. O Reilly MM, Featherstone JD : Demineralization and remineralization around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial Orthop, 92:33-40, 1987. 6. gaard B, R lla G, Arends J : Orthodontic appliances and enamel demineralization. Part 1. Lesion development. Am J Orthod Dentofacial Orthop, 94:68-73, 1988. 7. gaard B : Prevalence of white spot lesions in 19- year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop, 96:423-427, 1989. 8. Ardu S, Castioni NV, Benbachir N, et al. : Minimally invasive treatment of white spot enamel lesions. Quintessence Int, 38:633-636, 2007. 9. 강지선, 이상호, 이난영 : CPP-ACP제제를이용한법랑질초기우식증의재광화치험례. 대한소아치과학회지, 35:159-165, 2008. 10. Willmot DR : White lesions after orthodontic treatment: does low fluoride make a difference? J Orthod. 31:235-242, 2004. 11. Wright JT : The etch-bleach-seal technique for managing stained enamel defects in young permanent incisors. Pediatr Dent, 24:249-252, 2002. 12. Bussadori SK, do Rego MA, da Silva PE, et al. : Esthetic alternative for fluorosis blemishes with the usage of a dual bleaching system based on hydrogen peroxide at 35%. J Clin Pediatr Dent, 28:143-146, 2004. 13. Haywood VB, Leonard RH, Nelson CF, et al. : Effectiveness, side effects and long-term status of nightguard vital bleaching. J Am Dent Assoc, 125:1219-1226, 1994. 14. Leonard RH Jr. : Efficacy, longevity, side effects, and patient perceptions of nightguard vital bleaching. Compend Contin Educ Dent, 19:766-774, 1998. 15. Basting RT, Rodrigues Ju nior AL, Serra MC : The effect of 10% carbamide peroxide bleaching material on microhardness of sound and demineralized enamel and dentin in situ. Oper Dent, 26:531-539, 2001. 16. Welbury RR, Shaw L : A simple technique for removal of mottling, opacities and pigmentation from enamel. Dent Update, 17:161-163, 1990. 17. Welbury RR, Carter NE : The hydrochloric acidpumice microabrasion technique in the treatment of post-orthodontic decalcification. Br J Orthod, 20:181-185, 1993. 18. Croll TP, Bullock GA : Enamel microabrasion for removal of smooth surface decalcification lesions. J Clin Orthod, 28:365-370, 1994. 19. Rodd HD, Davidson LE : The aesthetic management of severe dental fluorosis in the young patient. Dent Update, 24:408-411, 1997. 20. 박미령, 김종수, 김용기 : Microabrasion technique을이용한치아변색의치료증례. 대한소아치과학회지, 24:511-517, 1997 21. Dalzell DP, Howes RI, Hubler PM : Microabrasion: effect of time, number of applications, and pressure on enamel loss. Pediatr Dent, 17:207-211, 1995. 22. Wong FS, Winter GB : Effectiveness of microabrasion technique for improvement of dental aesthetics. Br Dent J, 193:155-158, 2002. 23. Malterud MI : Minimally invasive restorative den- 222
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Abstract RESIN INFILTRATION FOR THE ESTHETIC IMPROVEMENT OF ANTERIOR TEETH WITH DEVELOPMENTAL DEFECTS AND POST-ORTHODONTIC DECALCIFICATION Eun-young Kim, Ul-jin An, Shin Kim, Tae-sung Jeong Department of Pediatric Dentistry, School of Dentistry, Pusan National University The prevalence of developmental defects of enamel and lesios by post-orthodontic decalcification has been reported with increasing frequency. Even though there have been increasing interests and clinical challenges in esthetic improvement of these lesions, few of studies were reported for using non-invasive approach which is a very significant matter for child and young adults. This study was conducted to assess clinical effect on the improvement in color of these lesions via resin infiltration method developed as minimum invasive technique for white spot. For the 38 maxillary anterior teeth with calcification problem, the changes in color between before- and after- infiltration treatment, were evaluated and summarized as following. 1. A week after infiltration, 25% of developmental defects and 61% of decalcification lesions were improved in color as the value of ΔE below 3.7. 2. 40% of the developmental defects and 6% of decalcification lesions showed no significant change. 3. The developmental defects showed more remarkable changes in color 1 week after infiltration rather than immediately after the treatment. From our study results, it is considered that the amount of color improvement depended on the depth of lesion. In other words, for the lesion having more depth than the depth infiltrant resin can penetrate into, infiltration treatment showed no significant effect. Therefore, for clinical indication of resin infiltration treatment, further research on precise measurement technique of lesion depth is strongly required. Key words : Resin infiltration, Minimally invasive, Color, Demineralization, Developmental defect of enamel 224