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Enamel demineralization expressed as white spot lesions (WSLs) has been reported to be associated with both fixed and removable orthodontic appliances.

Case report: 

This case report described the management of a patient with clear aligner-related severe enamel demineralization using a modified resin infiltration technique. Microabrasion with Opalustre (Ultradent, Utah, USA) was performed to remove the remineralized enamel surface followed by repeated etching with ICON Etch (DMG, Hamburg, Germany) until the WSLs disappeared after ethanol application. A #12 blade could be used to check whether the superficial layer was demineralized enough for the resin to infiltrate. The ICON-Infiltrant (DMG, Hamburg, Germany) was applied to the etched enamel and light-cured. After treatment, all the WSLs showed improvement with the color nearly matching the adjacent sound enamel.

Modified resin infiltration technique combined with microabrasion could be an effective noninvasive method to treat severe enamel demineralization including shallow localized enamel breakdown. However, more clinical studies are required to assess the efficacy and safety of this method.