Caries treatment without drilling: Icon and other methods

Anna, 14, came in with her mother two weeks after her braces were removed. White spots appeared on the four upper front teeth, exactly where the brackets had been bonded. Her mother said: «Andrii, they suggested fillings, but my daughter doesn't want drilling». I examined and used ICDAS scoring: spots in stage 1-2 (early demineralisation, no cavity). I said: «We can skip the drill. Icon infiltration, one session, 45 minutes, no anaesthesia, and the spots disappear for good». Two weeks later her front teeth looked perfect. This is the classic post-orthodontic situation: 30-40% of teenagers develop white spots, and drilling here would be overkill.

Drill-free caries treatment (Icon, fluoride varnish, ozone, CPP-ACP) only works at the early stages ICDAS 1-2 (white or brown demineralisation spots, no cavity). For D2-D4 (cavity in enamel or dentine), only a classic filling will do. In this article I'll cover which method works at which stage, what it costs in Hamburg in 2026, and why you can't fix deep caries with «coconut oil from Instagram».

A white spot on the enamel (white spot lesion) is often the first sign of caries. At this stage the enamel has already lost some minerals but has not yet broken down. This is exactly where drill-free methods come in.

Icon (Infiltration Concept) by DMG is a caries infiltration method. It was developed at Charite University Hospital in Berlin and has been used in Germany since 2009. The principle is simple: a special resin penetrates the demineralised enamel and seals the pores, stopping caries progression.

How Icon works

The procedure takes about 15-20 minutes and requires no anaesthesia. The dentist applies hydrochloric acid (Icon-Etch) to the affected area for 2 minutes to open the enamel pores. The area is then dried with ethanol (Icon-Dry). Finally, a liquid resin (Icon-Infiltrant) is applied, which penetrates the micropores and is light-cured.

The result: the affected area becomes hard, acid-resistant, and visually indistinguishable from healthy enamel. The white spot disappears.

When Icon is not suitable

If the caries has already formed a cavity (cavitation), reached the dentine, or is causing pain, the Icon method is not appropriate. In these cases, standard treatment with removal of decayed tissue and a filling is necessary.

Other drill-free methods

Fluoride remineralisation: at the initial stage, the dentist can apply a fluoride varnish (e.g. Duraphat) or prescribe a toothpaste with a higher fluoride concentration (5,000 ppm). Fluoride helps the enamel restore its mineral balance.

Ozone therapy: ozone kills bacteria in the affected area. Some practices use it as a complement to remineralisation, though its effectiveness is less well studied than Icon.

Silver diamine fluoride (SDF): used mainly in paediatric dentistry to temporarily arrest caries. SDF stains the affected area black, so it is rarely used on permanent teeth in the smile zone.

Insurance coverage

The Icon method is considered a Privatleistung (private service) and is not part of standard GKV coverage. Some statutory insurers partially reimburse the procedure as part of prevention programmes. It is best to check with your insurer in advance.

With a Zahnzusatzversicherung, the procedure may be fully or partially covered depending on the tariff.

5 drill-free methods compared

What works, what doesn't. Based on DGZMK 2024 reviews.

1. Icon (DMG, 2009)

Caries resin infiltration. Effectiveness at ICDAS 1-2: 85% at 3 years (Cochrane 2024). Does not treat D2-D4 stages. Takes 30-60 minutes per tooth. Costs 90-200 € per tooth. My first choice for white spots and early interproximal caries.

2. Duraphat fluoride varnish (5% NaF)

Highly concentrated fluoride varnish, applied for 30 seconds. Stops and partially remineralises early caries. Needs to be repeated 4 times a year. Affordable (30-60 € per quadrant). GKV covers it for high-risk children.

3. CPP-ACP (Recaldent, Tooth Mousse)

Paste with casein, calcium and phosphate. Remineralises enamel at home. 2 tubes for 6 months, 50-80 € total. Apply daily for 5 minutes. Useful for kids after braces and as prevention.

4. Ozone therapy (HealOzone)

Ozone kills bacteria in the lesion in 10-40 seconds. Limited effectiveness; recent 2023 meta-analyses show clearly worse outcomes than Icon. Not my first recommendation. Costs 50-100 € per tooth.

5. Silver diamine fluoride (SDF)

Stops caries by «fixing» the caries bacteria. Major downside: turns the affected area permanently black. Only used on posterior primary teeth or for very young children with active ECC (early childhood caries). Costs 25-50 € per tooth.

Common myths about drill-free caries care

Instagram «dentistry» spreads plenty of misinformation. Here are five common myths.

Myth 1. «Coconut oil cures caries»

Cochrane 2022: no clinically meaningful effect of oil pulling on caries. It may improve hygiene a bit but doesn't heal caries. Deep caries cannot be cured by any oil without a drill.

Myth 2. «Activated charcoal removes caries»

No. Charcoal abrasively removes surface stains (external discolouration) but damages enamel and actually accelerates further caries. Don't use it.

Myth 3. «Diet alone cures caries»

Changing diet stops new caries and supports remineralisation at ICDAS 0-1 together with fluoride. But existing ICDAS 2+ caries does not disappear just by «quitting sugar». You need Icon or a filling.

Myth 4. «Hydrogen peroxide cures caries»

No. H2O2 is used to bleach surface stains, not for caries control. Long-term use damages the oral microbiome.

Myth 5. «Maybe it'll go away on its own»

White spots can stabilise with perfect hygiene and fluoride. But if spots have already turned brown (mineralisation phase) or there is sensitivity, professional help is needed. Don't wait until only a filling will do.