Biomimic Dentistry in modern dentistry and dental materials

1. Biomimic Dentistry
Done by : Ali Bahaa
Supervised by : Dr. Rania

2. Biomimetic Dentistry
• Biomimetic dentistry is the practice of dentistry which applies the
concept of Biomimetics. This treatment approach strives to preserve
intact tooth structure and restore the function and biomechanics of
natural teeth. Biomimetic dentistry is typically applied to restorative and
esthetic dentistry, but it can be applied to any dental discipline.

3. History
• Biomimetic dentistry has been developing gradually over many decades,
gaining momentum with advances in adhesive dentistry, dental
materials, and cariology. Adhesive dentistry has its beginnings in 1955
when Dr. Michael Buonocore published a groundbreaking paper on the
acid-etch technique, in which he states: “A filling material capable of
forming strong bonds to tooth structures would offer many advantages
over present ones. With such a material, there would be no need for
retention and resistance form in cavity preparation…”. These words
would be the beginning of an “adhesive revolution” in which further
advances in adhesive dentistry would gradually replace traditional
techniques which require more removal and destruction of intact tooth
structure. Additional advancements in restorative materials and caries
removal would contribute to techniques, which minimize tooth
preparation and maximize pulp vitality.

4. Core Philosophies
• Biomimetic Dentistry emphasizes preserving and mimicking the various
properties of natural teeth.
• The preparation and restorative techniques preserve natural tooth
structure and pulp vitality. Restorative materials replicate the function of
natural enamel, dentin, and DEJ and the restored tooth is
biomechanically and esthetically similar to natural teeth.

5. Important Concepts
• BIOMIMETIC APPROACH
• Preserve Intact Tooth Structure
• Maximize Adhesion
• Minimize Residual Stress
• Restore Structural Integrity
• Replicate Natural Biomechanics
• Caries Removal Endpoints
• Preparation Design
• Restorative Materials which are Biomimetic

6. Biomimetic Dentistry vs Traditional Dentistry
• Traditional dental procedures rely on preparation designs that
accommodate the restorative material or technique. This includes
preparation features such as retention and resistance form, as well as
tooth reduction to meet the strength requirements of the restorative
material instead of prioritizing the preservation of intact tooth structure.
As a result, the restored tooth has significant additional preparation and
a significantly higher chance of complications such as pain, sensitivity,
root canal treatment, recession, and fracture. Examples of such dental
procedures include full coverage crowns (zirconia, porcelain fused to
metal, gold) and a variety of metallic inlays and fillings (amalgam, glass
ionomer).

7. Biomimetic Dentistry vs Traditional Dentistry
• In contrast, the Biomimetic approach unites an understanding and
appreciation of the biomechanics of natural teeth with principles and
techniques which maximize adhesion. These concepts comprise the
necessary components to mimic the natural tooth most faithfully.
Restorative materials replicate the properties of the dental structures
and healthy intact tooth structure is preserved through adhesion without
additional preparation requirements. The biomimetically restored tooth
mimics the strength, function, and esthetics of natural teeth. Biomimetic
restorations include composite fillings, partial coverage restorations, and
when necessary, full-coverage ceramic restorations. However, the
application technique and material selection makes a significant
difference in the performance of these techniques and, therefore, it is
important to have a sound understanding of the science.

8. Biomimetic Dentistry vs Traditional Dentistry

9. The science behind Biomimic dentistry
• Nowadays, direct composite resin restorations (white fillings) are the
most common way of restoring damaged teeth. However, it is a very
technique sensitive procedure and if not performed correctly, can result in
premature failure of the filling leading to recurrent tooth decay.
• Some Background Information:
• Before composite resin is placed into the tooth, it has a putty-like
consistency and is composed of individual single molecules called
monomers. A UV light activates a chemical reaction called
polymerization, where the monomers join together in a chain to form a
much larger molecule called a polymer. This polymerization reaction
hardens the composite resin (white filling) and bonds the filling to the
tooth.

10. The science behind Biomimic dentistry

11. The science behind Biomimic dentistry
• During the polymerization process, a phenomenon called polymerization
shrinkage occurs where the monomers loses some atoms in order to form
the polymer chain. This results in an overall decrease in the volume of
the composite resin (white filling) material after it hardens. The
larger/thicker the layer of composite resin, the greater the volume
shrinkage. The volume shrinkage puts stress (aka polymerization stress)
on the filling and tooth because it causes the filling to pull away from the
tooth surface which reduces the bond strength. It is a constant tug-of-war
between bond strength and polymerization stress .

12. The science behind Biomimic dentistry

13. The science behind Biomimic dentistry
• When bond strength is reduced, microgaps can form between the filling
and the tooth. Microgaps can allow bacteria to reenter the tooth and
eventually cause recurrent dental caries and premature failure of the
filling .

14. The science behind Biomimic dentistry
• Also, reduced bond strength can permit the filling have micromovements
during chewing, leading to tooth sensitivity and pain called post-
operative sensitivity.

15. The Science Behind Biomimic Dentistry
• Biomimetic Dentistry utilizes research proven techniques to minimize
polymerization stress thereby increasing bond strength resulting in long
lasting restorations.

16. STRESS REDUCING PROTOCOLS:
• 1. Restore teeth with multiple thin layers of composite resin.
• The thinner the layer of composite resin, the less volume shrinkage
occurs and therefore less stress and increased bond strength of the filling
to the tooth. Conventional white filling techniques as taught in dental
schools typically requires 1 layer for a small filling and up to 4 layers of
composite resin to complete a large filling. Biomimetic fillings take at
minimum 4-6 layers for small fillings and up to 20 layers to complete a
large filling. This reduces the polymerization stress considerably
resulting in higher bond strength of the filling to the tooth.

17. STRESS REDUCING PROTOCOLS:
• 2. Use indirect (lab-made) restorations whenever possible .
• A lab-made indirect restoration is the most stress-reducing technique as
there is zero volume shrinkage. However, due to cost, this may not be
affordable for everyone.

18. STRESS REDUCING PROTOCOLS:
• 3. In large cavities, a fibre mesh is placed on the cavity floor to minimize
stress .
• The fibre mesh interrupts polymerization shrinkage and reinforces the
tooth by dispersing the forces imposed on the tooth when chewing.

19. STRESS REDUCING PROTOCOLS:
• 4. Removing dentin cracks completely [10] [11]
• Cracks into dentin are as destructive to teeth as is tooth decay. Both are
leading causes of root canals and loss of tooth structure and integrity. If
cracks are left under the restoration, micromovements during chewing
causes cracks to propogate due to concentration of stress at the crack tip.

20. STRESS REDUCING PROTOCOLS:
• 5. Use of round burs to avoid sharp internal angles
• Sharp corners and angles concentrates stress, which can lead to crack
formation in teeth over time from the vibrations caused by chewing. This
is the reason why entry-ways and windows in ships and planes are round
and never rectangular.

21. STRESS REDUCING PROTOCOLS:
• 6. Use slow start and/or pulse activation polymerization techniques
• Rather than cure the composite material quickly with high intensity UV
light, the composite resin is allowed to polymerize slowly. Studies have
shown that this reduces polymerization stress by allowing the composite
resin to shrink towards the tooth surface rather than away.

22. BOND-MAXIMIZING PROTOCOLS
• 1. Air abrasion of tooth surface before bonding
• Air abrasion is using small sand particles under high air pressure to
roughen the surface of the tooth to be bonded. This increases surface
energy and surface area to permit the formation of a much stronger bond.

23. BOND-MAXIMIZING PROTOCOLS
• 2. Employ gold standard three-step bonding systems .
• At Da Vinci Dentistry, we use a bonding system called Optibond FL, a
three-step bonding system. Many dental companies are trying to simply
the bonding steps to a single step to save time, however, three step
bonding systems are still the gold standard and achieves the highest bond
strength.

24. BOND-MAXIMIZING PROTOCOLS
• 3. Utilize immediate dentin sealing .
• Apply dentin bonding agents at time of tooth preparation for indirect (lab-
made) porcelain restorations. This will increase bond strength by 400%
compared to the traditional approach of bonding at the time of
cementation.

25. BOND-MAXIMIZING PROTOCOLS
• 4. Resin coat the immediate dentin sealing .
• Flowable resin is applied onto the immediate dentin sealing. This acts as
an adjunct to the adhesive layer and ensures complete polymerization of
the bonding agent.

26. BOND-MAXIMIZING PROTOCOLS
• 5. Deactivate matrix metalloproteinases
• Matrix metalloproteinases is an enzyme present in tooth that degrades 25%
to 30% of the bond strength of fillings. 30 second treatment with 2%
Chlorhexidine can deactivate this enzyme and increase bond strength.

27. THE ART IN BIOMIMETIC DENTISTRY
• The artistic aspect of Biomimetic Dentistry complements the science
discussed above. Because Biomimetic fillings require 3-5 times more
layers than the traditional filling technique, it allows the dentist to create
fillings that look as real as natural teeth. In order to create beautiful life-
like fillings, multiple layers must be used. Rather than one or two flat
layers of composite resin (like traditional white fillings), several layers
are used to build each cusp of the tooth one at a time to create fillings
that look so real that sometimes it can be hard to distinguish where
natural tooth ends and where filling begins. To master the art of
Biomimetic Dentistry, like any other art form, takes patience and years of
practice and an artistic talent. At Da Vinci Dentistry, we take great pride
in our attention to detail and artistic skill.

28. THE ART IN BIOMIMETIC DENTISTRY

29. Thank You !!