Six years ago, a group of like-minded dentists came together to form the Academy of Biomimetic Dentistry. Unlike many of the options for restoring teeth, biomimetics is a philosophy that is based on our desire to maintain as much healthy tooth substance as possible. The procedures and protocols used for these techniques are dependent on modern advances in adhesive dentistry. Rather than cutting down teeth for crowns, the biomimetic dentist will only remove old filling material and any tooth structure that is decayed. Remaining tooth material is then strengthened with the application of Polyethylene Fiber that is chemically bonded to the tooth. This fiber serves to brace the tooth and strengthened the weakened cusps. Our ultimate goal is to replicate the natural tissue (tooth enamel and dentin) with composite materials that mimic the biomechanical properties of natural teeth.
That is what Biomimetic means, mimicking life. The Europeans have a sister organization known as the Academy of Bioemulation, again meaning to emulate life.
The combination of natural tooth material, reinforcing polyethylene fiber, and various composite materials enables us to create a tooth from composite rather than covering a tooth with metal or porcelain, materials much stronger than tooth and do not function in a similar fashion. We also realize is that nothing last forever. Long-term clinical trials have clearly shown that failures of teeth restored with crowns have a created tendency to develop endodontic problems, requiring root canals. Also, failures may be catastrophic in nature necessitating removal of the tooth and placement of an implant. Failures in the biomimetic world normally affect only the restorative material which is easily repaired. In a worst case scenario, if the restoration loses its adhesion, it simply has to be bonded back in place.
Dr. Resnick is a member of the International Academy of Adhesive Dentistry and an Accredited Member of the Academy of Biomimetic Dentistry. For additional information you can go to the websites of either organization.
Here are some examples from our own patients who have benefited from biomimetric dentistry:
Case One – 1 – Imaging during pre-treatment showed some suspicious discoloration on the chewing surface of the tooth.
2 – The tooth is prepared using a minimally invasive technique, the goal being not to remove any health tooth substance.
3- The red circle outlines an occlusal pit that is not decay; however, to prevent future breakdown, this area is scheduled to be sealed with a fissure sealant.
4- The tooth is repaired using four different composite fillings in order to control the stresses exerted by the composite on the tooth itself. The final restoration should provide decades of use in the restoration of this tooth.
Case Two – 1 – The patient complained of pain when biting where an old silver amalgam filling was present. A diagnosis of a cracked tooth was made and replacement of the restoration with a fiber reinforced stress reduced composite restoration was advised.
2 – The silver amalgam was removed demonstrating decay and a large crack running through the tooth.
3 – The crack is explored and removed as much as possible. To strengthen the tooth and prevent further damage, polyethylene fiber is bonded to the tooth surface and the cusps. By bridging the crack and bracing the weakened areas, the fiber prevents the crack from growing larger or the tooth becoming weaker.
4 – Using multiple layers of different composites permits us to maximize the biomechanical similarities between the restorative material and the tooth’s physiology. Once the final restoration is completed, the patient reported no more pain when biting.
Case Three – 1 – The patient complained of pain with cold foods and biting where there was a deteriorating silver amalgam filling. A diagnosis of a cracked tooth was made and replacement with a fiber reinforced direct stress reduced direct composite was advised. Most practitioners would advise placement of a full cut down crown in this situation; however, if a crack is present, a crown will not prevent the crack from deepening even further.
2 – Once the existing silver amalgam is removed; a number of cracks are very evident. The treatment plan is to remove as much of the cracks as possible and to use polyethylene fiber to bridge the remaining crack lines to prevent them from deepening.
3 – The initial layer of composite is added, the biobase layer that is only .5 mm thick, but is highly bonded to the tooth substance. You can visualize multiple segments of polyethylene fiber used to bridge the cracks and to brace and strengthen the weaken cusps. Once the fiber is in place, the tooth actually regains its original strength.
4 – The completed restoration. patient is functioning normally without any symptoms or cusp fracture.