Biomimetic Dentistry at the IADR: How do we heal, how do we destroy?

The failure rate of composite restorations is double that of amalgam (Ferracane, 2013). Composite restorations accumulate more biofilm, experience more sec- ondary decay, and require more frequent replacement. In vivo biodegradation of the adhesive bond at the composite- tooth interface is a major contributor to the cascade of events leading to restoration failure.The failure rate of composite restorations is double that of amalgam (Ferracane, 2013). Composite restorations accumulate more biofilm, experience more sec- ondary decay, and require more frequent replacement. In vivo biodegradation of the adhesive bond at the composite- tooth interface is a major contributor to the cascade of events leading to restoration failure.The failure rate of composite restorations is double that of amalgam (Ferracane, 2013). Composite restorations accumulate more biofilm, experience more sec- ondary decay, and require more frequent replacement. In vivo biodegradation of the adhesive bond at the composite- tooth interface is a major contributor to the cascade of events leading to restoration failur

Biomimetic Dentistry

Durable, biomimetic and command-set restorations with Glass Restoratives.

The majority of the existing posterior restoratives are not biocompatible and not bioactive. Both amalgams and composites release toxic products, which can harm both patients and dentists.

The third group of restoratives the Glass Ionomers are biocompatible but too weak to compete with amalgam and composite.

The new improved Glass-fillings however are biomimetic, strong, aesthetic, non-shrinkable and bulk fill restoratives. Using these materials will change our concepts in dentistry: from “Drill and Fill we transfer to “Seal and Heal” with less drilling and less endodontic treatments.

With “normal” procedures these glasses are just at the edge regarding the flexural strength to withstand all the lateral forces in a class II restoration. With easy curing techniques, using LED curing devices, the flexural strength can be boost to fulfill the needed properties for loaded posterior fillings!

Fig) Extended posterior Glass Restoration (26 DO) command cured with Thermo-cure!
(made by Han Heesen)

Excavation versus Mineralisation.

The existing rules for excavation are very old and based on the knowledge of the past. During the GV Black era also “Extention for Prevention” was often used.

The reason for this was that decay developed very rapidly during those days oral hygiene and food consumption (to much sugar intake) was very poor.

At the average Dental School still the 3 layers are educated:

1st layer is the very soft layer
2nd layer is the infected demineralized layer
3rd layer is the so-called non-infected demineralized layer

Students are learned to remove all the decay till the 3rd layer.

However there is no evidence that this is true!

The moment decay is entering the dentine bacteria are already found in the pulp. In fact all the dentine is immediately infected.

Also hardness and discoloration aren’t very good guidelines for preparation and excavation.

In 1992 we proved already that decayed (infected) dentine mineralizes within 3 months if a conventional Glass Ionomer is used even under very bad circumstances. (verwijzen!)The same research is showing that Amalgam and even worse Composite doesn’t mineralize the dentine.

The latest reports are showing (verwijzing research) that selective excavation always gives better results in young and old patients, low and high risk patients, long and short term!

Also from extensive reports using ART technique, where only hand excavation is used (leaving decay!) the same conclusion can be drawn.

The rules for excavation should be revitalized and updated to our modern standards.

New rules:

• Use in dentine if possible only hand instruments to remove the very soft layer.
• Disinfection seems to be more important than deep excavation (see dentine conditioning)
• Pre-treatment with a low concentration NaOCl 1% is very efficient to kill the majority of the bacteria without opening the tubilli. (5 sec followed 5 sec rinsing with water spray)
• Take care with dentine close to the pulp. Even healthy dentine can be very soft like decayed dentine. Even when the dentine is very soft it will mineralize if a proper conventional GIC is used.
• Use always a conventional GIC to replace all the dentine, Thermo-cure will accelerate the reaction!
• The dentine enamel border should be clean with patients with poor oral hygiene, or with a lot of sugar intake.

The question should be: “Which part can be mineralized instead of how much do I need to excavate”

Examples of Biomimetic Dentistry in Vivo

       
After preparation using a partial matrix system filled with Glass with no monomers! set with Thermo-cure. Courtesy: Han Heesen

Biomimetic Dentistry is a new way of dentistry which takes advantages of the natural mineralization processes in the mouth without using harmfully products.

Decay is a unbalance of re- and demineralisation leading to a loss of minerals like Calcium and Phosphates. Biomimetic Dentistry aims to reverse this unbalance by offering the lost minerals back to the tooth. Hand excavation (ART protocol) is preferred to keep as much as tissue which
can be re-minerelised. (see also video’s) Glass Ionomers can be used to deliver the desired minerals. Glass Ionomers are with normal auto cure are too weak to survive all the forces in a loaded multi surface posterior filling. With the help of Thermo-cure the properties can be boosted to get a permanent restoration which can compete with the strength of a sound tooth. Also minerals in a past or as a sealant can prevent ongoing decay. When the majority of the tooth is lost Bioactive porcelains can be bonded with a natural mineralization process without any margins. (see mineralization in vivo!)

Inventors Glassionomer and Composite

England ±1970 Makato Nakoa (GC), Dennis Smith, Alan Wilson and John McLean (inventors glassionomer), Ray Bowen (inventor composite), Ivar Mjor