What is Biomimetic Dentistry?
Biomimetic dentistry (or BRD), is a type of restorative (operative) dentistry. It’s goal is to have the final restoration closely mimic the properties and function of a natural tooth. The central idea governing biomimetic dentistry is that the natural tooth is ideal and therefore we want future restorations to behave and function exactly like the natural tooth. If the restoration behaves more like a natural tooth, it is more likely to last longer, cause fewer issues for the patient, and be less destructive to adjacent dentition. BRD is also known as “bioemulation.”
Techniques and Materials
BRD utilizes certain protocols, techniques and materials to best achieve this outcome. There are many materials that biomimetic dentists do not use because their properties deviate from the properties of a natural tooth. For example, BRD dentists do not use amalgam or gold. That being said, it is important to note that amalgam and gold were once very important materials in dentistry, but in BRD they no longer have a place. Why don’t they use such materials? For several reasons.
Amalgam and gold have a modulus of elasticity entirely different from a natural tooth. While the modulus of dentin is 147 GPa and the modulus of enamel is 80 GPa the elastic modulus of amalgam is around 36 GPa and gold is about 80 GPa. What does this mean? It means amalgam and gold will not deform under a load. In effect, this means that when you’re chewing, these materials don’t have as much give.
So, for example, if someone with a gold inlay is chewing on an almond, the inlay will not deform, but it will transfer that force to the tooth itself. As you can imagine, this is problematic because the remaining tooth structure will weaken and fracture as it is continually receiving this load.
In order to practice this type of dentistry, one must have a thorough understanding for the natural tooth and how it functions.
Because biomimetic dentists believe that the natural tooth is ideal, they try to have their restorations emulate natural teeth as much as possible. If the restoration closely mimics a natural tooth, it is more likely to last longer and provide the patient with fewer post-operative complications. As aforementioned, in order to accomplish these goals, the dentist must be well versed in how natural teeth already function and the types of materials and techniques that are conducive to this goal. Dr. Graeme Milicich and his colleague Dr. Tim Rainey, for example, wrote several important publications on how teeth function. In episode 55 of the Dental Digest podcast, Dr. Milicich discusses this topic extensively. Click here to listen.
Can this technique help save teeth?
Yes, for several reasons. It uses techniques and protocols to prevent unnecessary root canal therapy and it involves techniques to help combat polymerization shrinkage stress. Polymerization shrinkage stress, if not addressed, can lead to post operative sensitivity, recurrent caries, marginal leakage and dislodgment of the restoration.
BRD can prevent unnecessary root canal therapy in instances of deep carious lesions because of the use of the “Caries Removal End-Point” technique which was pioneered by Dr. David Alleman and Dr. Pascal Magne. This evidence-based technique uses caries detection dye, anatomical and histological landmarks to aid the clinician in identifying when to stop the process of caries excavation. Note, it is extremely important to gather the patient’s history associated with the carious tooth and conduct vitality testing. This technique is not intended on teeth that have a pulpal diagnosis of necrosis or irreversible pulpitis.
BRD can help promote the longevity of restorations because it involves techniques to prevent polymerization shrinkage stress. Polymerization shrinkage is unfortunately a shortcoming all composites have. It is the shrinkage that occurs to the composite as it is being light cured. Of course, better composites will shrink less, but this is still a shortcoming unique to all composites. BRD involves composite layering techniques to help combat shrinkage.
In effect, if teeth can avoid root canal therapy (when possible) and forces such as polymerization shrinkage stress can be combated, teeth will last longer.
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Top Podcast Episodes on BRD
References & Resources
- Magne, P.. “Composite resins and bonded porcelain: the postamalgam era?” Journal of the California Dental Association 34 2 (2006): 135-47
- Morin DL, Douglas WH, Cross M, DeLong R. Biophysical stress analysis of restored teeth: experimental strain measurement. Dent Mater. 1988 Feb;4(1):41-8. doi: 10.1016/s0109-5641(88)80087-3. PMID: 3267603.
- Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach. Chicago, IL: Quintessence Publishing; 2002.
- The Protocols of Biomimetic Restorative Dentistry
- Magne P. Esthetic and Biomimetic Restorative Dentistry: Manual for Posterior Esthetic Restorations. Los Angeles, CA: USC School of Dentistry; 2006.
- Hybridization of Dental Hard Tissues