Biomimetic Dentistry vs Traditional Methods

Biomimetic Restorative Dentistry

• Traditional approaches to treating damaged/decayed teeth involve aggressive preparation for restorations, emphasizing strength over function and biomechanics
• This often leads to complications (e.g., endodontic treatment) and ultimately tooth loss
• Biomimetic dentistry aims to mimic natural tooth structure and function.
• It focuses on minimally removing damaged portions and bonding restorations to healthy tooth, preserving structure and function.
• Biomimetic dentistry is defined as the study of biological systems to inform the design of materials and restorations, aiming for a life-like resemblance in strength and function.
• The goal is to restore damaged, broken, or decayed teeth to their original strength, function, and appearance.
• Traditional methods like metal/porcelain crowns and amalgam fillings are considered not biomimetic.
• Biomimetic restorations include stress-reduced, direct composite restorations and porcelain/composite inlays and onlays, designed to restore the biomechanics of broken or damaged teeth.
• Biomimetic dentistry's philosophy promotes a "less is best" approach.

Introduction

• The success of non-diseased teeth stems from an intricate balance between biological, mechanical, and aesthetic parameters.
• Crucial biomimetic principles are restoring tooth function, restoring natural tooth biomechanics, and restoring natural tooth esthetics, as well as overall tooth vitality.

Achieving Biomimetic Goals

• Employing bioactive restorative materials
• Securing immediate dentin sealing
• Utilizing crown restoration techniques to optimize biological and cosmetic outcomes through restorative materials that mimic natural tooth tissue.
• Employing adhesive restorative techniques to preserve healthy tooth structure and maintain vitality.

Immediate Dentin Sealing (IDS)

• Applying adhesive resin coating to freshly cut dentin, following manufacturer instructions
• Pre-curing the dentin bonding agent leads to enhanced bond strength.
• This protects the dentin against bacterial leakage and sensitivity.

Composite Resins and Bonded Porcelain

• Biomimetic restorative techniques, the "mechanical retention and resistance form" era, are transitioning away from traditional techniques.
• Direct technique involves all restorative steps performed in a single intraoral appointment.
• Semi-direct technique is similar but includes additional steps outside the oral cavity.
• Indirect technique involves creating restorations away from the mouth (laboratory). These can be composite resins or ceramic inlays, onlays, or overlays.

Indirect Technique- Composite Resins or Ceramics

• Suitable for serial restorations without cusp coverage or with limited coverage.
• Avoided for extensive areas of occlusion or significant stress.
• Preferred for improved esthetics and morphology, allowing sophisticated layering techniques.
• Useful for moderate to large-sized cavity preparations, with or without ideal access.
• Inlays / Onlays offer advantages by improving adaptation and sealing due to minimized polymerization shrinkage.
• Also facilitates clinical procedures, enhancing occlusal anatomy, contact points, and function.

Restoration of Endodontically Treated Teeth

• A successful outcome depends on adequate root canal treatment and subsequent restorative treatment.
• Root filled teeth restorations are challenging due to structural differences between vital and non-vital teeth, as well as irreversible chemical/physical changes (dehydration, collagen alteration, effects of irrigating solutions).
• Biomechanical changes (loss of structure/proprioception) also affect restoration options

The Coronal Seal

• Resumption of the final restoration should be rapid after root canal treatment, prioritizing the prevention of coronal micro-leakage.
• Delaying definitive restoration increases risks of periapical recontamination and future failures.
• Advances in techniques and materials for restoring endodontically treated teeth (improved adhesive techniques, composites, and ceramics) help offer benefits
• These benefits, such as bio-economy (efficiency with teeth structure), periodontal tissues preservation, and esthetic advantages, allow the clinician to choose the appropriate restoration technique.

Bio-Economy Considerations

• Remaining tooth structure affects fracture resistance; More tooth structure correlates with longer tooth longevity
• Preserving tooth structure and cervical tissues creates a ferrule effect.
• Conservative approach with mini-invasive techniques (such as surgical crown lengthening) is common.

Reinforcing Healthy Residual Dental Tissues

• Minimizing tissue sacrifice, especially in the cervical area, is essential for a ferrule effect.
• Adhesives improve structure retention.
• Using materials mimicking natural dentin enables lasting stability and optimal retention.