Biomimetic Dentistry PDF

.DR. FATEMA ALDABBAR MASTER DEGREE OF OPREATIVE DENTISTRY  INTRODUCTION Traditional approaches used in treatment of damaged and decayed teeth require more aggressive preparation to place a “strong”, stiff.restoration The emphasis is on the strength of the restoration, but no att...

.DR. FATEMA ALDABBAR MASTER DEGREE OF OPREATIVE DENTISTRY  INTRODUCTION Traditional approaches used in treatment of damaged and decayed teeth require more aggressive preparation to place a “strong”, stiff.restoration The emphasis is on the strength of the restoration, but no attention is placed into the function and biomechanics of final restored teeth. By ignoring this critical aspect, it is no surprise that complications such as endodontic treatment occur more frequently and future treatment becomes progressively more aggressive and invasive, and so begins the restorative dental cycle in which the teeth are.ultimately lost from successive treatments  INTRODUCTION The basic science for dentally mimicking nature is found in the biomechanical characteristics of teeth. Teeth move and bend, they have physical dynamics of force that must be accounted. In other words, a restoration design based on sound engineering principles to absorb and distribute stress through the tooth as in nature and with least possible treatment, more of the tooth is left intact. The concept is building the tooth up, not grinding it down to prevent future breakage and so tooth preservation and dental conservation lie at the heart of biomimetic.dentistry With Biomimetic dentistry, only the damaged portion is removed from the tooth and the final restoration is bonded to the remaining healthy natural tooth structure. These bonded restorations function and behave “Biomimetically”.and break the restorative dental cycle WHAT IS BIOMIMETICS AND ?BIOMIMETIC DENTISTRY Biomimetics can be defined as “The study of structure and function of biological systems as models for the design and engineering of materials”. Biomimetic.dentistry means to copy what is life-like hen restoring damaged, broken, and decayed teeth, the goal is to return the tooth to its original strength, function, and esthetics. Biomimetic Dentistry is the art and science of restoring damaged teeth with restorations that imitate natural teeth in both.appearance and function The philosophy is “less dentistry is the best.”dentistry WHAT IS WRONG WITH ?CONVENTIONAL DENTISTRY :Old techniques can cause.Teeth to eventually crack and leak.1 Fillings leak around the edges, teeth break around.2.large fillings and fillings can shrink resulting in failure Metal and porcelain crowns concentrate force at.3.the edges and break the teeth and/or cause leakage This can result in root canal treatment or loss of.teeth In the “Biomimetic Approach,” the dental tissues (enamel, dentin) are returned to full function through a hard tissue bond, allowing functional stresses to pass through the tooth and returning the damaged.tooth to a functional, biological, and esthetic result WHAT IS WRONG WITH ?CONVENTIONAL DENTISTRY Biomimetic restorations include stress-reduced, direct composite restorations and porcelain/composite inlays and onlays that restore the biomechanics of broken and damaged teeth. Traditional dental treatments including porcelain fused to metal crowns, gold crowns, and amalgam fillings are not.biomimetic by any measure THE BIOMIMETIC PRINCIPLE IN RESTORATIVE DENTISTRY The physiological performance of intact (non- diseased) teeth is the result of an intimate and balanced relationship between biological, mechanical, functional, and esthetic parameters.Restoration of tooth to full function.1 Restoration of biomechanics of the natural.2.teeth.Restoration of natural tooth esthetics.3.Preservation of tooth vitality.4 THE BIOMIMETIC PRINCIPLE IN RESTORATIVE DENTISTRY :This could be achieved via.Use of bioactive restorative materials · Immediate dentin sealing to avoid post- ·.operative hypersensitivity Drawing the entire crown into the final functional · biologic and esthetic results via use of restorative.materials mimicking natural tooth tissue Creation of a hard tissue bond that allows · functional stresses to pass through the tooth.safely Use of adhesive restorative techniques to allow · maximum preservation of sound tooth structure and maintenance of the vitality of the teeth to be THE BIOMIMETIC PRINCIPLE IN RESTORATIVE DENTISTRY The goal of biomimetics in restorative dentistry is to return all of the prepared dental tissues to full function by the creation of a hard tissue bond that allows functional stresses to pass through the tooth, drawing the entire crown into the final.functional biologic and esthetic result Moderate alterations of teeth (caries, wear).1.should be treated with composite resins Bonded porcelain restorations are.2 recommended to treat the most perilous situations (worn, non-vital, or fractured teeth) thus avoiding the use of intra radicular posts or.full-coverage crowns MODERN ADHESIVES AND BONDING TECHNIQUE THE DRIVING FORCE OF.BIOMIMETIC DENTISTRY With traditional dentistry we had to destroy healthy tooth structure in order to accommodate a new restoration. In other words, we had to destroy in order to create. Many competing synthetic dental materials are stronger, stiffer and seemingly more beautiful; however, their use often leads to undesirable results or even.failures Dentistry has had structural failures and problems related to the Over- engineering of materials, mostly of less :I. IMMEDIATE DENTIN SEALING (IDS) It is the application of an adhesive resin coating to the freshly cut dentin according to the manufacturer instructions when a significant area of dentin has been exposed during tooth preparation for indirect restoration as inlays,.onlays, overlays or even crowns :I. IMMEDIATE DENTIN SEALING (IDS) :I. IMMEDIATE DENTIN SEALING (IDS) Freshly cut dentin is the ideal substrate for -1 :dentin bonding Dentin contamination owing to provisionalization can reduce the potential.for dentin bonding Precuring of the dentin bonding agent -2 :leads to improved bond strength Polymerization of the infiltrating resin and adhesive layer are before placement of composite increments appears to generate improved bond strength when compared with samples in which dentin bonding agent and.the overlaying composite are cured together I. IMMEDIATE DENTIN SEALING :(IDS) Allows stress-free dentin bond -3 :development Dentin bond strength develops progressively overtime, probably owing to the completion of the copolymerization process involving the.different monomers Protects dentin against bacterial leakage and -4 sensitivity that happened during provisionalization COMPOSITE RESINS AND BONDED ?PORCELAIN: THE POST-AMALGAM ERA BIOMIMETIC RESTORATIVE TECHNIQUES IS THE “MECHANICAL RETENTION AND RESISTANCE FORM” ERA ?COMING TO AN END There are numerous treatment modalities allowing the placement of esthetic adhesive restorations in posterior :teeth The direct technique: all restorative steps are.accomplished intraorally during a single appointment The semi-direct technique: also requires a single appointment but differs from the direct one by a number of extra oral steps. The semi-direct restoration is finally luted as is the case with the indirect technique. Only direct and semi-direct restorations are made.entirely chair-side The indirect technique– composite resins or ceramics Indications for Indirect composite inlays Recommended for serial restorations without · cusp coverage or with limited cuspal coverage.leaving at least one functional cusp It should be avoided for large areas of occlusion ·.or stress Recommended for improved esthetics and · morphology of composite restorations as it.allows more sophisticated layering techniques Can be used for moderate to large-size cavity ·.preparations with or without ideal access The indirect technique– composite resins or ceramics A. INDIRECT COMPOSITE INLAYS/ONLAYS Advantages of Extra oral composite inlays/ :onlays Improving restoration adaptation and seal because.1 the main polymerization shrinkage is achieved.without stress on the adhesive interface Facilitating clinical procedures; improve occlusal.2.anatomy, contact points and related function B. INDIRECT CERAMIC INLAYS/ONLAYS/OVERLAYS Laboratory processed restorations are best indicated · for larger serial restorations that include cusp.coverage RESTORATION OF THE ENDODONTICALLY TREATED POSTERIOR TOOTH A successful clinical outcome of endodontically treated teeth depends on adequate root canal treatment as well as on adequate restorative treatment performed afterwards. The restoration of endodontically treated teeth involves a variety of treatment options and still represents a.challenging task for clinicians Restoration of root filled teeth can be challenging :due to  Restoration of root filled teeth can :be challenging due to Structural differences between vital and.1 non-vital root filled teeth Irreversible chemical—physical.2 (dehydration of dentin; reduction of micro- hardness; collagen alteration; effects of irrigants and medicaments) Bio-mechanical changes (loss of tooth.3 structure; loss of proprioception), due to the endodontic treatment, increase the potential to dental fracture and condition the.restoration options for the clinician  The objectives of a restoration following :root canal treatment and re-treatment are.To restore form, function and esthetics.1 To prevent bacterial micro-leakage into the.2 root canal system 3. To ensure periodontal.health To protect the residual tooth structure.4.against fracture To prevent fracture and wear of the.5 restoration and the abrasion of the.antagonistic teeth The importance of the coronal seal he final restoration should commence as soon as possible after root canal treatment, better in the same visit of the endodontic treatment, in order to prevent coronal micro-leakage. Delaying definitive restoration and filling temporary obturation for long time enhances the risks of periapical recontamination and future.failure The recent changes in the methods available for restoring endodontically treated teeth depend on the improvement of the adhesive techniques, composite resin materials, and indirect ceramic materials. Focusing on the relevant advantages (bio economy of dental tissues, bio economy of periodontal tissues, reinforcing of healthy residual dental tissues, esthetic, ergonomic and economic advantages) of the conservative bonded techniques help.the clinician to choose the proper restoration Bio economy of dental )1( :tissues There is a direct relationship between remaining tooth structure and fracture resistance. Greater remaining tooth structure means greater longevity for the teeth. The prognosis of root-filled teeth depends not only on the success of the endodontic treatment but also on the amount of remaining dentine tissue, and the nature of.final restoration Bio economy of periodontal )2( :tissues Preserving intact coronal and radicular tooth structure and maintaining cervical tissue to create a ferrule effect are considered to be crucial to optimize the biomechanical behavior of the restored tooth. A conservative approach in cavity preparation and restoration often means mini-invasive surgical crown lengthening, and sometimes.no periodontal surgery Preserving intact coronal and radicular tooth structure and maintaining cervical tissue to create a ferrule effect are considered to be crucial to optimize the biomechanical behavior of the restored tooth. A conservative approach in cavity preparation and restoration often means mini-invasive surgical crown lengthening, and sometimes.no periodontal surgery Reinforcing of healthy residual )3( :dental tissues Thebest current approachforrestoring endodontically treated teeth seems to: minimize tissue sacrifice, especially in the cervical area so that a ferrule effect can be created, use adhesive procedures to strengthen remaining tooth structure and optimize restoration stability and retention and finally use post and core materials with physical properties close to those of natural.dentin