The History of Biomimetic Dentistry
The term “biomimetic dentistry” was adopted when Dr. David Alleman, Dr. Ray Bertolotti and Dr. Pascal Magne discussed how to describe the dental advancements they had been researching in the 1990’s and 2000’s. These advancements yielded results so superior to standard industry techniques that they needed to be differentiated. Previously described as “advanced adhesive dentistry” and “tooth conserving dentistry,” Drs. Alleman, Bertolotti and Magne decided on the term from Dr. Magne’s 2002 book, Bonded Porcelain Restorations in the Anterior Dentition: biomimetic.
In 1995, Dr. David Alleman’s goal was to find a way to treat teeth that didn’t result in post-operative sensitivity. The techniques he learned in dental school were not delivering the outcomes he wanted for his patients. In this year, he studied with Dr. Ray Bertolotti, who was teaching adhesive dentistry, and that is when Dr. Alleman’s journey into dental research began.
Still with the goal of eliminating post-operative sensitivity, Dr. Alleman’s research showed that bonding to dentin was a complex process but ultimately produced better results if applied in the correct way. Traditional practices and materials marketed to dentists over-simplified the steps, leading to restorations that did not solve a patient’s problems.
As his research and time with mentors continued, Dr. Alleman organized what he learned into a set of protocols he used in his own office. Inspired by his other passion, golf, he called this the Six Lessons Approach in homage to Ben Hogan’s Five Lessons: The Modern Fundamentals of Golf. By incorporating a scientific approach into his work, Dr. Alleman saw great improvements in patient outcomes, especially post-operative sensitivity. The protocols he added to every restorative case in his practice included:
Scientific caries and crack treatment: a red dye called caries detector dye allows for decayed tooth structure to be removed in a reproducible way. High magnification, like from a surgical microscope, makes cracks easier to see and treat. Traditional practices manage these pathologies in a way that is inconsistent between providers, which leads to unpredictable symptoms. Treating caries and cracks in a replicable way led to predictable results.
Techniques for better adhesion: early “adhesive” dentistry was no better at preventing further tooth pathologies than amalgam restorations because the composites were not bonding to the tooth. Gaps under these restorations would cause pain on biting, and the lack of adhesion would make a tooth susceptible to cracks. Research showed bond strengths to dentin (your tooth’s principle tooth material) could be increased by using thin layers and giving the bonds time to mature before moving on to the next steps of restoration. This took more time, but time was just what the adhesives needed to get bonded and stay bonded long-term. Higher bond strengths meant restorations have been shown to last over 20 years without symptoms while protecting the tooth from reinfection and cracks.
Giving the tooth a chance: traditional recommendations said that certain instances of deep caries or types of symptoms meant a tooth could not be preserved and would need root canal therapy, essentially killing the nerve and severely weakening the tooth. Advances in adhesion gave teeth that were responding vitally a chance by sealing deep bacteria, causing it to go dormant, and allowing the tooth to heal. Using this technique reduced the need for root canal therapy by 90% — and even more if the tooth was treated in the early stages of decay.
These points came before the term “biomimetic dentistry.” With the goal of creating asymptomatic restorations that lasted as long as possible, Dr. David Alleman, Dr. Pascal Magne and Dr. Ray Bertolotti and Dr. Simone Deliperi, who completed similar research in the field, found that mimicking a natural tooth offered the best results. By replicating the way a natural tooth is connected and functions during chewing, a restoration will stay bonded and symptom-free, based on our patients’ experiences, for decades.
If you have questions, we’re happy to talk about the work we do any time. Reach out at office@allemancenter.com or (801) 717-9860 any time, or ask Dr. Alleman at your next appointment.
