One of the biggest contradictions of modern restorative dentistry is that many cosmetic procedures require the removal of existing dental material before a final prosthetic can be attached. In order to save a tooth, existing dental paradigms demand that a portion of the target tooth must be destroyed. Nowhere is this counterintuitive thinking more apparent than in the execution of a dental crown procedure. Dental crowns are typically used when a tooth has suffered severe damage as a result of decay or trauma.
One really must wonder, if the goal of modern dentistry is to save and salvage as much of a patient’s natural dentition as possible, how does it make sense to rely on procedures that require the destruction of the very thing you are trying to save?
That’s where biomimetic dentistry comes in.
Preserving natural teeth and dental conservation at the heart Biomimetic dentistry. This new approach is all about seeking the synthesis of modern dental technologies and low-impact tooth conservation. Instead of relying on dental replacements, as in the case of dental crowns, biomimetic dentistry is about retaining as much of a natural tooth as possible. Instead of covering over dental flaws, as in the case of onlays and overlays, it’s about repairing and restoring existing dental surfaces. Instead of relying on dental techniques that remove or destroy parts of an existing tooth, such as dental extractions, crowns, and root canals, biomimetic techniques strive to minimize the removal of natural dental material. It’s all about conserving what’s there if possible and making it stronger and more resilient.
Biomimetic dentistry relies on the assumption that your natural tooth got it right to begin with. There’s no need to reinvent the human tooth. Instead, when it comes to cosmetic dentistry, we should mimic the structure and materials of a natural tooth. This biomimicry will result in a tooth that is not only more natural, but also more esthetic, stronger, and longer lasting.
Here’s how biomimetic dentistry works.
Biomimetics fully integrates available dental materials and technologies such as composite resins (microhybrids) and feldspathic ceramics. When combined with sophisticated adhesive (high C-factor) technologies, these biomimetic materials are able to act as direct substitutes for existing dental substrates such as dentin and enamel. Composite resin, in particular, can be used as a substitute for dentin. Meanwhile, special ceramic materials can be used as a substitute for natural dental enamel. These are simple, cost-effective, and traditional dental materials used in an advanced way.
Many biomimetic treatments and procedures are additive rather than subtractive in nature. What this means is that they involve adding on material, usually both composite resins and ceramics, onto a damaged tooth to restore its form and structural stability. This additive process can be summed up in five general steps:
Demineralize collagen to expose the porous layer. The purpose is to provide a suitable bonding substrate.
Apply a hydrophilic resin.
Apply a bonding resin.
Apply the ceramic layer. This can be ceramic inlays or onlays.
Curing should occur throughout the process.
An instructive way to think about biomimetic dentistry is in the context of buildings and architecture. Imagine, if you will, an iconic historic building such as the White House or the U.S. Capitol Building. These are old buildings that, over time, may suffer structural damage or fall into disrepair as the U.S. Capitol Building did. When faced with a dilapidated historic structure, there are two routes an architect tasked with renovating the building can take conservation or total replacement.
With a conservation approach, the architect attempts to preserve all or as much of the original building materials and components as possible to retain the original historic qualities and charm of the building. Any new materials are chosen to match existing components. As much of the original structure is left untouched as possible. An architect could also gut the entire building while leaving the structurally sound “bones” of the building intact. The building would then be updated and dressed up with new materials and components to look like the original.
With a replacement approach, the old historic building would be demolished and a new one with all new materials, components, and structure would be built in its place. The resulting new piece of architecture can be made to resemble the original or could be designed to look like something else entirely.
Biomimetic dentistry has more in common with the first approach and less so with the latter. Conventional dentistry is much more similar to the replacement of an old building. Could you imagine completely demolishing and replacing the White House or the U.S. Capitol building with something totally different? It would not only be expensive but would result in a dubious value as well. Most importantly, it would have none of the historical charm or national symbolism of the originals. Similarly, your natural teeth are the best teeth you will ever have. While man-made prosthetics can get close, no artificial replacement can beat your natural teeth. Biomimetic dentistry strives to conserve and preserve your natural teeth as opposed to replacing them.
Biomimetic dentistry strives to conserve and preserve your natural teeth as opposed to restoring or replacing them. This minimalist approach not only saves patients and dentists time and expense, but it may also offer up far more long-term value to the patient. Your teeth are not dead things. They are living, anatomical structures connected to bone and tissues, and integrated into the body through blood vessels and nerves. Each tooth is composed of intricate layers, from the inner pulp to the outer enamel, that all work in tandem to create a perfect union of form and function. Why throw all that out if the tooth is damaged? Instead, it pays to do less and save or salvage more of the original tooth. In doing less, dentists may actually be doing far more for their patients.
In a biomimetic approach, longevity is everything. Biomimetic material substitutes, such as resin and ceramic, are designed to mimic the biomechanical and functional properties of dentin and enamel. Because a biomimetic approach seeks to retain much of the living natural tooth rather than replace it with a “dead” prosthetic, the tooth tends to last much longer. A living tooth that is integrated into the body’s various bodily systems, including the cardiovascular system and immune system, is much more resilient than an artificial replacement tooth. This natural resilience is exactly what biomimetic dentistry is trying to take advantage of. By retaining as much of a living tooth as possible, doctors hope that future re-treatments that are common with man-made prosthetics can be avoided. Saving more teeth saves money and time in the long run.
For a long time, the paradigm of successful cosmetic dentistry was the replacement of failing natural dentition with a set of perfectly formed and fitted prosthetics. In patients where a tooth absolutely cannot be salvaged or has been totally lost, this is still very much the case, and very much necessary. However, in the thousands of cases where a living tooth can still be saved, replacement or restoration with mechanical attachments is no longer the gold standard. In fact, there is a growing concern amongst dentists and dental professionals that many clinics are actually needlessly over-treating patients. Invasively extracting a natural tooth that is integrated into the body and replacing it with a foreign object that is not integrated at all can often create additional cascading issues. Implants, for example, can fail to become properly osseointegrated into the underlying bone leading to inevitable failure and retreatment. Improperly sealed root canals can become infected leading to failure and retreatment. An amalgam filling can break and leak leading to failure and retreatment. As it turns out, overtreatment is just as dangerous as undertreatment.
With a biomimetic approach, the entire mindset is different. Instead of focusing on mechanical solutions, the focus is on conservation. Key to this process of conserving a patient’s natural dentition is the idea of minimizing the impact of any dental intervention or treatments.
Conventional cosmetic dentistry is concerned with mechanical solutions to dental problems. It employs titanium, ceramics, screws, and adhesives to replace or at least cover up dental problems. The ultimate goal of conventional cosmetic dentistry is to replace natural structures with supposedly superior, man-made materials. However, more and more doctors and dentists alike are finding that the body’s natural structures can’t simply be replaced.
Take a natural tooth as an example. A natural tooth consists of an inner layer of living dental pulp, an intermediate layer of dentin, and an outer layer of hard enamel. The pulp provides the surrounding dental tissues with nutrition. It also functions to collect sensory information, such as temperature, pressure, and pain and send it back to the brain. Meanwhile, the dentin and enamel give a natural tooth structure an unparallelled functional strength. The dentin, while relatively soft, has excellent tensile strength characteristics. This prevents a tooth from simply fracturing when exposed to the slightest lateral force.
Esthetic integration is not obtained through a single procedure, final work, or comprehensive cosmetic treatment. Rather, it can only be achieved with a holistic approach that takes into account every aspect of an esthetic treatment from beginning to end, including financial and physical costs, maintenance, and future re-treatment needs. It is not purely concerned with esthetics, but also with the long-term physical and financial health and wellbeing of the patient which, ultimately, leads to long-term patient satisfaction.
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