Frequently Asked Questions — FAQ
Biomimetic dentistry means to “mimic” or replicate natural teeth. More specifically, biomimetic dentistry is a type of restorative dentistry that mimics the structure and function of natural teeth while preserving the maximum amounts of healthy intact portions. Major concepts of this approach include using materials with properties similar to the structure of natural teeth layers (Enamel, Dentin, and DEJ) and utilizing proven science and techniques to maximize the survival and health of the tooth (the vitality). Maximum adhesion strength is a critical aspect and the formation of a strong adhesive seal minimizes complications that occur from the traditional dental approach. This strong adhesion eliminates the need for drilling and shaving the teeth for crowns. Preserving more of your teeth provides many long-term advantages and eliminates the need for most root canals.
Biomimetic dentistry is related to holistic dentistry and provides many holistic advantages. Biomimetic dentistry requires advanced training and most holistic dentistry is NOT biomimetic. A holistic dentist may place tooth-colored fillings or provide conservative restorations, but this is not the same as a biomimetic restoration which restores the structure, function, and biomechanics of natural teeth.
Biomimetic dentistry requires advanced study and training. Many dentists have not had the opportunity to be trained or advance their skills. Some are not aware of the biomimetic approach or reluctant to change the way they practice. Additionally, the techniques require more time and effort which is not always manageable for different practice settings, especially insurance offices which are incentivised to provide work that fails routinely.
Biomimetic dentistry was first mentioned in the 1990s, but the core science and techniques date back as far as 1955. Countless advancements and scientific contributions since then have contributed to the great success and interest in Biomimetic dentistry.
Not necessarily. Biomimetic dentistry does typically take more time and effort per procedure than traditional approaches. This usually translates to higher procedure costs, but there are many instances where treatment fees are higher despite the quality being low. However, biomimetic dentistry will almost always cost less long-term by avoiding catastrophic complications like root canals, root fractures, and implants.
NO! Unfortunately, there is a lot of incorrect information claiming that Ozone is a critical aspect of holistic and biomimetic dentistry and it is important to know the facts. Ozone does not improve or enhance the results of biomimetic restorations, and its use can actually cause problems and failures.
The purpose of ozone is to disinfect or kill bacteria prior to restoring the tooth with either a filling, inlay, or an onlay. However, numerous scientific publications have demonstrated that using Ozone reduces the strength of adhesion (“the bond”) to tooth structure. In order to provide biomimetic results, restorations MUST be bonded with extremely high bond strengths to replicate the natural adhesion present between layers of teeth (Enamel & dentin). This strong bond provides the ability to replicate the structure and function of natural teeth and provide a strong seal to prevent leakage and cavities. Using anything that will reduce this strong bond will jeopardize the objectives of biomimetic dentistry and increase the complications.
Fortunately, there are more effective ways to disinfect or kill bacteria which do not affect the bond strength. One particularly good method to disinfect involves the use of MDPB and this has been shown to be more effective than ozone without affecting the bond strength. It is important to understand that there is no issue with success rates on biomimetic restorations due to the presence or disinfection of bacteria, therefore using something like Ozone can only make matters worse with no benefit.
Magnification is a very important component of biomimetic dentistry. Biomimetic dentistry involves the application of scientific protocols with exacting precision. This level of precision requires enhanced vision and the ability to see great detail. The recommended magnification level is 6-8x and this can be realized with high power dental loupes or a dental microscope. At this magnification, you are able to see fine cracks and accurately identify intact vs defective tooth structure. Regardless of magnification, some cracks are impossible to visualize even with the highest magnification.
Cracked teeth have been pushed past their limit, usually due to previous fillings or restorations which have weakened the teeth. These teeth are structurally compromised and need to regain the function and strength of healthy intact teeth. The challenge with cracked teeth is to adequately treat (remove or reinforce) the cracked portion of the teeth AND restore the structural integrity of the tooth with the final restoration.
Depending on the specific clinical situation and the severity of the crack, the treatment may involve a biomimetic filling or a biomimetic ceramic restoration. The filling option combines the use of a fiber mesh or fiber reinforced composite along with the application of small layers of filling material to control shrinkage and stress development and maximize the bond.
For larger cracks or more severely compromised teeth, a ceramic restoration is the treatment of choice due to its properties more closely mimicking the strength and hardness of the enamel layers of your tooth and providing more resistance to further crack progression. It is important to know that filling material is 4x weaker and less rigid than your enamel, so its ability to restore moderate to severely compromised teeth is not comparable to ceramic restorations.
White fillings rely on adhesion to seal the interface between the tooth and filling. Many white fillings have little to no adhesion due to the materials and application technique. This makes them extremely susceptible to leakage and cavities. When a white filling is placed, a light is used to make the filling turn solid and during this transition, there is shrinkage of the material. When this shrinkage is not controlled, there will be large gaps and a poor quality of seal which leads to cavities and failures. A lot of white fillings are placed in one large increment and this is especially likely to fail.
In contrast, the biomimetic composite filling uses smaller layers placed incrementally and sometimes the use of fibers (or fiber containing materials). With this approach, the shrinkage of the material can be controlled and the adhesion to tooth structure can approach the same strength that layers of the tooth are naturally joined together (enamel and dentin bond strength). Biomimetic composite fillings minimize the chance of major complications and have the best long-term performance when compared to standard white fillings. Additionally, the biomimetically restored tooth regains the strength of the weakened tooth back to natural levels comparable to a normal tooth.
Biomimetic dentistry has eliminated the need for posts entirely. A post is traditionally used when there is insufficient tooth structure left to restore a tooth with a crown. The post is inserted into the root of the tooth and used to support or “hold” the crown. If the tooth is currently alive (“vital”), then a root canal must be completed first before the post is placed. This is completely avoidable with a biomimetic approach which eliminates the need for posts through the power of adhesion. When maximum adhesion (or “bond strength”) is achieved, the tooth can be restored without requiring a post. To achieve this level of adhesion requires a combination of ideal materials, precise technique, and a meticulous application protocol.
Good materials are important but the dentist providing the treatment is the most important aspect of biomimetic dentistry. Materials make nearly no difference without the proper application technique, moisture control, and protocols.
Biomimetic dentistry is based on replicating the properties, function, and esthetics of natural teeth. The Biomimetic approach relies on advanced adhesive dentistry to achieve this result. Techniques, materials, and protocols of the biomimetic approach aim to maximize the bond to tooth structure and minimize stresses that would lead to complications (shrinkage stress and residual stress).
In terms of materials, there isn’t one specific material for every situation and there are several options that fit the ideal properties for different material types like adhesives, fillings, and ceramics.
Compatibility to materials is unique to each person. Materials used in biomimetic dentistry are consistently among the best performing and least reactive materials available. A Clifford material reactivity report (or similar) can be ordered to evaluate your specific reactivity to most dental materials. We only recommend this report if you have serious concerns about reactivity to dental materials or know that you are extremely sensitive.
No. A laser is not an important part of biomimetic dentistry. Lasers are popular among patients because the concept sounds cool, and they do have some application in minimal intervention for small cavities such as pit-and-fissure caries, but a good air abrasion unit provides the same advantages and increased precision. Neither a laser or air abrasion can replace an electric handpiece entirely and without an electric handpiece, the results would be unacceptable.