Biomimetic Dentistry: Acceptable Alternative Materials and Techniques When “Gold Standard” Products Aren’t Available

Because the technique matters more than the label

Dr. Jeff Davies | Biomimetic Study Club & Dallas Designer Smiles

Biomimetic dentistry has grown far beyond a list of “approved” materials. It’s a philosophy — a mindset that prioritizes bonding to preserved tooth structure, sealing dentin immediately, and managing stress through careful layering and design.

But what happens if you can’t get SE Protect, Optibond FL, or Ribbond in your country, or if your distributor is back-ordered? Are you suddenly non-biomimetic? Of course not.

The truth is, many materials can perform beautifully if used within the biomimetic principles of sealing, stress reduction, and adhesion preservation. This article outlines clinically acceptable substitutes — based on current evidence and real-world success — when the ideal materials aren’t available.

1. Adhesive Systems: When You Don’t Have SE Protect or Optibond FL

If SE Protect (Kuraray) isn’t available:

Goal: Achieve a durable, hydrolysis-resistant hybrid layer with functional MDP and immediate dentin sealing (IDS).

Acceptable Alternatives:

• Clearfil SE Bond 2 (Kuraray) – Same core chemistry (MDP + hydrophobic layer), just lacks the antibacterial fluoride additive of SE Protect. Excellent bond strength and long-term reliability.

• Adhese Universal (Ivoclar Vivadent) – Contains MDP and hydrophobic monomers; solid performer if applied in multiple coats and light-cured thoroughly.

• Scotchbond Universal Plus (3M) – When used in self-etch mode and followed with a hydrophobic resin layer, it can approximate SE Protect’s performance.

Clinical tip:
If your adhesive doesn’t contain MDP or lacks a hydrophobic final layer, you can add a thin coat of a flowable composite, as a resin coating, over your cured adhesive to improve long-term stability and reduce nanoleakage.

2. Immediate Dentin Sealing (IDS) Workflow

If you can’t perform the ideal three-step IDS (etch-rinse-seal-flowable) with premium adhesives as mentioned above, the important thing is that you just do it regardless.  If you are using a thinner bonding system, like a universal, its important to add a thin layer of flowable over it to 'secure the bond', and to resin coat it further. 

Acceptable Technique Adjustments:

• Use a two-bottle etch-and-rinse system like, Prime & Bond NT, or All-Bond 3 — just ensure you keep the dentin is slightly glistening and moist before applying primer.

• After curing your adhesive, apply 0.5 mm flowable composite (Clearfil Majesty Flow or Filtek Supreme Flow) to create a resin coating that mimics the “hybridized dentin” barrier of classic IDS.

• Its preferrable to avoid single-bottle “one-step” adhesives as they’re can be too permeable and possibly not hold over long-term function.  However, there are times when I do prefer it. Clearfil universal Quick Bond (and 2) are ones that I have in my office and use whenver the situation arises. 

Bonus Tip: If using a non-fluoride adhesive, you can mimic SE Protect’s antibacterial benefit by scrubbing with 2% chlorhexidine before sealing. This inactivates MMPs and helps preserve the bond.

3. Short Fiber Reinforcement: When You Don’t Have EverX Flow or Ribbond

If you can’t use Ribbond or EverX:

Goal: Create a fiber-reinforced “bio base” that distributes stress and stops crack propagation.  If fibers aren't availible and you have a high C-Factor configuration, then I'd recommend more smaller incremental layers.  If fibers aren't avialbe and there is potential crack damge, then I  would change or ensure that the final restoration is a form of an onlay that would help cover the cusps and reduce the potential propigation. 

Acceptable Alternatives:

• Grandio Fiber (VOCO) – Fiber-reinforced flowable with similar modulus and strength.

• SDR Flow+ (Dentsply) – Not fibered, but low-shrinkage stress and can be layered beneath hybrid composites to absorb polymerization stress.

• Fiber-reinforced polyethylene posts (GC everStickPOST, RTD DT Light-Post) – If Ribbond isn’t available for endodontic reinforcement, these translucent posts distribute stress effectively when bonded coronally into composite.

Technique Note:
If you don’t have fiber material at all, you can approximate its mechanical benefit by using a thin increment of flowable composite, as a resin coating (0.5–1 mm) followed by a stiff micro-hybrid composite like Clearfil AP-X or Filtek Z250. The modulus gradient created between layers helps mimic dentin’s stress distribution and creates a 'fail safe' if you were to have a catosrophic failure. 

4. Composites: When “Biomimetic-Endorsed” Restoratives Are Unavailable

Posterior Restorations

Goal: Match dentin’s modulus of elasticity (~18 GPa) and enamel’s (~80 GPa) with layered, stress-modulated materials.

Acceptable Alternatives:

• Filtek Z250 or Z350 XT (3M) – Excellent mechanical properties, good polishability, well-researched.

• Tetric EvoCeram or Tetric EvoFlow (Ivoclar) – Ideal combination of strength and translucency when used in thin layers.

• GC Essentia or G-aenial Posterior – Lower shrinkage stress and reliable bond compatibility.

• Enamel replacement: Use microfilled or nanofilled composites (Venus Diamond, Enamel HRi, etc.) for the outermost layer to mimic light transmission and surface hardness.

Anterior Restorations

If Clearfil Majesty Esthetic or Kuraray composites are unavailable:

• Renamel Microfill (Cosmedent) – Beautiful polish and low wear.

• Filtek Supreme Ultra – Nanofiller system produces durable esthetics.

• GC Essentia Light Enamel – Great for biomimetic translucency.

5. Bases and Liners (When You Don’t Use Bioceramics)

You already practice the biomimetic “no-liner” approach — sealing dentin instead of covering it.  Sealing the dentin will help hold and preserve the pulpal floor hybrid layer for long term, but if you are newer to biomiemtics and aren't fealing 100% comfortable and want to use a liner, then choose:  (remeber to keep this as minimal and as small as possible with its placement,  like a small drop is adequate)

• TheraCal LC (Bisco) – Light-cured calcium silicate alternative when pulp capping.

• Resin-modified glass ionomer (Fuji II LC) – Acceptable as an interim liner, but should never be left exposed or under final composite layers in bonded biomimetic cases.

• Fuji Triage - Can be placed as a small drop sized layer over a potential pulp horn, as an indirect pulp cap, if you feel uncertain.  This can also be used a longer-term temporary solution if unsure about the restorabiltiy or if a tooth needs endo or not.

• Alternative biomimetic approach: Apply IDS with adhesive and flowable composite to seal dentin instead of a liner, even in deep cases, provided hemostasis and cleanliness are achieved.  With practing for ten + years, I've yet to do use of these as a liner.

6. Caries Detection & Preparation

If you don’t have Caries Detector dye (Kuraray) or Air Abrasion (Aquacare, CrystalMark):

• Substitute Dye: Use Sable Seek / Green Seek (Ultradent) for infected dentin identification.

• Alternative to Air Abrasion: Use slow-speed round diamond burs with copious water and micro-etching (CoJet, 27 µm alumina) before bonding.

  The key is not the tool, but the control. Preserve affected dentin that can remineralize and avoid over-cutting.  If you dont have access to air abrasion, its best to finish your prep with a red stripe polishing bur, preferrably a round.  

7. Etchants & Silanization

If you lack Kuraray K-Etchant Gel or Ceramic Primer Plus:

• Etch: Any 35–37% phosphoric acid gel with good viscosity is fine (Ultradent, 3M Scotchbond, Bisco Select HV).

• Silanes: Use Monobond Plus (Ivoclar), RelyX Ceramic Primer (3M), or Ultradent Silane — all acceptable alternatives for ceramic surface treatment before bonding to enamel/composite.

8. Isolation & Field Control

If you don’t have access to a full rubber dam setup:

• Alternative: Isolite or DryShield systems maintain acceptable moisture control if you follow with active air drying and avoid contamination during adhesive placement.

• Supplement: Use Teflon tape, OraSeal, and retraction cords to isolate margins and prevent fluid wicking.

Remember: Perfect bonding happens in a perfectly dry but not desiccated environment. Isolation is as much about workflow discipline as equipment.  I also use Katana Cleaner wehenver there is a possible contamination that I  am needing to clean prior to my bonding steps.  If I have already placed the primer and bond, and it gets contaminated, then wick away the contaminants with uncured bond and brush and air dry as needed.  You can repeat those steps as needed. 

9. Indirect Restorations: When Premium Systems Aren’t Accessible

Resin Cements

If Panavia V5 or Clearfil Esthetic Cement are unavailable:

• RelyX Ultimate (3M) or Variolink Esthetic DC (Ivoclar) – Excellent alternatives with MDP or silane integration.

• G-CEM LinkForce (GC) – Dual-cure, MDP-containing, biomimetic-compatible.

• Do not use self-adhesive cements — they compromise hybrid layer quality and defeat the biomimetic seal. Dual cure cements are preferred.  

• Remeber, heated compsoite is almost always the preferred method of bondoing an onlay due to the bond strengths, the wear properties, the working time, the ease of opperation, etc.

Ceramics

If you can’t get e.max or lithium disilicate blocks:

• Celtra Duo (Dentsply) or VITA Suprinity – Similar mechanical properties.

• High-strength hybrid ceramics (GC Cerasmart, Lava Ultimate) – Work well for onlays when properly bonded and sealed with IDS.

For me, theres very few times when I will prefer zirconia as the ceramic material of choice.  Its true that the zirconias are getting 'softer' to where they mimic the natural tooth's properties more but they can still be too hard. 

10. When You Can’t Do Everything “Perfect” — Focus on the Hierarchy of Biomimetic Priorities

Even without every ideal material, your case can still be biomimetic if you respect the following order of importance:

If you achieve those five, you’re practicing biomimetic dentistry — even without the label on the bottle.

11. The Real Takeaway

Biomimetic dentistry isn’t about brand loyalty — it’s about biological honesty.
The materials matter, yes, but your understanding of why they work matters even more.

You can be in a small clinic, rural setting, or a country where SE Protect or Ribbond aren’t sold — and still deliver world-class biomimetic results. The secret lies in your bonding discipline, layering technique, and commitment to preserving natural structure.