TBU: #035 The Four Paradigms of Biomimetic DentistryJan 21, 2023
New Issue of The Biomimetic Uprising
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Paradigms can be defined as a distinct set of concepts. These concepts should be easily repeatable in any situation. Paradigms are also used to help show a way of doing things. It should be a method to help others see a possible way to solve an issue. Biomimetic Paradigms do this. The biomimetic paradigms that we are building on are a set and precise approach to dentistry. Meaning, the paradigms don't change regardless of how you get there.
There are four basic biomimetic outcomes that can be expected with biomimetic restorative dentistry:
1. Maximizing Bond Strength
Reducing polymerization stress to the developing hybrid layer results in a 300% to 400% increase in bond strength. Dentin bond strengths in the range of 30 MPa to 60 MPa are in the same range as the tensile strengths of enamel, the dentinoenamel junction, and dentin. This strong bond allows the biomimetically restored tooth to function and handle functional stresses like an intact natural tooth. By achieving bond in this level, we are essentially recreating the DEJ and allowing the tooth to be connected from all sides.
2. Maintaining Marginal Seal
A strong and secure bond allows for a long-term marginal seal to be established and maintained during functional stresses. This means our restorations will last typically longer than traditional dentistry, virtually eliminating the need for subsequent treatments.
3. Increasing Pulp Vitality
Keeping the teeth alive for as long as possible should always be the goal fro any dentist. Biomimetics helps us with that goal. By maintaining a highly bonded seal, the restoration will provide long-term function without recurrent decay, dental fractures, or pulp deaths. A vital tooth is also three times more resistant to fracture.
4. Decreasing Residual Stress
While hard to visualize, residual stress leads to cuspal deformation, debonding, gaps, cracks, pain and sensitivity, and recurrent decay. reducing residual stress while maintaining the maximum possible bond strength is the ultimate goal of any biomimetic restorative technique. We want teeth to function like teeth.
Everything we do in biomimetic dentistry can be tied back to at least one of these four concepts.
The paradigms will be the same regardless of how we get there. There are many ways to do biomimetic dentistry. All are good in the right situation. Our clinical knowledge will help us to determine when to use certain techniques and when not to use them. Even with the differences we can still APPLY our techniques to honor these important biomimetic paradigms.
We often don't always have the ideal situation or setup at our disposal. What if we have poor isolation? What if we have less than ideal materials and bonding agents? What if we have open margins? What if we are having to work faster than ideal and have to complete the treatment faster than what we would like?
Do we change how we do things? Possibly. But if we have to, the goal should be just to change just a FEW of the steps or materials while still reaching the biomimetic paradigms. Power comes from understanding the sciences and knowing how to apply what the research says.
If we are constantly analyzing our work and taking note of what is working and what could be improved on, we will find ourselves doing better work and always improving. This will only help the prognosis of our work. Being able to self critique, diagnose and even adapt mid treatment will make you deliver better restorations for your patients.
Biomimetic Dentistry is about changing the way you think and analyze cases. You will begin to diagnose, treatment plan, and even execute your treatment completely differently than what you did before. You will start to notice an elevated quality in your care. Your treatments will last longer. You will spend less time redoing previous treatments. Dealing with post operative sensitivity becomes a thing of the past. This higher level of care helps you build your practice. Your patients will start telling their friends and family all about your office.
So while you're working, be sure to remember these four paradigm shifts. Tie all the steps you do back to at least one of these methods of treatment. There's a reason we do what we do. Its all based of years of research, trial and error, and tons of experience.
Whenever you're ready, here are the ways I can help you:
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