Community Magazine April 2013

I n the past, if you broke a large chunk of your lower back molar, the treatment of choice would have been a root canal and a crown (cap). But adhesive dentistry and the latest research have changed that. Biomimetic dentistry, a type of tooth-conserving dentistry, treats weak, fractured, and decayed teeth in a way that keeps them strong and seals them from bacterial invasion. In my own dental practice over the last eight years, many of the teeth that we used to cut down for crowns are now being treated with large fillings or direct composite onlays. One of the goals of this approach, which is called biomimetic dentistry, is to avoid root canal treatment. Our patients are happier because they save money and save more of their own tooth structure. Biomimetic means to copy or mimic nature, which is our ideal model to imitate. In order to mimic nature, we must understand what nature looks like or feels like. We need to know how it moves or behaves. In other words, we need to study nature’s properties so that we can duplicate it as precisely as possible. In the past, and even today, the world tries to improve nature by attempting to make synthetic materials that are stronger, stiffer and more beautiful. Sometimes this can lead to new problems --even catastrophic failures. One example of such a failure in dentistry was the use of “very strong” posts in teeth that had root canals. Those posts were so strong – stronger than the roots of the teeth – that they actually caused the roots to fracture and the teeth to be lost. Biomimetics seeks to avoid that by using technology that imitates natural teeth. Now it is possible to rebuild teeth with materials that simulate natural teeth much more closely, and hold up better to constant chewing. Biomimetics studies the dental scientific literature and applies these principles to dentistry. Modern adhesives and bonding techniques are the driving force of biomimetic dentistry. Before adhesive dentistry techniques were developed, we had to remove more tooth structure in order for the crown to hold. In other words, we had to destroy in order to create. Now we are able to bond or glue teeth back together and even add missing parts of the tooth reliably without removing volumes of precious tooth structure. This method has the added value of sealing the tooth from bacterial infection. When a nerve has been damaged to the point that a root canal is needed – this is a tooth saving procedure. The tooth can then be protected with a post and crown (cap). Biomimetic dentistry is conservative. The fundamental rule we follow is that less dentistry is the best dentistry. We might even say no dentistry is the best dentistry. And thankfully, modern science enables us to eliminate or prevent much of the cutting aspect of dentistry . Periodontal disease and cavities (decays) can practically be eliminated with preventive treatment and good home hygiene, and cavities and old fillings can be treated with the most conservative materials and techniques. When it comes to dentistry, less is more. This goal of preservation and conservation lies at the heart of biomimetic dentistry, allowing us to copy nature so we don’t have to tamper too much with your natural teeth. DR. JACQUES DOUECK What is Biomimetic Dentistry? 94 COMMUNITY MAGAZINE