Six Lessons Approach Podcast by Dr. David Alleman

Dental isolation should be used with every adhesive restoration. Why? In this episode, Dr. David Alleman discusses how isolation improves bond strength, tips for practitioners on rubber dam placement, and additional techniques like copper band placement for deep margins.

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September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Do dental liners and bases benefit a restoration? Originally developed for retention restorations, liners and bases were believed to seal the dentinal tubules to protect the pulp, but later research showed their ineffectiveness. 

As restorative dentistry transitioned to adhesive materials and protocols, their use continued, but are they still necessary to seal the pulp? In this episode, Dr. David Alleman, DDS, discusses the research and effectiveness of liners and bases, and how the right adhesive protocols can render them unnecessary by using your dentinal bonding system to seal the tooth instead.

Articles referenced in this episode:

• Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457

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September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Biomimetic dental materials mimic a natural tooth’s flexibility and cohesive strength. How does this help a restoration long-term? These materials, when used with the right techniques, work with the remaining tooth structure around the restoration, rather than in opposition to it, like with materials that are too stiff, poorly bonded or stress weaker areas of the tooth.

In this episode, Dr. David Alleman, DDS, dives into dentinal bonding systems, flowable composites and fiber, discussing what makes them biomimetic, how they are developed and researched and their benefits in a restoration. 

Articles referenced in this episode:

• Akimoto N, Takamizu M, Momoi Y. 10-year clinical evaluation of a self-etching adhesive system. Oper Dent. 2007 Jan-Feb;32(1):3-10. doi: 10.2341/06-46.

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September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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What materials should you use to maximize adhesive strength, restoration longevity and tooth conservation? While how you use the materials — your techniques – are more important than the materials themselves, materials do still make a difference in restorative outcomes. In this episode, Dr. David Alleman, DDS, discusses zirconia, ceramic and composite and these materials’ interaction with natural tooth structure.

Articles referenced in this episode:

• Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. 2000 Jun;13(3):129-35.

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September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Fiber placement in restorative dentistry: Does it stop cracks, improve bonds or just add time to your restorative process? Dr. David Alleman, DDS, dives into the history of dental fibers, including Ribbond, Everstick Net and Ever-x Posterior, their uses in different clinical settings, and the research that shows how they support the restoration long-term. 

Articles referenced in this episode:

• Belli S., Et al. The effect of fiber placement or flowable resin lining on microleakage in class II adhesive restorations. J. Adhes. Dent. 2007; 9: 175-181
• Fennis  WMM,  Kuijs  RH,  Kreulen  CM,  Verdonschot  N,  Creugers  NHJ. Fatigue Resistance of Teeth Restored with Cuspal-Coverage Composite Restorations. Int J Prosthodont 2004 17(3)-313-317

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Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Cracks put teeth at risk of infection and fracture if left untreated, but treating cracks in teeth can create many challenges for practitioners. Removing cracks without good magnification, visibility and an understanding of crack propagation puts the nerve and critical tooth structure at risk. Once the crack is removed, the non-standard defect requires specific techniques to bond to deep areas of the tooth while maintaining a strong bond.

Dr. David Alleman, DDS, first began researching treatment options for cracks because he recognized that full coverage crowns weren’t yielding predictable results. Adhesive dentistry had the potential to offer a more predictable alternative, but the protocols didn’t exist for practitioners. So he formulated those protocols for predictable crack treatment himself. 

Articles referenced in this episode:

• Belli S., Et al. The effect of fiber placement or flowable resin lining on microleakage in class II adhesive restorations. J. Adhes. Dent. 2007; 9: 175-181.
• Nikolaenko SA, Et al. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent. Mater. 2004;20-579-585

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Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Dentists have been attempting to treat cracked teeth for decades, with the goal of alleviating patient pain and conserving teeth through restorative treatment. But as Dr. David Alleman, DDS, describes in this episode, “it’s a coin toss of success.” Methods such as retention to hold the crack together or bonding over the crack with adhesion are unpredictable. Sometimes the treatment works, and sometimes it doesn’t, leaving patients and practitioners frustrated. 

The solution: treat cracked teeth like engineers have been treating cracks for over a century. 

The challenge: applying these techniques to a biological environment and accounting for bacteria, dentin hydration and dental adhesives.

Dr. David Alleman, DDS, discusses the history and treatment protocols for predictable cracked tooth treatment in this episode of the Six Lessons Approach podcast.

Articles referenced in this episode:

• Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457
• Gordon, J. E. The New Science of Strong Materials: Or, Why You Don't Fall Through the Floor. Princeton, N.J: Princeton University Press, 2006.
• Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.

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View upcoming course dates at allemancenter.com/events 

Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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The most minimally invasive dentistry is early diagnosis and treatment. Dr. David Alleman created the 1-2-3-4 risk assessment so he could better diagnose teeth that were at risk of fracture or decay to prevent large fractures or carious lesions under the restoration. In this episode, Dr. Alleman discusses research into the structural integrity of different preparations and how practitioners can use this research to prevent cracks and marginal leakage before they pose a risk to the tooth.

Articles referenced in this episode:

• Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5.
• Wang RZ, Weiner S. Stain-structure relations in human teeth using Moire fringes. J of Biomechanics. 1998;31:135-141.

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View upcoming course dates at allemancenter.com/events 

Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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Treating cracks in teeth can still feel ambiguous for many dentists. Is it better to observe? Is it better to crown? Is there a less invasive treatment option? In this episode, Dr. David Alleman discusses a key piece of research that offers practitioners more insight into crack diagnosis and treatment: cracks that cause decay.

Occlusal effect caries is a carious lesion that forms from cracks that extend into dentin, creating a pathway for bacteria to enter the tooth. These cracks, called peripheral rim fractures, occur mostly around large restorations that leave the surrounding tooth structure unsupported, making crack initiation easier in the tooth. By understanding how these cracks form, practitioners can better learn how to detect and restore teeth affected by peripheral rim fractures.

Articles referenced in this episode:

• Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.
• Walker et al. Enamel cracks the role of enamel lamella in caries initiation. Australian Dent J. 1998;43(2) 110-116.

Next Biomimetic Mastership class starts May 18. Learn more and register at allemancenter.com/mastership.

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View upcoming course dates at allemancenter.com/events 

Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

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With the invention of new materials for restorative dentistry, new techniques for application were needed. Research in bonding to dentin showed bond strengths that approached the cohesive strength of a tooth, but getting this research into the hands of practicing dentists was another process entirely. 

As Dr. David Alleman was learning and researching new protocols in adhesive dentistry, his questions about why debonds occurred in select areas of the tooth led to his formulation of the concepts of the hierarchy of bondability and decoupling with time, all while creating his Six Lessons Approach to Biomimetic Restorative Dentistry. These new concepts that built on a foundation of dental research from the past four decades gave dentists anywhere the ability to bond predictably to deep dentin and restore the tooth in a way that mimicked the form and function of a natural tooth: biomimetic dentistry. 

Send us Fan Mail

View upcoming course dates at allemancenter.com/events 

Upcoming dates:

September 14: Biomimetic Mastership starts
September 25-26: SLA Workshop (optional DME/Isolation intensive)
October 7-10: In-Person Biomimetic Mastership
December 4-5: SLA Workshop (optional DME/Isolation intensive)

Instagram
@david.alleman.dds
@davey_alleman_dmd
@allemancenter.com

YouTube
@allemancenter