The wallpapering technique is a key protocol for extending the function of endodontically treated teeth. More brittle due to their reduced hydration, non-vital teeth are more prone to fracture, so using fiber in this way creates a fail-safe that prevents failure beneath the coronal portion of the tooth and reinfection of the root.

Dr. David Alleman discusses how he helped pioneer this technique and other advancements in adhesive dentistry for cases with non-vital teeth in his Six Lessons Approach to Biomimetic Restorative Dentistry.

Articles referenced in this episode:

• Deliperi S, Alleman D, Rudo D. Stress reduced direct composites for the restoration of structurally compromised teeth: fiber design according to the wallpapering technique. Oper Dent. 2017, 42-3 (233-243)
• Belli  S,  Donmez  N, Eskitascioglu  G. The Effect of C-factor and Flowable Resin or Fiber Use at the Interface on Microtensile Bond Strength to Dentin. J Adhes Dent 2006_8-247-253
• 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
• Erkut S. Highlighted Microleakage in Overflared Canals with different fiber reinforced dowels. Oper Dent 2008 33(1)92-101.

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

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Dr. David Alleman first created his Six Lessons Approach for vital teeth, but the same conservative principles can benefit endodontically treated teeth too. Compared to traditional techniques for retention and bonding, the advanced adhesive and stress-reducing techniques of biomimetic dentistry are better suited for treating non-vital teeth, which are more brittle and susceptible to cracking than fully hydrated teeth with healthy pulps. This episode outlines how biomimetic techniques approach endodontically treated teeth differently and the research that supports these protocols.

Articles referenced in this episode:

• Kishen A., Vedantam S. Hydromechanics in dentine: Role of dentinal tubules and hydrostatic pressure on mechanical stress-strain distribution. Dent Materials. 2003;23: 1296-1306
• Magne  P,  Belser  U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433
• Jayasooriya  PR,  Pereira  PNR,  Nikaido  T,  Tagami  J. Efficacy of a Resin Coating on Bond Strengths of Resin Cement to Dentin. J Esthet Restor Dent 2003 15(2)105-113
• 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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Daily dentistry, the cases you see every day, usually involves minor occlusal adjustments that can be treated quickly and predictably using the Six Lessons Approach, but biomimetic techniques can benefit more advanced occlusal cases too. In this episode, Dr. David Alleman discusses the cause of abfractions, how complex temporaries are a thing of the past and options for doctors seeking more advanced occlusal training beyond everyday cases.

Articles referenced in this episode:

• Magne P,  Belser  U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433
• Pintado M, Et al. Variation in tooth wear in young adults over a two-year period. J Prosth Dent. 1997(77)3. 313-320.

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Biomimetic dentistry aims to mimic a natural tooth throughout the restorative process. The last four decades of research has shown that mimicking and conserving a tooth’s natural connection to itself, its natural bond and resilience to occlusal forces and its natural defense mechanisms for infection benefits the tooth’s long-term health. This is also true for occlusion.

In this episode, Dr. David Alleman discusses what all dentists can learn from a body’s natural occlusion, lost research from the last few decades and approaches for daily occlusal techniques that can be applied to cases doctors regularly see in their office.

Articles referenced in this episode:

• Michael C. Alpern. The Ortho Evolution: The Science and Principles Behind Fixed/Functional/Splint Orthodontics. editor GAC International, Inc; 2003.

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What is the best material for enamel replacement? It depends! When selecting the material of an onlay or overlay, understanding how a natural tooth functions during occlusion is essential if your goal is biomimetic dentistry. Harder is not better, but rather mimicking a natural tooth’s bond to itself and its modulus of elasticity will aid in selecting your enamel replacement material.

In this episode, Dr. David Alleman reviews ceramic, composite and gold and outlines best practices for completing the final steps of a biomimetic restoration.

Articles referenced in this episode:

• Wendt, S. L. (1988). A laboratory and clinical evaluation of a heat-cured composite resin inlay. [Master’s Thesis, University of Alabama].

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Air abrasion functions as a conditioning step when bonding, which means it prepares the dentin or composite molecules for bonding. Dr. David Alleman discusses the progression of bonding systems for dentin adhesion and how this conditioning step evolved along with the bonding system molecules. The latest studies from researchers independent from the bonding system manufacturers show that air abrasion increases bond strengths to a level that mimics the strength at which a natural tooth is connected to itself (30-50 MPa). This conditioning technique is what brings dentin bond strengths into the biomimetic range, maximizing bond strength and the longevity of the restoration.

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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Dr. David Alleman’s landmark paper written with Dr. Pascal Magne in 2012 gave practitioners predictable steps for deep caries, and now crack, treatment without exposing the pulp. But why is preventing pulp exposures so important? Dr. Alleman discusses research about the outcomes of pulp exposures and their effect on the tooth long-term in addition to proven treatment for teeth that have had exposed pulps.

Adhesive dentistry offers these teeth a second chance, but only when the seal is bonded at the nanometer level, like with biomimetic dentistry. Just like each step in the Six Lessons Approach to Biomimetic Dentistry, the protocols for treating pulp exposures offer predictable results and protect the tooth’s long-term vitality.

Article referenced in this episode:

• Thompson T., Et al. Treatment of deep carious lesions by complete excavation or partial removal. JADA. 2008;139:705-712.
• Hafez A., Et al. An in vivo evaluation of hemorrhage control using sodium hypochlorite and direct capping with a one- or two-component adhesive system in exposed nonhuman primate pulps. Quintessence Int. 2002 Apr;33(4):261-72. 

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Early diagnosis and treatment of dental pathologies allows for more conservative treatments while saving patients time and money. When developing the Six Lessons Approach to Biomimetic Dentistry, Dr. David Alleman created a risk assessment for determining if teeth were at risk of caries or cracks based on pathologies and treatment history.

Drawing on research from how teeth experience pain, the pulp’s immune response and how dental histology affects restoration, the risk assessment has been proven to be an effective tool over the last 20 years, especially where x-rays do not identify a cause of symptoms. Now that we understand how gaps and cracks cause pain and sensitivity, identifying them early is the next step for more conservative treatment.

Article 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
• Galler K., Et al. Inflammatory response mechanisms of the dentine–pulp complex and the periapical tissues. Int J Mol Sci. 2021 Feb; 22(3):1480
• 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.
• Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5. 

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Caries removal can be reproducible — this means consistent regardless of patient or practitioner. Caries detecting dye is essential to creating reproducible caries removal endpoints, but the techniques doctors pair with the dye are what prevent pulp exposure and maximize bond strength.

When Dr. David Alleman pioneered his methods for determining caries removal endpoints, he found that any doctor he trained could achieve the same predictable caries treatment that he saw in his own cases. How caries is treated is the first step in a restoration and determines whether that restoration succeeds or whether that restoration fails.

Article referenced in this episode:

• Anderson M, Charbeneau G. A comparison of digital and optical criteria for detecting carious dentin. J Prosth Dent. 1985;53(5): 643-646.

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

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Each lesson in the Six Lessons Approach to Biomimetic Dentistry (SLA) is essential to restoring a tooth in a way that stays bonded and symptom-free. These two failings of traditional techniques — debonded restoration and post-operative sensitivity — are addressed in each lesson, but when it came to the bonding stage of the restoration, Dr. David Alleman was able to reach a pivotal conclusion from the published research.

Different parts of the tooth form hybrid layers at different rates based on the amount of hydroxyapatite. Composite will shrink to the best possible bonding surface, potentially leaving gaps in areas that have weaker bond potential. Understanding how to overcome these two variables is key to creating a restoration that bonds the tooth side to side, front to back and top to bottom like a natural tooth. This biomimetic bond eliminates gaps under restorations that cause post-operative sensitivity, but it requires understanding how bonding systems, composite and dentin need to work together within the first five minutes of the polymerization process. Dr. David Alleman named this process decoupling with time.

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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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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