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Biomimetic Dentistry

Biomimetic Restorations

The guiding principles of all dentistry should be; Nothing we can do or place in the mouth is as suitable as a natural tooth. Everything we do will eventually fail. And so in our treatment we should try to conserve as much of the natural tooth as possible and design the restorations so that when they fail, they do so safely in a way that is easy to repair with as little damage to the natural tooth as possible.

Biomimetic Dentistry;

The objective is;

To replicate the natural tooth mechanically and biologically.

To remove only the diseased tooth, conserving all healthy tooth structure.

To protect the nerve of the tooth and keep it healthy.

To replace the lost tooth structure with similar materials that are compatible both mechanically and biologically with the underlying tooth structure.

To produce a shape that works harmoniously within the mouth.

To work with a predictable methodology based on our scientific knowledge.

The natural tooth is an engineering marvel, the outer core enamel, is a like porcelain substance hard and impermeable. The underlying denting is a softer material that will flex and absorb energy.

The genius lies in the Dentin-Enamel Junction (DEJ), this is a 3D structure that unites the hard enamel outer shell to the soft flexible engine core to produce the tooth’s structural integrity, flexibility and ability to adsorb damaging forces.

A natural tooth will flex, if cracks occur in the outer enamel shell they will limit in size and can self repair from minerals found in saliva (and toothpaste) And finally the nerve within the tooth adds further protection, we thought that the nerve in the tooth informed us of temperature, this is incorrect, the information of temperature and pressure comes from nerve endings in gum. If we bite too heavily on a tooth and it begins to dangerously over flex, the nerve fibres within the dentine start to get stretched, this leads to a reflex action (that we are totally unaware of) to immediately stop us biting and prevents fracture of the tooth. Once a tooth has been root filled we loose this protective mechanism, and so root filled teeth are more prone to fracture and need to be restored with an onlay instead of a simple filling Two factors that we can directly link to the success of a restoration is; the amount of healthy tooth remaining under a filling and if the nerve is vital and healthy.

At Crescent Dental Health, we provide minimally invasive, biomimetic, adhesive dentistry. We do not use amalgam due to the risk of mercury exposure and it forces us to remove healthy tooth to create a shape that locks in the filling.

When restoring a tooth we either use Glass Ionomer/Composite or Cerec restorations.

All our work is carried out under rubber dam to isolate the tooth and protect you from the waste products as we remove the filling. When we bond the fillings into place the rubber dam prevents the tooth surface from contamination by saliva and the moisture within your breath. It is impossible to achieve the best bond strength without using a rubber dam. Bonding seals the tooth to resist decay, the bond strength are vital for a long lasting restoration.

We use an operating microscope to give us the best possible light and magnification. Removal of the restoration is carried out using a drill, the magnification allows us to remove the filling without touching the tooth, and so accurately assess the extent of decay and more importantly the healthy tooth remaining.

Once any gross decay is removed we use our Yag Laser to complete the preparation. The laser is a precision tool, far superior to a conventional drill. A rotary drill rips the tooth surface, raising the temperature to damaging levels and leaving fractures within the enamel These fractures leave the tooth margins weakened and prone to further decay. The laser works at a cellular level, removing decay with no damage to the surrounding tissues, once completed the tooth surface is sterile and in the best possible condition to optimise bonding strength.

When restoring the tooth size of the filling and wether or not the tooth has been root filled dictate if we can use a Glass Ionomer/Composite or Cerec restoration.

Small to medium sized cavities can be restored with Glass Ionomer and Composite. Composite most closely mimics the outer Enamel shell of the tooth and so we use it to replace the outer walls of the tooth, this needs to be built up in small sections to minimise stress and develop strength.

Glass Ionomer is similar to dentine with the same sort of flexibility , it is rich in natural minerals that are released into the tooth helping to protect it, it is bacteriostatic in that bacteria doesn’t like to grow on it adding protection to the tooth.

Finally as we place the restoration we introduce fibresplints, these are a 3D ribbon that is incorporated into the restoration, these mimic the DEJ, greatly increasing the strength of the filling, they act as shock absorbers and prevent fractures developing in the filling.

For larger fillings were a corner (cusp) of the tooth has been lost or root filled molar teeth, Cerec restoration are the best choice. These restorations are done as inlays/onlays and are milled out from a solid block of an inert material that is bonded into place, replacing the missing tooth substance. In the past these would have been done as crowns, however the tooth preparation for a crown is incredibly destructive, requiring us to remove a lot of healthy tooth tissue unnecessarily.

There are a variety of materials that we can choose, but the latest materials are designed to mimic the natural tooth in both its flexibility and hardness. These provide a finished restoration that is totally inert and much stronger than a Glass Ionomer/Composite restoration.

The restoration is designed using computers, on a 3D image taken from the mouth, this is then milled on our in house milling unit glazed and fired before it is cemented in. the Cerec unit allows us to provide inlays/onlays and crowns in a single visit.

Cerec restorations represent the Gold Standard of restorative treatment available.