Biomimetics: Taking Dentistry in a New Direction

Biomimetics: Taking Dentistry in a New DirectionCDR Juan K. PackerCDR Juan PackerGraduate of the Univ. of Mississippi School of Dentistry 1998USAF 1998-2003(Little Rock AFB,AR and Sheppard AFB, TX)Inter-service transfer to USPHS 2003Staff dental officer-Advanced Tahlequah, OK 2003-2005AGPR Residency Tahlequah, OK 2005-2007Northeast Wisconsin Technical College Public Dental Health Certificate 2009-2011 Implant Seminars Miami, FL 2010-2011Chief Dental officer Seminole Tribe of Florida(Hollywood, FL) 2007-present

Learning ObjectivesWhat is BiomimeticsWhat materials are considered biomimeticHow will this improve the quality of dental care that you provideIs biomimetic dentistry applicable in an IHS settingBiomimeticsBio = lifeMimetic = to mimicTermed coined by Otto Schmitt in the 1950s

Schmitt was the founder of biomedical engineering field James Steele coined the term Bionics in the 1960sBoth Schmitt and Steele worked at Wright Patterson AFB in Dayton, OH4Biomimetic quoteA preferred treatment is one that attempts to replicate the stress distribution, energy absorption, and other characteristics of the intact natural tooth.(Randall G. Cohen, DDS | David Rudo, DDS ) Inside Dentistry November 2011, Volume 7, Issue 10 Published by AEGIS Communications

Biomimetic dentistryThe use of dental materials and technologies that mimic tooth structure and functionMaintaining as much natural tooth structure as possibleMaterials should absorb and distribute stress like tooth structure Enamel like materialsDentin like materials

Function of Dentin Dentin is the most important part of the toothSupports the enamelProtects the pulpMade up of 70% hydroxyapatiteGives color to the tooth(enamel is semi-translucent)

Primary dentin lies between the enamel and the pulp and makes up the majority of the dentinSecondary dentin forms as the root formsTertiary dentin forms in response to stimuli( i.e cavities)7Function of enamelHardest substance in the human bodyProtects the dentinGives shape to the toothAids in chewingBiomimetic Materials(Kuraray)AdhesivesClearfil SE BondClearfil SE protectThis technique does not utilize phosphoric acid. Self-etch bonding agents utilize a water-based primer with a mild acid, which is kinder to the tooth structure. The smear layer is preserved and becomes part of the hybrid layer. Drastic reduction in post-operative sensitivity.

9Clearfil SE bondCan be used with all light curing restorationsContains MDP(methacryloyloxy dodecylpyridinium bromide) which creates a strong chemical bond with hydroxyapatiteRegarded as the Gold Standard for self etching productsMDP is methacryloyloxy dodecylpyridinium bromide 10Clearfil SE protectIn a liquid state has antimicrobial propertiesAfter light polymerization forms a antibacterial copolymer that kills bacteria on contact(MDPB)Described as having a bio-active function that has a therapeutic effect on caries controlAids in preventing 2 cariesFluoride releasing

The two new added features; MDPB monomer in the primer and the patented Encapsulated Fluoride Releasing provide some distinguishing advantages;

MDPB: Antibacterial Cavity Cleansing Effect & Deactivates Matrix Metalloproteinases MMPs, NO DENTIN BOND DEGRADATION (1 Year Clinical Study Class-Is). 94% - 100% Class-V Retention Rates 5 year studies.

Encapsulated Fluoride Release;This feature combined with it mild acidity create a 2 m thick acid resistant layer (fluorapetite) now called Super Dentin by Dr. Tagami of Tokyo Medical & Dental University.

11What are MMPsZinc-dependent endopeptidases (endogenous enzymes)Capable of degrading extracellular matrix proteinsTrapped within the mineralize dentin matrix during tooth development In the presence of water, can breakdown collagen fibrils that are not protected by intrafibrillar minerals.

MDPBMDPB (an antibacterial monomer used in a two-step, self-etching primer adhesive). The advantage of MDPB over Chlorhexidine and Benzalkonium Chloride is that it polymerizes with adhesive resins and cannot leach from the hybrid layer. This is an example of what can be termed a Therapeutic adhesive system that provides anti-MMP activity along with antibacterial qualities.

MDPB continuedMDPB is a polymerizable bactericide, and the antibacterial component in the molecule is immobilized after the resinous materials incorporating MDPB are cured(Dental Materials Journal 2009; 28(1): 1119)Composite( Kuraray)Majesty compositesOnly composite with Vita approved shadesUses Kuraray patented light diffusion(LD) technologyDoes not compromise tooth elasticityFlexes with the underlying dentin

Resin-Dentin bondResin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months. The cause of this poor durability is a combination of the activation of matrix metalloprotinases (MMPs) by weak acids such as lactic acid released by caries-producing bacteria, and acid-etchants used in adhesive bonding systems. These acids uncover and activate matrix-bound MMPs. The other contributing factor is incomplete resin infiltration. If all exposed collagen fibrils were enveloped by resin, the MMPs would not have free access to water, an obligatory requirement of these enzymes. Recently, several inhibitors of MMPs have been added to adhesive primers. Examples include chlorhexidine (CHX), benzalkonium chloride (BAC), and MDPB (David H. Pashley, DMD, PhD; Franklin R. Tay, BDSc (Hon), PhD; and Satoshi Imazato, DDS, PhD )

Improving dental QualityMinimally invasive dentistryRemove only infected tooth structure( no extension for prevention)Maintain tooth's structural integrityChoose proper restorative materialsMaterials should mimic tooth structure

IS this you????

IHS Applicable????YES!!More predictable outcomeMaterials that continue to fight against cariesBudget friendly Cost of Majesty composite $87.00/boxCost of amalgam $89.00/box

Questions