Biomimesis: A Bioengineering Concept Applied to Dentistry

[drsushant]

 

Biomimesis: A Bioengineering Concept Applied to Dentistry

INTRODUCTION
Biomimesis, a bioengineering concept that means mimicking natural biologic essence, is the key factor of all healers in restoring lost natural substance.
As dentists, today more than ever, we have the ability to repair, replace, and restore lost natural structure in such a way that biologic form, function, and appearance are restored, as well as masking the fact that there ever was a defect.
Direct composite resin systems provide ultraconservative, long-lasting solutions to many dental aesthetic problems.¹ Success with composite resin restorations depends on the combination of 3 factors: material selection, the type of adhesion used, and placement technique.² Simplification and speed are emphasized with most of the newer materials and the equipment available today.
Research has now produced self-adhering restorative composite resin systems that successfully bond to tooth structure, and that has eliminated the need for the separate use of etchants or bonding agents. Collectively, this category of self-adhering, light-cured, resin-based composite dental restoratives are designed for direct placement. They are indicated for all cavity classes in the anterior and posterior teeth alike. They have incorporated adhesion technology, which eliminates the additional steps of etching/priming/bonding otherwise necessary to bond a resin composite to dentin and enamel.
Other systems, like the nanofilled composites, produce all of the positive characteristics of the microfilled resins, including polishing and handling, along with the better physical properties of the microhybrid systems. The formulations of these composites have been designed to combine dentin color and enamel value in relationship to the natural tissue anatomy. These composite restorative systems not only simplify the replication of the optical properties of the natural tooth, but have similar physical and mechanical properties to that of tooth structure and can easily be combined with the self-adhesive systems for sensitivity elimination. Therefore, composite resins have become simpler to use. The resin systems that have been available to dentists for more than 40 years now are not the same anymore.

Before Image. Preoperative photo. Previously placed amalgam and composite, active caries, potholes, and cracks were evident.	After Image. The postoperative view reflects an ideal integration of composite to tooth structure.

 

        

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 CASE REPORT

Diagnosis and Treatment Planning 
A 50-year-old patient presented with symptoms of severe sensitivity. Clinical evaluation and consultation revealed an old amalgam restoration (tooth No. 30), old composite (tooth No. 29), active caries (tooth No. 31), potholes, and visible cracks due to bruxism (Before Image). Pulp testing was done, revealing vital and healthy pulps.

Prerestorative Considerations
The following considerations were completed before any restorative treatment was initiated: First, prior to administering anesthesia and rubber dam isolation, the preoperative contact zone and excursive occlusal patterns were evaluated. Next, the shade of the tooth was determined. Shade selection must be accomplished prior to dental dam placement to prevent improper color matching as a result of dehydration and elevated values.³ When teeth dehydrate, air replaces the water between the enamel rods, changing the refractive index, which makes the enamel appear opaque and white.⁴
Before starting any restorative procedure, it is important (if physically permissive) to place a dental dam after anesthesia administration to achieve adequate field control and protect against contamination.⁵

Operative Treatment
Once the rubber dental dam (Hygenic [Coltène/Whaledent]) was placed, the first step was to remove the old amalgam in tooth No. 30, composite in tooth No. 29, and the decay in tooth No. 31 (Figure 1). The preparations were then scrubbed with a 2% chlorhexidine digluconate aqueous solution (BISCO). One can simply remove diseased tooth structure and be able to maintain (with confidence) the integrity of the natural enamel/dentin as much as possible. The Hawe SuperMat Matrix System (Kerr) was used to separate the cleaned preparations prior to bonding.

Figure 1. The rubber dam has been placed (Hygenic [Coltène/Whaledent]), and removal of amalgam, composite, and decay was accomplished.	Figure 2. Placement of Vertise Flow (Kerr) with the applicator tip after air-drying the cavity preparations.
Figure 3. The self-adhering flowable composite was brushed with moderate pressure onto the cavity floor for 15 to 20 seconds.	Figure 4. Light-curing with the Optilux 501 (Kerr) curing light.
Figure 5. The rest of the preparation was etched for 15 seconds with 35% phosphoric acid (Ultra-Etch [Ultradent Products]), then rinsed for 5 seconds and gently air-dried.	Figure 6. OptiBond Solo Plus (Kerr), a single-component adhesive, was applied for 20 seconds, air-thinned, and then light-cured.

        

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