Treating endodontically compromised teeth has advanced far enough that the risk of endodontic failures has become minimal. But one key issue remains prevalent in much of dentistry today – the restorative materials we use often don’t work intrinsically with our bodies. There is a lack of synchroneity between our materials and our body’s capacity to integrate those materials. One of the only biological processes that help dentists perform procedures is the process of osseointegration, which works only for specific treatments such as implants and bone grafts. However, biomimetic dentistry attempts to change everything about how we approach treatments.
Biomimetics handles research related to synthetic materials and their ability to mimic biological processes. Also referred to as biologic or biological dentistry, biocompatible materials are the primary focus, allowing those materials to mimic and mend with our bodies’ similar biological makeup. Endodontists working in biomimetics can bring a lot to the table, as it can potentially treat complex tooth cases more effectively than most treatments cannot even reach.
The Biomimetic Approach: How Did It All Start?
Since the early 1950s, biomimetics has been developing concerning the use and invention of adhesives, cement, and other materials, focusing on mimicking natural body processes. This field of dentistry was first developed by Dr. Michael Buonocore when he published a new paper on the acid-etch technique. This technique worked by incorporating a new adhesive that formed bonds with the tooth’s enamel, which removed the need for cavity preparation when handling cases of cavity-affected teeth. Not only did it reduce the need for extensive enamel removal, but it also helped advance dentistry by gradually replacing traditional restoration techniques. This resulted in improved aesthetics, function, and enamel strength, which led to a higher success rate for acid-etch techniques.
Biomimetic dentistry has evolved over the last few decades, with its primary goal of preserving the remaining tooth structure with biocompatible materials. These techniques and materials are normally used in a restorative dental setting, and this field heavily focuses on preparation, adhesion, and retention when treating disease-affected teeth. The focus is to use materials that can replicate the tooth’s biological processes without needing extra preparation and extensive tooth removal. This field removes the need for materials that the body may reject later. Alongside developing adhesive or cement-like materials, preparation techniques have heavily changed to accommodate these new materials.
Alongside newer, safer materials, preparation techniques have shifted the focus from mechanical retention to a biological form of retention. Most forms of retention used in preparation techniques focus on the material’s durability and strength to maintain the tooth’s internal structure and porous material. Still, traditional techniques tend to pose a larger risk due to their lack of biological buildup. Post-restoration cracks, insufficient tooth seals, hidden bacteria buildup, and stress factors can lead to a higher risk of a failed restoration. Biomimetic dentistry has changed how bonding materials are applied, allowing dentists to achieve a more natural form of retention, and enhancing the restorative process.
The Types of Adhesives in Biomimetic Dentistry
Currently, biomimetic adhesives and preparation techniques are still in their primitive stages. To prevent future crown fractures, endodontists attempting to work in this field use biological adhesives to treat endodontically-failed teeth. The adhesives restore occlusions within the tooth and help maintain strong dentin bonds to reduce overall tooth stress. But adhesives are still being circulated in small dental practices and large dental groups to enhance and advertise their body-friendly techniques, removing the unnecessary steps during the preparation process to create a more biocompatible restoration. In their attempts to incorporate this field, endodontists have found that it’s greatly enhanced the patients’ overall experience, despite how far and few these products are today.
Right now, a few available biocompatible adhesives are currently standing out as potential markers for endodontists. These adhesives are as follows:
- Mineral Trioxide Aggregate (MTA): A well-known bioceramic material used in dentistry, MTA cement has osteoconductive, inductive, and biocompatible properties when used in the inner tooth. While MTA was initially developed as a root-end filling material, it is now used for pulpotomies, capping, and apical barrier formation treatments. Currently, there are two types of MTA: grey and white. The grey MTA adhesive contains iron ions, and the white MTA does not have those ions. This adhesive works by bonding with the Ca ions, forming hydroxyapatite when it comes in contact with the affected tooth.
- Calcium Silicate Bioceramics: Also known as Biodentine, calcium silicate works to improve some of the properties of the MTA cement by speeding up the setting time and enhancing the ion’s structure. By doing these things, the adhesive improves maneuverability for the endodontist using the material and its viscosity levels. In some studies, researchers reported that it has high bond strength, doesn’t present any adverse side effects, and has no cell differentiation compared to the teeth.
- Calcium Alumino-Silicates: Calcium alumino-silicates are an experimental cement that contains calcium-aluminate, dental glass, bismuth oxide, and other ingredients. Its been studied has been studied to a limited degree. Still, some studies report that it helps remove the traces of free magnesium oxide, a byproduct often found within MTA that contributes to undesired tooth darkening. It’s also been reported to improve mineralization capacity, but these components have not been fully determined.
- Bioaggregate: BioAggregate is a brand-name product that contains a mixture of cement of calcium silicates and calcium phosphates, with tricalcium silicate as its main component. It removes the presence of aluminum and other additives, which work to ensure a higher bonding strength to the tooth. It has a slower reactive timeframe but is considered more bioactive than other dental cement.
- Ceramicrete: Ceramicrete is a unique product and works as a self-setting phosphate ceramic. It uses an acid-base reaction between acid phosphate and basic metal oxide, making it highly compatible with teeth’ molecular structure. Its become a popular alternative because it’s easy to manipulate, has low glucose penetration for diabetic patients, and has better resistance to washout. One downside is that it has a higher leakage risk and thus depends on how it is used.
The list above is only a small example of the advancements in biomimetic dentistry. Hopefully, with the growth of these products, endodontists can meet the challenge of complex dental problems with more natural solutions.
