Bio enhancing restorative materials ? treating teeth as though-2

Treating teeth as though they are a vital and functioning part of the human body

Joseph A Marino DDS, FAGDLTC, USA DC

We Are Not Mouth MechanicsIt is not “just a filling”.Need to pay attention to the anatomy,

biology, and biochemistry of the teeth we are restoring

As a mechanicWe could be over-stressed

Our prof. could be going to the dogs

Most of the Biochemistry is happening at the dentin layer. Enhance the function by first treating the Dentin.

AKA Bio-enhancing MaterialsFirst material featured… Was FluorideTaken for grantedIt has not always been

thereReduced caries rateMore important – reduced

severity of cariesSlowed down the rate of

growth but did not eliminate caries

Most important effect is topical

Created a more “tricky” diagnostic conditionTopical effect leads to a…

Selective remineralization

From Previously Done PPT- Fl. And the New Caries (J. Marino)Creation of “fluoride”… Aka “hidden” caries

We want to get the fluoride…From here… To here..

Development of bioactive restorativesTransporting fluoride Enhancing the dentin

Dentin Bonding relies on intact Collagen Fibrils

Relies on a true chemical bond Sharing ions Sure bond to dentin

If failure, it is cohesive. Dentin remains protected

The workhorse of bio-active materials

Properties improve over time (days/weeks/months)

Greatly enhanced properties from R&D

Most important is coefficient of thermal expansion

BioactivityFluoride deposition Remineralization

If the material is exposed to a source of fluoride such as in an open sandwich.

Foundation is Mineral Trioxide Aggregate (MTA)Older version was known as Portland Cement

– one of the early examples of bio-active glass (BAG)

Takes the material inter-action with tooth to the next level…Acts to remineralize tooth structureAlso stimulates both Dentinogenesis and

Osteogenesis Original use in medicine for bone regenerationDental uses include repair of perforations,

apexification, as a liner on implants to aid in osteo-integration

Improvements in ease of handling and setting time have led to use as a restorative material (Biodentine – Septodont)

Tri Calcium SilicateStimulate Odontoblasts Into renewed

Dentinogenesis

Tri Calcium Silicate

Composite Resin – Bioactive?No YesMost composites Giomers

Hybridization of Glass Ionomers and Composite Resins (1)

Release fluoride and are re-chargable (1)

Improvement over compomers (1)

Composite Resin – BioEnhancing? Yes YesMost compositesGood bond strengths,

especially enamel, enhance overall strength of tooth

A kind of “fusing” effect

GiomersGood bond strengths,

especially enamel, enhance overall strength of tooth

A kind of “fusing” effectResist plaque formation

by forming material film layer (aluminum, silica, strontium, other ions)

Biological/Biomimetic Restorative DentistryCan be minimally invasive..

Post OP

Biological/Biomimetic Restorative DentistryCan involve deep or “hidden” caries

Post Op

Tri Calcium Silicate (Biodentine)

Highly Filled Glass Ionomer (Fuji IX Extra)

Giomer (Beautiful)