Biomimetics: Taking Dentistry in a New Direction

BIOMIMETICS: TAKING DENTISTRY IN A NEW DIRECTION

CDR Juan K. Packer

CDR JUAN PACKER Graduate of the Univ. of Mississippi School of Dentistry

1998 USAF 1998-2003(Little Rock AFB,AR and Sheppard AFB,

TX) Inter-service transfer to USPHS 2003 Staff dental officer-Advanced Tahlequah, OK 2003-2005 AGPR Residency Tahlequah, OK 2005-2007 Northeast Wisconsin Technical College Public Dental

Health Certificate 2009-2011 Implant Seminars Miami, FL 2010-2011 Chief Dental officer Seminole Tribe of Florida(Hollywood,

FL) 2007-present

LEARNING OBJECTIVES What is Biomimetics What materials are considered

biomimetic How will this improve the quality of

dental care that you provide Is biomimetic dentistry applicable in an

IHS setting

BIOMIMETICS Bio = life Mimetic = to mimic Termed coined by Otto Schmitt in the

1950’s

BIOMIMETIC QUOTE A 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 DENTISTRY The use of dental materials and

technologies that mimic tooth structure and function

Maintaining as much natural tooth structure as possible

Materials should absorb and distribute stress like tooth structure

Enamel like materials Dentin like materials

FUNCTION OF DENTIN Dentin is the most

important part of the tooth

Supports the enamel

Protects the pulp Made up of 70%

hydroxyapatite Gives color to the

tooth(enamel is semi-translucent)

FUNCTION OF ENAMEL Hardest substance in the human body Protects the dentin Gives shape to the tooth Aids in chewing

BIOMIMETIC MATERIALS(KURARAY) Adhesives Clearfil SE Bond

Clearfil SE protect

CLEARFIL SE BOND Can be used with all light curing

restorations Contains MDP(methacryloyloxy

dodecylpyridinium bromide) which creates a strong chemical bond with hydroxyapatite

Regarded as the “Gold Standard” for self etching products

CLEARFIL SE PROTECT In a liquid state has antimicrobial

properties After 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 control

Aids in preventing 2° caries Fluoride releasing

WHAT ARE MMP’S Zinc-dependent endopeptidases

(endogenous enzymes) Capable of degrading extracellular

matrix proteins Trapped within the mineralize dentin

matrix during tooth development In the presence of water, can

breakdown collagen fibrils that are not protected by intrafibrillar minerals.

MDPB MDPB (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 CONTINUED MDPB 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): 11－ 19)

COMPOSITE( KURARAY) Majesty composites Only composite with

Vita approved shades

Uses Kuraray patented light diffusion(LD) technology

Does not compromise tooth elasticity

Flexes with the underlying dentin

RESIN-DENTIN BOND

Resin-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 (MMP’s) 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 MMP’s.

The other contributing factor is incomplete resin infiltration. If all exposed collagen fibrils were enveloped by resin, the MMP’s would not have free access to water, an obligatory requirement of these enzymes. Recently, several inhibitors of MMP’s 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 QUALITY Minimally invasive dentistry Remove only infected tooth

structure( no extension for prevention) Maintain tooth's structural integrity Choose proper restorative materials Materials should mimic tooth structure

IS THIS YOU????

IHS APPLICABLE???? YES!! More predictable outcome Materials that continue to fight against

caries Budget friendly 1. Cost of Majesty composite $87.00/box2. Cost of amalgam $89.00/box

QUESTIONS