Dr. Diksha Batra, renowned prosthodontist and an ardent advocate for pain-free dentistry host a series of interviews with stalwarts in similar arenas. This interview elaborates philosophies regarding bio-mimetic dentistry with the one and only resto rehabilitator Dr. Nikhil Bahuguna.
She focuses on the practices intended to adopt in 2021 and the practices to be better left in 2020 for the improvisation of our dental practices. She means to upgrade practice for the upcoming year. In this interview, Dr. Nikhil Bahuguna shares his views on adopting the revolutionizing trends of dentistry – Biomimetic dentistry which intends to seek dental treatment that is strikingly similar to the existing biology of the tooth and surrounding structures. This kind of dentistry intends to be restorative and minimally invasive in nature. Biomimetic dentistry provides a line of treatment that is as close to nature as possible. Providing aesthetics and solid function without compromising the enamel is the desired utopia, every dentist wants.
This year 2020 has reiterated sanitation protocols in practices requiring utmost security and disinfection. As we enter the New Year, it’s important to highlight the practices we step into another year with and the ones we need to leave.
Properties of Bio-Mimetic Dentistry
The novel concepts of Bio-mimetic Dentistry revolve around the following properties:
Biology- Keeping in mind the functional biology of the tooth and its surrounding structures the treatment intends to restore the tooth as close to the natural biology as possible. It should be viable biologically.
Mechanics- The treatment ensures that there is the restoration of the previous mechanics of the tooth and its surrounding structures.
Function- Significant part of any treatment involves long-term functional restoration for the patient. It also involves avoiding any impending complications further.
Aesthetics- Equally vital along with functional restoration, especially nowadays with innumerable options present.
Why choose Bio-mimetic Dentistry?
Dr. Nikhil Bahuguna believes that while we treat any patient it should be kept in our minds that the restoration should fit the tooth not the other way around. Dental materials having significantly similar properties alike the tooth should be used. The dental materials should match the biological quality and properties.
He quotes his favorite line by GV Black who revolutionized dentistry –
‘The complete divorcement of dental practice from studies of pathology of dental caries, that existed in the past is an anomaly in science that shouldn’t continue. It has the apparent tendency plainly to make dentists mechanics only’ – GV Black
The restoration concept should include aging like natural teeth. This allows an all-natural teeth break down to simulate and embrace nature as much as possible. This helps to reduce muscle tension and reduce the stress on the temporomandibular joint. We should intend to think of treatment from TMJ joint to the tooth.
Material Considerations for Bio-mimetic dentistry
These dental materials should be resilient and strong. This resilience refers to the ability to absorb load and let go after certain threshold limit. He discusses how enamel takes load up to 384 mPa and the dentin takes up to 18-19gPa. An ideal restorative shall have a similar load-bearing capacity. He focuses the work on being bio-aesthetic in nature. Composite include dental materials which are glass infiltered and laser-sintered. The glaze of ceramic is provided and has a load-bearing capacity of, 550mPa whilst the core is 18gPa. Placement of fibers in deep restoration allows flexibility of restorations.
- The durability of resin cement?
Research according to literature dictates that direct restoration last up to 6-8 years. Indirect restoration lasts up to 8-10 years.
He advises that in his practice, he always educates the patients for 6 monthly checkup. Patients have no false sense of security regarding the treatment. This helps them to make better informed decisions.
Dentaprime is a great dental material. Its placed unidirectionally for posteriors and multidirectional for anteriors. Concept changes from cementable to bondable cement. Cementable material has many interfaces hence it tends to fall apart. Cementable material becomes monoblock hence becoming an entire unit, preventing displacement. Retrievable fiber post and resin cement should be used. A drill hand file with an ultrasonic tip should be used. The translucent material is seen clearly, and easily comes out, with no need for post space preparation. Use of RC dual-core and push fiber is advised since its adaptive to walls. Post distribution in such instances is neutral and natural. These nanomites go inside and induce repairs. Teeth become immune by fluoride and phosphate deposition. Bioactive materials regenerate hydroxyapatite making the tooth stronger to future acid attacks. Calcium hydroxide improves color defects. Pulpdent provides an active baseline with no etching and bond.
Tips for New Dentistry:
- Ultraconservative dentistry.
- Incorporation of magnification loupes with illumination.
- Use of rubber dam as much as possible.
- Don’t procure bulk resin.
Economical liabilities with cost of restorative vs resin.
Stark indication for crown includes big contact space and patient’s compliance. It reduces money during impression and material. It reduces two visits to the dentists. Treatment should include being pain-free for the patient.
New materials like Brics 3000 have papaya seeds which dissolve the carious part of the tooth. It softens the demineralised decayed dentin and leaves the healthy dentin intact. It only removes weak dentin, the hardness of which is lesser than actual dentin.
When to choose crown/restoration?
Crowns are indicated in instances when there is enough ferrule present but no contact area. Its not indicated when there isn’t enough contacts or vertical left. Manual dexterity skills fail to create contacts thereby. Custom made post is advisable when there is a two wall-defect present with greater horizontal and vertical ferrule.
People should embrace biomimetic dentistry to help contribute to a better future. 2021 is about embracing conscious decisions that last for a lifetime.