Coquitlam dentist, Family dentist in Coquitlam, Vancouver, BC
Da Vinci Dentistry is proud to be one of the few dental clinics in Canada that fully embraces the principles and techniques of Biomimetic Dentistry in our everyday practice. At Da Vinci Dentistry, this is our standard level of care, which means patients do not pay more Biomimetic Dentistry.
What Is Biomimetic Dentistry?
At Da Vinci Dentistry, we believe in providing the best possible care to our patients. We want give our patients long lasting restorations and to reduce the need for future crowns and root canals. For this reason, our doctors have received extensive training to master the discipline of Biomimetic Dentistry.
Biomimetic Dentistry is centred around the Art and Science of dentistry. Biomimetic basically means mimicking biology—in this case, the biology of teeth. The goal of biomimetic dentistry is to conservatively restore damaged teeth with long lasting restorations that looks and functions like natural teeth. Biomimetic Dentistry utilizes techniques established through years of research to create restorations that have 300% to 400% higher bond strength than conventional restorations    . This strong bond allows the biomimetically restored tooth to function and handle chewing stress like an intact natural tooth.
What Is The Science Behind Biomimetic Dentistry?
Nowadays, direct composite resin restorations (white fillings) are the most common way of restoring damaged teeth. However, it is a very technique sensitive procedure and if not performed correctly, can result in premature failure of the filling leading to recurrent tooth decay.
Some Background Information:
Before composite resin is placed into the tooth, it has a putty-like consistency and is composed of individual single molecules called monomers. A UV light activates a chemical reaction called polymerization, where the monomers join together in a chain to form a much larger molecule called a polymer. This polymerization reaction hardens the composite resin (white filling) and bonds the filling to the tooth.
During the polymerization process, a phenomenon called polymerization shrinkage occurs where the monomers loses some atoms in order to form the polymer chain. This results in an overall decrease in the volume of the composite resin (white filling) material after it hardens. The larger/thicker the layer of composite resin, the greater the volume shrinkage. The volume shrinkage puts stress (aka polymerization stress) on the filling and tooth because it causes the filling to pull away from the tooth surface which reduces the bond strength. It is a constant tug-of-war between bond strength and polymerization stress .
When bond strength is reduced, microgaps can form between the filling and the tooth. Microgaps can allow bacteria to reenter the tooth and eventually cause recurrent dental caries and premature failure of the filling .
Also, reduced bond strength can permit the filling have micromovements during chewing, leading to tooth sensitivity and pain called post-operative sensitivity.
Biomimetic Dentistry utilizes research proven techniques to minimize polymerization stress thereby increasing bond strength resulting in long lasting restorations.
Stress Reducing Protocols:
1. Restore teeth with multiple thin layers of composite resin 
The thinner the layer of composite resin, the less volume shrinkage occurs and therefore less stress and increased bond strength of the filling to the tooth. Conventional white filling techniques as taught in dental schools typically requires 1 layer for a small filling and up to 4 layers of composite resin to complete a large filling. Biomimetic fillings take at minimum 4-6 layers for small fillings and up to 20 layers to complete a large filling. This reduces the polymerization stress considerably resulting in higher bond strength of the filling to the tooth.
2. Use indirect (lab-made) restorations whenever possible 
A lab-made indirect restoration is the most stress-reducing technique as there is zero volume shrinkage. However, due to cost, this may not be affordable for everyone.
3. In large cavities, a fibre mesh is placed on the cavity floor to minimize stress  
The fibre mesh interrupts polymerization shrinkage and reinforces the tooth by dispersing the forces imposed on the tooth when chewing.
4. Removing dentin cracks completely  
Cracks into dentin are as destructive to teeth as is tooth decay. Both are leading causes of root canals and loss of tooth structure and integrity. If cracks are left under the restoration, micromovements during chewing causes cracks to propogate due to concentration of stress at the crack tip.
5. Use of round burs to avoid sharp internal angles
Sharp corners and angles concentrates stress, which can lead to crack formation in teeth over time from the vibrations caused by chewing. This is the reason why entry-ways and windows in ships and planes are round and never rectangular.
6. Use slow start and/or pulse activation polymerization techniques 
Rather than cure the composite material quickly with high intensity UV light, the composite resin is allowed to polymerize slowly. Studies have shown that this reduces polymerization stress by allowing the composite resin to shrink towards the tooth surface rather than away.
1. Air abrasion of tooth surface before bonding 
Air abrasion is using small sand particles under high air pressure to roughen the surface of the tooth to be bonded. This increases surface energy and surface area to permit the formation of a much stronger bond.
2. Employ gold standard three-step bonding systems 
At Da Vinci Dentistry, we use a bonding system called Optibond FL, a three-step bonding system. Many dental companies are trying to simply the bonding steps to a single step to save time, however, three step bonding systems are still the gold standard and achieves the highest bond strength.
3. Utilize immediate dentin sealing 
Apply dentin bonding agents at time of tooth preparation for indirect (lab-made) porcelain restorations. This will increase bond strength by 400% compared to the traditional approach of bonding at the time of cementation.
4. Resin coat the immediate dentin sealing  
Flowable resin is applied onto the immediate dentin sealing. This acts as an adjunct to the adhesive layer and ensures complete polymerization of the bonding agent.
5. Deactivate matrix metalloproteinases 
Matrix metalloproteinases is an enzyme present in tooth that degrades 25% to 30% of the bond strength of fillings. 30 second treatment with 2% Chlorhexidine can deactivate this enzyme and increase bond strength.
What Is The Art In Biomimetic Dentistry?
The artistic aspect of Biomimetic Dentistry complements the science discussed above. Because Biomimetic fillings require 3-5 times more layers than the traditional filling technique, it allows the dentist to create fillings that look as real as natural teeth. In order to create beautiful life-like fillings, multiple layers must be used. Rather than one or two flat layers of composite resin (like traditional white fillings), several layers are used to build each cusp of the tooth one at a time to create fillings that look so real that sometimes it can be hard to distinguish where natural tooth ends and where filling begins. To master the art of Biomimetic Dentistry, like any other art form, takes patience and years of practice and an artistic talent. At Da Vinci Dentistry, we take great pride in our attention to detail and artistic skill.
 Bertischinger C, Paul SJ, Luthy H and Scharer P, "Dual application of dentin bonding agents: effect on bond strength," Am J Dent, vol. 9, no. 3, pp. 115-119, 1996.
 Magne P, Kim TH, Cassione D and Donovan TE, "Immediate dentin sealing improves bond strengths of indirect restorations," J Prosthet Dent, vol. 94, no. 6, pp. 511-519, 2005.
 Van Meerbeek B, DeMunck J, Mattar D, Van Landuyt K and Lambrechts P, "Microtensile bond strengths of an etch and rinse and self-etch adhesive to enamel and dentin as a function of surface treatment," Oper Dent, vol. 28, no. 5, pp. 647-666, 2003.
 Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W and Franenberberger R, "Influence of C-Factor and layering technique on microtensile bond strength to dentin," Dental Materials, vol. 20, no. 6, pp. 579-585, 2004.
 Giachetti L, Scaminaci Russo D, Bambi D and Grandini R, "A review of polymerization shrinkage stress: current techniques for posterior direct resin restorations," J Contemp Dent Pract, vol. 7, no. 4, pp. 79-88, 2006.
 Deliperi S and Bardwell D, "An alternative method to reduce polymerization shrinkage [stress] in direct posterior composite restorations," J Amer Dent Assoc, vol. 133, no. 10, pp. 1387-1398, 2002.
 Dietschi D and Spreafico R, "Current clinical concepts for adhesive cementation of tooth-colored posterior restorations," PPAD, vol. 10, no. 1, pp. 47-54, 1998.
 Belli S, Orucoglu H, Yildirim C and Eskitascioglu G, "The Effect of Fiber Placement or Flowable Resin Lining on Microleakage in Class II Adhesive Restorations," J Adhes Dent, vol. 9, no. 2, pp. 175-181, 2007.
 El-Mowafy O, El-Badrawy W, Eltanty A, Abbasi K and Habib N, "Gingival microleakage of class II resin composite restorations with fiber inserts," Oper Dent, vol. 32, no. 3, pp. 298-305, 2007.
 Brannstrom M, "The hydrodynamic theory of dentinal pain: sensation in preparations, caries and the dentinal crack syndrome," Journal of Endodontics, vol. 12, no. 10, pp. 453-457, 1986.
 Milicich G and Rainey JT, "Clinical presentations of stress distribution in teeth and their significance in operative dentistry," Pract Periodontics Aesthet Dent, vol. 12, no. 7, pp. 695-700, 2000.
 Charton C, Colon P and Pla F, "Shrinkage stress in light-cured composite resins: Influence of material and photoactivation mode," Dental Mater, vol. 23, no. 8, pp. 911-920, 2007.
 Krejci I and Stavridakis M, "New perspectives on dentin adhesion—differing methods of bonding," Pract Periodontics Aesthet Dent, vol. 12, no. 8, pp. 727-732, 2000.
 Jayoosariya PR, Pereira PNR, Nikaido T and Tagami J, "fficacy of a resin coating on bond strengths of resin cement to dentin," J Esthet Restor Dent, vol. 15, no. 2, pp. 105-113, 2003.
 Pashley D, Tay F, Yui C, Hashimoto M, Breschi L, Carvalho R and Ito S, "Collagen degradation by host-derived enzymes during aging," J Dent Res, vol. 83, no. 3, pp. 216-221, 2004.