Transcript Biomimetics: Taking Dentistry in a New Direction

CDR Juan K. Packer
BIOMIMETICS: TAKING DENTISTRY IN A
NEW DIRECTION
CDR JUAN PACKER
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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
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BIOMIMETICS
Bio = life
 Mimetic = to mimic
 Termed coined by Otto Schmitt in the 1950’s
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BIOMIMETIC QUOTE
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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
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FUNCTION OF DENTIN
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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 semitranslucent)
FUNCTION OF ENAMEL
Hardest substance in the human body
 Protects the dentin
 Gives shape to the tooth
 Aids in chewing
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BIOMIMETIC MATERIALS(KURARAY)
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Adhesives
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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
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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
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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.
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MDPB
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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
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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)
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Majesty composites
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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
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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
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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/box
2. Cost of amalgam $89.00/box
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QUESTIONS