What is Biomimetic Endodontics and Is it Worth The Investment?

Biorejuvenation Tooth Vector

Right now, our materials don’t intrinsically relate to our biology. One of the biggest issues faced in almost all medical situations is the lack of synchronicity our treatments have with the human body. For our oral health, many of our restorative treatments tend to lack this sense of integration, where right now, the only biological process that holds everything together is osseointegration. Biomimetics attempts to change everything. 

As a fascinating place of research, biomimetics handles research relating to synthetic materials and methods and their ability to mimic biological processes. Also known as biologic dentistry or biological dentistry, the process of mimicking body functions currently operates through biocompatible materials with similar molecular makeup to our natural teeth. Endodontists can learn and appreciate a lot from this field, as it has plenty of potentials to treat more complex tooth cases where current standards of treatment cannot fully apply. 

The Newest Concept in Dentistry: The Biomimetic Approach

Biomimetics has been in development since the early 1950s, and this approach typically concerns itself with the development of adhesives and other materials to mimic the human body’s natural processes. First developed by Dr. Michael Buonocore, he published a paper on the use of the acid-etch technique. This technique incorporated a new adhesive that was able to form bonds with the tooth structure, thus removing the need for retention and resistance to cavity preparation. Further advancements in adhesives have begun to gradually replace traditional restoration techniques, all of which improved function, strength, and aesthetics. 

The concept of biological dentistry has since evolved, with a primary focus on preserving the remaining tooth with biocompatible materials. Normally applied in a restorative dental setting, biomimetic dentistry unites the understanding of tooth biology with a heavy focus on preparation, adhesion, and retention. Instead of using material that the body may potentially reject, the materials can replicate the tooth’s biological process without any additional preparation. But biomimetic adhesives aren’t the only focus of this field, as these adhesives have helped change preparation techniques. 

Preparation techniques tend to focus on mechanical retention to provide strong adhesion to the tooth’s porous material, but this retention can also have its side effects. Traditional techniques tend to pose a larger risk of post-restoration tooth cracks, insufficient seals, bacteria buildup, and other factors created by stress—higher chances of tooth pain, temperature sensitivity, and loss of tooth sensitivity. Biomimetic dentistry helps create a higher success rate for bonding strength and adhesion, removing unnecessary prep work and creating a more natural tooth restoration. Endodontists attempting to preserve natural tooth structure can find that biomimetic dentistry works hand in hand with their goals, and as further developments go on, it can enhance the restorative process for everyone involved. 

What Adhesives Work Within Biomimetic Dentistry? 

Right now, biomimetic techniques are in their primitive stages. Endodontists working with these techniques tend to use them for endodontically-failed teeth often to help prevent future crown fractures. These adhesives work to restore occlusions within the tooth and help maintain strong dentin bonds that reduce overall tooth stress during the restorative procedure. However, adhesives today can easily enhance and remove unnecessary steps during the preparatory stages, and because of their component of biocompatibility, endodontists can adapt their techniques to enhance patient treatment. 

While biocompatible adhesives are far and few in between, there are some that stand out. These include: 

  • Mineral Trioxide Aggregate (MTA): As one of the primary and well known bioceramic materials in dentistry, MTA cement is know to be osteoconductive, inductive, and biocompatible with the inner tooth. MTA was initially developed as a root-end filling material. Today, it is now also used for pulpotomies, pulp capping, and apical barrier formation. There are two types of MTA, known as grey and white. Grey MTA contains iron ions, and the white MTA does not have those ions. The reaction is created through the Ca ions, which form hydroxyapatite when it comes in contact with the tooth.
  • Calcium Silicate Bioceramics: Known by brand name as Biodentine, this adhesive improves some of the properties of the MTA cement. Its composition helps speed up the setting time by enhancing the ion’s structure. Doing so reduces its viscosity and improves maneuverability for the endodontist using the material. Some studies report that it also has high bond strength, doesn’t have any adverse side effects, and has no cell differentiation within the teeth’s molecular composition.
  • Calcium Alumino-Silicates: This experimental cement contains calcium-aluminate, dental glass, bismuth oxide, and a combination of other ingredients and has been studied to a limited degree. Some studies report that it helps remove the traces of free magnesium oxide often found within MTA. These traces typically contribute to undesired tooth darkening. These studies have also reported that this cement can improve mineralization capacity, but it is not fully determined.
  • Bioaggregate: BioAggregate is a mixture cement of calcium silicates and calcium phosphates, with tricalcium silicate as its main component. BioAggregate removes the presence of aluminum and other additives, ensuring a higher bonding strength to the tooth’s layers. Although it has a slower reactivity timeframe, it is considered more bioactive than other dental cement. Overall, it has greater potential for inducing mineralization within the tooth.
  • Ceramicrete: Ceramicrete is a self-setting phosphate ceramic. It uses an acid-base reaction between acid phosphate and basic metal oxide to become biocompatible. Dentists have reported using this cement because it’s easy to manipulate, has low glucose penetration (in cases of diabetic patients), and has better washout resistance. However, it has a higher leakage risk, as biocompatible versions of Ceramicrete vary depending on usage. 

Overall, it is up to the dentist’s discretion to determine which biocompatible adhesive is right for them, as the list above only shows a small sample of what’s being done in biocompatible dentistry. As these methods are continuously being expanded on, these advancements in biomimetic dentistry can eventually lead to other forms of dentistry, including regenerative endodontics, where the tooth’s structure can not only be repaired but renewed through the process of healing in a more natural manner, regrowing the inner pulp through methods such as stem cell medicine. 

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