Restoring in Harmony

Since its inception, restorative dentistry has endeavored to repair teeth that have been damaged by disease or trauma in a way that returns them to proper form and function with the best esthetics possible. As restorative materials have evolved in an attempt to mimic the natural dentition, some have improved our ability to restore function but are lacking in esthetic value, whereas others have improved the esthetics but are limited in their ability to handle the forces of mastication. Wouldn't dentistry be so much easier if we could just create restorations using materials with the same compositions as the naturally occurring hard and soft tissues?

The advent of biomimetic dentistry, which seeks to more closely mimic biological processes using conservative techniques and bioactive materials, has changed the way that many clinicians practice. From limited preparations that conserve more natural tooth structure and bioactive materials that remineralize and strengthen these structures to the use of patient-derived blood products and regenerative endodontic procedures, dentistry is changing its approach across all disciplines to one in which therapies work with the body instead of merely being tolerated by it.

The techniques employed and the materials used are, at a minimum, more respectful to the body's physiologic processes and, at best, better able to work with these processes to maintain and sometimes regrow natural structures, improving the strength and longevity of restorations as well as the esthetics.

In our March cover story, Inside Dentistry examines the increasing use of bioactive, biorestorative, and biomimetic materials and techniques in dentistry and how they've improved the predictability and long-term success of restorative procedures. Relatedly, our Inside Endodontics article, which discusses how to identify regenerative procedures radiographically, makes an excellent point that although the tissues involved are not true pulpal tissue, they are the patient's own vital tissues and thus, are inherited with immune system defense mechanisms to protect against infection. In another nod to biomimetics, our clinical brief on posterior direct composite examines the advantages of structural color matching over chemical color selection.

Until science has advanced to the point that we can simply regrow all of the damaged natural tooth structures in a patient's mouth, biomimetic dentistry will continue to evolve in an attempt to harmonize our materials and efforts with those of the body. If you haven't yet adopted a biomimetic approach to treatment, I'd advise you to do so. Whatever the materials, this approach will be indelibly tied to the future of dentistry.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
rmargeas_eic@aegiscomm.com