BIOMIMETICS: TAKING DENTISTRY IN A

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15 Νοε 2013 (πριν από 3 χρόνια και 9 μήνες)

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BIOMIMETICS: TAKING DENTISTRY IN A
NEW DIRECTION

CDR Juan K. Packer

CDR JUAN PACKER


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

BIOMIMETICS


Bio = life


Mimetic = to mimic


Termed coined by Otto Schmitt in the 1950’s


BIOMIMETIC QUOTE


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


FUNCTION OF DENTIN


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 semi
-
translucent)


FUNCTION OF ENAMEL


Hardest substance in the human body


Protects the dentin


Gives shape to the tooth


Aids in chewing

BIOMIMETIC MATERIALS(KURARAY)


Adhesives

´
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

CLEARFIL SE PROTECT


In a liquid state has antimicrobial properties


A
fter
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


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.


MDPB


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


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)


Majesty composites


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



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



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


QUESTIONS