Drs David and Davey Alleman teach biomimetic success

Anisha Hall Hoppe, Dental Tribune International

Fri. 19. April 2024

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A unique highlight of the conference programme, Drs David and Davey Alleman held the Singapore Dental Association Masterclass on the six lessons approach to biomimetic dentistry this morning at IDEM Singapore. This approach, based on peer-reviewed scientific literature, is the basis for instruction at the Alleman Center of Biomimetic Dentistry. The father and son team shared more about their approach and participation at IDEM in an interview with Dental Tribune International.

Drs Alleman, in the first and second lessons of the six lessons approach to biomimetic dentistry, you emphasise the importance of caries treatment and structural analysis of cracks in dentine. Could you elaborate on how these initial steps contribute to the overall success of restorations and the preservation of tooth vitality compared with traditional methods?
David: Without ideal caries removal end points and crack removal end points in the peripheral seal zone, all bonds on the cavosurface are at risk of failing. Adhesive dentistry is about more than the adhesive system. There are steps to take before bonding that have an impact on the success of an adhesive restoration. By achieving a successful bond, the tooth is protected from reinfection and crack reinitiation, thus protecting the tooth’s vitality.

Davey: Without a caries-free and crack-free foundation, adhesive success will be limited owing to poor seals and exaggerated micro-movements of the tooth. Both deep carious lesions and vertical cracks create a pathway for bacteria to enter the pulp and create an inflammatory cascade that can lead to nerve necrosis. Caries treatment and structural analysis of cracks in dentine promote a more predictable outcome and preserve tooth vitality long term.

Your approach includes immediate dentine sealing and resin coating as crucial steps. How do these techniques specifically address the issue of postoperative sensitivity and contribute to the longevity of restorations?
David: Without a seal in the biomimetic range, which is 30–50 MPa, seepage of pulpal fluid under the restoration will cause sensitivity. Immediate dentine sealing and resin coating are the only way to prevent this in a deep composite restoration of a posterior tooth.

Davey: Immediate dentine sealing and resin coating prevent pulpal fluid from moving in and out of the dentinal tubules. This fluid movement is often associated with postoperative pain due to gaps underneath a restoration. Immediate dentine sealing increases the bond of an indirect restoration by 400%, and resin coating further creates a secure bond, preventing failures at the adhesive–dentine interface. It is easy to get a bond, but retaining it requires immediate dentine sealing and resin coating.

How do you feel clinicians will benefit from choosing to attend IDEM?
David: IDEM is putting scientific advancements in dentistry front and centre this year. For dentists new to biomimetic dentistry, those who follow me and Davey on Instagram or the alumni we have trained in Singapore and the surrounding countries, there will be opportunities to learn more about what I have been practising and teaching for the past 20 years.

Davey: We are flying halfway across the world, and we hope you’ll come to meet us in person. IDEM is going to be a great opportunity to be exposed to biomimetic restorative techniques that alleviate many of patients’ problems and dentists’ frustrations. I look forward to sharing the dentistry that I do every day in my office with the dentists at IDEM.

You both have trained hundreds of dentists worldwide. Have you encountered differences in the various countries in which you have taught regarding dental practices and technologies and have you had to adapt the six lessons approach to accommodate these?
David: There are some differences, but none of them have proved to be insurmountable. Learning new skills can be challenging, but the effort is worth the result. The dentist who uses the six lessons approach is focused on quality. Every country has dentists and patients who want that. We focus on the science and the techniques and on giving dentists the tools to understand how to achieve the best possible results wherever they practise.

Davey: We have helped dentists in over 40 countries to understand techniques that create the best results with the materials they have access to in their particular region. Biomimetic dentistry is technique-sensitive. You have to understand how a specific step affects your restoration. The dentists we train achieve amazing outcomes, and I am sure any dentist in any country can do the same with the same training.

Is there anything else you would like to share with our readers about your work or any additional initiatives you might be working on?
David: In March, the International Association for Dental, Oral, and Craniofacial Research held its annual meeting, and it featured a presentation by four of the leaders in advanced adhesive dentistry—Dr Sema Belli, Dr Hidehiko Sano, Dr Junji Tagami and myself. This has begun the process of bringing this scientific viewpoint to dental school curricula and elevating the standard of care for patients everywhere.

Davey: Follow me on Instagram @davey_alleman_dmd to see real cases from the patients I see in my office every day.

Editorial note:

More information about the IDEM Singapore conference programme can be found at www.idem-singapore.com. This interview was published in today IDEM Singapore 2024.