Lecture Notes: The Six Lessons Approach to Biomimetic Dentistry

Introduction

• Focus on the six lessons approach to biomimetic dentistry.
• Previous topics: cracks and decay as major pathologies in dental practice.
• Importance of early diagnosis for teeth at risk of decay and cracks.

Understanding Tooth Anatomy

• Anatomy details: brittle enamel, tough dentin, and the dentino-enamel junction (DEJ).
• Sensitivity indicators: Cold, sweet, or biting sensitivity.

Diagnosis and Sensitivity Testing

• Cold Testing: Helps evaluate the health of the pulp.
  • Vital pulp assessment through cold response.
  • Sensitivity varies; bell curve distribution.
• Extreme cold sensitivity possibly indicates a crack or gap.

Research and Historical Context

• Martin Brannstrom's research on pulp histology and response to thermal stimuli.
• Discovery of odontoblastic processes and nociceptors by Charlie Cox.
• Significance: Pulpal fluid movement as a response to stimuli.

Symptoms of Cracks

• Sensitivity to sweets linked to osmotic gradient.
• Infection enhances cold and sweet sensitivity.
• Infected cracks as pathways for decay (occlusal effect caries).

Risk Assessment for Cracks and Decay

• 1-2-3-4 System: Evaluates risk based on symptoms and physical indicators.
  1. Cold sensitivity.
  2. Biting pain.
  3. Sweet sensitivity.
  4. Visible cracks in enamel.

Historical Insights

• Brannstrom vs. Fusayama: Differing views on odontoblastic processes.
• Importance of reading footnotes in historical documentation.

Tooth Structure and Fracture Resistance

• Studies by Larson, Douglas, and Rainey on fracture resistance.
• Impact of GV Black’s preparation methods on tooth strength.
• Importance of isthmus width and cusp width in evaluating fracture risk.

Early Diagnosis and Treatment

• Early diagnosis leads to less invasive and cost-effective treatments.
• Importance of understanding fracture risk and decay for early intervention.

Conclusion

• Emphasis on biomimetic practices: Mimic the natural tooth.
• Future direction: Permanent bonds through stress reduction in restorations.
• Call to action: "Get bonded, stay bonded."