Please activate JavaScript!
Please install Adobe Flash Player, click here for download

cosmetic dentistry_ beauty & science

feature _ interview I and minimally invasive approaches—no post, no crown dentistry. Restorative dentistry is likely to evolve in a manner similar to technological advancements in general. If you have a smartphone, you know what I mean. CAD/CAM and technology will be used increasingly, and I hope for the best, mean- ing just as an additional tool in our armamentar- ium and not as an excuse to treat more patients. I believe we will stop using posts, crowns and metal alloys, and stop performing inten- tional endodontics eventually—this has already happened for many of us who believe in the biomimetic approach. My hope is that technology will make better treatment accessible to more patients, with a re- duced need for root-canal treatment and crown lengthening. I see an increase in the diagnosis of diet-related problems and improved differential diagnosis between wear- and erosion-related lesions. Such cases will force us to strive for the solution that will preserve as much of the tooth as possible (keep the pulp alive using non-re- tentive preparation) that is no-post no-crown restorative dentistry. In summary I would say for the future less is more (minimally invasive). We will learn to think differently, think biomimeti- cally, think bonding. Technically, good bonding implies some cardinal rules: good isolation (very important; ideally a rubber dam) and knowledge of your materials, products, and procedures. A checklist is the best aid—this is similar to pilots going through a checklist before flying an airplane! Dentists need to have a look at sound, un- biased literature before choosing products. Manufacturers do not always sell the best prod- uct but rather the most convenient one. Many new products today have been developed in re- sponse to the pressure of the market; for exam- ple, one company starts a new trend and then all the other companies follow with competing prod- uctsevenifthistrenddoesnotyieldthebestper- formance. It is business driven. It happens a lot. I would say that dentists need to undergo training and gain as much experience as possible because we know that the operator factor is evenmorecriticalthanthechoiceofproductand technique. This is why as an academic I want my students to have as much experience as possible with the materials and techniques that are going to represent their daily bread when they start their practice. Today, we can no longer ignore that adhesive dentistry is this daily bread. _Is it possible to reproduce the original stiff- ness of a tooth? How can this be achieved? Absolutely! Much research, starting in the early 1980s, has demonstrated that adhesive forces obtained solely on enamel can restore the original stiffness of a tooth. Various de- grees of stiffness are obtained with a combi- nation of dental adhesives, composite resins and ceramics that simulate dentine and enamel, respectively. _Oneoftheobjectivesofyourcoursesistoex- plain a new biomimetic approach to restorative dentistry. What is this concept about? I can respond in two words: mimicking na- ture. As said earlier, it implies first respecting biological parameters, such as pulp vitality— once lost, the pulp will not come back and we know that a non-vital tooth has a poor prognosis—then emulating mechanical func- tion as intended by nature. This will ultimately form an aesthetic and pleasing whole with the tooth because dental materials that are able to simulate the mechanical properties of dentine and enamel are also available in tooth colours. This is the fundamental difference between a filling (old alloy restorations) that only fills a cavity like an obturator and one that rehabili- tates the biomechanics of the tooth. Biomimetic research is changing dentistry using apparently weak materials synergistically tosimulateenamelanddentine.Afterall,enamel is extremely brittle (more brittle than glass) Fig. 1_Partial bonded restorations teeth 13 to 23 (porcelain by Michel Magne, Oral Design Beverly Hills, on teeth 12–22). (Image courtesy of European Journal of Esthetic Dentistry) I 15cosmeticdentistry 4_2013