Articles

Dr. Alleman has condensed over 1,400 research articles into his patent pending teaching program (used in conjunction with the Academy of Biomimetic Dentistry) which provides alternatives to full coverage crowns. He has trained over 200 dentists world-wide over the past 6 years, helping dentists achieve excellence in Biomimetic Dentistry. Dr. Alleman has been using biomimetic procedures in his practice for more than 11 years.

Early diagnosis and intervention for children can reduce future dental work for adults by up to 80% (Rainey, 2011). In addition, accurate tooth decay and caries diagnosis, conservative tooth preparation, and adhesion dentistry can reduce the need for crowns and subsequent root canals by up to 80% (Alleman, 2011). The latter is provided for mid to late interventions utilizing state-of-the-art adhesive bonding techniques and innovative biomaterials which are among the tools utilized in the field of biomimetics. “Restoring or mimicking the biomechanical, structural and esthetic integrity of teeth constitutes the driving force of biomimetics.” (Magne, 2006)

In summary, an ounce of prevention is worth a pound of cure. Routine visits to the dentist (beginning with children) for early diagnosis and intervention in conjunction with mid to late intervention (as adults) using biomimetics can eliminate up to 96% of crowns. This reduction in crowns reduces chronic problems resulting from leaky crowns and bacterial infections that eventually cause periodontal disease and the need for root canals, implants and bridges. A vital tooth restored with biomimetic procedures will seldom ever require endodontic treatment. Of course dental patients must be encouraged to incorporate good oral hygiene, eat balanced diets and live healthy lifestyles in order to acheive these results. Biomimetics encompasses general dentistry, pediadontics, prosthodontics, and periodontics.

The Biomimetic Principle & Restorative Dentistry

The intact tooth in its ideal hues and shades, and perhaps more importantly in its intracoronal anatomy, mechanics and location in the arch, is the guide to reconstruction that determines success. The biomimetic approach using adhesive bonding and biomaterials is basically conservative and biologically sound. This is in sharp contrast to the porcelain-fused-to metal technique, in which the metal casting with its high elastic modulus makes the underlying dentin hypofunctional. The goal of biomimetics in restorative dentistry is to return all of the prepared dental tissues to full function by the creation of a hard tissue bond that allows functional stresses to pass through the tooth, drawing the entire crown into the final functional biologic and esthetic result. (Magne, 2006)

Producing hard tissue bonds is the key to adhesive dentistry which can “be expressed as a simple relationship between bonds and stress. If the bonds can withstand the stress, the restorative technique will be successful.” (Unterbrink & Liebenberg, 1999; Deliperi & Alleman, 2009) The following is an introduction to a systemic approach for early diagnosis, intervention, and successful adhesive dentistry as developed by David S. Alleman, DDS and J Tim Rainey, DDS. Alleman and Rainey are successful dentists, leading research scientists, and pioneers of minimally invasive biomimetic dentistry.

Integration of Oral Systemic Health & Biomimetics via Ozone Treatments

In accordance with the AMIBD mission statement, one of our objectives is to utilize an evidence based, multidisciplinary approach to treating oral hard and soft tissue disease through early, accurate diagnosis and intervention. Though oral systemic health is not typically considered biomimetic in nature, it is an important element of preventive dental care which can have a profound effect on healthcare in general including reduction of periodontal disease (including gingival recession) and the long term success of minimally invasive biomimetic restorations.

"New scientific research has shown that when long-term inflammation (such as peridontal disease) persists in the body, poor health is the result. Low-grade infections and inflammation are now recognized to be at the root of heart disease, diabetes, strokes, pregnancy complications, kidney disease, certain cancers, as well as many other diseases and medical conditions. Inflammation is now recognized as being a new risk factor for many of the medical diseases and conditions which plague our society.

As it relates to oral health, inflammation from oral sources is particularly worrisome because of its widespread prevalence and the stealthy manner in which it operates. The American Academy of Periodontology states that three out of four Americans suffer from some form of gum disease – ranging from mild gingivitis to the more severe form known as periodontitis. They state that despite this prevalence, only about 3% seek treatment for their gum disease. This obviously touches many lives and makes gum disease one of the more important sources of inflammation anywhere in the body.

Gum disease is more appropriately termed "periodontal disease". Perio is Latin for "around" and dont is Latin for ‘tooth’. Periodontal is thus dealing with the anatomical tissues and structures which surround the tooth. This includes the soft gum tissues as well as the underlying jawbone which serves as the foundation for the teeth. Type 2 diabetics have an increase in death rate from 3.7% to 28.4% (a 768% increase) when comparing diabetics with no gum disease and diabetics with severe gum disease, respectively. Periodontal disease is a strong predictor of death from heart and kidney disease. Diabetic Care 28:27-32, 2005.” (Ostler, 2011)

"Ozone is an inexpensive yet powerful antimicrobial, neither bacteria, viruses, nor fungi develop resistance to it. Ozone is a holistic and natural pharmaceutical approach to infection control, wound management, and tissue repair." (Vander Stoep, 2011) Ozone treatments can be utilized in early diagnosis and intervention procedures to kill bacteria and other pathogens, thus reducing or preventing periodontal disease in conjunction with minimally invasive biomimetic restorations.

The common factor among all pathogenic organisms is the weak antioxidant/enzyme systems in the cell membranes of those organisms. Ozone treatments allow for penetrating the cell membranes, thus killing pathogenic organisms. After penetration and subsequent death of the organism, the contents of the organism are exposed to the biological environment of the host. This allows the immunologic system of the host to start its physiological cascade. According to recent biochemical and physiological studies conducted at Scripps Institute, this process mimics biological processes, e.g. it is a form of biomimetics. Biomimetics includes human-made processes, substances, devices, or systems that imitate nature. Biomimetics is the art and science of designing and building biomimetic apparatuses, and it is of special interest to researchers in the nanotechnology and medical industries. An example is the artificial synthesis of antibiotics. The Scripps Institute study reveals how antibodies actually produce ozone to kill microorganisms (Babior et al, 2003). Now antibodies, in addition to identification of pathogens, are used to kill pathogens with ozone.

"The chemical properties of ozone are the foundation of what makes it work so well in dentistry. Ozone is a powerful oxidizer — it effectively kills bacteria, fungi, viruses, and parasites at a dramatically lower concentration than chlorine, with none of the toxic side effects. One molecule of ozone is equal to between 3,000 to 10,000 molecules of chlorine and it kills pathogenic organisms 3,500 times faster! In a medical/dental ozone generator, the medical grade O² is converted to O³ in special tubes via a corona discharge reaction (similar to lightning). This type of generator is able to control the concentration of ozone critical to delivering the correct dose in micrograms/milliliters (mcg/ml). Concentration is determined by exposure and contact time of the medical-grade oxygen to the 5 to 13 millivolts [Bocci] sealed-corona discharge tubes.

Because of ozone’s physical properties in the dental model, the ratio of ozone to oxygen is extremely low. The typical average concentration of ozone used in treatments is 25 micrograms of ozone per milliliter of oxygen/ozone gas mixture. That translates into 0.25 parts of ozone to 99.75 parts of oxygen. Evidence-based research reveals that at this concentration, ozone effectively kills bacteria, fungi, viruses, and parasites." (Mollica & Harris, 2011)

In addition to killing pathogen populated biofilms (plaque), ozone denatures the toxic waste of those microbial populations. Pathogenic biofilms thrive in acidic environments, quickly reproducing and outnumbering beneficial bacteria. In the process bacteria produce an abundance of organic acids (such as pyruvic acid) that support growth of pathogenic biofilms. These acidic waste streams also facilitate the increased loss of minerals in teeth above the gumline, subsequently leading to decay. The presence of acidic waste from the pathogens below the gumline in the loose area between the gums and teeth serves as an incubator for accelerating growth of pathogens. Organic acids emitted by bacteria also aid in the growth of subgingival plaques which grow on the tissue side of the subgingival wall of the gum pocket, in the sulcular fluid of the gum pocket, and accumulate on the roots of teeth below the gums. This encourages the formation of harmful calculus. (Rainey, 2011; Vander Stoep, 2011)

Utilizing accurate ozone generators and state-of-the-art techniques, ozone gas treatments can be used by dentists to:

  • kill pathogens in the periodontal pockets and other areas where microbial communities thrive using a systemic approach;
  • specifically kill decay causing bacteria on root surfaces, smooth surfaces,and the pit, fissure, and groove system of the enamel of teeth;
  • mitigate organic acids produced by microbial populations through direct injections into the root canal of teeth.
  • Ozone gas, when sufficiently applied to reach the base of a cavitated tooth lesion can dramatically shift the pH and chemical characteristics of the microbial environment. Ozone treatments denature the protective protein coat on teeth that safeguards germs from pharmaceutical products and our immune system, then oxidizes both the germs and their waste products.

    "Teeth are essentailly mineral banks – the balance of minerals into or out of teeth shifts depending on the oral environment. They lose minerals in an acid environment, they gain them in an alkaline environment Saliva provides all the minerals a tooth needs to stay healthy; we just have to keep the oral environment mildly alkaline to keep them going in the right direction. It is microbial waste products that create the acid environment (pH 3-3.5) that sustains microbial growth and subsequently dissolves teeth." (Vander Stoep, 2011)

    If demineralization or frank decay is present, ozone gas, carefully applied, can penetrate up to 5mm into the tooth lesion. In this way ozone treatments shift the oral environment towards a neutral pH. Friendly bacteria begin to predominate. Even when patients do not support therapy with appropriate self care, it takes months for germ populations to revert to an unfriendly balance. In the meantime, tooth banks are conditioned to accept mineral deposits rather than lose them.

    "If a person actively seeks to insure good oral health, they can support the positive mineral balance of their teeth by monitoring their oral pH. If their saliva consistently tests below 6.8, they should detect and address possible causes. Taking oral probiotics such as Evora or iFLora, mechanically removing biofilms daily, and using remineralizing washes and pastes support a permanent terrain change. Minimally invasive dentists will “gas” a tooth, then paint on Caphasol or its generic to begin the remineralization process. A new hydroxyapatite nanoparticle that tested superbly in studies will soon be available. This product even more closely mimics tooth structure." (Vander Stoep, 2011)

    The oral environment in general changes as friendly bacteria begin to predominate. Even in the worst case scenarios, it takes months for germ populations to revert to an unfriendly balance. In the meantime, tooth banks accept mineral deposits, demineralization stops and remineralization begins. When microbes and their wastes are neutralized to its base, the biological environment within the tooth shifts immediately to a less acidic state. That less acidic environment begins to favor mineral gain over mineral loss for about four months." (Baysan 2000; 2001; 2004; Vander Stoep, 2011)

    Ozone treatments stimulate the immune system in many ways. Ozone treatments (often referred to as ozone therapy when treatments are performed in succession) are utilized for prevention of peridontal disease, in pediadontics, for conducting root canals when necessary, and for routine treatment of caries, oral osteonecrosis, herpetic and apthous ulcers, and preventing infections after surgery. (Vander Stoep, 2011)






    Dr. David S. Alleman, DDS
    The Alleman Center
    for Minimally Invasive Biomimetic Dentistry

    Phone: (801) 617-3840
    10319 Beckstead Lane
    South Jordan, UT 84095

    THE ALLEMAN CENTER
    MINIMALLY INVASIVE BIOMIMETIC DENTISTRY

    A MODERN APPROACH TO PATIENT ORIENTED DENTISTRY