CDR Juan K. Packer

 Graduate of the Univ. of Mississippi School of Dentistry 1998  USAF (Little Rock AFB,AR and Sheppard AFB, TX)  Inter-service transfer to USPHS 2003  Staff dental officer-Advanced Tahlequah, OK  AGPR Residency Tahlequah, OK  Northeast Wisconsin Technical College Public Dental Health Certificate  Implant Seminars Miami, FL  Chief Dental officer Seminole Tribe of Florida(Hollywood, FL) 2007-present

 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

 Bio = life  Mimetic = to mimic  Termed coined by Otto Schmitt in the 1950’s

 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

 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

 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)

 Hardest substance in the human body  Protects the dentin  Gives shape to the tooth  Aids in chewing

 Adhesives  Clearfil SE Bond  Clearfil SE protect

 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

 In a liquid state has antimicrobial properties  After 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

 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 (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 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)

 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 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 )

 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

 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