Biomimetic Dentistry – What Actually Is It? – PDP135

Jaz’s Introduction:
Because essentially, from my understanding of BIOMIMETIC DENTISTRY, it is like EXTREME BONDING. Basically, it’s extreme adhesive bonding and using a set of philosophies and guidelines following the literature to get the best bond strengths possible. Today I’ve got on Dr. Taylor Paton, and I love him because he’s a young dentist, like he’s super young, and I respect that a lot because he’s got something to share. He’s got fantastic online resource, all about his passion and his learning and his journey with Biomimetic dentistry. And sometimes what happens in education is that the grand master, the king of any discipline within dentistry, they are so far removed from the plight and the struggles of that learner that sometimes they may not be the best person anymore to introduce someone to that topic.

So, I think Taylor, what he presents today is a young Scottish dentist and I just love his energy and his knowledge. You know how much I love geeky dentists, and so therefore I’ve got him to talk about Biomimetic dentistry, answering my questions from the lens of a young dentist who’s just very well read up and very keen in this field, and that way he’s also learning and therefore, as us, we are all learning together with him. I think this episode is more impactful as an introduction to Biomimetic Dentistry than if I got on an established superstar that’s already well known. So, Taylor, keep up the good work, my friend.

Hello, Protruserati. I’m Jaz Gulati and welcome back to the Protrusive Dental Podcast. If you’re listening to this, I love you. Thank you so much. If you’re watching this, then you can see the hoodie that I’m wearing. Oh, my goodness! Dr. Nekky Jamal, the dentist who made the Third Molars Online course. The course I always rave on about as the course to learn wisdom tooth surgery wherever you are around the world, because it’s online. It really helped me start tackling cases. He has this fantastic merchandise. This hoodie has got a photo of Drake wearing a mask and wearing loops. It just looks brilliant. So, thank you Nekky, for sending it all the way from Canada I absolutely love it. In fact, I’m lecturing tonight at local BDA Kingston branch. I’m talking about HOW TO STOP YOUR COMPOSITE VENEERS FROM CHIPPING, and I’m gonna be wearing this hoodie tonight, so I’m doing something quite brave. A borderline unprofessional. Is it? I don’t know, maybe it’s just a new thing now, and we can be a little bit, I don’t know if it’s unprofessional. I think my heart’s in the right place here, but this is representing the future of education. So, if you are listening, watching, and you are wanting to learn more about WISDOM TOOTH EXTRACTIONS and see videos of surgeries to guide you in your own practice, there’s only one course in the world to checkout. That’s Nekky Jamal’s Third Molars Online. It’s on thirdmolarsonline.com, and if you use Protrusive at checkout, you guessed it, you get a 15% off. So, that’s once again that’s third molars online.com. Use Protrusive for 15% off. And trust me, you will not regret it. It is a fantastic resource for anyone who wants to do third molars in practice.

[Protrusive Dental Pearl]
The Protrusive Dental Pearl I have for you is HOW TO BLOCK OUT A METAL POST. So, imagine you take off an old crown and you find an ugly metal post inside, and now you want to place your future crown. And maybe you don’t want to use PFM, maybe you don’t want to use porcelain fused to metal maybe you want to use a ceramic for whatever reason. And therefore, sometimes to mask that metal sub-structure can be very difficult. It can have shine through. It can look very ugly. So, what you can do is you can use something like Ivoclar Direct Opaque. It’s like this flowable resin, which is a masking agent. It’s there, it’s extremely opaque. It’s like Tipp-Ex for teeth. And essentially you put your air abrasion adhesive and you paint this on. And like for those of you watching, you paint it on the tooth, you cover the post with it, or you cover the metal with it. And it can also be used for really dark cavities. Like sometimes you remove an old amalgam and it leaves a really dark base. And if you go ahead and restore with your usual body shade composite, it’ll look really gray, it’ll look really ugly.

So, if you put a base of opaque resin, it doesn’t have to be Ivoclar could be any brand, and a Cosmedent do a very popular one, pink opaque, anything too opaque to block it out, whether that’s the metal post or that’s the base of a dark cavity. Using an opaque like this can really bring your restoration to life, or it can prevent that shine through. So top tip for today is to consider, it’s one of those things that it’s good to have in your armamentarium. A syringe of a masking resin. This episode is sponsored by the Academy of Implant Excellence, and they have a flagship course by that man himself, Dr. Pav Khaira, let’s hear a few words from him.

[Pav]
There’s no secret to success. There’s a system to success, and I’ve developed a three-step training program. If you want to start your implant career or if you’ve already started and you want to accelerate it. Knowledge clarity, knowledge depth and building muscle memory so it becomes second nature to you. I’ve taken all of my years of experience everything that I’ve learned from my MClinDent and all of the courses that I’ve attended and condensed it into the Academy of Implant Excellence course. If you want to know more, head to the website page. And you can learn everything that I’m going to be including in that course. I am so excited! It is going to be absolutely phenomenal, and I am ready to give you guys my knowledge.

[Jaz]
That was indeed Dr. Pav Khaira from the Dental Implant Podcast. Do check it out if you haven’t already, and if that interests you, do check out his website, academyofimplantexcellence.com. That’s academyofimplantexcellence.com and of course, you can check it out in the show notes. That’s all for me and I’ll catch you in the outro. Let’s listen to Dr. Taylor Paton now.

[Main Episode]
Taylor Paton, welcome to the Protrusive Dental Podcast. How are you, my friend?

[Taylor]
Oh, very good. Thanks Jaz, and thanks so much for having me. I’m saying that, it’s very, very, very surreal. So, I think you’ve been the soundtrack to my very long commute to VT this year. So it’s been, yeah, I feel like I’ve been listening to you in my ear every car journey, so it’s crazy to be actually talking to, so thanks very much for having me.

[Jaz]
Absolutely. An honor to have you on, you are a Protruserati as we connected on Instagram. And then I remember, do you remember when we first like, we’re messaging on Instagram and I was really liking your page, the hybrid layer. And so I’ll be sure to put everything in the show notes for everyone to click on and find you. But then you had this like, and it’s very normal. It’s good to have this, you had this little imposter syndrome, he said, ‘Ah, but I’m only in like a DF1.’ So, guys, Taylor’s in Glasgow. He’s at the end of his DF1 but I’ve haven’t seen such beautiful commitment from someone such a young dentist before. And I said, ‘Look, you need to come to the show. We’ll talk about your journey. I also want to learn from you about Biomimetic dentistry.’ And then you probably had some imposter syndrome. And did you have that firstly?

[Taylor]
Oh, definitely. Yeah. And I think you were, I was actually listening to that the other day actually. I think you were talking to that about one of your other case the other day. And I think it’s definitely, I would agree with yourself that one, it is a good thing as well. Definitely in terms of Biomimetic dentistry, because it’s definitely not the sort of thing that I know we’re obviously doing this podcast, but not the sort of thing that you listen to one podcast then you’re suddenly an expert and know what you’re doing. Even at my stage, I still feel there’s so many parts of it. I’m using some of the basic principles and that sort of thing, but there’s so much of it that I’m still not completely comfortable with, even though I’ve kind of made the website and that sort of thing. I think it is good to have a bit of that.

[Jaz]
I think the main reason I wanted to do one, like to tell I could have had someone who’s got 25 years experience. But I think the beauty of now and again, having different levels of experience, so you’ve only had like one year experience in clinical practice, but from your website, from your Instagram page, your dedication, your hunger is so evident, and I want to extract that and share that. And sometimes, when you speak to someone who’s really super experienced, they forget the struggles that they had earlier on. So, you are very much in the midst of the struggles of a very young dentist. And I feel as though some of the audience will be able to connect so well with you and you’ll be able to break it down in a way that, you know, I might have forgot what it was like eight years ago to explain a certain concept.

So, I think, I’m really excited to actually speak to you, say about an area of dentistry, which is very much like modal. Like in the last 10 years, Biomimetic dentistry has become like a buzzword. It’s also come under scrutiny by some experienced lecturers. They call it bio-pathetic dentistry. They say that ‘Oh, it’s just a fad name for just a brand of restorative dentistry. So, let’s just start with that, Taylor. Okay. Before we then also, talk about your journey and how you got into it. But essentially, what is Biomimetic Dentistry?

[Taylor]
Yeah, so I would agree with you that in terms of the label Biomimetic dentistry, it’s quite a vague one, and it can be quite fluffy at times when you see it. So, a lot of people, if you kind of start talking to them about it and they maybe haven’t looked into it too much, the first thing you usually tend to hear is, ‘Oh yeah, that’s just the, is that thing where you do the tabletop prep with the big smooth surface and only trying your best to stick on with your adhesive.’

And I personally think it’s quite about more than that and there’s so many of these kind of Biomimetic type dentists that there’s so much to learn from them. Just in terms of the fundamentals and the basics of just general dentistry as well, I would say, so I would kind of asking about defining it. I would say it’s obviously along the lines of a tease of dentistry, but a tease of dentistry and itself. I think you could see that as; say we’ve got Zirconia Crowns bonding that onto a tooth with a really heavy crown prep. That could be a tease of dentistry. I think Biomimetic dentistry would then be beyond that. Also, then just kind of respecting how the natural tooths build up and how the kind of natural tooth functions. So, it’s made of enamel and dentin, which are, you know, they’ve got very specific properties. And I think it can be quite-

[Jaz]
Would you say Biomimetic dentistry is a philosophy?

[Taylor]
I would say it would probably be just respecting that. We’re trying to build a tooth up the way that kind of nature intended. So, I suppose the word Biomimetic would be to mimic life. So, I think especially early in your career, like myself, I think it could be quite easy to maybe looking at like how to do crown preps and that sort of stuff. You’re looking at materials, what materials should I use, whether it’s eMax Zirconia, quite easy to think or which material then’s the hardest for this crown. So if you get a really hard zirconia, that’s good. That thing’s, it’s likely never going to break. But I think Biomimetic dentistry as well as probably using materials that if there is some sort of failure, then you would probably rather that your restoration were to fail rather than the likes of a really hard non-Biomimetic restoration that the patient might come in and you’re a hero because their crown’s completely intact and there’s no chips or anything on it, but the rest of their tooth’s fractured off at the gingival level. And it’s extracted and implant, that sort of thing.
Whereas Biomimetic dentistry, I would think it would be accepting that you’re not necessarily wanting to just go for the hardest materials. You’re wanting to try and actually first kind of understand the way the tooth works and function and while I was listening to someone and thought recently, actually they kind of comparing it. I think it was, Graeme Milicich, have you heard?

[Jaz]
Nope. But please tell me.

[Taylor]
So, I think he does a lot of research about the compression dome concept of enamel. So that’s basically where the enamel basically works. So, the compressor forces on the tooth and it’s kind of redirecting those vertical forces in the kind of cervical area of the tooth, and it’s kind of disrupting those to the dentine. And he’s kind of saying, and a lot of Biomimetic dentists are kind of saying that by doing these kinds of aggressive, heavy crown preps that we’re used to doing and taking away that kind of cervical area of the tooth, you basically don’t want to do that because it’s the strongest part of the tooth and it’s the area that’s receiving all that tension under function. So, by taking that away, you’re not really doing the tooth any favors.

And that little area, the cervical kind of two to three millimeters, if you go and then read about Biomimetic dentistry, you hear a lot of people calling that the bioderm. So, you hear a lot about kind of preserving that bioderm. And with doing that, you’re then taking a more kind of minimally invasive to an extent, but not going too far with that either. So, if there’s like a really thin cusp or that type of thing, it’s not like an extreme minimally invasive or you’re relying on, you know, ridiculous bone strengths and that sort of stuff. I think it’s more of an approach where you’re removing your carries, removing track. Trying to preserve the vitality of the pulp.

[Jaz]
I think the word approach is a good one though, Taylor because from my perception, from what I’ve seen, from my speaking and also, I actually did have David Alleman on the podcast, but we had such massive connection issues. They never actually got posted. But from what I’ve seen and from speaking to lots of my colleagues, you know, Germàn. He’s very active on social media. I’ll have to put his, Germàn Tekilla is his Instagram handle, so I speak to a lot with him about Biomimetic dentistry and what I like, and why I’m open to it and why I don’t think it is a fad, as some colleagues will say it is, is because it’s an approach, it’s a set of protocols and no one else is talking about cariology, but Biomimetic dentists are.

No one else is talking about how to maximize bond strengths and actually those three words is how Dr. David Alleman described it when he had his brief little stint in my podcast, he said, Biomimetic DENTISTRY is really MAXIMIZING BOND STRENGTH. So, is it adhesive dentistry? What could he do to the tooth with your restoration to get the best outcome through the best adhesion possible? And also, it’s a way of preserving the longevity of teeth. So, all these philosophies and the protocols that Biomimetics has in place all lends itself to a favorable restorative outcome. So, for me, I see it as a philosophy and a branch of restorative density best practices. It’s another way to think about it. How did you get drawn to this? Because most couple people qualified one year maybe haven’t even heard of Biomimetic dentistry. Are you finding that you’re having to explain a lot to someone who you’ve met? Who’s like maybe at your level in terms of one year qualified or a dental student and you’re having to explain every time what Biomimetic dentistry is?

[Taylor]
Yeah, so I think how I kind of fell into it was, so I graduated, so it was 2020. So, it was Glasgow I graduated from, so we were the year that kind of stopped a bit earlier because of Covid as well. So, we had that really abrupt stop. It was about March time where we were in the clinic one day, the next day. That’s it. You’re done.
So, there was a few weeks on, maybe a couple of months of waiting about to see. ‘Oh, do we still need to do this last OSCE exam?’ That sort of stuff. And then after that it just kind of fizzled out and that was it. So, at that point, lockdown was happening. I had a lot of time on my hands at that point as well. There was the big influx of all the webinars every day. Like you couldn’t keep up with so many webinars and stuff. There was one every morning, afternoon, night, you were kind of spoiled for choice really. And I think at that point, I was kind of then realizing like, wait a minute here. There’s just so much that I don’t know from dental school really, and I think we’ll come onto that a bit as well, but-

[Jaz]
I still feel like that every time my friend. Don’t worry. It’s very normal to feel that way. And it’s good to recognize it. It’s the most important thing is to recognize that, whoa. Yeah. It’s so much that you don’t know that you haven’t exposed to. And then the more you learn about things, then the more you realize that actually I thought I knew crown lengthening. But then when you start learning about crown lengthening, when you do your first crown lengthening case and then you’re like, holy crap, I need to learn more about crown lengthening. So it’s never ending my friend. Embrace it. Embrace it.

[Taylor]
Yeah. So, I think they started off with all the webinars, that sort of stuff. I think a similar point I probably found your podcast as well, and it’s genuinely being so helpful for like that stage in my career as well, I don’t know how much feedback you get from people at my stage and stuff, but it’s genuinely, completely changed my outlook on everything, and I’m not just saying that because you’re there.

[Jaz]
Much appreciated. You can stay. We’ll keep this in running. Very good. No, thank you so much. It’s nice to get feedback. It keeps me going, you know, sometimes where, yeah, like today, I’m behind on my episode and I’ve got so much to do behind the scenes and you may not, have not seen actually, and I’ll take it for everyone’s benefit. You might have not seen this, but on YouTube now for the last couple of episodes, not only is the interview on the right side, but there’s notes now coming up on the left side, so that’s double our production time. But, so, you know, let me know what you think of that. And guys, if you’re listening, watching this, let me know, should we continue working OT and maybe delaying the episodes a little bit to have the notes on the left, as we’re speaking, or is this a function that you really don’t need? So yeah, something to get some feedback for. So, feedback, always welcome. Thank you.

[Taylor]
Sounds good. No. Yeah. So, I’m one of the audio listeners who have then kind of started listening to your podcast, quite a long commute this year, like I was saying, it was about an hour later and an hour back. So, I’ve listened to all the podcasts from that, I was then just reading a lot more and following a lot of other dentists. And I think from that, it was kind of about on Instagram that I then fell into the little group of-

[Jaz]
Huge community on Instagram or Biomimetic dentist are sharing lovely things, great lessons, very educational posts, I, which need to be respected, you know, whether you agree with Biomimetic approaches or not. I think there’s a beauty in sharing and presenting information on Instagram that is disseminating information and research. So, I think we have to re respect that.

[Taylor]
Yeah. And at the start it was, I found there was so much information on these pages, and it was all, it wasn’t just a case of, I think it’s quite easy to think, oh, you’re reading that stuff on Instagram. Like that can’t be the way of doing it, but it’s all linked back to research articles and you know, reviewers and that sort of stuff. So, you can go away yourself and start reading through all those papers and kind of a lot of the time, I would then also form my own opinions as well. There’d be some things that people would post about, and I would think. Oh, I’m not, not too sure about that, but I think the more you kind of read about it at the start, it’s quite overwhelming. I was reading it at the start thinking, I have no clue what any of them are talking about.

And I think maybe after about five, six months or so of just continuing to read and I then kind of then went to, there was a online conference. It was quite big, roundabout Christmas time. It was a karma dentistry. Biomimetic conference. I don’t know if you’ve heard of that. That’s been on a couple of years now. So that had about, it must have been about 15 or 16 speakers and learned so much from that. It kind of got to the point, I just-

[Jaz]
Just quickly, who’s your favorite speaker in Biomimetic dentistry?

[Taylor]
Who? Favorite speakers? I think-

[Jaz]
You had to pick one.

[Taylor]
I always enjoy listening to the duo of David and Davey Alleman.  They’re very, very, very entertaining. It was actually just in March this year, I actually got to meet them. It was a HandsOn course. That was-

[Jaz]
Of course, Tariq Bashir probably organized that, right?

[Taylor]
Yeah, that’s it.

[Jaz]
That’s right. The famous Scottish dentist. Yeah.

[Taylor]
That’s right. Yeah. So. Well, Tariq’s great. So, I think he’s done the Mastership program with David and Davey, so he obviously knows his stuff. And I think if someone like that’s, you know, following protocols like this, then you know, he’s sensible and you can tell he just really knows what he is talking about and I think, like you were saying as well, I don’t think it does. Even if you don’t agree with all of it, it doesn’t do any harm to have some of these concepts and approaches like in your toolkit really as well. So, I know that like, say yourself, you’re, you talk about bit like the verti preps and that sort of thing, and that wouldn’t be then saying that you don’t do things like that. It’s just another, you know, approach to how you can do things. So, it’s-

[Jaz]
I’m very much against like, dogmatic approaches. So, if anyone’s like two on one side, I think there are cases where I don’t think you can solve it. And I mean this, you know, with humility, I don’t think you can solve every single case with just one approach. So, I can show you some wear cases where like, you can’t stick anything on this. You need to do crowning; you need to do vertical preparations. You may need to use zirconia in certain cases to be able to fix it. Okay. On this 75-year-old man, for example, whereas other cases, Biomimetic dentistry all the way, I mean all the onlays that I do, I very much try and follow all that I’ve consumed so far when it comes to maximizing adhesive strength. So, I think there’s a beauty in learning from all the philosophies.

[Taylor]
Yeah. Completely agree with that as well. And yeah, I think sometimes people are quite quick when you’re talking about the Biomimetic type things, to think that, oh, that’s all that you then, then do. I know in my case, just now anyway, it, if anyone’s listened to it, it certainly isn’t. I sometimes feel like I’m going to work and I’m going to doing a completely different thing. So, I’m practice, I, I just. Like kind of heavily NHS type practice. So, to be fair, I’m spending most of my time going and doing extractions, dentures, that sort of stuff.

When I get the chance with composites, whether that be in every anterior composite or a posterior composite or the odd chance to get a little chance to do onlay, or that type of thing, I can then go into some of these concepts and use these things. But I would only do that if I’m absolutely sure that I’d definitely know what I’m doing because you do hear a lot with the very experienced Biomimetic dentist as well, who are really keen on it. They would rather have a traditional dentistry done very well to them than someone who’s maybe on the fence about the Biomimetic dentistry and doesn’t maybe completely know what they’re doing. So, I would think if maybe anyone’s listening and think they want to jump straight into it, I would really just, read up a lot about it. I think your best bets probably to find a mentor as well, which I’ll-

[Jaz]
Well, tell us because tell you, you’ve been through this journey. You found Tariq, obviously in Glasgow. You went to the course when Davey and David came along. So, if you are speaking, if you’ve got your microphone to young dentist all over the world and they wanted to take the next step to learning about Biomimetic industry, maybe one or two of the key lessons. Do they have to fly to the states? Do they have to buy a book? What’s the good first step?

[Taylor]
So, I would say, if I can be cheeky and pluck the website for a second as well-

[Jaz]
Do because I loved it.

[Taylor]
Yeah, I’ve started up the little website and the website is in, it’s called the hybridlayer.com. Also, on Instagram as well @thehybridlayer where the share cases and that sort of thing. And the website, the main kind of goal of that. I got to the stage where maybe after about a year or so of reading things, I felt like I would then see people asking things and that sort of thing, and it would get to the point where I thought, yeah, I can start. And I know the answers to some of these questions. I can see that people are pretty confused as I was at the start, and the kind of goal of the website was basically just to get some of that basic info down so that it could maybe even give people the chance to have a read data, it saves you read, scrolling through thousands of Instagram posts that aren’t in any order trying to figure out what’s happening.

And that can give you just a little kind of basic insight into what it is. The rough concepts, not necessarily read the website and then you’re a Biomimetic dentist, but it can give you an insight into saying, is this the sort of thing you’re may be interested? And if you are, there’s, I know I had the two-day hands-on course with David and David Allman. I would say even that sort of thing. I knew quite a bit. I don’t even know if the two days would be enough to then start doing it, but I know they also offer the kind of online mentorship programs as well.
So, I know there’s the Alum Center for Biomimetic Dentistry and some of the people they’ve trained, they’ve also got similar kind of centers throughout the world as well. So, a lot of it’s going to, looks like it’s been done online, which I think makes sense as well. So, I would definitely recommend if you are going to be kind of serious about it and trying to use it on a day-to-day basis, definitely try and find someone who knows –

[Jaz]
Well, so much of our dentistry nowadays, adhesive dentistry, so if anything, we can do to improve our adhesive dentistry. So, what I’m going to do actually Taylor is I’m going to ask you the last question, straight up. And then we’ll go to some of the other ones. Because on this note, from what you’ve learned so far in your journey so far with Biomimetic dentistry and a year down dental school and because some of the knowledge that you have from dental school is more fresh, you’ll remember some more of the dental learnings than I do certainly. So, I like that you have that recent background plus all the courses that done in Biomimetic dentistry and how passionate you are about it. Give us your top tips on improving bond strengths. So, this could be with either direct composite resin or bonding onlays. What are the key lessons that you can pass on in just a few months?

[Taylor]
Yeah, so I would say one of the main concepts that I didn’t come across at all, maybe I missed it, but in dental school was the fact that when you are forming that initial bond to the test. So, if I imagine you’ve got your caries free tooth, or if you’re using the partial caries removal, you’ve got your peripheral seal and everything, maybe come onto that with the caries dye and everything. But if you’ve got your tooth that you’re happy to then say, bond a direct composite on tooth, so, an MO that you’ve prepared and your you’re happy with when you do etch the dentine, prime the dentin and use your first layer of adhesive, I didn’t realize that, that a tease of it takes time to mature, basically. So, it takes time for that bond to form. And I’m not sure if that’s something that I just missed, but I feel like it’s a really quite important point because-

[Jaz]
Is that the decoupling time?

[Taylor]
Yeah, that’s right. So, it’s basically the concept where obviously there’s a different types of bonding system, so the total etched, self-fetch, that type of thing. So obviously important, first of all to understand what you’re using, but if we assume you know what you’re doing, you’ve etched appropriately, primed appropriately, and you’ve got your first layer of adhesive on there. Once you’ve got-

[Jaz]
Now, what if you’re using something like a universal, so you’ve etched the enamel and now using a self-adhesive universal, and then that’s got the prime and bond mixed into it. Can you still apply? Can you still apply this philosophy of decoupling time, or does it lend itself more to a separate primer and separate adhesive stage?

[Taylor]
So, I would say just based on whatever, I think if you’re using a universal bonding system, which I’d imagine a lot of people will be using, you’re naturally maybe not going to quite reach the, the absolute best bond strengths that you possibly can. But I would say that-

[Jaz]
I think we know; I think everyone who uses universal bonding agents, I think we know that. I think we know that. You know, from the papers in the past anyway, the OptiBond™ FL was so high and then everything else is always a bit lower. I don’t know, which is the king of adhesives. Now maybe could fill me in, in terms of what you’ve read, but yeah, certainly. I think when we use Universal, we know that for convenience we accept a little bit of a compromise, but we’re hoping that it’s not a massive compromise and still good enough to get a long-lasting restoration. But I think let’s go with that fourth generation or fifth generation.

So, we’re gonna do etch rinse and make it really tangible now. So, we’re gonna prime, and then sometimes we need a couple of coats of primer. That’s why I was taught, so you please tell me if- Get a nice shiny surface, get that dry, and then you’re gonna be using your adhesive. And then is that when you are waiting time? But just tell us more about how this decoupling works.

[Taylor]
Yeah. As soon as the adhesive goes on and you’ve cured it, you’re basically at that point, the hybrid layer is starting to mature. So, the hybrid layer obviously being that kind of interface between the hydroxy appetite, a little bit of the collagen and your resin monomer particles, but that bond, once you’ve cured that, that’s when the clock kind of start. So, you tend to think that a lot of the studies that they’ve done, if you were to just inject a big bit of composite right on top of that kind of bulk fill type technique, all of the shrinkage of the composite, if you do it straight away, the bond hasn’t fully formed at that point.

So, you tend to find all of that shrinkage and the flow of the composite has basically shrinking towards like the kind of greatest center of mass of the composite. And by doing that, because you’ve got that shrinkage, it basically then just pulls the adhesive layer off the tooth or weakens that bond as well. So, the concept is basically that after about a minute, you’ll have about 70% roughly of your total bond strength, whatever that total bond strength happens to be. And after about five minutes, you’ll roughly have about 80, 90%. So that’s kind of what you’re aiming to give it just a. little bit of time, but it’s not a case of- I think when I first heard that, I thought, okay, so it’s a case of you do your etch, prime, bond and then you’re just kinda sitting there waiting, not doing anything.

But there are things that you can do in that five minutes as well. The thing that they would usually suggest in a lot of the lessons and stuff would be to put just a little layer of what they call resin coating. So that would be basically your little kinda 0.5 millimeters probably of some flowable composite. And because it is such a low volume, you basically find that flow of the composite, it goes towards that hybrid layer. So, it’s kind of maintaining that bond strength. It’s not pulling it away, and that clock at that point is still ticking. So that’s increasing your bond strength there. You then tend to find as well that the rule is that from what they’ve read, that if you go more than about two millimeters in your first increment, in that five minutes, you’re a chance of losing about 50% of the bond strength in a lot of the studies. So, they recommend basically the simple rule of not getting any deeper than 1.5 millimeters within the first five minutes.

And at that point as well, you could easily be doing that first 1.5 millimeters, you could be building up your little proximal wall as well, which isn’t then connected to that composite, that’s forming the hybrid layer. So, it is not like you’re sitting there doing nothing. I think that’s a simple kind of thing to understand and something that you could easily kind of incorporate. And if you just kind of understand that that bond takes time to develop, I feel like it really changes the way. Look at things all lot the time when you’re doing composites and that sort of thing. And I think-

[Jaz]
Listen, Taylor, I’m just gonna go have a coffee for like five minutes and then that’s still decoupling. And I can justify that to my patient. So that’s the other way to do it. But no, I prefer your way, you made it really tangible there too, to add a little bit of flowable. That’s great. And then you could be curing that flowable? And that’s still, the clock is still ticking.

[Taylor]
Yeah, that’s right. You would cure your flowable, and as long as, so there’s shrinkage of the kind of polymerization shrinkage tends to be to do with like the volume of the layer and also the kind of modules of elasticity as well. So, because it’s such a low volume, you tend to find it’s, it doesn’t have that strength to kind of pull away from the first layer anyway, so, that’s why.

[Jaz]
So, you could be curing that flowable, you could doing the contact area, but on the matrix and then like you said, so you’re not connecting it to the body of the composite elsewhere, obviously. And then you can be just getting that. So yeah, I think fill in five minutes and I would like to encourage everyone to practice TAKING QUADRANT PHOTOGRAPHY PHOTOS. So, get your buccal mirror and make sure it’s nice and warm. Or if you’re using rubber dam, it’s not an issue because it’s not gonna warm up, it’s not gonna steam up. And then you can start taking some photos, improve your photography. That’s easily a minute that you can do there. So, I would encourage everyone through that. So that’s a top tip. So, great. You mentioned about the decoupling time. Give us one more top tip because this is such a big, huge topic. If anyone gains something from this episode, I want to remember, okay, I’ve improved my bond strength in some way. So give us one more tip.

[Taylor]: So, I think another one of the big main Biomimetic concepts, which I think you’ve heard of yourself as well from, I know you’re a Pascal Magne fan, aren’t you Jaz?

[Jaz]
Of course. Who isn’t?

[Taylor]
Yeah. So, the kind of immediate dentin sealing concept. So that’s basically the concept where you’ve got your freshly cut dentin and if we say, for example, this time we’re going for an indirect onlay type of restoration. I know from when I was at dental school, I would’ve thought just do the preparing. First of all, probably wouldn’t have thought to do an onlay, it would be a tune I was probably thinking of. But if I had thought onlay at dental school, it would probably be do the preparation, taking the impression that sort of stuff. And then at the time, just cementing it with your etch bond, resin cement, that sort of stuff. The concept of the immediate dentin sealing was basically with your freshly cut dentin. When you’re finished your prep, your then, just as we were saying, whichever system you’re using, the etch prime bond, obviously, your layer of adhesive and then again possibly that little resin coating over the top as well.

And by doing that, I don’t know if you’ve read some of the papers by Pascal Magne as well. He basically found that by doing the immediate dentin sealing, professionalizing that, and then cementing it the next visit because you’ve been allowing similar to what we’re sending in that first point because you’ve given it so you potentially, if you’re sending your love work away and it’s coming back in 10 days, two weeks, that’s potentially two weeks of decoupling with time that you’re doing. So, he’s finding you’re getting four times in times the bond strengths with using that kind of method. Things like that, though. There are still some areas that can kind of trip you up as well. So that’s what I’m gonna seem to be careful that you can’t just start thinking, right, okay, I’ll start doing this tomorrow. So, things like the, so because it’s such a thin layer that you’re using there, you’ve got the little oxygen inhibited layer as well. So, if you have this little thin layer of resin coat, there’s potentially say, I’m not sure exactly, but maybe 20, 30 microns at the top of that, that just isn’t polymerized. So that can also react a bit with the impression material. So, it would usually recommend a little bit of the kind of glycerine-

[Jaz]
With the temporary material like bisacryl?

[Taylor]
Yeah. So that, and also the actual, if you were using a kind of impression material to actually take impression, it can interfere with that as well. I think it’s more the kind of polyether type materials that can interact with it. So, you basically want to make sure that you are curing through a little layer of glycerine, similar to when you’re doing a composite and you cure that last layer through the Vaseline or that type of thing. And so, it’s definitely do that. And then also just making sure, I think some people do the immediate dentine sealing and maybe think you can just use your etch bond etch prime, and a little layer of the adhesive.

But you tend to find at times that layer of adhesive, you have to know the thickness of it as well because if it’s about as thick as the level of the oxygen inhibited layer could potentially be, you could potentially just have pretty much nothing there. So that little layer of the resin coating over the top, it provides, I think the concept is it kind of provides more of the free radicals for it to all polymerize and I’ll just make sure you have that good thickness and that’s, I think it’s definitely something to go away and read about and see if it’s something you can maybe incorporate in your practice as well.

[Jaz]
I encourage everyone to read about IDS, immediate dentin sealing, but as a practical dentist, I think there are some other advantages, ie if the temporary comes away, then there’s less sensitivity. Okay. That’s a real good advantage there. The other one is at the same time as doing my immediate dentin sealing, I’m blocking out any undercuts with my G-aenial™ Flo whatever. So, you know, if you just do it for those two reasons alone, and then now, if you get some added improved bond strengths, which we think we will, then it’s a great thing to do. I think it’s very- Some dentist, young dentists might get scared away from it because it sounds very complex. It really isn’t. It’s just your standard adhesive procedure, bit of a flowable resin coating on top. And then when you come to fit it, you have the whole air abrasion.

I would suggest everyone checks out the episode I did with David Gerdolle, the episode with the David Gerdolle, Extreme Bonding. David is a very well-known Biomimetic as well. And he talked all about the main things we can do to improve our bond strengths and, and yes, one was talking about how we can use those concepts. So that’s great. We’ve covered two top tips there for improving your bond strength. Number one was decoupling time, and number two was immediate dentine sealing. Let’s switch gears to caries detector dye, because the biometric community is the community online that I see using as part of their protocol, caries detection dyes the most. And then, Germàn influenced me to start using it, and I love it. I think it’s great. I love that objectivity that it gives. So if, no one’s ever used carrie’s detected dye before, can you just explain the steps in using it? And then B, how do you interpret that information? That tooth you’re looking at now that’s pink or green depending on which one you got. I got the pink one. And then based on what you see, how do you act upon it? So, it’s three levels of questions. Okay. So why should we use it? How do you interpret it? And then how do you act on it?

[Taylor]
Yeah, so I would say like you’re saying the caries detector, that it’s probably another one of those ones that is seen as a bit controversial maybe with people that don’t know exactly the method you could consider using it in. So, it’s definitely not just a case of you’re using this dye and it’s helping you see, you know, all the occlusal cases and you’re just drilling away all the red stuff. I would say, I would probably break it down a bit back to how you’re actually wanting to deal with your caries removal, Biomimetically, possibly. So, I would personally, I think the kind of caries removal concepts make sense to me. And the main things that I would usually associate that with would be forming that peripheral seal zone and getting your caries removal endpoint. If I was able just to say what both of those are. It’s the peripheral seal zone would be basically-

[Jaz]
Which is exactly what we are taught at Dental School. You know, get the ADJ super clean and it’s just an extension of that and really linking it back to your bond strengths because- But you know, we said there, teach me at dental school that, oh, because that’s where your seals are most important. But that’s where also we want to maximize our bond strengths as well, so it makes sense.

[Taylor]
Yep, definitely. And then your caries removal endpoint, similar to the concepts you would learn at dental school as well, but maybe just making it a little bit more tangible would be once you’re approaching the pulp, basically, and it’s something that you’re probably doing at dental school and without really realizing it, but you’re getting towards the pulp, you’re starting to get a bit cautious. Should I keep taking away anymore? So, the caries removal endpoint concept was basically, it was giving you like a tangible set of numbers to follow changes a little bit depending on tooth to tooth and the age of the patient and stuff. But it was generally looking usually about five millimeters vertically. So that would be from if you were coming from occlusally removing caries. Once you get five millimeters deep, roughly you would consider, even if there is still caries, you would be stopping there and horizontally coming from the marginal ridge of the adjacent tooth. So that’s kind of your little three-millimeter peripheral seal zone.

You’re basically then stopping there to avoid pulpal exposure. So, you’ve got your clean peripheral seal zone, and then you’re possibly a little bit of affected dentine, that type of thing with a little bit of caries life behind that, you’re willing to accept the slightly lower bond strengths and instead of basically exposing the pulp, and I think it’s at that point that the caries detector dye, I feel could be really useful. So, to use the caries detector dye, so, if I talk a bit about what it is first, so the benefits of it, I would see, it’s basically like, I think you mentioned as well, Jaz, it’s kind of given you an objective way of looking at caries removal rather than being subjective. And I heard-

[Jaz]
And that subjectivity has been studied and every dentist is different in terms of where they stop. So, I was attracted to it because, you always question, should I remove some more, should I not? And it surprised me enough for a couple times. You know, I use it many times. And I was like, okay, I’m doing good. I’m doing good. And then I got surprised. I was like, WHOA had I not used this, I would’ve missed it. And I like what Germàn said on a Facebook post recently. Like, yes, there are those people who argue that, yeah, well, you know, I just use my probe. And I can feel it with my probe, but are you gonna really be able to probe every square millimeter of your cavity? Probably not. And that’s got me thinking is like, yes, he’s right.

[Taylor]
That’s right. And then another thing with the probe as well that I’ve heard David Alleman as well talk about quite a lot in a lot of his lectures. He talks about, was from like a Japanese researcher that came up with it all. And I think he would be at his dental school clinic and talking to the students and a lot of the time they would be removing caries and he would tell them, you know, just keep removing it until it’s hard with your probe. And they would then ask him, well how hard, and that’s a good question as well, because like how hard is hard? So, I think caries detector dye, it’s a good way of, basically the way it works. Not sure if they know exactly how it works, but it extends denatured collagen, so it’s basically a solvent type of solution. It’s got some acid red, the carious dentin, so the likes of the affected and infected dentin.

The collagen fibers are a bit looser in their denature, so it’s able to penetrate a bit more. And by doing that, it then stains the kinda red or pink type color. So, I mean the studies that you read about it, they’re all pretty, I feel like they seem all pretty conclusive, to be honest, that it does seem to work.

And as long as you’re kind of accepting, there maybe are some limitations to it as well in that really deep dentin that you get really close to the pulp could potentially stain a little bit red, but at that point you’ve stopped your caries removal because of the end points anyway. So, it doesn’t really matter at that point. And I find from using it, A lot of the time if I think I’ve taken away the caries from that peripheral seal zone and I’ll put the caries detector dye on. And a lot of the time, like you’re saying, you do get a bit of a surprise at times and even if there’s little patches that you think you kind of look at and feel what the problem thinks. Oh yeah, fair enough. I’ve left that bit there, so and it is good then you can see the area over the pulp that you’re kind of leaving as well and you know, roughly depending on, I think you can kind of tell a little bit that the redness in terms of how red it is or how pink it is, roughly what you’ve got to work with in terms of your bond strengths and that type of thing as well.

[Jaz]
So, guys, everyone listening, all those watching, there’s an episode coming up with Germàn actually, we’re gonna talk all about with whole 45 minutes. All on caries, what you’ve done is you’ve given us a nice introduction. You got dentist thinking now maybe about it. So, we wet your appetite for the one with Germàn coming soon. I was actually gonna record with him straight after you, but we’ve had to reschedule that, but we will cover that in a good depth. So brilliant. We’ve covered some Biomimetic principles. We defined Biomimetic dentistry. We talk about caries detector die just now; you gave your top tips for improving bond strengths.

So as an introduction, as a final introduction, as a final part of this podcast, I see a lot about crack management and now this crack managing cracks is very polarized. Like a lot of things in dentistry, I guess. And many schools of thoughts will manage cracks in a different way. So, I’ve been taught before chase cracks. I’ve been taught for never chase cracks. And what I do hand on heart will vary in every single case, it’s different to me. If it’s a nasty crack I might chase, but, if it’s not so mad, I won’t chase it so much. So, can you introduce us to the Biomimetic philosophy or thinking or protocols when it comes to crack? And I imagine this, I dunno, crack removal endpoints. What names have you got for that?

[Taylor]
Yeah. So, I feel like the crack element of it, I think that’s one of the parts of it that’s probably especially tough for me without having the years of experience at things. Because I am kind of going purely just based on like, Theoretical lesson to what other people have to say and just kinda-

[Jaz]
And that’s fine. Share, because this is new for me. The Biomimetic approaches. Absolutely cool. Just share what you’ve picked up so far and maybe in five years we’ll record again and see what your thinking’s changed anyway but share what you’ve learned so far.

[Taylor]
Yeah, so what I’ve kind of learned so far would be, I’ve learned from David and David Allen, and they had quite a good way of assessing. So, cracks were kind of forming a part of. They were quite good at teaching us ways of kinda assessing the tooth for structural compromise. So, there were basically four red flags that they told us to watch out for. So, the first one was obviously cracks into dentin. The second one was any kind restoration, say an amalgam that’s got an isthmus width of greater than two millimeters. The reason-

[Jaz]
Which is most amalgam!

[Taylor]
Yeah, that’s right. I know most of them. Yeah. And the reason for that was basically, I think more studies by Pascal Magne and several other people that basically show that when you do have an amalgam like that and it’s got say an MOD cavity that’s more than two millimeters, instead of the usual, the tooth can flex about two or three microns. With even an amalgam in there, it’s flexing about 180 microns, which is, you know, a really big difference. So that’s one of the reasons why these big amalgam teeth, you know, do tend to crack as well. The third one was any cusps that are less than three millimeters in width, which quite common as well. And the fourth one was-

[Jaz]
Let’s make that one really tangible. Where do you measure that three millimeters from? Do you measure it at the top of the cusp or the base where the cusp then joins onto the floor?

[Taylor]
Yeah, so I’ve seen some different answers for that one as well. I would tend to; I’ve mostly seen from the bottom of the cusp, and you can use the like in a caliper. That’s the way I’ve tended to do it and I think that kind of makes the most sense because that’s shown you how much connection that cusp actually has.

[Jaz]
It’s the base, the main strength of that cusp comes from what’s below it. So, absolutely. That’s fine. Yeah. Yeah. I just thought I mentioned that so that, you know, people listening can think where do you know, how do you begin to measure it? So that’s fine. Please tell us more.

[Taylor]
Oh, that’s good. And then, the fourth, last one, there was any kind of box there, so an interproximal box that was less more than four millimeters. So that’s another reason that a tooth will be structurally compromised because like we were saying at the start, you’re then into that kind of bio area as well. So then if you go back to the first one, which was the cracks into dentine, if I even just talk a little bit about, you know, it was Davey Alleman at the course, it was kind of a, a little talk about cracks and that type of thing, and his concept was basically he’s, I think he’s spent a lot of time in, obviously David Alleman. A lot of time they’ve spent a lot kinda looking into the engineering aspect of it and seeing how engineers deal with cracks and other industries and things like that as well. And they’ve kind of come to the conclusion that if you are to just leave a crack as it is, then it has the chance that can always propagate no matter what you do. If you’re putting force in that tooth, if that crack can continue to propagate, it might take a while.

So, their concept is that similar to the caries removal endpoint, you’ve called it crack removal endpoint. So basically, that inside that peripheral seal zone. The likes of Davey Alleman, he would tend to try and chase that crack as much as he can. Basically being, wanting to try and avoid any pulp exposure or perforation or anything like that. But he’ll feel that if you can either remove that crack or at least remove a bit of it, then you’re kind of reducing the length of the crack. And by reducing the length of the crack, you’re kind of reducing the lever arm of it. By doing that, it then needs a lot more force for them for that crack to then propagate. So, he kinda sees that as the best way of doing it. It tends to be the only thing that I see with it as well, it’s kind of challenges it is that you’ve then got these areas that you’ve cracked really high, like C factor situations to try and then restore back and you’re kind of wonder if is that any better? What you’ve gonna made there? So, I’m kind of above the main that, I’ve personally not really decided. I’m probably like yourself. I’m so, so-

[Jaz]
I still don’t know. Look, I’ve been in nine years. I still don’t know what is the best way, and I think it will vary in every single scenario. I just hate cracks, man. I had like, I think episode 0.7 wasn’t my title. I just hate cracks with a passion. No one likes cracks. And there’s so many different opinions I mean, one of my friends, colleagues, Pasquale Venuti, which I know he’s like the anti-Biomimetic dentist, and that’s cool. It’s okay. And he’s very much like, don’t chase cracks, because if you’re chasing cracks, you never know where the endpoint really is. You can’t see the endpoint.

But you mentioned briefly in case anyone missed it, is that actually, if you’re removing, you know, some of the crack, you are improving the mechanics of the situation. So at least we have the four themes that you touched on when it comes to crack considerations. So, if you have a crack and it fulfills all the other four factors, so, and you think the crack is into dentin and it is got a isthmus large in two millimeters and more than four millimeters, was the four millimeters in terms of the depth of the restoration?

[Taylor]
Yeah, just the depth in general-

[Jaz]
Occlusal gingiva?

[Taylor]
Of the restoration. Otherwise just from the marginal ridge to the deepest point. And then you’re into the Biomimetic at that point. So, they tend to say then if you are kind of beyond that, trying to bond, you know, a tough bit of ceramic into that really deep box, it creates a lot of stress in that area. So that’s when you’d maybe be considering the likes of the. The deep margin elevation with a material like composite which might have a wee bit more flex in it as well, which is another benefit of that sort of technique as well.

[Jaz]
Brilliant. I think we’ve covered a lot of breadth and I think we, you know, if wherever you are listening and watching this give Taylor around applause because it’s not easy to talk about these kinds of concepts. And I’m so happy to see what you’re doing with how proactive you’ve been, how you’ve been open to the universe in terms of a learner and a sharer. I think good things happen to those who share. Please continue to share your journey. I love it. It’s wonderful, Taylor. So, thanks for making time to share your learning with all the Protruserati, and I hope you guys gained a few lessons. If anything, it may have wet your appetite to learn some more, which is a beautiful thing and maybe you disagree with some of the concepts. That’s okay as well. I can always say, guys, it’s okay to disagree with your management of cracks, which may be different in a Biomimetic way. It’s completely cool as long as you have your own philosophy. If you have a philosophy rather than winging it the whole time, which it kind of sounded like I did with cracks. I promise you; I do have a bit more philosophy to it. But yeah, no, thanks so much. Any last words, Taylor?

[Taylor]
No, just thanks very much again, Jaz and yeah, today, I mean, you’ve covered it enough, but I’m very, very early doors in my career. I’m just kind of exploring all of these concepts, not necessarily then taking all of it into work. So, if anyone’s kind of listening, thinking, what is he doing at this stage to do all that sort of stuff, then I feel like I’m doing it kind of safely. And you know, I think I’m being sensible about it. And if anyone’s getting any kind of questions or wants to ask anything about anything at all, then feel free. I’m more than happy to talk to anyone. If there’s anything you think would help at all, then feel free to get in touch.

[Jaz]
Reach out to Taylor, guys @thehybridlayer. Again, I always, always encourage young dentists who are keen to learn, who are proactive and who go on courses like you have and you’re doing things that ultimately is gonna improve your dentistry, improve your outcome. And you are on the journey, right? Every master was once a disaster. Right. So, we’ve gotta be on our journey and the reason I got you on, it’s because you’ve spent time to think you’ve really, you know, read the books. You’ve been on some courses, you still early, you still need to drill some more teeth. You still need to remove some more cracks. But I feel as though your journey is valid and you are learning, and your sharing is valid. So, keep going. Don’t think that, ah, you know, I can’t talk about this because I’m not experienced enough. Sharing is absolutely a good thing to do. So, keep it up, my friend.

[Taylor]
Sounds great. Thanks very much, Jaz. Thanks very much.

Jaz’s Outro:
Thank you so much. There we have it guys, thank you so much for listening all the way to the end. Hopefully now we’re a little bit more clued up about Biomimetic DENTISTRY. Do check out Taylor’s website. I’m gonna put everything in the show notes for you, and if you’ve listened this far, you might as well claim CPD, like it’s just four or five questions away from getting a simple certificate that you can use for your end of year quota but also to validate your learning and its of space. For those of you who like to reflect and like to make notes. You can do that. Of course. Speaking of notes, all those premium notes that you see on this side. Or if you don’t see if you’re listening, you can download them as a pdf. So, every episode within about 48 hours we publish on the app. That’s a Protrusive app on Android or iOS. Do download it, do get stuck in, join the community, and gain CPD, but also watch the exclusive monthly content that Protrusive Dental Pearl at the beginning of masking a post that was actually taken from December’s premium content of actually showing you how I fit three emax Crowns and an emax veneer under Rubber dam. A full clinical walkthrough as you’ve seen perhaps on some videos on YouTube. So, if you like that kind of stuff, do check out the Protrusive app just for you, the Protruserati. Thank you so much and I’ll catch you next week.