Six Lessons Approach Podcast by Dr. David Alleman

A long-lasting dental restoration comes down to molecules. Dr. David Alleman breaks down the research timeline of developing adhesives that can bond to dentin, and you don’t have to share his love of chemistry to appreciate how impactful that is to the field of dentistry.

These adhesives were available to dentists as early as 1951, but just using an adhesive containing a proven molecule does not guarantee success in a dental restora...

C-factor is more than the ratio of bonded to unbonded surfaces. Understanding C-factor, or Configuration Factor, is essential to understanding how composites behave in a tooth, but this topic was still being researched as manufacturers were trying to bond to dentin. Eventually, c-factor and its role in composite bonding showed the potential for a strong bond to dentin, but overcoming the c-factor stresses was the key element  that ...

We are able to visualize how molecules move during polymerization thanks to the work of Carel L Davidson in the 1980s. Being able to visualize and then measure this movement, also known as flow, helps create more predictable bonds when working with different substrates in enamel, but Dr. David Alleman took years to systematize this concept into his practice as he was developing his concept of Decoupling with Time.

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Early adhesive dentistry showed promise, but as Dr. David Alleman began implementing these new techniques into his practice, the success wasn’t immediate. Struggling with continued failures and wading through the sea of new bonding systems that were becoming available year after year,  he sought to eliminate the guesswork and go to the source of what was causing unpredictable restorations: the science.

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The tops of teeth don’t matter… as much as the bottoms. The key to any biomimetic restoration is the direct component, which is why I describe biomimetic dentistry as a bottom to top approach. When I first learned of Simone Deliperi’s work and we began working and then teaching together, we both understood how this direct component needed to be carefully managed for a successful restoration. Deliperi’s Stress Reduced Direct Composi...

Why aren’t all dentists performing deep margin elevations with composite? It might be because you’re listening to old research. “Violating the biologic width” was disproven in 2014. Gingival tissue doesn't have an adverse reaction to the material, it has an adverse reaction to the biofilm under a retention crown or poorly bonded restoration. If you have experienced failures with glass ionomers, use composite instead. In 2019, ...

In 1995 Dr. David Alleman wanted to quit dentistry. Frustrated with failing restorations and post-operative sensitivity, he couldn’t see how his work was helping his patients. A long-time friend and colleague encouraged him to take a course by Ray Bertolotti to learn about a new type of dentistry: adhesive dentistry. It was then that Dr. Alleman first thought, “maybe this type of dentistry could make me a happy dentist.”

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In 2000, Graem Milicich and Tim Rainey published an article outlining how traditionally treated teeth were at greater risk to infections from cracks due to the increased stresses on the tooth. This includes peripheral rim fractures, which occur when restored teeth are not connected side to side like with amalgam or poorly bonded composite. These small cracks around the edge of the restoration lead to occlusal effect caries and incr...

Throughout dental school and into his early career, Dr. David Alleman had a tooth with an occlusal amalgam that experienced intermittent pain on biting. The tooth was examined, but no cause for the symptom was found. Years later, after thoroughly studying adhesive dentistry, Dr. Alleman understood that there must be a crack in the tooth. Having recently acquired an intraoral camera in his office, he could now visualize the crack an...

Immediate dentin sealing is a commonly known technique even outside of advanced adhesive and biomimetic restorative dentistry. Originally developed in the 1990’s to solve the issue of temporization contamination, its uses once refined were immense when applied to dentin adhesion. Yet for doctors currenting using immediate dentin sealing as part of their restoration protocols, there may be more benefits left untapped when not used a...

Resin coating should always be included in the conversation with immediate dentin sealing, but it isn’t. Immediate dentin sealing can increase bond strengths by 400%, but resin coating functions at the opposite end of the adhesive equation by reducing polymerization stress to the hybrid layer.

Dr. Alleman discusses materials used in resin coating — flowable composites — their history, uses and how to use them effectively when establ...

Where do failures happen in dentistry? At the micron level. Bacteria create infections; micromovements initiate cracks; these are the root of failed restorations, infected pulps, and cracked teeth. Experiencing his own failures from traditional and early adhesive restorations, Dr. David Alleman discusses how thinking small led to significant advancements in restorative outcomes.

Articles referenced in this episode:

• Intro-3 Magne ...

Cracks are the third most common dental pathology dentists treat, but treating them in a predictable way requires an understanding of principles from engineering, histology and immunology. How do cracks in teeth form? Why do cracks in teeth cause infection? How can we treat cracks predictably and prevent root canal therapy? In this episode Dr. David Alleman discusses his research process for crack treatment and the results he has s...

Each lesson in the Six Lessons Approach to Biomimetic Dentistry (SLA) is essential to restoring a tooth in a way that stays bonded and symptom-free. These two failings of traditional techniques — debonded restoration and post-operative sensitivity — are addressed in each lesson, but when it came to the bonding stage of the restoration, Dr. David Alleman was able to reach a pivotal conclusion from the published research.

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Caries removal can be reproducible — this means consistent regardless of patient or practitioner. Caries detecting dye is essential to creating reproducible caries removal endpoints, but the techniques doctors pair with the dye are what prevent pulp exposure and maximize bond strength.

When Dr. David Alleman pioneered his methods for determining caries removal endpoints, he found that any doctor he trained could achieve the same pre...

Early diagnosis and treatment of dental pathologies allows for more conservative treatments while saving patients time and money. When developing the Six Lessons Approach to Biomimetic Dentistry, Dr. David Alleman created a risk assessment for determining if teeth were at risk of caries or cracks based on pathologies and treatment history.

Drawing on research from how teeth experience pain, the pulp’s immune response and how dental ...

Dr. David Alleman’s landmark paper written with Dr. Pascal Magne in 2012 gave practitioners predictable steps for deep caries, and now crack, treatment without exposing the pulp. But why is preventing pulp exposures so important? Dr. Alleman discusses research about the outcomes of pulp exposures and their effect on the tooth long-term in addition to proven treatment for teeth that have had exposed pulps.

Adhesive dentistry offers t...

Air abrasion functions as a conditioning step when bonding, which means it prepares the dentin or composite molecules for bonding. Dr. David Alleman discusses the progression of bonding systems for dentin adhesion and how this conditioning step evolved along with the bonding system molecules. The latest studies from researchers independent from the bonding system manufacturers show that air abrasion increases bond strengths to a le...

What is the best material for enamel replacement? It depends! When selecting the material of an onlay or overlay, understanding how a natural tooth functions during occlusion is essential if your goal is biomimetic dentistry. Harder is not better, but rather mimicking a natural tooth’s bond to itself and its modulus of elasticity will aid in selecting your enamel replacement material.

In this episode, Dr. David Alleman reviews ceram...