Six Lessons Approach Podcast by Dr. David Alleman

Dr. David Alleman is known today as an innovator in the dental field, but it didn't start that way. Dr. Alleman recalls his early interest in science, his journey as a dental student, experiences in his early career and how all of this led to him wanting to leave dentistry.Frustrated with sensitivity and failing restorations, he expectation that fillings would one day need crowns and then root canal therapy the next made his work feel worthless. He wondered: is this the best a dentist could do for their patients? In 1998 Dr. Alleman learned about advancements in adhesive dentistry, which offered the opportunity for improved results, but some of his mentors' teaching left him with more questions than answers. So he took the research into his own hands.Dr. Alleman's literature review opened his eyes to techniques that would later be called biomimetic restorative dentistry, but at the time he was just looking for a better way to fix teeth. He sought solutions to post-operative sensitivity, failing and debonding restorations and cracked teeth. As Dr. Alleman incorporated the research into his work, the results were impressive. This research is the basis for his Six Lessons Approach to Biomimetic Restorative Dentistry, a system now used by doctors around the world.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 restoration. Understanding materials and how they interact with a natural tooth are part of Lessons 3 and 4 in Dr. David Alleman's Six Lessons Approach to Biomimetic Restorative Dentistry. These lessons turn discussions about molecules' interaction with dentin into actionable steps for practitioners.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 Dr. David Alleman studied in his search for predictable adhesive dentistry.Articles referenced in this episode:Cho BH. Effect of interfacial bond quality on the direction of polymerization shrinkage flow in resin composite restorations. Oper. Dent. 2002;27:297-304.Alleman DS. The protocols of biomimetic restorative dentistry: 2002 to 2017. Inside Dent. 2017;June 64-73.Nakajima M. Bonding to caries-affected dentin using self-etching primers. Am. J. Dent. 1999;12(6)309-314Nikaido T. Evaluation of thermal cycling and mechanical loading on bond strength of self-etching primer system to dentin. Dent. Mater. 2002;18 269-275.Fusayama  T. Clinical guide for removing caries using a caries-detecting solution. Quintessence Int. 1988;19(6)397-401.Deliperi S. An alternative method to reduce polymerization shrinkage in direct posterior composite restorations. J. Am. Dent. Assoc. 2002;133 1387-1398.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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.Articles referenced in this episode:Alleman DS. Decoupling with time. A solution to the problem of the hierarchy of bondability. Inside Dent. 2021;August: 35-41Fusayama T. A Simple Pain-Free Adhesive Restorative System by Minimal Reduction and Total Etching. 2nd Edition. Ishiyaku EuroAmerica, Inc.; 1993Davidson CL, de Gee AJ. Relaxation of polymerization contraction stresses by flow in dental composites. J Dent Res. 1984: 146-148Davidson CL, de Gee AJ, Feilzer A. The competition between the composite-dentin bond strength and the polymerization contraction stress. J Dent Res. 1984;63(12): 1396-1399Feilzer A, de Gee AJ, Davidson CL. Setting stress in composite resin in relation to configuration of the restoration. J Dent Res. 1987;66(11): 1636-1639Kemp-Sholte CM, Davidson, CL. Complete marginal seal of Class V resin composite restorations effected by increased flexibility. J Dent Res. 1990 Jun;69(6):1240-3.Lu H, Stansbury JW, Bowman CN. Towards the elucidation of shrinkage stress development and relaxation in dental composites. Dent. Mater. 2004;20: 979-986Nikolaenko SA, Et al. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent. Mater. 2004;20-579-585Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 Composite technique, which we co-authored a publication on in 2009, is a necessary tool for any dentist who aims for conservative dentistry.Article referenced in this episode:Deliperi S, Alleman D. Stress-reducing protocol for direct composite restorations in minimally invasive cavity preparations. Pract Proced Aesthet Dent. 2009;21(2):E1-E6.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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, 12-year clinical evaluations showed the success of composite, a material that better mimics a natural tooth compared to brittle glass ionomers. Understanding how to perform deep margin elevations is an essential tool for dentists wanting to save more teeth.Article referenced in this episode:Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodont Aesthet Dent 1998;10(1):47-5,Dietschi D, Et al. In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect class II composite restorations with different resinous bases. Ea J Oral Sci. 2003(111):73-80Magne P, Spreafico R. Deep margin elevation: a paradigm shift. Am J Esth Dent. 2012(2)86-96.2014 proximal box elevation with resin composite and the dogma of biological width clinical r2-techinique and critical reviewBresser RA, Et al. Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region. J Dent. 2019.Dietschi, Spreafico. Adhesive Metal-Free Restorations. Quintessence Books; 1997.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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.”Books referenced in this episode:Nobuo Nakabayashi, David H. Pashley. Hybridization of Dental Hard Tissues. Quintessence Publishing Company; 1998.Dietschi, Spreafico. Adhesive Metal-Free Restorations. Quintessence Books; 1997.Hubert E. Schroeder. Oral Structural Biology. G. Thieme Verlag; 1991.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 increased risk of larger cracks in the tooth.When Dr. Alleman began learning more about structural compromise, he purchased a microscope for his office and was then able to visualize cracks in dentin. He saw how these cracks were symptomatic, but the dental school recommendation of a full-coverage crown wasn't enough to stabilize them. Dr. Alleman began removing the cracks and seeing symptoms resolve. This was confirmed by a paper he discovered later by Abbott and Leow, two Australian endodontists who studied symptoms after crack removal and found superior results to previous recommendations of full coverage crowns or attempting to bond over the cracks. When the cracks were removed the symptoms went away.Articles referenced in this episode:Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5.Walker et al. Enamel cracks the role of enamel lamella in caries initiation. Australian Dent J. 1998;43(2) 110-116.Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 and, with the help of his assistants, dissect the crack and restore the tooth himself. The symptoms resolved and the tooth is still healthy and functioning to this day.A few years after restoring the first tooth, the tooth directly above it chipped. Dr. Alleman assumed the chip was only in the enamel because the tooth was asymptomatic, so he thought further treatment could wait. But in 2011, to his regret, the tooth fractured through the root and had to be extracted. This unfortunate incident taught Dr. Alleman a valuable lesson about the urgency and importance of timely and accurate crack diagnosis, which he now teaches to his colleagues and students.Both teeth had vertical cracks. One tooth was saved with proper diagnosis and treatment, but the other was not. This happens to patients every day, but understanding how cracks in teeth propagate and how cracks are treated outside the field of dentistry [engineering] can significantly contribute to saving more teeth. This knowledge empowers us as dental professionals and students, motivating us to learn more and improve our practices.Articles discussed in this episode:Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 as part of a larger system of protocols that aim to mimic the natural function of a tooth: the Six Lessons Approach to Biomimetic Restorative Dentistry.Dr. Alleman discusses the history of immediate dentin sealing, its early pioneers and how doctors can use this technique in their own practice to save pulps and maximize adhesion.Publications discussed in this episode:Paul SJ, Schärer P. The dual bonding technique: a modified method to improve adhesive luting procedures. Int J Periodontics Restorative Dent. 1997 Dec;17(6):536-45.Van Meerbeek, B. (1993). Dentine adhesion: morphological, physico-checmial and clinical aspects [Catholic University of Leuven]Fusayama T. A Simple Pain-Free Adhesive Restorative System by Minimal Reduction and Total Etching. 2nd Edition. Ishiyaku EuroAmerica, Inc.; 1993Kashiwada T, Takagi M. New restoration and direct pulp capping systems using adhesive composite resin. Bull Tokyo Med Dent Univ. 1991 Dec;38(4):45-52.Sato M, Eta al. How to use "Liner Bond System" as a dentin and pulp protector in indirect restorations. Japan Society for Adhesive Dentistry. 1994:41-48.Bertschinger C, Paul S, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength 1996Akimoto N, Takamizu M, Momoi Y. 10-year clinical evaluation of a self-etching adhesive system. Oper Dent. 2007 Jan-Feb;32(1):3-10. doi: 10.2341/06-46.Magne P, Kim TH, Cascione D, Donovan T. Immediate dentin sealing improves bond strength of indirect restorations. J Prosthet Dent. 2005 Dec;94(6):511-9.Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. 2000 Jun;13(3):129-35.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 establishing your hybrid layer. Once again, it all comes back to decoupling with time.Articles discussed in this episode:Van Meerbeek, B. (1993). Dentine adhesion: morphological, physico-checmial and clinical aspects [Catholic University of Leuven]Kemp-Sholte CM, Davidson, CL. Complete marginal seal of Class V resin composite restorations effected by increased flexibility. J Dent Res. 1990 Jun;69(6):1240-3.Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457Unterbrink GL, Liebenberg WH. Flowable resin composites as “filled adhesives” literature review and clinical recommendations. Quintessence Int. 1999; 249-257.Alleman DS, Et al. Decoupling with time. A solution to the problem of the hierarchy of bondability. Inside Dent. 2021;August: 35-41Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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  P,  Belser  U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433Magne P, Oganesyan T. CT scan based finite-element analysis of premolar cuspal deflection following operative procedures. J Periodontics Restorative Dent. Volume 29, Number 4, 2009:360-369.Send us a Text Message.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 seen in his practice for over 20 years.Send us a Text Message.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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.Different parts of the tooth form hybrid layers at different rates based on the amount of hydroxyapatite. Composite will shrink to the best possible bonding surface, potentially leaving gaps in areas that have weaker bond potential. Understanding how to overcome these two variables is key to creating a restoration that bonds the tooth side to side, front to back and top to bottom like a natural tooth. This biomimetic bond eliminates gaps under restorations that cause post-operative sensitivity, but it requires understanding how bonding systems, composite and dentin need to work together within the first five minutes of the polymerization process. Dr. David Alleman named this process decoupling with time.Articles referenced in this episode:Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457Send us a Text Message.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 predictable caries treatment that he saw in his own cases. How caries is treated is the first step in a restoration and determines whether that restoration succeeds or whether that restoration fails.Article referenced in this episode:Anderson M, Charbeneau G. A comparison of digital and optical criteria for detecting carious dentin. J Prosth Dent. 1985;53(5): 643-646.Send us a Text Message.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 histology affects restoration, the risk assessment has been proven to be an effective tool over the last 20 years, especially where x-rays do not identify a cause of symptoms. Now that we understand how gaps and cracks cause pain and sensitivity, identifying them early is the next step for more conservative treatment.Article referenced in this episode:Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10):453-457Galler K., Et al. Inflammatory response mechanisms of the dentine–pulp complex and the periapical tissues. Int J Mol Sci. 2021 Feb; 22(3):1480Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5. Send us a Text Message.Registration for the September Biomimetic Mastership is now open at allemancenter.com/mastership.Learn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 histology affects restoration, the risk assessment has been proven to be an effective tool over the last 20 years, especially where x-rays do not identify a cause of symptoms. Now that we understand how gaps and cracks cause pain and sensitivity, identifying them early is the next step for more conservative treatment.Article referenced in this episode:Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10):453-457Galler K., Et al. Inflammatory response mechanisms of the dentine–pulp complex and the periapical tissues. Int J Mol Sci. 2021 Feb; 22(3):1480Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5. Send us a Text Message.Upcoming programs:September 16: Biomimetic MastershipOctober 11-12: In-Person WorkshopLearn more at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 these teeth a second chance, but only when the seal is bonded at the nanometer level, like with biomimetic dentistry. Just like each step in the Six Lessons Approach to Biomimetic Dentistry, the protocols for treating pulp exposures offer predictable results and protect the tooth's long-term vitality.Article referenced in this episode:Thompson T., Et al. Treatment of deep carious lesions by complete excavation or partial removal. JADA. 2008;139:705-712.Hafez A., Et al. An in vivo evaluation of hemorrhage control using sodium hypochlorite and direct capping with a one- or two-component adhesive system in exposed nonhuman primate pulps. Quintessence Int. 2002 Apr;33(4):261-72. Send us a Text Message.Upcoming programs:September 16: Biomimetic MastershipOctober 11-12: In-Person WorkshopLearn more at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 level that mimics the strength at which a natural tooth is connected to itself (30-50 MPa). This conditioning technique is what brings dentin bond strengths into the biomimetic range, maximizing bond strength and the longevity of the restoration.Articles referenced in this episode:Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. 2000 Jun;13(3):129-35.Send us a textUpcoming programs:September 16: Biomimetic MastershipOctober 11-12: In-Person WorkshopLearn more at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

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 ceramic, composite and gold and outlines best practices for completing the final steps of a biomimetic restoration.Articles referenced in this episode:Wendt, S. L. (1988). A laboratory and clinical evaluation of a heat-cured composite resin inlay. [Master's Thesis, University of Alabama].Send us a textUpcoming programs:September 16: Biomimetic MastershipOctober 11-12: In-Person WorkshopLearn more at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Biomimetic dentistry aims to mimic a natural tooth throughout the restorative process. The last four decades of research has shown that mimicking and conserving a tooth's natural connection to itself, its natural bond and resilience to occlusal forces and its natural defense mechanisms for infection benefits the tooth's long-term health. This is also true for occlusion.In this episode, Dr. David Alleman discusses what all dentists can learn from a body's natural occlusion, lost research from the last few decades and approaches for daily occlusal techniques that can be applied to cases doctors regularly see in their office.Articles referenced in this episode:Michael C. Alpern. The Ortho Evolution: The Science and Principles Behind Fixed/Functional/Splint Orthodontics. editor GAC International, Inc; 2003.Send us a textLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Daily dentistry, the cases you see every day, usually involves minor occlusal adjustments that can be treated quickly and predictably using the Six Lessons Approach, but biomimetic techniques can benefit more advanced occlusal cases too. In this episode, Dr. David Alleman discusses the cause of abfractions, how complex temporaries are a thing of the past and options for doctors seeking more advanced occlusal training beyond everyday cases.Articles referenced in this episode:Magne P,  Belser  U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433Pintado M, Et al. Variation in tooth wear in young adults over a two-year period. J Prosth Dent. 1997(77)3. 313-320.Send us a textLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Dr. David Alleman first created his Six Lessons Approach for vital teeth, but the same conservative principles can benefit endodontically treated teeth too. Compared to traditional techniques for retention and bonding, the advanced adhesive and stress-reducing techniques of biomimetic dentistry are better suited for treating non-vital teeth, which are more brittle and susceptible to cracking than fully hydrated teeth with healthy pulps. This episode outlines how biomimetic techniques approach endodontically treated teeth differently and the research that supports these protocols.Articles referenced in this episode:Kishen A., Vedantam S. Hydromechanics in dentine: Role of dentinal tubules and hydrostatic pressure on mechanical stress-strain distribution. Dent Materials. 2003;23: 1296-1306Magne  P,  Belser  U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433Jayasooriya  PR,  Pereira  PNR,  Nikaido  T,  Tagami  J. Efficacy of a Resin Coating on Bond Strengths of Resin Cement to Dentin. J Esthet Restor Dent 2003 15(2)105-113Fennis  WMM,  Kuijs  RH,  Kreulen  CM,  Verdonschot  N,  Creugers  NHJ. Fatigue Resistance of Teeth Restored with Cuspal-Coverage Composite Restorations. Int J Prosthodont 2004 17(3)-313-317Send us a textLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

The wallpapering technique is a key protocol for extending the function of endodontically treated teeth. More brittle due to their reduced hydration, non-vital teeth are more prone to fracture, so using fiber in this way creates a fail-safe that prevents failure beneath the coronal portion of the tooth and reinfection of the root.Dr. David Alleman discusses how he helped pioneer this technique and other advancements in adhesive dentistry for cases with non-vital teeth in his Six Lessons Approach to Biomimetic Restorative Dentistry.Articles referenced in this episode:Deliperi S, Alleman D, Rudo D. Stress reduced direct composites for the restoration of structurally compromised teeth: fiber design according to the wallpapering technique. Oper Dent. 2017, 42-3 (233-243)Belli  S,  Donmez  N, Eskitascioglu  G. The Effect of C-factor and Flowable Resin or Fiber Use at the Interface on Microtensile Bond Strength to Dentin. J Adhes Dent 2006_8-247-253Belli S., Et al. The effect of fiber placement or flowable resin lining on microleakage in class II adhesive restorations. J. Adhes. Dent. 2007; 9: 175-181.Fennis  WMM,  Kuijs  RH,  Kreulen  CM,  Verdonschot  N,  Creugers  NHJ. Fatigue Resistance of Teeth Restored with Cuspal-Coverage Composite Restorations. Int J Prosthodont 2004 17(3)313-317Erkut S. Highlighted Microleakage in Overflared Canals with different fiber reinforced dowels. Oper Dent 2008 33(1)92-101.Send us a textLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Biomimetic restorative dentistry has been taught and practiced for over 20 years, with its roots linked to minimally invasive dentistry that started decades earlier. Minimally invasive dentistry sought to conserve tooth structure and restore only parts of the tooth affected by pathologies. With the invention of adhesive materials, adhesive dentistry showed promise in advancing minimally invasive principles with new materials that no longer required retention, but the adhesive restorations still fell short. Teeth are more complex than many other materials that are adhesively connected, so simply bonding the restoration to the tooth did not yield long-term success.In this episode Dr. David Alleman discusses how minimally invasive dentistry paved the way for the more conservative approaches we use today, how biomimetic dentistry made adhesives more predictable, allowing for longer-lasting bonds, and where cosmetic dentistry fits in to the adhesive dentistry spectrum.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Adhesive dentistry has been taught in dental schools for decades and is widely used by dentists today. Bonding to a tooth offers increased adaptability of restorations, allowing for more minimally invasive treatment and preparation, but long-term success with adhesive dentistry is not a guarantee.Dr. David Alleman repeatedly saw failing composite restorations and realized that in order to improve restorative outcomes, posterior teeth needed more advanced protocols than anterior teeth. Subjected to higher forces of occlusion and with deeper restored defects, understanding polymerization dynamics is essential to a long-lasting adhesive posterior restoration. His research of these principles served as the basis for him developing his Six Lessons Approach to Biomimetic Restorative Dentistry.Article referenced in this episodeGibbs CH,  Mahan  PE,  Mauderli  A,  Lundeen  HC,  Walsh  EK. Limits of human bite strength. J Prosthet Dent 1986;56-226-229Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5. Nikaido T. Evaluation of thermal cycling and mechanical loading on bond strength of self-etching primer system to dentin. Dent. Mater. 2002;18 269-275.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Does biomimetic dentistry mean to mimic how teeth look? It can, but there is more to it than that. Dr. David Alleman discusses the evolution of cosmetic dentistry and its intersection with minimally invasive dentistry, adhesive dentistry and biomimetic dentistry. During his own research and teaching of biomimetic dentistry, Dr. Alleman met and taught a number of cosmetic dentists, including Joe Willardson, a longtime colleague, teaching partner and friend whose life and work is remembered after news of his passing in January 2025. Our thoughts and sympathies are with his family and friends.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Biomimetic dentistry can be defined by three main principles: preserve pulp vitality, conserve critical tooth structure and fully connect the tooth at 30 MPa or more. Mimicking nature (biomimetic) is about scientific analysis of how natural teeth function and replicating those principles during the restorative process. This isn't art; this is science. In this episode Dr. David Alleman discusses the research behind understanding how a natural tooth functions and how practitioners can replicate that to improve clinical outcomes with biomimetic restorative dentistry.Article referenced in this episodeWang RZ, Weiner S. Stain-structure relations in human teeth using Moire fringes. J of Biomechanics. 1998;31:135-141.Alleman D, Magne P, A systematic approach to deep caries removal endpoints PSZ. Quintessence Intl. 2012;43(3):197-208.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Evidence-based dentistry aims to bring current dental research into daily practice, but the process of adopting new findings and translating them into protocols is a complicated and time-consuming process. Dr. David Alleman discusses how dentists should approach literature and what to keep in mind when considering adopting findings into their own practice. From his own experience of wading through the sea of dental research, Dr. David Alleman created the Biomimetic Mastership, a comprehensive program that trains doctors in evidence-based dentistry while teaching them how to study and understand dental literature for themselves. Most practitioners do not have time to devote the thousands of hours he spent during his literature review of advanced adhesive principles, so the Biomimetic Mastership distills this science and puts it in the hands of practitioners.Article referenced in this episodeY Shono, T Ogawa, M Terashita, R M Carvalho, E L Pashley, D H Pashley. Regional measurement of resin-dentin bonding as an array. J Dent Res. 1999 Feb;78(2):699-705.M  Nakajima, K Hosaka, M Yamauti, R Foxton, J Tagami. Bonding durability of a self-etching primer system to normal and caries-affected dentin under hydrostatic pulpal pressure in vitro. Am J Dent. 2006 Jun;19(3):147-50.R Kishikawa,, A Koiwa, H Chikawa, E Cho, N Inai, J Tagami. Effect of cavity form on adhesion to cavity floor. Am J Dent. 2005 Dec;18(6):311-4.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

How does peer-reviewed literature make it into the hands of practicing dentists? Sometimes it doesn't. Other times research can be misinterpreted and applied incorrectly. The process of analyzing and applying current research is time consuming for practitioners to the point where new dental findings often fail to be widely adopted in practice.Reminiscing on his first meetings with researchers John Purk and Jack Ferracane, Dr. David Alleman discusses how synthesizing research into practical protocols requires a deep understanding of how research is conducted and a treatment-focused view of how different protocols interact with others. Without this perspective, research may be applied incorrectly, but with productive conversations and large-scale clinical examples, his Six Lessons Approach protocols show how using current literature to benefit patient outcomes is possible.Send us a textNew 2025 training programs announced:Biomimetic Mastership - class starts February 10. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:April 25-26August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingLearn more about Dr. Alleman's work at training programs at allemancenter.com.Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Popular during the early years of adhesive dentistry, chemical-cure dentin bonding systems have since become less common with the rise of light-curing, but they still serve a purpose when restoring the pulp chambers of endodontically treated teeth. In this episode Dr. David Alleman discusses the polymerization dynamics of chemical-cure and light-cure adhesives and how that impacts their effectiveness in different aspects of a successful adhesive restoration.Article referenced in this episode:Toshifumi Kuroe, Kana Tachibana, Yukinori Tanino, Noriyuki Satoh, Noboru Ohata, Hidehiko Sano, Nobuo Inoue, Angelo A Caputo, Contraction stress of composite resin build-up procedures for pulpless molars. J Adhes Dent. 2003 Spring;5(1):71-7.S Deliperi, D Alleman, D Rudo. Stress-reduced Direct Composites for the Restoration of Structurally Compromised Teeth: Fiber Design According to the "Wallpapering". Oper Dent. 2017 May/Jun;42(3):233-243. doi: 10.2341/15-289-T. TechniqueAt 12:35 Dr. Alleman creates illustrations to demonstrate air inhibition. To view this video, watch the episode on YouTube https://youtu.be/Y1xHishKlOo or search for Six Lessons Approach Podcast.Send us a textLearn more about Dr. Alleman's work at training programs at allemancenter.com/events. Upcoming training programs April 25-26: SLA In-Person Workshop May 12 Biomimetic Mastership Instagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

As new dental materials are developed, manufacturers and key opinion leaders play a role in how widely those products are adopted. Manufacturers market new products, but key opinion leaders and teachers also influence practitioners by comparing the benefits of various materials and lending their expertise.In this episode Dr. David Alleman discusses his early introduction to adhesive materials, how his role models and mentors led him to a growing network of key opinion leaders in the dental materials community and his own experience of growing from a young dentist to a teacher and key opinion leader in the field of biomimetic restorative dentistry.Send us a text2025 training programs:Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Referred dental pain can be difficult for practitioners to diagnose without an understanding of the cause of dental pain and how teeth respond to different pathologies. Referred dental pain is caused by real symptoms that need to be treated, and in this episode Dr. David Alleman discusses types of referred dental pain, tips for diagnosing cracks under restorations and procedures for eliminating post-operative sensitivity through biomimetic restorative dentistry.Article referenced in this episode:Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10):453-457Send us a text2025 training programs:Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Dr. Charley Cox was one of the early contributors to adhesive dental research, specifically in the field of histology. During the development of adhesive dentistry, Dr. Cox studied long-term pulp health in non-human primates, identified immune responses that confirmed Martin Brannstrom's hydrodynamic theory of pain and connected internationally with adhesive dental researchers like Takao Fusayama, Stefan Paul and Sema Belli. Dr. Cox's dental research contributions are to this day still largely unincorporated into adhesive dental applications. In creating his Six Lessons Approach to Biomimetic Restorative Dentistry, Dr. David Alleman found Dr. Cox's research to be instrumental in answering questions about preserving pulp health and preventing reinfection. Send us a text2025 training programs:Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Dental research developments don't happen overnight. The key players in dental research — university faculty, dental product manufacturers and the practitioners who adopt this research — work in varying capacities with the overall goal of improving dental outcomes for patients. Yet there is often a disconnect, slowing the lines of communication.In this episode Dr. David Alleman discusses leading universities who have contributed to the field of dental research, how dental manufacturers have influenced scientific developments and the gaps his own literature review filled when developing his Six Lessons Approach for practicing dentists.Send us a text2025 training programs:Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

With the invention of new materials for restorative dentistry, new techniques for application were needed. Research in bonding to dentin showed bond strengths that approached the cohesive strength of a tooth, but getting this research into the hands of practicing dentists was another process entirely. As Dr. David Alleman was learning and researching new protocols in adhesive dentistry, his questions about why debonds occurred in select areas of the tooth led to his formulation of the concepts of the hierarchy of bondability and decoupling with time, all while creating his Six Lessons Approach to Biomimetic Restorative Dentistry. These new concepts that built on a foundation of dental research from the past four decades gave dentists anywhere the ability to bond predictably to deep dentin and restore the tooth in a way that mimicked the form and function of a natural tooth: biomimetic dentistry. Send us a textStudy with Dr. David Alleman in 2025:Biomimetic Mastership - class starts September 15. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter