Caries, along with the cavities it causes, is the most common dental pathology, but caries is not necessarily the cause of every cavity. Cracks that extend beyond the dentin-enamel junction, in both restored and virgin teeth, function as a highway for bacteria to enter the tooth and can lead to the formation of a cavity. Understanding crack initiation and propagation is an essential part of fully understanding how cavities form in teeth.

Cracks in anterior teeth often come from trauma or high occlusal forces. In addition to being an aesthetic concern, how these teeth are treated can mean the difference between conserving remaining tooth structure or extraction. The goal of biomimetic restorative dentistry is to conserve as much critical tooth structure as possible, even in severely cracked teeth, to prolong the tooth’s natural function as long as possible and delay more invasive treatment, like implants, until it is absolutely necessary.

Fractured cusps are a common failure of restored and even virgin teeth. In moderate cases, patients will notice their tooth feels different with their tongue or experience food impaction. In severe cases, patients will experience pain when larger portions of their tooth fracture. In either scenario, these fractures could often have been prevented with better crack diagnosis and restorative protocols, like those in Dr. David Alleman’s Six Lessons Approach to Biomimetic Restorative Dentistry.

“If cuspal coverage is needed…. a full coverage crown is considered the least desirable treatment option” 

This quote is from a book that most dentists learned from during dental school, so why are crowns still the recommendation for cracked teeth? In past decades, retention form was the best available option for restorative dentistry, but developments in adhesive materials and techniques allow for more conservative alternatives to crowns that save tooth structure that is essential to a tooth’s natural function and longevity.

Horizontal cracks in teeth, also referred to as oblique cracks, are a common pathology, especially in teeth with large restorations. These cracks extend horizontally and vertically around a restoration, posing a risk to cusps that may fracture as a result of the crack. In more severe cases, horizontal cracks may propagate under a restoration near the pulp. When treated early, horizontal cracks can be treated conservatively, minimizing loss of healthy tooth structure. Advanced adhesive techniques, like those used in biomimetic restorative dentistry, not only restore teeth to their natural function but also prevent future cracks from forming.

Cracks are one of the most common dental pathologies after caries and periodontal disease, yet many practitioners lack confidence in their approach to crack diagnosis and treatment. Traditional recommendations for treating cracked tooth syndrome are to crown the tooth and, if symptoms persist, perform endodontic treatment.

For practitioners around the world, daily dentistry is more complicated than incipient lesions. Doctors are confronted with deep boxes, deep decay and deep cracks, what we at the Alleman Center call “The Three D Problems.” These deep cavities bring bacteria close to the pulp, putting it at risk of infection and death, while often resulting in pain or sensitivity for patients. Understanding the challenges and researched restorative techniques for tackling these deep areas is essential for a long-lasting, asymptomatic restoration.

In March 2024, Drs David Alleman, Sema Belli and Junji Tagami authored a presentation about advances in adhesive dental protocols for the International Association for Dental Research General Session in New Orleans, Louisiana, USA. IADR general sessions regularly feature over 1,000 presentations highlighting the latest dental research from around the world.

Dr. David Wold has been with the Alleman Center from the beginning. As part of our very first Biomimetic Mastership class in January 2020 he was determined to learn as much as he could about biomimetic dentistry, still a new concept to him at the time.

Deep margin elevation is a technique that allows subgingival defects in a tooth to be restored without crown lengthening surgery. Saving patients healing time and higher treatment costs, deep margin elevations can be performed as part of a restoration appointment and can benefit overall oral health compared to traditional recommendations for treating subgingival areas of the tooth.

Dental students spend their time in dental school honing their hand skills, studying the pathologies they will eventually treat and so much more. Having trained doctors for the past 20 years, Dr. David Alleman has seen where dental schools provide students with crucial knowledge but also the critical information many leave out. At the Alleman Center, our view is not that dental schools need to teach more information, but that they should modernize the protocols and concepts they teach based on current research. By understanding the last four decades of dental research and innovations, students can graduate from dental school with a better understanding of how to make predictable, long-lasting restorations.

Have you ever cut a tooth down for a crown and felt that removing that much tooth structure is wrong? You’re not alone. Many dentists (and patients) are looking to conservative dental practices with the goal of preserving their healthy tooth structure. But when doctors are faced with delaminations and sensitive restorations, it can be difficult to move away from retention form.

Seeing dental photography online may give the impression that the goal is sharing a beautiful photo and that unless you want to invest in a DSLR camera, lighting and editing software, it isn’t a hobby worth exploring. While many dentists get great satisfaction from a beautiful photo of a restoration — Alleman Center doctors included! — we recommend that every dentist should be taking photos of their work. This is because we see dental photography as a tool for better dentistry.

Many students are drawn to the field of dentistry because of how it combines science, art and helping patients. Honing your skills in both the scientific and artistic elements of dentistry can greatly contribute to professional satisfaction, and your work in these areas can set you apart as a practitioner. Art in dentistry is inspired by natural teeth, so, naturally, biomimetic dentistry offers a scientific foundation for the artistic aspects.

Many dentists execute everything they were trained to do perfectly and still experience failing restorations. Why? Traditional techniques do not address these key problems.

Dr. David Alleman, DDS is one of the founding leaders in biomimetic restorative dentistry, but when he was first introduced to adhesive principles by Dr. Ray Bertolotti in 1995, he had already quit practicing dentistry.

Despite having a scientific foundation from research that is four decades old, biomimetic dentistry, also known as biomimetic restorative dentistry, may seem new to many doctors and patients. So the question will arise, “Is biomimetic dentistry worth it?” This is a decision every doctor and patient should make for themself, so let’s explore some sides to this question.

When it comes to crack diagnosis and treatment, cracks are often overlooked without proper magnification during routine check-ups. Pain on biting is often treated by trying to stabilize the fracture with a crown or try to bond over and infiltrate the crack. These treatments have varied success with some teeth proceeding to root canal or extraction.

Like many dentists, Alleman Center mentor Dr. Dafina Doberdoli was drawn to the field from her interest in science, medicine and helping others. Inspired by her aunt who is also a dentist, she thought of dentistry as a possible career for herself. “I saw that not many women were dentists in my country. Seeing her work, I thought I could do that too.”

This June saw the Alleman Center’s second-annual Retreat in Park City, Utah. Doctors from as far as Denmark, Belgium and Chile gathered to share their work, celebrate science and connect with other doctors in the field. With ten classes of expert doctors already trained through the Alleman Center Biomimetic Mastership, the pool of alumni is quickly growing, but the bonds formed between the doctors who learn together are here to stay.