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The Changing Face of Dental Biomaterials Dental biomaterials offer probably the largest range of biomaterials available to a professional. For the same clinical situation, the dentist can even choose among various types of biomaterials. The diversity and the sophistication of the products available on the market have increased over the recent years. New technologies have markedly changed the panel of the main products, including dental implants and tooth colored restorative biomaterials. The biological solutions, like tissue regeneration and tissue engineering are coming to dentistry too. The purpose of this Main Article is to present these changes which affect a field dominated until now by a constant improvement of synthetic biomaterials.

This composite picture shows three steps in the making of a traditional metal-ceramics bridgwork, with the metal framework on top, with the first layer of opaque ceramics in the middle, and, below, the final appearance after the various layers of the dentine ceramics have been applied.
Such large restorations are not as frequent as it used to be.

For which reasons have dental biomaterials changed, and are still changing ?

The faded (and fading) glories

Since the middle of the 19th century, people have had their teeth filled with dental amalgams, and since the beginning of the 20th century, gold alloys could be cast precisely enough to be luted into cavities (inlays) or to restore highly damaged teeth (gold crowns). But today, these traditional dental biomaterials have lost their appeal to the profession and to the patients alike, mainly because of their metallic appearance, but also for fear of intoxication by the mercury contained in the dental amalgams. Therefore,
- dental amalgams
- metals / alloys in general
are, for many practionners, not considered anymore as the proper solution for fillings and crowns.

Some uses of dental biomaterials have also sharply diminished. Among them,
- tooth supported fixed prosthodontics
appears today to many as a procedure using up too much sound tissues (the adjacent and often sound teeth being prepared as abutments for a bridge to replace a single missing tooth). Bridges are most often abandonned in favor of a single implant, a procedure which doesn't affect the adjacent sound tissues. The picture on top of this article, which shows a full arch metal-ceramics restoration, represents therefore a superb laboratory work, but very seldom used anymore on that extent .

The influence of public expectation
Patients, acting more and more like « customers », are projecting their expectations on their dentist. They are based on some public awareness, like the fear of toxicity (mainly from mercury and metals), and also on their want to enhance their self image. Too look better, they want a perfect, natural smile, and therefore, there is a strong demand for “white” restorations.

Everyday life – and its constant move toward more complexity and increased technicity - contributes to the ever changing face of dental biomaterials

The influence of information technology developments on the development of dental biomaterials and their technologies

The developments of the information technology have a direct impact on the development of dental biomaterials and their technologies

Computer-driven electronics are present everywhere in today's life:
To cite some examples which have influenced the development of materials applications in all kinds of fields:

Microprocessor / Workstation / Finite Element Analysis simulation / Process control / Fabrication control

This influences the fabrication of biomaterials at the production site as well as their transformation right in the user area (chairside, as well as labside).

This also provides access to more sophisticated technologies, like:

Titanium casting / Laser welding / Vacuum furnace ( ceramic ) / High power halogen lamp ( up to 3000 mW/cm 2 )

It also provides access to new domains of use in dentistry, like:

Digital radiography / Digital imaging & image management / Shade measuring systems

To top

Dental biomaterials form a niche in our technological world, and have borrowed (and produced) several specific processes

Technology transfers

Dentistry (dental practice / dental laboratory / manufacturing of dental biomaterials) has imported many technologies to be applied in its field own field, like:

But dentistry has also refined or developed some specific technologies, which have then been exported to industry or medicine, like:

CAD / CAM
This stands for:
CAD C omputer A ided D esign
CAM C omputer A ided M anufacturing

A key element in this process is the scanning, which is used for the acquisition of shapes of a physical 3D model: it transforms the readings of the scanning device (the scanner) into digital data. They are then used to design the object to be manufactured, and to create the toolpath necessary to instruct the milling machine how to fabricate the object.

Scanning........................................ CAD........................................... CAM

The main applications of CAD / CAM in dentistry are:
- titanium machining
- chairside ceramics machining
- labside ceramics machining

Consequences on the structure of dental laboratories
The high cost of devices and machines used in this process makes it a tough decision to invest in CAD/CAM. Here are some criteria, as defined by a practitioner:

After J. Trénit in: Technologie Dentaire, Jul/Aug 2003

Content

The faded (and fading) glories

The influence of public expectation

The influence of information technology developments on the development of dental biomaterials and their technologies

Technology transfers

CAD / CAM

Telemanufacturing

Stereophotolithography

One step beyond: tissue regeneration

Looking further forward: tissue engineering

Conclusion