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Biomimetic Fillings

Biomimetic Fillings

A different way to repair a damaged tooth. Instead of reducing the tooth and covering it, we rebuild what is there and keep the healthy parts. It suits cracked teeth, mouths with old amalgam fillings, and teeth someone has said cannot be saved.

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What do you want your teeth to look like when you are 70?

Most of us plan for retirement. We think about the house, the pension, where we might live. Almost nobody plans for their teeth.

Tooth enamel is a finite resource. It does not grow back, it cannot be replaced, and every time a tooth is drilled a little more of the original is gone. Basically a tooth has a limited number of repairs in it.

So the useful question is not “how do we fix this tooth today?”. It is “how many more times can this tooth be fixed before it runs out?”.

You already know which tooth it is

Most patients we meet can point straight to it. The one they chew away from. The one that is sensitive. The one with the big silver filling that has been there for years.

They are not in pain, so they have not done anything about it. Instead they work around it. They chew on the other side. They take care with hot and cold drinks. They stop eating certain foods. All signs that a tooth is on borrowed time.

Some of these teeth never give you a sign at all. A large filling can be quietly running out of tooth around it and feel completely normal right up until the day it does not.

The tooth was cracking for years before it broke

Teeth are not rigid. When you bite down, a healthy tooth will flex very slightly, then spring back.

A tooth with a large old filling cannot do that. The filling is stiffer than the tooth around it, so instead of flexing, the tooth takes the strain at the join. Every bite can add a fraction to a crack you cannot see. Then one day you eat something and the tooth breaks.

It feels like it happened out of nowhere. It did not. It had been quietly deteriorating for years.

The teeth that get watched

A large filling that is not causing any problems usually gets watched. That is a reasonable thing to do, and most of the time nothing comes of it.

The difficulty is that watching tells you what a tooth has done so far. It does not tell you what it is about to do. The tooth that breaks on a piece of bread had been watched for years, and the day before it broke it looked no different from every tooth that is fine.

A tooth only has so many repairs in it

Most teeth follow a similar path over a lifetime. A small filling, then a larger one, then something that covers the whole tooth, and eventually a conversation about whether the tooth should be extracted.

Every one of those steps is a reasonable answer to the problem in front of it. What is easy to miss is that each one also uses up a little of what is left, because a repair always involves removing something before anything goes back.

There are two ways to restore a tooth that has been damaged, and the difference between them is worth understanding before you choose.

A crown works by covering. For a crown to stay on, it needs something to grip. The tooth is reduced on every side until it is the right shape for the crown to sit over. Some of what comes off is decayed or cracked. Some of it is a healthy tooth, removed because the crown needs the room.

A bonded rebuild works by adhesion. It is held on by the bond itself rather than by the shape of the tooth underneath, so the tooth does not have to be cut to a particular form for it to stay put. What comes out is what is diseased or cracked. What is healthy stays where it is.

That is the whole difference, and it decides a great deal. With a crown, how much of your tooth is removed is largely determined by the crown. With a rebuild, it is determined by the damage.

Neither option is wrong. A crown is the right answer when there is not much tooth left to bond to, and it always has a place. But the two approaches start from opposite ends, and thirty years later that difference shows.

Rebuilding the tooth rather than replacing it

What biomimetic dentistry does differently. Biomimetic means copying nature. In practice, it means three things.

We only remove what is diseased. Decay comes out. Healthy tooth stays, including the parts that would otherwise be reduced to fit a cover over the top.

We rebuild in layers, using materials that behave like teeth. Enamel and dentine have different properties, so we use different materials to replace them, bonded in stages so the finished tooth flexes the way it is supposed to. That is what stops the cracking from starting again.

We work under high magnification. Bonding is only as good as the surface it is done on, and the detail that matters here is not visible to the naked eye. Appointments take longer than a standard filling as a result.

The result is a tooth that is still substantially your tooth, fully sealed, doing the job it was built for. In practice that means:

More of your own tooth left after the restoration, which matters in the long term
Less risk of needing a root canal later, because a properly sealed tooth protects the nerve
Less sensitivity after treatment
Restorations that are difficult to spot, because the materials handle light the way enamel does

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Is this you?

Biomimetic treatment is not the answer to everything. It comes into its own in four situations.

A cracked tooth. This is the clearest case. A crown deals with a crack by covering the tooth and holding it together from the outside. That works, and for some teeth it is the right call, but the crack is still there underneath the cover.

A bonded rebuild deals with the crack itself. It is opened, cleaned and sealed, and the tooth is rebuilt in layers so that the force of biting is carried across the whole tooth rather than concentrated at the join. Cracked teeth are the problem this technique was developed to solve.

A mouth with a lot of old amalgam. Silver fillings are held in place by shape rather than by adhesion. To keep one in, the cavity had to be cut wider at the base than at the top, which means the filling is almost always larger than the original decay.

Then add decades of hot drinks and cold water. Metal and tooth expand and contract at different rates, so the join between the two is worked loose a fraction at a time. That is why teeth with large old silver fillings are the ones that are inclined to crack.

Most of these teeth do not hurt, which is why they get watched rather than dealt with. The question is not whether the tooth is sore but how much of it is left holding the filling in, and that is what the assessment measures. Where the answer is “not much”, replacing it now is a smaller piece of work than dealing with it after it splits, and the tooth gets rebuilt and sealed rather than reduced for a crown.

A tooth that is not suited to a crown. Sometimes there is simply not enough tooth left for a crown to hold on to. That is often when tooth extraction is discussed. Bonding does not need anything to grip. It can sometimes work where a crown cannot, which is exactly why it is worth asking about at the point a tooth is being written off rather than afterwards.

A tooth you have been told needs to come out. An extraction is the one decision that cannot be revisited. Before it happens, it is worth knowing whether the tooth genuinely cannot be saved or whether it is suitable for the biomimetic approach.

Not every tooth can be saved, and Rachel will tell you straight if yours is one of them. But teeth that have been written off can sometimes be rebuilt, and it is worth finding out which yours is while you still have the choice.

Your dentist for biomimetic treatment: Rachel Addison

Rachel trained on the Amber Aplin Biomimetic Dental Programme and leads biomimetic treatment at the practice. Biomimetic dentistry is unhurried by design. Every stage is about preserving the tooth you still have. Rachel has built her clinical interest around that approach, and she is the dentist you will see.

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Sixteen stages, one appointment

This is technique-sensitive work. There are sixteen stages to a full restoration and the result depends on every one of them being done correctly.

Two different glues are used, one for the inner part of the tooth and one for the enamel, because the two behave differently and need different handling. Where the cavity is deep, a fine fibre patch goes in over the nerve to protect it and spread the load. The tooth is isolated behind a rubber sheet throughout, since bonding fails in the presence of saliva, and the whole thing is done under magnification.

None of the stages can be hurried, which is why the appointment can take around two hours. You leave with the tooth fully restored.

Has someone told you a tooth cannot be saved?

Rachel is happy to look and provide a 2nd opinion, whether or not you are a patient here.

Teeth that have been recommended for extraction can sometimes be rebuilt biomimetically. Sometimes they genuinely cannot, and she will tell you that straight. Either way you will leave knowing where you stand, with an honest answer.

You can book a consultation directly with us, or ask your own dentist to refer you. If you are a dentist with a patient you would rather not extract, please complete our referral form.

Book a consultation with Rachel

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We pride ourselves on offering an outstanding dental service that makes a real difference to people’s lives. There’s a reason why our clients call us the best dental practice in Gloucester.

FAQs

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Is biomimetic dentistry more expensive than a crown?

The appointment costs more than a standard filling, because it takes longer and the tooth is rebuilt in layers under magnification. Set against a crown it is usually comparable, and it is considerably less than the crown, root canal and implant sequence that a heavily filled tooth often ends up needing over the following years. You will have a full cost breakdown before any treatment starts.

How long does treatment take?

Most teeth are finished in one appointment of around two hours. That is longer than you may be used to, because each layer is placed, set and checked before the next one goes on. There is no temporary filling and nothing to come back and fit, so you leave with a fully restored tooth.

Does it hurt?

The tooth is numbed first, so you should not feel anything while we work. Afterwards most people notice less sensitivity than they expect, because the inner layer of the tooth is sealed the moment it is exposed rather than at the end of the appointment. A tooth that was already sore beforehand can take a little longer to settle.

Will it look like my other teeth?

Yes. The materials are chosen because they handle light the way enamel and dentine do, so the finished tooth is difficult to pick out. The shade is matched at the start of the appointment while the tooth is still hydrated, since teeth lighten as they dry and a colour matched at the end would look wrong a day later.

Can any tooth be treated this way?

Most can, including teeth that have already been heavily filled. What matters is how much healthy tooth is left to bond to and whether the nerve is still healthy. A tooth that has already had a root canal, or that has broken below the gum, may need a different approach. Rachel will tell you which of those your teeth are at the consultation, including if the answer is no.

Do I have to leave my current dentist to have it done here?

No. Plenty of people come to us for one specific piece of treatment and stay registered with their own practice for check-ups and hygiene. You are welcome to move across if you would like to, but nothing about this treatment requires it.

How do I get referred, and can I refer myself?

Either route works. You can book a consultation with Rachel directly, arrange a free consultation with a treatment coordinator to find out more or ask your own dentist to refer you.

How is this different from a normal white filling?

"White filling" describes the material. Biomimetic describes how the tooth is assessed beforehand, how much of it is removed, and how the material is bonded and built up afterwards. The same composite can be placed in ten minutes or over two hours, and most of the difference in how long it lasts comes from that. It is the method rather than the material.

Do I need my old fillings replaced?

Not all of them, and not simply because they are old. Size matters more than age, and more than whether the tooth hurts. A small filling in a tooth that still has plenty of structure around it can be left alone. A large one that has left the tooth thin around the edges, or one with a crack line running from it, is worth dealing with before it breaks, because while the tooth is still intact it can be rebuilt rather than crowned or taken out. Rachel will go through yours and tell you which are which.

Will it be sensitive afterwards?

Usually less than a conventional filling. Sensitivity afterwards comes largely from the bond shrinking as it sets and pulling on the tooth. The layering technique is designed around that, so most patients find these teeth settle quickly.

How long will it last?

A well-bonded restoration in a tooth that still has good structure left should give you many years of service, and the aim of the technique is to keep the tooth itself going rather than to hit a particular number. Every restoration needs attention eventually. The difference is that work done this way can usually be repaired rather than cut off and started again.

I grind my teeth. Does that rule me out?

No, but it changes the plan. Grinding is one of the main reasons restorations fail, so we will look at how your teeth meet and usually recommend a night guard and or botox to protect the work.