TBU: #032 Convincing My Own Dad About Biomimetic Dentistry

 New Issue of The Biomimetic Uprising

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 So I'm coming out of dental school in 2016 super pumped on biomimetic dentistry.  I just spent the last four years learning all about it.  The first year, 2012, was when I first heard about it from Pascal Magne in our Dental Morphology Function and Esthetics class.  The following years he would let me go back and sit in his same class as much as I could.  I was researching topics; learning about IDS, bio-base, layering, prep designs, etc. I also would work in his clinic section whenever possible.  I thought I knew it all.  Needless to say, I was excited about finally getting the chance to put it all into practice. 

Biomimetic Dentistry translated literally means to "copy life".  Its lifelike dentistry.  We are mimicking the tooth and what is already there.  

Its takes a solid understanding of the tooth to be able to copy it and mimic it. 

I would always explain to my patients that Biomimetic Dentistry is the way to go, that it was dentistry done right, that it was 'life like' dentistry.  Sometimes I'll mention to them that we are doing advanced adhesive dentistry.  Some people would get it.  Some would not.  Trying to explain to patients 'what is biomimetic dentistry' seemed that it should be an easy task but it wasn't always.  

Hell, my own dad was struggling to understand what it was and wasn't. My dad was focused on what his almighty insurance would cover.  He was money driven and wanted what was easy.  We would spend lots of time trying to convey what is biomimetics how it works.  He suggested I offered a different tier pricing service, taking a few select insurances, among other ideas.  He was a nice, concerned parent and was trying to help me make good business decisions.  But bottom line, he wasn't understanding the value we were bringing to our patients with biomimetics.  He needed more education and perhaps just to experience it. 

So remember how I was super excited about biomimetics? Well, lucky for me, a few months out of school my dad would become my patient.  He was visiting and on the last day in town, he cracked a tooth.  

Luckily for me, my assistant (my mom 😂😬🙄) was able to snap a quick pic to document the experience.  Sadly not the pre-op I wanted. He was in for a fractured tooth.  #30 had the DL cusp fractured off at/ below the gum line.  Symptoms were mild and the tooth tested vital.  We ended up doing a semi-direct resin onlay.  This was a preferred choice as he was leaving town the next day.  The damage was a bit too large for a stress reduced direct composite in my opinion but that could have been a great choice.

This one is a post-op radiograph from 2019.  The follow up looks great, no issues.  The margins are clean.  But notice the crown on #31...

 ... Its gone! In march of this year we took this radiograph.  He since had #31 removed due to failed root canal and crown. 

The next few intra-oral pictures were from last month at a hygiene appointment that my hygienist took.  There is slight wear along the margins and some of the occlusal details have worn a bit.  General wear and tear. But overall a very restoration that has five years of life.  

The lingual view of the restoration, albeit a semi poor picture, shows enough and the margins are still intact with no signs of leaking. 

The dial view.  I like this view, whenever possible.  The interproximals are typically the fist area to breakdown.  Of course we are able to see this view with the adjacent tooth now missing.  It looks to be going well with no signs of slowing down.  

As for the treatment, semi-direct onlays are nice and quick. They are fairly easy to do but have a lot of steps.  The downside to them is the wear thatchy take due to the size.  The compromise to that is, its a quick repair if ever needed.

One of the interesting things about this case is that he has lost a few teeth during this same five year window.  He has seen traditional dentistry fail him and leading to larger more complicated solutions compared to the hour procedure DOL resin semi-direct onlay we did that day. 

So lets break down some of the potential prices and 'savings'.

For a biomimetic practice. Initial DOL Resin Onlay (typically ADA Code D2663 or so) can be $1500-$2000.

Crowns can be as low as $500-$2000.  Especially if the patient is insurance driven and wanting to go the most economical route available.

Extractions can be $200-$700.

Root canals can be about $700-$1200 

If you add up the time and money to traditional dentistry, it could be a wash depends on what the issuance covers and where they go.  If anything, I  think we might be undercharging for our work.  Its been estimated that over the life of a tooth, the average tooth needs about $6000 of dental work, if not more with today's inflation and things.

Biomimetics, is about the cost savings; for the tooth, time and money.  I'd say we might be more expensive upfront but typically we aren't retreating these restorations with larger procedures.  And if we are, its definitely not as frequent or severe.  Obviously it goes without saying that biomimetics can have its own complications and failures. 

So what are we trying to convey to our patients? Do we stress the science behind our treatment? Do we tell them our success cases? Do we say anything at all? Or do we convey a potential savings like this to our patients? Maybe.  Maybe not.  Its definitely worth knowing, however, and understanding this concept for ourselves.  I'm sure you have a similar story of your own like my dad's.  He's a believer now.  He just needed experience and education.  I'd say for a money driven patient, it could be worth your time to gently explain these concepts.  Keep these concepts in mind when setting you fees, explaining to patients, or even trying to convince your own dad! 

Whenever you're ready, here are the ways I can help you:

1.  If you're looking for better application in your practice, take a look at our online courses and guides 
   1. The Foundations Of Biomimetic Dentistry
   2. How To Do Biomimetic Posterior Direct Composites.
   3. Get our 53 page biomimetic protocols guide for posterior direct restorations. 
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