TBU: #050 Learning From Our Failures

 New Issue of The Biomimetic Uprising

Read Time: 3 min 

I used to think that I had to be perfect doing biomimetic dentistry.  I mean, with biomimetics, we've found the Holy Grail right?  We can establish super strong bonds that will last a lifetime.  We can bond an onlay on flat prep with no retentive features.  After we do our work, its perfect!  We can save teeth! Yeah... thats cool and all buuuuut....  

But theres a lot of things we cant control.

There's a lot that happens once the patient leaves our chair.  And no...I'm not putting the blame on the patient.  I actually kinda hate when the dental profession does that.

Don't be afraid of dental failures.  There are so many things that can be learned from a failing restoration.  Some of these issues we can control, some of these we cannot.  Not all failures are bad. 

Lets look at some dental failures.

Dental failure typically refers to the loss or malfunctioning of dental restorations, such as fillings, crowns, bridges, or dental implants. These restorations are designed to restore the form, function, and aesthetics of natural teeth. However, in some cases, they may fail due to various reasons.

Common causes of dental restoration failure include:

• Decay: If the underlying tooth structure around a filling or crown becomes decayed, it can compromise the restoration's integrity and lead to failure.
• Fracture or breakage: Restorations can fracture or break due to excessive forces from grinding or clenching, trauma, or biting on hard objects.
• Poor fit: If a dental restoration does not fit properly or lacks proper adaptation to the tooth, it may lead to recurrent decay, discomfort, or failure.
• Infection: In the case of dental implants, an infection around the implant site, known as peri-implantitis, can cause the implant to fail. 
• Gum disease: Advanced gum disease (periodontitis) can weaken the supporting structures around teeth and dental restorations, leading to their failure.
• Material wear or deterioration: Over time, dental restorations can wear down, break, or degrade, especially if they are made of materials that are not durable or not properly cared for.

Within that list, we can 100% control the proper fit.  Thats not on the patient. The rest of the list, I’d say we share at least half the responsibility of the failures.  

Our techniques and our ability to get adequate bond strengths have a lot to do with the failure rates of these restorations.  

Typically with high bond strengths, techniques, and proper material choice, the chewing forces will be transmitted thru the tooth in a favorable manner, like as if the tooth never had the damage in the first place. 

If we get a failure back that we did, we can look to see where it failed.  Looking at the place where we had the lowest bond strengths will help us know what we need to fix and improve upon.  For example, if we have a crown come back that fell off, looking at where the cement is will give us clues to what happened.  If the cement is on the tooth still, we can know that the weak bond was between the crown and the cement.  So we should then look to see what we did to condition the crown for cementation.  There might have been a missed step, wrong material used, not enough time, etc.  Typically, these are an easier fix.

If this same case comes back and the cement is in the crown, we can know that our tooth conditioning needs improvements.  This means the bond to the ceramic was stronger than the bond to the tooth.  This case can actually bring up more questions and possibly needing to redo the case.  There could be decay causing a weak bond, poor, non existent, or inadequate IDS, contaminations, etc. 

The same approach can be done if we’re looking to figure out why other restorations had complications.  I’ll often be looking for the reasons why a composite filling failed and to see where the weak link was.  Most of the time a composite filling fails in the deeper regions of the tooth, either on the pulpal floor or inside the proximal box.  Zirconia crowns have their own set of complications.  They typically have lower bond strengths and require some sort of retentive features. 

The next time a failed restoration walks in the door, look to see what happened and where the strong bond is at compared to the lower bonds. Analyze to see what area needs improvement.  This will help improve your overall technique. 

 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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