Six Lessons Approach Podcast by Dr. David Alleman
Dr. David Alleman, creator of the Six Lessons Approach, hosts this podcast on the evolution of biomimetic restorative dentistry. Each episode explores dental research, developments in adhesive dentistry, and practical methods dentists can use for more predictable results. The show is produced by Hillary Alleman and Audrey Alessi, with ties to the Alleman Center for continued education.
Episodes
Biomimetic Dental Materials Part 2: Dentinal Bonding Systems, Flowable Composites and Fiber
Biomimetic dental materials mimic a natural tooth’s flexibility and cohesive strength. How does this help a restoration long-term? These materials, when used with the right techniques, work with the remaining tooth structure around the restoration, rather than in opposition to it, like with materials that are too stiff, poorly bonded or stress weaker areas of the tooth.In this episode, Dr. David A
Biomimetic Dental Materials Part 1: Comparing Zirconia, Ceramic and Composite
What materials should you use to maximize adhesive strength, restoration longevity and tooth conservation? While how you use the materials — your techniques – are more important than the materials themselves, materials do still make a difference in restorative outcomes. In this episode, Dr. David Alleman, DDS, discusses zirconia, ceramic and composite and these materials’ interaction with natural
Fiber Placement in Restorative Dentistry
Fiber placement in restorative dentistry: Does it stop cracks, improve bonds or just add time to your restorative process? Dr. David Alleman, DDS, dives into the history of dental fibers, including Ribbond, Everstick Net and Ever-x Posterior, their uses in different clinical settings, and the research that shows how they support the restoration long-term. Articles referenced in this episode:Belli
Treating Cracks in Teeth: Propagation, Visibility, C-factor and Composite Layering
Cracks put teeth at risk of infection and fracture if left untreated, but treating cracks in teeth can create many challenges for practitioners. Removing cracks without good magnification, visibility and an understanding of crack propagation puts the nerve and critical tooth structure at risk. Once the crack is removed, the non-standard defect requires specific techniques to bond to deep areas of
Stop Treating Cracked Teeth with Retention or Adhesion (Do This Instead)
Dentists have been attempting to treat cracked teeth for decades, with the goal of alleviating patient pain and conserving teeth through restorative treatment. But as Dr. David Alleman, DDS, describes in this episode, “it’s a coin toss of success.” Methods such as retention to hold the crack together or bonding over the crack with adhesion are unpredictable. Sometimes the treatment works, and some
Diagnosing Structural Compromise in Teeth with the 1-2-3-4 Risk Assessment
The most minimally invasive dentistry is early diagnosis and treatment. Dr. David Alleman created the 1-2-3-4 risk assessment so he could better diagnose teeth that were at risk of fracture or decay to prevent large fractures or carious lesions under the restoration. In this episode, Dr. Alleman discusses research into the structural integrity of different preparations and how practitioners can us
Occlusal Effect Caries: Caries Caused by Cracks Into Dentin
Treating cracks in teeth can still feel ambiguous for many dentists. Is it better to observe? Is it better to crown? Is there a less invasive treatment option? In this episode, Dr. David Alleman discusses a key piece of research that offers practitioners more insight into crack diagnosis and treatment: cracks that cause decay.Occlusal effect caries is a carious lesion that forms from cracks that e
Dental Concepts that Shaped a New Adhesive Dentistry: Biomimetic Dentistry
With the invention of new materials for restorative dentistry, new techniques for application were needed. Research in bonding to dentin showed bond strengths that approached the cohesive strength of a tooth, but getting this research into the hands of practicing dentists was another process entirely. As Dr. David Alleman was learning and researching new protocols in adhesive dentistry, his questi
The Importance of Universities in Adhesive Dental Research
Dental research developments don’t happen overnight. The key players in dental research — university faculty, dental product manufacturers and the practitioners who adopt this research — work in varying capacities with the overall goal of improving dental outcomes for patients. Yet there is often a disconnect, slowing the lines of communication.In this episode Dr. David Alleman discusses leading u
The Histology and Dental Research of Dr. Charley Cox
Dr. Charley Cox was one of the early contributors to adhesive dental research, specifically in the field of histology. During the development of adhesive dentistry, Dr. Cox studied long-term pulp health in non-human primates, identified immune responses that confirmed Martin Brannstrom’s hydrodynamic theory of pain and connected internationally with adhesive dental researchers like Takao Fusayama,
Diagnosis and Treatment of Referred Dental Pain
Referred dental pain can be difficult for practitioners to diagnose without an understanding of the cause of dental pain and how teeth respond to different pathologies. Referred dental pain is caused by real symptoms that need to be treated, and in this episode Dr. David Alleman discusses types of referred dental pain, tips for diagnosing cracks under restorations and procedures for eliminating po
Early Adhesive Dentistry: Materials and Key Opinion Leaders
As new dental materials are developed, manufacturers and key opinion leaders play a role in how widely those products are adopted. Manufacturers market new products, but key opinion leaders and teachers also influence practitioners by comparing the benefits of various materials and lending their expertise.In this episode Dr. David Alleman discusses his early introduction to adhesive materials, how
Using Chemical-Cure Dentin Bonding Systems for Endodontically Treated Teeth
Popular during the early years of adhesive dentistry, chemical-cure dentin bonding systems have since become less common with the rise of light-curing, but they still serve a purpose when restoring the pulp chambers of endodontically treated teeth. In this episode Dr. David Alleman discusses the polymerization dynamics of chemical-cure and light-cure adhesives and how that impacts their effectiven
Synthesizing Research to Create Practical Dental Protocols
How does peer-reviewed literature make it into the hands of practicing dentists? Sometimes it doesn’t. Other times research can be misinterpreted and applied incorrectly. The process of analyzing and applying current research is time consuming for practitioners to the point where new dental findings often fail to be widely adopted in practice.Reminiscing on his first meetings with researchers John
Evidence-Based Dentistry: Literature Review for Dentists
Evidence-based dentistry aims to bring current dental research into daily practice, but the process of adopting new findings and translating them into protocols is a complicated and time-consuming process. Dr. David Alleman discusses how dentists should approach literature and what to keep in mind when considering adopting findings into their own practice. From his own experience of wading through
What is Biomimetic Dentistry?
Biomimetic dentistry can be defined by three main principles: preserve pulp vitality, conserve critical tooth structure and fully connect the tooth at 30 MPa or more. Mimicking nature (biomimetic) is about scientific analysis of how natural teeth function and replicating those principles during the restorative process. This isn’t art; this is science. In this episode Dr. David Alleman discusses th
What is Cosmetic Dentistry?
Does biomimetic dentistry mean to mimic how teeth look? It can, but there is more to it than that. Dr. David Alleman discusses the evolution of cosmetic dentistry and its intersection with minimally invasive dentistry, adhesive dentistry and biomimetic dentistry. During his own research and teaching of biomimetic dentistry, Dr. Alleman met and taught a number of cosmetic dentists, including Joe Wi
What is Adhesive Dentistry?
Adhesive dentistry has been taught in dental schools for decades and is widely used by dentists today. Bonding to a tooth offers increased adaptability of restorations, allowing for more minimally invasive treatment and preparation, but long-term success with adhesive dentistry is not a guarantee.Dr. David Alleman repeatedly saw failing composite restorations and realized that in order to improve
What is Minimally Invasive Dentistry?
Biomimetic restorative dentistry has been taught and practiced for over 20 years, with its roots linked to minimally invasive dentistry that started decades earlier. Minimally invasive dentistry sought to conserve tooth structure and restore only parts of the tooth affected by pathologies. With the invention of adhesive materials, adhesive dentistry showed promise in advancing minimally invasive p
Wallpapering Technique for Endodontically Treated Teeth
The wallpapering technique is a key protocol for extending the function of endodontically treated teeth. More brittle due to their reduced hydration, non-vital teeth are more prone to fracture, so using fiber in this way creates a fail-safe that prevents failure beneath the coronal portion of the tooth and reinfection of the root.Dr. David Alleman discusses how he helped pioneer this technique and
Biomimetic Dentistry for Endodontically Treated Teeth
Dr. David Alleman first created his Six Lessons Approach for vital teeth, but the same conservative principles can benefit endodontically treated teeth too. Compared to traditional techniques for retention and bonding, the advanced adhesive and stress-reducing techniques of biomimetic dentistry are better suited for treating non-vital teeth, which are more brittle and susceptible to cracking than
Biomimetic Occlusion Part 2: Abfractions and Full-Mouth Cases
Daily dentistry, the cases you see every day, usually involves minor occlusal adjustments that can be treated quickly and predictably using the Six Lessons Approach, but biomimetic techniques can benefit more advanced occlusal cases too. In this episode, Dr. David Alleman discusses the cause of abfractions, how complex temporaries are a thing of the past and options for doctors seeking more advanc
Biomimetic Occlusion in Restorative Dentistry
Biomimetic dentistry aims to mimic a natural tooth throughout the restorative process. The last four decades of research has shown that mimicking and conserving a tooth’s natural connection to itself, its natural bond and resilience to occlusal forces and its natural defense mechanisms for infection benefits the tooth’s long-term health. This is also true for occlusion.In this episode, Dr. David A
Enamel Replacement: Ceramic vs Composite
What is the best material for enamel replacement? It depends! When selecting the material of an onlay or overlay, understanding how a natural tooth functions during occlusion is essential if your goal is biomimetic dentistry. Harder is not better, but rather mimicking a natural tooth’s bond to itself and its modulus of elasticity will aid in selecting your enamel replacement material.In this episo
How Does Air Abrasion Affect a Restoration?
Air abrasion functions as a conditioning step when bonding, which means it prepares the dentin or composite molecules for bonding. Dr. David Alleman discusses the progression of bonding systems for dentin adhesion and how this conditioning step evolved along with the bonding system molecules. The latest studies from researchers independent from the bonding system manufacturers show that air abrasi
Best Practices to Avoid and Treat Pulp Exposures
Dr. David Alleman’s landmark paper written with Dr. Pascal Magne in 2012 gave practitioners predictable steps for deep caries, and now crack, treatment without exposing the pulp. But why is preventing pulp exposures so important? Dr. Alleman discusses research about the outcomes of pulp exposures and their effect on the tooth long-term in addition to proven treatment for teeth that have had expose
Early Diagnosis of Caries and Cracks
Early diagnosis and treatment of dental pathologies allows for more conservative treatments while saving patients time and money. When developing the Six Lessons Approach to Biomimetic Dentistry, Dr. David Alleman created a risk assessment for determining if teeth were at risk of caries or cracks based on pathologies and treatment history.Drawing on research from how teeth experience pain, the pul
Should You Remove All Stained Dentin?
Caries removal can be reproducible — this means consistent regardless of patient or practitioner. Caries detecting dye is essential to creating reproducible caries removal endpoints, but the techniques doctors pair with the dye are what prevent pulp exposure and maximize bond strength.When Dr. David Alleman pioneered his methods for determining caries removal endpoints, he found that any doctor he
The Difference Five Minutes Make: Decoupling with Time
Each lesson in the Six Lessons Approach to Biomimetic Dentistry (SLA) is essential to restoring a tooth in a way that stays bonded and symptom-free. These two failings of traditional techniques — debonded restoration and post-operative sensitivity — are addressed in each lesson, but when it came to the bonding stage of the restoration, Dr. David Alleman was able to reach a pivotal conclusion from
Understanding the Third Most Common Dental Pathology
Cracks are the third most common dental pathology dentists treat, but treating them in a predictable way requires an understanding of principles from engineering, histology and immunology. How do cracks in teeth form? Why do cracks in teeth cause infection? How can we treat cracks predictably and prevent root canal therapy? In this episode Dr. David Alleman discusses his research process for crack
What Causes Dental Failures?
Where do failures happen in dentistry? At the micron level. Bacteria create infections; micromovements initiate cracks; these are the root of failed restorations, infected pulps, and cracked teeth. Experiencing his own failures from traditional and early adhesive restorations, Dr. David Alleman discusses how thinking small led to significant advancements in restorative outcomes.Articles referenced
Resin Coating
Resin coating should always be included in the conversation with immediate dentin sealing, but it isn’t. Immediate dentin sealing can increase bond strengths by 400%, but resin coating functions at the opposite end of the adhesive equation by reducing polymerization stress to the hybrid layer.Dr. Alleman discusses materials used in resin coating — flowable composites — their history, uses and how
Immediate Dentin Sealing
Immediate dentin sealing is a commonly known technique even outside of advanced adhesive and biomimetic restorative dentistry. Originally developed in the 1990’s to solve the issue of temporization contamination, its uses once refined were immense when applied to dentin adhesion. Yet for doctors currenting using immediate dentin sealing as part of their restoration protocols, there may be more ben
A Tale of Two Teeth
Throughout dental school and into his early career, Dr. David Alleman had a tooth with an occlusal amalgam that experienced intermittent pain on biting. The tooth was examined, but no cause for the symptom was found. Years later, after thoroughly studying adhesive dentistry, Dr. Alleman understood that there must be a crack in the tooth. Having recently acquired an intraoral camera in his office,
Australian Mavericks: Let's Remove the Cracks
In 2000, Graem Milicich and Tim Rainey published an article outlining how traditionally treated teeth were at greater risk to infections from cracks due to the increased stresses on the tooth. This includes peripheral rim fractures, which occur when restored teeth are not connected side to side like with amalgam or poorly bonded composite. These small cracks around the edge of the restoration lead
Could This Type of Dentistry Make Me a Happy Dentist?
In 1995 Dr. David Alleman wanted to quit dentistry. Frustrated with failing restorations and post-operative sensitivity, he couldn’t see how his work was helping his patients. A long-time friend and colleague encouraged him to take a course by Ray Bertolotti to learn about a new type of dentistry: adhesive dentistry. It was then that Dr. Alleman first thought, “maybe this type of dentistry could m
Deep Margin Elevation
Why aren’t all dentists performing deep margin elevations with composite? It might be because you’re listening to old research. “Violating the biologic width” was disproven in 2014. Gingival tissue doesn't have an adverse reaction to the material, it has an adverse reaction to the biofilm under a retention crown or poorly bonded restoration. If you have experienced failures with glass ionomer
Stress-Reduced Direct Composite
The tops of teeth don’t matter… as much as the bottoms. The key to any biomimetic restoration is the direct component, which is why I describe biomimetic dentistry as a bottom to top approach. When I first learned of Simone Deliperi’s work and we began working and then teaching together, we both understood how this direct component needed to be carefully managed for a successful restoration. Delip
1995-2000: The Wild West of Dental Bonding Systems
Early adhesive dentistry showed promise, but as Dr. David Alleman began implementing these new techniques into his practice, the success wasn’t immediate. Struggling with continued failures and wading through the sea of new bonding systems that were becoming available year after year, he sought to eliminate the guesswork and go to the source of what was causing unpredictable restorations: the sci
Flow and Dental Composites
We are able to visualize how molecules move during polymerization thanks to the work of Carel L Davidson in the 1980s. Being able to visualize and then measure this movement, also known as flow, helps create more predictable bonds when working with different substrates in enamel, but Dr. David Alleman took years to systematize this concept into his practice as he was developing his concept of Deco
What is C-Factor?
C-factor is more than the ratio of bonded to unbonded surfaces. Understanding C-factor, or Configuration Factor, is essential to understanding how composites behave in a tooth, but this topic was still being researched as manufacturers were trying to bond to dentin. Eventually, c-factor and its role in composite bonding showed the potential for a strong bond to dentin, but overcoming the c-factor
History, Chemistry and Why They Matter in Dentistry
A long-lasting dental restoration comes down to molecules. Dr. David Alleman breaks down the research timeline of developing adhesives that can bond to dentin, and you don’t have to share his love of chemistry to appreciate how impactful that is to the field of dentistry.These adhesives were available to dentists as early as 1951, but just using an adhesive containing a proven molecule does not gu
Finding a Better Way to Fix Teeth
Dr. David Alleman is known today as an innovator in the dental field, but it didn’t start that way. Dr. Alleman recalls his early interest in science, his journey as a dental student, experiences in his early career and how all of this led to him wanting to leave dentistry.Frustrated with sensitivity and failing restorations, he expectation that fillings would one day need crowns and then root can
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