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 to occlusal effect caries and increased risk of larger cracks in the tooth.

When Dr. Alleman began learning more about structural compromise, he purchased a microscope for his office and was then able to visualize cracks in dentin. He saw how these cracks were symptomatic, but the dental school recommendation of a full-coverage crown wasn’t enough to stabilize them. Dr. Alleman began removing the cracks and seeing symptoms resolve. This was confirmed by a paper he discovered later by Abbott and Leow, two Australian endodontists who studied symptoms after crack removal and found superior results to previous recommendations of full coverage crowns or attempting to bond over the cracks. When the cracks were removed the symptoms went away.

Articles referenced in this episode:

• Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.
• Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5.
• Walker et al. Enamel cracks the role of enamel lamella in caries initiation. Australian Dent J. 1998;43(2) 110-116.
• Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.
• Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457

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2025 training programs:
Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastership

In-Person SLA Workshop Dates:

• August 8-9
• October 24-25
• December 12-13

Learn more and register at allemancenter.com/training

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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, he could now visualize the crack and, with the help of his assistants, dissect the crack and restore the tooth himself. The symptoms resolved and the tooth is still healthy and functioning to this day.

A few years after restoring the first tooth, the tooth directly above it chipped. Dr. Alleman assumed the chip was only in the enamel because the tooth was asymptomatic, so he thought further treatment could wait. But in 2011, to his regret, the tooth fractured through the root and had to be extracted. This unfortunate incident taught Dr. Alleman a valuable lesson about the urgency and importance of timely and accurate crack diagnosis, which he now teaches to his colleagues and students.

Both teeth had vertical cracks. One tooth was saved with proper diagnosis and treatment, but the other was not. This happens to patients every day, but understanding how cracks in teeth propagate and how cracks are treated outside the field of dentistry [engineering] can significantly contribute to saving more teeth. This knowledge empowers us as dental professionals and students, motivating us to learn more and improve our practices.

Articles discussed in this episode:

• Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.
• Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457

Send us a text

2025 training programs:
Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastership

In-Person SLA Workshop Dates:

• August 8-9
• October 24-25
• December 12-13

Learn more and register at allemancenter.com/training

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@davey_alleman_dmd
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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 benefits left untapped when not used as part of a larger system of protocols that aim to mimic the natural function of a tooth: the Six Lessons Approach to Biomimetic Restorative Dentistry.

Dr. Alleman discusses the history of immediate dentin sealing, its early pioneers and how doctors can use this technique in their own practice to save pulps and maximize adhesion.

Publications discussed in this episode:

• Paul SJ, Schärer P. The dual bonding technique: a modified method to improve adhesive luting procedures. Int J Periodontics Restorative Dent. 1997 Dec;17(6):536-45.
• Van Meerbeek, B. (1993). Dentine adhesion: morphological, physico-checmial and clinical aspects [Catholic University of Leuven]
• Fusayama T. A Simple Pain-Free Adhesive Restorative System by Minimal Reduction and Total Etching. 2nd Edition. Ishiyaku EuroAmerica, Inc.; 1993
• Kashiwada T, Takagi M. New restoration and direct pulp capping systems using adhesive composite resin. Bull Tokyo Med Dent Univ. 1991 Dec;38(4):45-52.
• Sato M, Eta al. How to use "Liner Bond System" as a dentin and pulp protector in indirect restorations. Japan Society for Adhesive Dentistry. 1994:41-48.
• Bertschinger C, Paul S, Luthy H, Scharer P. Dual application of dentin bonding agents: effect on bond strength 1996
• Akimoto N, Takamizu M, Momoi Y. 10-year clinical evaluation of a self-etching adhesive system. Oper Dent. 2007 Jan-Feb;32(1):3-10. doi: 10.2341/06-46.
• Magne P, Kim TH, Cascione D, Donovan T. Immediate dentin sealing improves bond strength of indirect restorations. J Prosthet Dent. 2005 Dec;94(6):511-9.
• Urabe I, Nakajima S, Sano H, Tagami J. Physical properties of the dentin-enamel junction region. Am J Dent. 2000 Jun;13(3):129-35.

Send us a text

2025 training programs:
Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastership

In-Person SLA Workshop Dates:

• August 8-9
• October 24-25
• December 12-13

Learn more and register at allemancenter.com/training

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@allemancenter.com

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