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

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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

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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

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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.

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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

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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 to use them effectively when establishing your hybrid layer. Once again, it all comes back to decoupling with time.

Articles discussed in this episode:

• Van Meerbeek, B. (1993). Dentine adhesion: morphological, physico-checmial and clinical aspects [Catholic University of Leuven]
• Kemp-Sholte CM, Davidson, CL. Complete marginal seal of Class V resin composite restorations effected by increased flexibility. J Dent Res. 1990 Jun;69(6):1240-3.
• 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
• Unterbrink GL, Liebenberg WH. Flowable resin composites as “filled adhesives” literature review and clinical recommendations. Quintessence Int. 1999; 249-257.
• Alleman DS, Et al. Decoupling with time. A solution to the problem of the hierarchy of bondability. Inside Dent. 2021;August: 35-41

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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

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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 in this episode:

• Intro-3 Magne P, Belser U. Rationalization of Shape and Related Stress Distribution in Posterior Teeth A finite Element Study Using Nonlinear contact Analysis. J Periodontics Restorative Dent. 2002;22-425-433
• Magne P, Oganesyan T. CT scan based finite-element analysis of premolar cuspal deflection following operative procedures. J Periodontics Restorative Dent. Volume 29, Number 4, 2009:360-369.

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2025 training programs:
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• August 8-9
• October 24-25
• December 12-13

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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 treatment and the results he has seen in his practice for over 20 years.

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2025 training programs:
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In-Person SLA Workshop Dates:

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• December 12-13

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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 the published research.

Different parts of the tooth form hybrid layers at different rates based on the amount of hydroxyapatite. Composite will shrink to the best possible bonding surface, potentially leaving gaps in areas that have weaker bond potential. Understanding how to overcome these two variables is key to creating a restoration that bonds the tooth side to side, front to back and top to bottom like a natural tooth. This biomimetic bond eliminates gaps under restorations that cause post-operative sensitivity, but it requires understanding how bonding systems, composite and dentin need to work together within the first five minutes of the polymerization process. Dr. David Alleman named this process decoupling with time.

Articles referenced in this episode:

• 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

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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 trained could achieve the same predictable caries treatment that he saw in his own cases. How caries is treated is the first step in a restoration and determines whether that restoration succeeds or whether that restoration fails.

Article referenced in this episode:

• Anderson M, Charbeneau G. A comparison of digital and optical criteria for detecting carious dentin. J Prosth Dent. 1985;53(5): 643-646.

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2025 training programs:
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In-Person SLA Workshop Dates:

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

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