Envisioning the future of dental materials

11 April 2018 Congress

The future of dental materials is a timely hot topic that will be debated in Buenos Aires. The three participating speakers of the session give their views on the role of amalgam in today’s dental practice – and what’s to come. We interviewed:

Portrait of Prof. Gottfried Schmalz

Prof. Gottfried Schmalz, Department for Conservative Dentistry and Periodontology at the University of Regensburg and Department of Periodontology at the University of Bern

Portrait of Prof. Mutlu Ozcan

Prof. Mutlu Ozcan, Director of the Dental Materials Division at the University of Zurich

Portrait of Dr Martin Edelberg

Dr Martin Edelberg, Director of the Postgraduate School at the University del Salvador

What’s the role of amalgam in modern dentistry?

Gottfried Schmalz

The future of dental materials is driven by the clinical needs of the practitioner, the scientific progress and the political, administrative and economic constraints of the healthcare system. In this context, national and international commissions have highlighted that amalgam is a reliable and – for the general population – safe material. It can be used under difficult clinical situations and is considered to be cost-effective. However, it is not tooth-coloured, thus failing to meet the aesthetic wishes of some patients.  It is also not an adhesive material and in some clinical situations, like very small cavities, other materials like resin-based composites need lees sound tooth removal. Furthermore, the Minamata Convention on Mercury, signed in 2013, will have an impact on the use of amalgam.

"While amalgam remains a material of choice, other materials – together with preventive measures – also belong to the armamentarium of the modern dentist."
Prof. Gottfried Schmalz

Dentists, together with patients, should decide which material is best considering the clinical situation such as cavity size or caries activity, as well as the medical conditions e.g. allergies and economic situation.

 
Mutlu Ozcan

Over the last decades, the advances in material science – specifically adhesive materials and technologies – have transformed macro-mechanical thinking to a minimally invasive approach where sound dental tissues can be preserved. Given that the oral environment is hostile, all kinds of restorations or reconstructions have a certain lifetime. Adhesive dentistry, however, allows for a decrease in the restoration cycle.

"Since amalgam fillings do require in some cases more sacrifice from dental tissues to achieve mechanical retention, amalgam does not completely fit in the philosophy of modern dentistry – which is minimally invasive and preventive."
Prof. Mutlu Ozcan

Yet, due to its simplicity in application, not necessitating additional armamentarium and being an affordable and forgiving alternative as opposed to many other restoration materials, amalgam is still perceived as the most convenient material in many parts of the world – especially where mass populations need dental services or where other economic constraints have to be taken care of.

 
Martin Edelberg

"For over 150 years, amalgam has been one of the mainstays of dentistry and there are billions of amalgam restorations still in service. Nevertheless, dentistry must be prepared for a new era in which new and less harmful filling materials than amalgam will be increasingly important."
Dr Martin Edelberg

As long as the search for the ideal tooth replacement material remains ongoing, amalgam will continue to be a relevant material to be considered in all public oral health programmes; but in a post-amalgam era, the dental profession will have to re-focus both restorative and preventive approaches with new materials and concepts.

Why is it important to be aware of the developments in dental materials in today’s practice?

Mutlu Ozcan

Dental materials and technologies have been and will be the driving force in all disciplines of dentistry, which has major clinical implications. Biological, bioactive or smart materials are replacing the classical term and understanding of dental materials. Certain chemicals with artificial or natural origin are also considered on the palette of dental materials.

Some of the developments in dentistry are very dynamic, meaning that scientific information is accumulated at a high pace.

"It is crucial for practitioners to be aware of dental developments, with their pros and cons, and the available evidence so that they can decide when to implement these developments in material science into their clinical practice."
Prof. Mutlu Ozcan

Furthermore, due to an increasing number of materials introduced into the dental market, practitioners should also be aware of the basics of each individual product and its working mechanisms.

In your own words, what are bioactive dental materials?

Martin Edelberg

Biomaterials in contact with living tissues, can elicit three types of biological response: 1) they may be harmful, producing a toxicological or immunological response; 2) they may be harmless or inert, they are integrated with no biological reaction; or 3) they may induce a favourable reaction that improves in time and this is considered a bioactive response.  

Bioactive materials offer remarkable possibilities for dentistry: they can have a remineralization and strengthening effect on human hard tissues, they may chemically bond to dentin, they can release ions from their composition, forming a mineral matrix equivalent to that of natural hydroxyapatite, bioactive glasses are effective in the surgical treatment of intrabony defects.

Newer formulations for glass ionomer cements, composite restorative and luting materials and a new generation of preventive biomaterials are available to dentists, most of them with evidence-based bioactive properties.

"The development of bioactive materials will allow dentistry to induce dental and periodontal regeneration, will improve materials for implants and implant-supported restorations, and will radically change the practice of dentistry."
Dr Martin Edelberg 

What makes the future of dental materials a hot topic?

Gottfried Schmalz

The Minamata Convention is a legally-binding treaty being ratified by more than 50 countries which aims to reduce the impact of mercury on the environment. Although the impact from dental amalgam is comparatively low, the Convention includes a phase-down of dental amalgam use. Several provisions were listed, like improving prevention and teaching of alternative materials, but more research and developing new and better materials are also required. The fact is that the use of amalgam on the long run must be reduced, the important question is: where and how?

Countries have – for example within the European Union – or will install regulations on how to implement the phase-down approach, such as restricting the use of amalgam in certain cases like deciduous teeth or in young patients.

"Dentists face an urgent need to have suitable alternatives for when amalgam is discouraged, for instance when it comes to deciduous teeth. On the other side, there is a lot of new (adhesive) materials and recently bioactive materials that have been developed. The big question is: which material when?"
Prof. Gottfried Schmalz 

 
Mutlu Ozcan

Currently, we have dental materials that could mimic nature from an optical point of view. However, none of the artificial dental materials could mimic the anisotropy of the tooth structure.

"Instead of looking to the future, preserving dental hard and soft tissues should be the first policy. The best dental material is the tooth itself."
Prof. Mutlu Ozcan 

After better understanding of the nature of the tooth and the dynamic changes over time due to ageing, future materials along with the corresponding technology could mimic both optics and mechanics.

However, the material and the technology must be developed concurrently when thinking of future dental materials. When I say technology, I do not necessarily mean sophisticated devices for fabrication but rather biological and/or chemical innovations with reparative and regenerative features. In other words, a future material which would act as a game changer. Conversely, had we spent all the resources on prevention and eliminating infection, rather than developing new materials over the last decades, perhaps we would not have to search for an exceptional future material.

 
Martin Edelberg

A more accurate knowledge of human biology has impacted the development of new materials and techniques for tissue replacement and restoration. New materials, presently considered as biomaterials, have been developed to be less harmful to patients when replacing lost tissues or inducing favourable biological responses.

"New technologies for future research and developments in the field of dental biomaterials, have produced a revolutionary change in all phases of dentistry."
Dr Martin Edelberg

New terminology – such as bioactive materials, ion-exchange mechanisms, remin-demin process, pulp-dentin regeneration, biomimetic, digital dentistry, bioceramics, CAD-CAM, and periodontal regeneration – must be acquired and fully understood by dentistry to study, learn and practice a non-traditional approach to patients’ care. Undoubtedly, new dental biomaterials research is a fascinating and exciting science field of action that involves not only graduated dentists, but also specialist and research scientist.

As an upcoming speaker at the FDI World Dental Congress, what makes this international event different from other dental congresses?

Gottfried Schmalz

"This is a world congress, which means that clinicians, scientists, and colleagues from the industry will come together from all five continents."
Prof. Gottfried Schmalz 

A wide range of speakers from different speciality areas will cover hot topics, as well as a wide spectrum of other subjects, allowing participants to organize their own congress experience according to the needs. Discussions with colleagues are also possible (so-called networking) between sessions, so everybody can really learn from each other during the congress.

 
Mutlu Ozcan

"The number of international dental events is considerably increasing worldwide, but there are only a few of them that really serve to disseminate scientific and clinical knowledge or to support global oral health promotion activities – eventually affecting healthcare policies globally."
Prof. Mutlu Ozcan 

FDI brings together dentists, scientists and healthcare policymakers from approximately 200 member associations and specialist groups in some 130 countries, which makes this congress a unique international platform.

And what does it mean to have the congress take place in your home country?

Martin Edelberg

In 1986, Argentina hosted the FDI Word Dental Congress, and it was a great success. At that time, we were very proud of our dentistry status and we were able to show it to the world. Argentina is a country with a rich and productive dental history. Our professionals have had a strong influence not only in Latin America, but also in Europe and North America.

Today, scientific achievements have changed dentistry’s practice all over the world; globalization and communication allow faster dissemination of knowledge and research results.

"This congress will consolidate Argentina’s dentistry in the dental world and we hope that everyone coming from abroad will enjoy their stay in Buenos Aires."
Dr Martin Edelberg 

 

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