Six Lessons Approach Podcast by Dr. David Alleman

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 Alleman, DDS, dives into dentinal bonding systems, flowable composites and fiber, discussing what makes them biomimetic, how they are developed and researched and their benefits in a restoration. 

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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 tooth structure.

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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. 

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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 the tooth while maintaining a strong bond.

Dr. David Alleman, DDS, first began researching treatment options for cracks because he recognized that full coverage crowns weren’t yielding predictable results. Adhesive dentistry had the potential to of...

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 sometimes it doesn’t, leaving patients and practitioners frustrated. 

The solution: treat cracked teeth like engineers have been treating cracks for over a century. 

The challenge: applying these techniques to a biological environmen...

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 use this research to prevent cracks and marginal leakage before they pose a risk to the tooth.

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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 extend into dentin, creating a pathway for bacteria to enter the tooth. These cracks, called peripheral rim fractures, occur mostly around large restorations that leave the surrounding tooth structure unsupported, making...

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 questions about why debonds occurred in select areas of the tooth led to his formulation of the concepts of the hierarchy of bondability and decoupling with time, all while creating his Six Lessons Approach to Biomimetic Restorative Dentistry. T...

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 universities who have contributed to the field of dental research, how dental manufacturers have influenced scientific developments and the gaps his own literature review filled when developing his Six Lessons Approach for practicing dentists.

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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, Stefan Paul and Sema Belli. 

Dr. Cox’s dental research contributions are to this day still largely unincorporated into adhesive dental applications. In creating his Six Lessons Approach to Biomimetic Restorative Dentistry, Dr. David Alleman found Dr. Cox’s research to be inst...

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 post-operative sensitivity through biomimetic restorative dentistry.

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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

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 his role models and mentors led him to a growing network of key opinion leaders in the dental materials community and his own experience of growing from a young dentist to a teacher and key opinion leader in...

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 effectiveness in different aspects of a successful adhesive restoration.

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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 Purk and Jack Ferracane, Dr. David Alleman discusses how synthesizing research into practical protocols requires a deep understanding of how research is conducted and a treatment-focused view of how different protocols interact with others. Without this pe...

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 the sea of dental research, Dr. David Alleman created the Biomimetic Mastership, a comprehensive program that trains doctors in evidence-based dentistry while teaching them how to study and understand dental literature for themselves. Most practitioners do not have t...

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 the research behind understanding how a natural tooth functions and how practitioners can replicate that to improve clinical outcomes with biomimetic restorative dentistry.

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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 Willardson, a longtime colleague, teaching partner and friend whose life and work is remembered after news of his passing in January 2025. Our thoughts and sympathies are with his family and friends.

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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 restorative outcomes, posterior teeth needed more advanced protocols than anterior teeth. Subjected to higher forces of occlusion and with deeper restored defects, understanding polymerization dynamics is essential to a long-lasting adhesive posterior restoration. His research of these principles...

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 principles with new materials that no longer required retention, but the adhesive restorations still fell short. Teeth are more complex than many other materials that are adhesively connected, so simply bonding the restoration to the tooth did not yield long-term success.

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 other advancements in adhesive dentistry for cases with non-vital teeth in his Six Lessons Approach to Biomimetic Restorative Dentistry.

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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 fully hydrated teeth with healthy pulps. This episode outlines how biomimetic techniques approach endodontically treated teeth differently and the research that supports these protocols.

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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 advanced occlusal training beyond everyday cases.

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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 Alleman discusses what all dentists can learn from a body’s natural occlusion, lost research from the last few decades and approaches for daily occlusal techniques that can be applied to cases doctors regularly see in...

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 episode, Dr. David Alleman reviews ceramic, composite and gold and outlines best practices for completing the final steps of a biomimetic restoration.

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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 abrasion increases bond strengths to a level that mimics the strength at which a natural tooth is connected to itself (30-50 MPa). This conditioning technique is what brings dentin bond strengths into the biomimetic range, maximizing bond strength and the longevity...

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 exposed pulps.

Adhesive dentistry offers these teeth a second chance, but only when the seal is bonded at the nanometer level, like with biomimetic dentistry. Just like each step in the Six Lessons Approach to Bi...

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 pulp’s immune response and how dental histology affects restoration, the risk assessment has been proven to be an effective tool over the last 20 years, especially where x-rays do not identify a cause of symptoms. Now that we...

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 pulp’s immune response and how dental histology affects restoration, the risk assessment has been proven to be an effective tool over the last 20 years, especially where x-rays do not identify a cause of symptoms. Now that we...

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.

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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...

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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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.

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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.

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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 de...

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.<...

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...

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 make me a happy dentist.”

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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 ionomers, use composite instead. In 2019, 12-year clinical evaluations showed the success of composite, a material that better mimics a natural tooth compared to brittle glass ionomers. Understanding how to perform deep margin elevations is an essential tool for dentists...

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. Deliperi’s Stress Reduced Direct Composite technique, which we co-authored a publication on in 2009, is a necessary tool for any dentist who aims for conservative dentistry.

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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 science.

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Our next Biomimetic Mastership class starts September 14. Register before August 14 for our special early-bird tuition discount at allemancenter.com/mastership.

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