Six Lessons Approach Podcast by Dr. David Alleman

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 canal therapy the next made his work feel worthless. He wondered: is this the best a dentist could d...

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 guarantee success in a dental restoration. Understanding materials and how they interact with ...

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 stresses was the key element that Dr. David Alleman studied in his search for predictable a...

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 Decoupling with Time.Articles referenced in this episode:Alleman DS. Decoupling with time. A solution...

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.Send us a Text Message.Learn more about Dr. Alleman's work at training programs at alle...

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, i...

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 mat...

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.”Books referenced in this episode:Nobuo Nakabayashi, David H. Pashley. Hyb...

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 bega...

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 rest...

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 n...

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 dec...