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Review Article

Biomimetic dentistry
Suchetana Goswami
Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Abstract “Biomimetics” is the field of science that uses the natural system of synthesizing materials through
biomimicry. This method can be widely used in dentistry for regeneration of dental structures and
replacement of lost dental tissues. This is a review paper that states its scope, history, different fields of
biomimetic dentistry, and its future conditions in India.

Keywords: Biomimetic materials, regeneration, remineralization

Address for correspondence: Dr. Suchetana Goswami, Dr. R. Ahmed Dental College and Hospital, 114 AJC Bose Road, Kolkata ‑ 700 014,
West Bengal, India.
E‑mail: goswamis1977@gmail.com

INTRODUCTION HISTORY OF BIOMIMETIC MATERIALS

The term “bio” means life and “mimesis” in Greek
means imitate. Biomimetics is the field of study that
attempts to design system and synthesize materials
through biomimicry.[1] Biomimetics can be defined as
the study of the structure, formation, and function
of biologically produced materials and also biological
mechanisms and processes especially for the purpose of
synthesizing similar products by artificial mechanisms
which mimic natural ones.[2] A material thus formed by
biomimetic technique based on the natural process is
called a biomimetic material.[2,3] The main principle of
biomimetic dentistry is to replace the lost dental tissues
by materials to restore full function and bear with all
functional stresses along with the maintenance of
esthetic results. Biomimetics is an interdisciplinary field
that gathers information from the study of biological
structures and functions with chemistry, physics,
mathematics, and engineering to develop principles
that are important for the generation of novel synthetic
materials and organs.[1-4]
The history dates back to the 1950s when Ottoschmit
coined the term biomimetics. The word “bionics” was
first used by Jack Steele in 1960. Although the concept
was very old, its real implementation is possible only
recently due to the enormous research in the fields
of biochemistry and molecular biology. It is believed
that the attempts to replace body parts started at least
2500 years ago when artificial teeth were carved from
the bones of oxen.
Crude dental implants were attempted as early as in the
first and second century AD in Roman population and in
pre-Columbian cultures of Central and South America.
The use of dental amalgam to repair decayed teeth was
recorded in the Chinese literature dates back to the year
of 659 AD.
The middle of 20th century was important in the history of
biomimetic medicine due to the sophisticated inventions
of the cardiac pacemaker, artificial heart valves, and knee

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10.4103/jorr.jorr_3_17 How to cite this article: Goswami S. Biomimetic dentistry. J Oral Res Rev
2018;10:28-32.

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Goswami: Biomimetic dentistry
joint replacement. Accidental organ and tissue loss have
been treated by surgical reconstruction and the use of
mechanical devices such as kidney dialyzers and organ
transplant from one individual to other increases in recent
years.[3,4]
OBJECTIVES
The main objectives of biomimetic dentistry are to
return the tooth to its function, esthetics, and strength.
In conventional approach, more tooth structures are
removed; the diseased tooth structures are replaced with
rigid materials. These techniques and materials have
shortened the life span of restorations and weakened the
tooth structures. Therefore, attempts are being made to
develop materials which will regenerate dental structures
and replacement of lost dental tissues by processes which
mimic natural ones.
BIOMATERIALS
The various bioactive materials that are used in dentistry
are discussed.
Synthetic polymer
Both biodegradable and nonbiodegradable polymers
are used as restorative materials in dentistry. The
biodeg radable polymers include polylactic acid
and polyglycolic acid copolymers. These polymers
are used primarily as suture materials but are
now also being examined as bone, skin, and liver
substitutes. Within the body, they are broken down
hydrolytically to produce lactic acid and glycolic
acid. Recently introduced materials in this field
are polyanhydrites, polyphosphazenes, polymethyl
methacrylate (PMMA), polytetrafluoroethylene (PTFE),
and polyhydroxyethylmethacrylate. These are alloplastic
synthetic nonbiodegradable polymers. PMMA is used
primarily for dentures base materials and also as cement
for many orthopedic prostheses. PTFE is used for bone
augmentation and guided bone regeneration.
Ceramics
Ceramics are commonly used for replacement of
lost tooth str uctures (crown fabrication) and in
bone tissue engineering. The common ceramics
that are used in dentistry and hip prosthesis are
alumina and hydroxyapatite. Alumina has a very good
corrosion resistance, high strength, and wear resistance.
Hydroxyapatite is a calcium phosphate-based ceramic
material and is the major component of bone and teeth.
Calcium phosphate hydroxyapatite and various types of
alumina are biocompatible in nature and are coated to the
Journal of Oral Research and Review | Volume 10 | Issue 1 | January-June 2018
implants that enhance osseointegration.[2-4] Bioceramics
are recent inclusion in this field. These materials are
highly biocompatible and chemically stable in oral
environment.
BIOMIMETIC PRINCIPLES IN RESTORATIVE
DENTISTRY
The main goal of biomimetics in restorative dentistry is
to return the hard tissues (enamel and dentin) to attain
full function by a hard tissue bond. This allows functional
stresses to pass through the tooth making the entire crown
into a unit that provides near normal function and biologic
and esthetic result.
Unfortunately, in dentistry, there is no such biomaterial
that has the same mechanical, physical, and optical
properties as that of tooth structures (i.e., enamel,
dentin, and cementum). In biomimetic approach of
restorative dentistry, the search is for materials that will
have esthetic and functional properties closer to tooth
structure.
Although lacking in strength, composites have many
favorable properties over amalgam. The newer techniques
favor minimal preparation, decrease pulpal involvement,
and reduce the chances of tooth fractures.
Glass ionomer cements (GICs) are considered as
biomimetic materials because it has properties similar
to dentin, adhesiveness to tooth structures, and fluoride
release.[5] GICs are useful in deep I and II cavities to
fill up the base as lining material. They are also used
as restorative materials in buccal class V cavities. GIC
releases fluoride, which has bactericidal properties, and
stimulates sclerotic dentin. However, its tensile strength is
poor and is not advocated in areas of high occlusal stress
and force concentration. Biodentine, a newly developed
material, may replace GIC as a liner in deep fillings in
the future, but further research is needed in this field.
GIC is currently being the main material for minimum
invasive dentistry.
Nowadays, due to the development of improved adhesives,
the use and indications for bases and lines have decreased.
The indication for placing a liner under adhesive restoration
is mainly for pulp protection in the form of partial lining
using Ca(OH)2 cements.[6,7]
Endodontically treated teeth are fragile and susceptible
to fracture because of tooth structure removal and loss
of cushioning effect due to the removal of pulp. In case
of posterior teeth, total cuspal coverage with porcelain is
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Goswami: Biomimetic dentistry
recommended because it will significantly strengthen the
crown and increase cusp stabilization.[4,8]
BIOMIMETICS IN COSMETIC DENTISTRY
Biomimetic dentistry is based on the philosophy that the
intact tooth in its ideal hues and shades are more important.
Its intracoronal anatomy, mechanics and locations in the
arch are also important to reconstruction and determines
success.[9,10]
BIOMIMETIC APPROACHES FOR
REGENERATION
Different regenerative technologies are invented based on
biomimetic approaches.
Regeneration of dentin-pulp complex
Recombinant human BMP2 and BMP4 can induce new
dentin formation. When recombinant BMP is delivered
in a scaffold of demineralized dentin matrix, it induces
classic tubular dentin in amputated pulp. Whereas BMP
when delivered using type I collagen matrix, it induces
osteodentin formation. In nonhuman primates, the use
of recombinant human BMP7 with an insoluble type I
collagen matrix induces reparative dentin formation in
freshly cut healthy pulp tissue. The size and shape of the
inductive material is important as it controls the size and
shape of the reparative dentin.[5,6]
Stem cell therapy
Stem cell therapy is an upgraded procedure that can be used
for the treatment of degenerated tissues. Stem cells are
multipotent cells that can be differentiated into any other
forms of cells. The easiest method of stem cell therapy is
to administer cells of definite regenerative potential into
the disinfected root canal system. The most commonly
used stem cells in regenerative endodontics are stem cells
from human exfoliated deciduous teeth (SHED), dental
pulp stem cells (DPSCs), and stem cells from the apical
papilla (SCAP). DPSCs are derived from human dental pulp.
The characteristic feature of these cells is their ability to
regenerate dentin-pulp complex like natural human tooth.
SHED are good alternative for dental tissue engineering.
They are more efficacious than adult teeth stem cells due to
higher proliferation rate and have the advantage of painless
stem cell collection with minimal invasion and abundant
viable cell supply.
Nowadays, stem cells are also collected from mesenchymal
stem cells present in the apical papilla of incompletely
formed teeth. They are called SCAP.[10,11]
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Pulp implantation
Generation of pulp tissue is possible in laboratory by tissue
engineering process and then it is transplanted into cleaned
and shaped root canal system. Rebeca et al. had developed
dental pulp-like tissue using the tissue engineering triad:
DPSCs, dentin matrix protein I and a collagen scaffold
following subcutaneous transplantation in mice. Collagen
acts as scaffold and dentin matrix protein I was the growth
factor. The investigators have shown that the tissue
engineering triad of DPSCs, dentin matrix protein I, and
a collagen scaffold can induce an organized matrix similar
to pulp tissue which may lead to hard tissue formation.[12]
Root canal revascularization
And Irrigation of root canal with sodium hypochlorite
and chlorhexidine along with the placement of antibiotics
(mixture of ciprofloxacin, metronidazole, and minocycline
paste) for several weeks to disinfect the root canal system is
the current practice. Our aim should be to increase chances
of revascularization of avulsed necrotic tooth. The success
of the revascularization process ensures the life of the
tooth in the arch. In this technique, the chances of immune
rejection and pathogen transmission are less as regeneration
of the tissue takes place by patient’s own blood cells.[12]
Injectable scaffold theory
In this procedure, pulp tissue is obtained by tissue
engineering process and then it is administered in a soft
three-dimensional scaffold matrix. Among all the injectable
biomaterials, hydrogels are more favorable in the field of
tissue engineering. Hydrogels are injectable scaffolds that
can be delivered by a syringe, are noninvasive in nature, and
easy to deliver into the root canal systems. Theoretically,
hydrogel promotes pulp regeneration by providing a
substrate for cell proliferation and differentiates into an
organized tissue structure.[12-15]
Gene therapy
It is a method of delivering genes with viral or nonviral
vectors. Viral vectors are genetically altered to eliminate ability
of causing disease without losing the capacity of infecting a
cell. Viral vectors are adenovirus, retrovirus, lentivirus, and
Herpes simplex virus. The nonviral delivery systems include
plasmids, peptides, cationic liposomes, DNA-ligand complex,
gene guns, electroporation, and sonoporation. The gene
delivery system in endodontics aims to deliver mineralizing
genes into pulp tissue to induce mineralization.[11-16]
Bioengineered tooth
Whole‑tooth regeneration is an advancing field which uses a
strategy of transplanting artificial tooth germ and allowing
it to develop in the oral environment.[17]
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Goswami: Biomimetic dentistry
Biomimetic mineralization
Biological mineral synthesis process manufactures
materials of highly controlled size, habit, texture,
composition, and structure. A recently introduced
technique of guided for mation of enamel-like
fluoroapatite layer on a mineral substrate has the potential
to enable remineralization of superficial enamel defects
on exposed dentin.[18-21]
Biomimetic remineralization
Biomimetic remineralization of dentin is possible
using some ion-containing solutions or ion-leaching
silicon-containing materials. Recent studies reported the
use of bioactive “smart” composites containing reactive
calcium silicate. Many researchers used “agarose” gel
containing sodium hypophosphate that covered an
acid-etched dentin material.[19-21]
Development of artificial salivary gland
Patients with autoimmune diseases such as Sjogren’s
syndrome or oral cancer patients who have undergone
radiotherapy may have their salivary glandular tissues
destroyed and the ultimate result would be dry mouth.
Patients experience difficulty in chewing, swallowing,
and speaking. In an attempt to regenerate salivary
gland, adult embryonic stem cells are used to develop
parenchymal cells and restoration of its secretory
functions. Efforts have been made to create a rather
simple device – blind‑end tube suitable for graft in
the buccal mucosa in patients whose salivary glandular
tissues have been destroyed. The lumen of this tube
would be lined with compatible epithelial cells which
are physiologically capable of unidirectional water
movement.[2]
BIOMIMETIC APPROACHES OF ORAL SURGERY
Attempts are made to utilize biomimetic techniques in oral
and maxillofacial surgery for craniofacial reconstruction.
Multipotent stem cells (MSCs) have been used in the tissue
engineering of human-shaped temporomandibular joints.
Mandibular condyles are made up of cartilaginous and
bone tissues. MSCs were differentiated into chondrogenic
and osteogenic cells and these cells were subsequently
encapsulated in a poly (ethylene glycol) diacrylate hydrogel
which was then molded into an adult human mandibular
condyle in stratified yet integrated layers of cartilage and
bone.[20,21]
CONCLUSION
Biomimetics in dentistry is a very useful concept and further
and firmer multidisciplinary scientific and technical research
Journal of Oral Research and Review | Volume 10 | Issue 1 | January-June 2018
is needed in this field. Regeneration of the lost dental tissue
rather than mild replacement with dental materials ensures
better prognosis, excellent biocompatibility, and high
success rate. The scope of biomimetic dentistry in India is
enormous in the near future. Biomimetic dentistry would
successfully replace lost dentin, enamel, cementum, and
pulp and open a new era of dentistry.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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