Finding a Better Way to Fix Teeth

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 do for their patients? 

In 1998 Dr. Alleman learned about advancements in adhesive dentistry, which offered the opportunity for improved results, but some of his mentors’ teaching left him with more questions than answers. So he took the research into his own hands.

Dr. Alleman’s literature review opened his eyes to techniques that would later be called biomimetic restorative dentistry, but at the time he was just looking for a better way to fix teeth. He sought solutions to post-operative sensitivity, failing and debonding restorations and cracked teeth. As Dr. Alleman incorporated the research into his work, the results were impressive. This research is the basis for his Six Lessons Approach to Biomimetic Restorative Dentistry, a system now used by doctors around the world.

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

Learn more and register at allemancenter.com/training

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Transcript

0:33

Well, we are very excited about this opportunity to start our podcast. The Six Lessons podcast has one purpose. We want to help you be a better dentist, and I've been a dentist for 44 years. That’s a long time, if you want to do better dentistry every day and stay motivated, then having a system that works well and consistently, that's the key to success. I'm going to discuss a little bit about why I decided to be a dentist. Going to include some memories of my early dental education in my early life and how that worked into having the Six Lessons available now worldwide to dentists who want to be the best dentists that they can. But let's just start with how I decided to be a dentist. That goes back to when I was in seventh grade. Seventh grade was the time when you’re starting to think about what you want to do in your life. And I went to a dental school graduation of a dentist who was graduating from University of Southern California. His name was Bob Heath. Bob Heath is still alive today. I visited with him five years ago, but he graduated from University of Southern California, where I was living with my family in Monterey Park. And when we went to this dental school graduation after the graduation was over, he took me into his lab in his little cubicle, which he used at dental school and was quite interesting. They were making some things and had some interesting tools, and he talked about using his hands and how he enjoyed working with patients. All of those things were motivating to me. Plus he was at University of Southern California, which had the best football team of the United States at that time. So being a USC Trojan seemed to be a win win situation. I didn't think much more about that until a couple of years later. In high school. I again actually recorded in a newspaper article that I was being interviewed for because I was the freshman class president at Mark Keppel High School, and they asked me about my future. And since, you know, I was keeping quiet my plans to become president of the United States, I mentioned that I was going to be a dentist in ninth grade. I said that and it's recorded in the Mark Keppel student newspaper. Well, what you say and what actually happens sometimes are two different things. My political success ended by being not elected as student body president by senior year. But you know, becoming a dentist was still a possibility. I have an early memory of my father and his. In one of his drawers in his bedroom had a small microscope, very small brass microscope, but something that I wish I had right now, I don't know exactly where it ended up, but he he mentioned that that microscope belonged to his father, my grandfather, who I knew. He died when I was six years old, but he lived with us in Monterey Park. He had had a stroke, so he didn't speak very much. But I. I do have fond memories of him and our dog , Sport being outside and and sitting in the sun. But my father was a physicist, very good at mathematics. And his father was the math teacher, Springville High School. So, Harold, my grandfather taught math his whole career over 40 years, at Springville High School algebra teachers weren't really popular in high school then. Maybe it's different now, but he had five children and raising five children. On what you would make as a math teacher in Springville, Utah wasn't the easiest thing to do. So he had a second plan to become a dentist. So he started to take more science classes at Brigham Young University. He bought a microscope, made those plans. But unfortunately, plans sometimes get in the way of reality and he remained his whole career as a math teacher and raised his family on what they made with that profession. But this microscope intrigued me because you could see things through it and they would get bigger. The microscope in dentistry has been the most important technological breakthrough. When I was a student at Brigham Young University and I did become a pre-dental student after I returned home from my Mormon mission that pre-dental options for majors you can major in anything. But I chose microbiology. So in microbiology you are using microscopes every day and you are thinking very small things and you learn the size of a micron. Now, in England and the United States, we like inches perhaps, but millimeters, centimeters. Those are the things, the measurements that most of the world uses. And when I learned how big a micron was as a microbiology, just that's the average diameter of a bacteria. Obviously, it's stuck in my mind to this day. 50 years later I know that a micron is 1/500 the thickness of your fingernail. Now, if you look at your fingernail and you divide that in five hundreds, it's like your mind takes a trip into a world that most people never think about. Microbiology has saved more lives than any other scientific discipline. And I enjoyed my microbiology major and my chemistry minor. But the chemistry minor was kind of interesting because I became a chemistry minor for one reason that I asked around my friends at Brigham Young University, you know, what does it take to get into dental school? I didn't really know. And they would say, well, you got to take the DAT. So that's going to ask you about all your basic sciences. It's going to have some spatial relationship testing, you know, just basically. But the one thing that schools really look like look at is organic chemistry. The grade you get in organic chemistry will determine whether you get into dental school. Well, in high school, I think I got a B-minus in chemistry I kind of spaced out. As soon as I learned that Avogadro's number was 1 to the 23 I mean, I can't even remember what Avogadro's number is now. I've got to go back in. But anyway, chemistry didn't excite me in high school. But I did get a B-minus. But when I got to Brigham Young University, then I started taking my freshman year in organic chemistry. Now inorganic chemistry is acid base equations and a lot of things that you know, don't excite you. How to dissolve salt in water. Well, you put salt in water and it dissolves, you know, but you have to be more technical if you're going to be an inorganic chemist, ask Ryan Nolan. He will tell you. But I got another B minus my freshman year before I'd really decided to become a dentist. But when I started my sophomore year and I was engaged to be married and my wife didn't know if I was smart enough to be a dentist. You know, I was kind of under the gun because I'd never got an A in a dental class and I mean a chemistry class. And when I started organic chemistry seriously, the first thing the guy said, you know, Dr. Smith, he said, I know that everybody taking this class wants to be a physician or a dentist or something. That's not a chemist. I know this isn't a class for chemistry majors, but you all want to get good grades because you have these professional aspirations. Melvyn Smith said If you've never got an A in chemistry, don't expect to get an A in this class. And so it was like I was on the front row, you know, I was ready. It was like he was talking to me like, Oh man, this was a challenge that I wasn't quite ready for, but it scared the heck out of me. And, you know, I didn't want to tell my wife. I don't know if this is going to work because this guy just told me. I probably I'm not going to get it. You know, many people do get into dental school without an a, an organic chemistry. But that being said, it motivated me to do more homework in the organic chemistry course than anybody else that was in that course. So there was, you know, probably 60 students in the class and I was in the top three or something like that. So once I disciplined myself in that organic chemistry course, I pretty much felt like I had what it took to become a dentist. But I didn't know that that course was actually going to mean anything in dentistry. But obviously I did get accepted to dental school and I had an interest from shadowing a dentist while I was undergraduate. His name was Niles Herrod, and Niles Herrod was a specialist. He was an oral surgeon in Provo, Utah. And this is a memory that's very interesting that maybe some will relate to. I was thinking that an oral surgeon sounded like something cool. So I'm going to watch this oral surgeon and I'm thinking I want to be an oral surgeon not knowing anything. This is before I've been in dental school, but I go to observe and shadowed Dr. Herrod for a couple of weeks, and I'm wearing a dress shirt and a tie, and I'm in this room and they're doing a what's called a dilantin hyperplasia gingivectomy If you take a certain anti-seizure medicine called by dilantin, your gums grow excessively and it takes you have to remove that excessive group growth of gum surgically. And it can either be done with electric surge or with the normal scalpels. But anyway, I'm excited. I'm going to be a dentist, maybe an oral surgeon and all of a sudden Dr. Herrod starts doing these these surgical procedures where he's basically burning cauterizing this excess of tissue in the smell. I started to pass out and the nurse saw that I was losing it. And she says, I think you better sit down, maybe unbutton your shirt and loosen your tie. Anyway, so my first actual experience in my pre-dental education was almost disastrous, but I did not faint. But it did set me on the course to get to know Dr. Herrod. And actually, after he retired, I was friends with him at the country club I was a member with in Provo for three years and all good experiences. But what I did get accepted and we went to dental school. I was ready to if you want to specialize in dental schools, you have to graduate in the top 10%. So if you have 100 students in your class, you better be in the top ten. If you want to be an orthodontist or an endodontist or an oral surgeon or a periodontist, all the specialties are out there. But during the middle of dental school, my wife and I already had two children and that was a happy little family. But then we found ourselves expecting our third child in the middle of dental school, and she surprised us with a, you know, three and a half months early. This baby's born one pound, ten ounces, and all of a sudden she's a a medical miracle experiment, progressive patient, we don't know. But she is hospitalized for six months, not six weeks, but six months. Right in the middle of dental school. We are busy in the hospital every day with our our third daughter, Megan. And she had many problems, had a stroke at birth, but anyway, That's a whole different story. But it did make me just have one goal and that's to graduate because I was so busy with my family and and those needs that I had to just try to get my requirements done and just graduate. And the idea of graduating the top ten, I just didn't have the time to to study all of the subjects and all of the intensity that you need to do to do that. And so I just graduated. And when I graduated from University Pacific, I was on a scholarship to the Navy. So I went into general practice in the Navy full time, and I was assigned to a Marine Corps base called 29 Palms, California, where there were eight other dentists, general dentist practicing there. And we had specialties in endodontics, oral surgery and prosthodontics And with those three years, you know, I did the dentistry that I was taught how to do and did it to my best abilities. But I remember very specific. I had a conversation with another dentist who was a year ahead of me. I was there three years and Harvey, the dentist ahead of me, he only had one more year of his payback on his scholarship and he became good friends and I said, Harvey, you know, the one thing I can't figure out, though, is when do you do a filling and when does it need a crown? And he said, Well, you don't really have the hard guidelines. You just know that you needed a crown if your filling or the tooth breaks. So you fill all the teeth and then if they break, they need crown, you know, then after three years and getting to know the endodontist you know, I understood that the reason why endodontics is necessary is because the inside of the tooth, the pulp dies from infection. Now, as an undergraduate microbiology major, I understood the decay was a process mediated by these little micron. bacteria. Well, if a decay causes the softness of the tooth and softness of the tooth causes the tooth to break and the death of the pulp is related to this decay process. I didn't know anything about cracks because it was obvious to me when these teeth that were decayed underneath fillings broke that, you know, they broke in two pieces. How did that happen? But I mean, these are all things that every dentist who learns how to do an amalgam filling or every dentist who learns how to do a bonded composite filling that breaks, you know, comes across and like, what do I do now? Well, you know, the traditional profession as well. You do the root canal and then you do the crown. And in the military, you didn't have the option to really do that on every soldier. Only the the high ranking officers really got that type of advanced training. Some would get root canals, but they wouldn't get crowns. And then we would see these teeth that were root canal treated without crowns break And there is a relation there that you learn from experience. And so when you get into private practice, you say, Well, all of my patients that get root canals are going to get crowns. And that was the thinking of the day when I finished my military experience in 1981. I went into private practice and for ten years I did the fillings. When the fillings broke down, I did crowns when the nerves died, did root canals or referred them to root canals. And then about ten years I started to see teeth break in an irreparable way, which we call a catastrophic failure. At ten years. I look back in my records and I realized that I had been for ten years setting the stage for this progression of fillings getting larger, having pulps die, getting crowns, and the crowns fracture in a way that you lose the tooth. The next stage would be a bridge, and bridge failures become even more short term successful. And so the emerging ideas of implants that came at this time from mid 1970s to the mid 1980s seem promising, but they were fraught with failures and so implants were really not a real viable option until the mid-nineties. And that was the time when I was really becoming depressed, frustrated with my profession, not happy. We had a growing family and Hillary wasn't even. What year were you born? But the idea is that I became frustrated after 17 years and I had started to study the history, which had always been interesting to me. And I told my wife my plan was to get a graduate history degree and teach history. I'd be happy doing that. I'm not happy being a dentist. Of course, she soon found out the history professors, no matter what level, are going to make about as half as much as the average dentist. So she had to do the budget and say, Well, I wonder if this is really a good idea. But, you know, she was supporting me. And from 1988 till 1995, I was preparing to make this transition to history, taking graduate history courses. But then in 1995, a friend of mine who an Army dentist, I was in the Army Reserve for the years from 1983 till I retired 20 years later. But in the Army Reserve, a good friend of mine, Joe Blanch, said, You know, I know you're frustrated, Dave, with all this sensitivity and things that don't go well for dentistry, he said. But there's a I've heard about this new type of dentistry called adhesive dentistry, and there's a man, a dentist named Ray Bertolotti, who is teaching courses on this that says if you do this bonding, you can get rid of sensitivity underneath your restorations. Well, I said, thanks, Joe lo look into it. So I looked into it and this Ray Bertolotti was teaching a two day course in 1995 in Surf City, USA, Huntington Beach, California, where I grew up, then surfed a lot. And it was in January. And so, you know, I'd been living in Utah 1981 to 1995. I've never been to Huntington Beach in that period. And I'm thinking, I know it's going to be snowing in January. I can either go two days Huntington Beach in the sun, watching the surfing listening to these lectures, who knows if they're going to mean anything but two days in the sun, two days in the snow might be worth the chance. So with Linda's permission, I investigated this new type of dentistry called adhesive dentistry. After a two day of lectures, Dr. Roy Bertolotti explained that most of this technology was coming out of Japan and the companies who produced it. Nobody had ever heard of the United States. It was called Kuraray. I had never heard of Kuraray in 17 years of being a dentist. So I called my wife up after two days and I said, You know, I don't know if this stuff is real. I mean. Ray Bertolotti has a Ph.D. and a DDS behind his name. So obviously with two doctor's degree, he's done some some studying. But this idea of bonding to a tooth and conserving two structure rather than removing two structure to retain the feeling of the crown, that intuitively did make sense to me. And so I said if half of what he said is right, it might really change things. And then came back home and started to investigate the material that Ray Bertolotti had given out at the course. And there were about 25 doctors at this course in Huntington Beach. And I started to collect the bibliography, the references that were in the bibliography, and started to read them. In 1995, the 3000 articles that are behind me, that's it starts with one article. And then when you start reading, you have more questions. And the questions were not unimportant. How do you make a restoration last longer? What causes failure? And those questions have driven me for the last 27 years. 28 years now in two months it'll be 28 years to improve my dentistry using these adhesive methods. And as the adhesive methods developed and advanced and were successful in my private practice after 5 to 7 years, I, you know, asked myself the question, where am I at in comparison to my other mentors that had influenced me? Ray Bertolotti He does a yearly course in Yosemite, and he brought out a speaker named Gary Unterbrink to bring in 2000. I had actually met Gary Unterbrink in 1998 at the ADA convention in San Francisco, and Unterbrink and Bertolotti were about as good as you got. But because I had been studying for over five years, very intensely, someplace between to maybe 5 hours a day for five years, mastering the literature and answering the questions as I saw where early researchers had made their mistakes. I mean, I appreciate everything that every mentor for me has done. And they all made me a better dentist. But at some point I had things. I had answers that were better than the best mentors in the world that I could find in the literature or in face to face conversations. And I would include Takao Fusayama, who mentored Ray Bertolotti. I would consider the advances that Gray Unterbrink made with Bill Liebenberg as very fundamental. But again, there were things that they got wrong. But that's no criticism other than saying the science progresses by better understanding and long term following of cases. And so this is the position we're in right now. We've been following these cases for over 25 years, and every time we have a failure, we've been able to troubleshoot it and progress. And after seven years, then from 1995 to 2003, that's eight years. After eight years, I, I knew that the system that I had was better than anybody else's in the world. And I started to teach that. And the first doctor that I ever trained is still doing it. Name is Arnoud Noot. And the second doctor I trained, Wendell Robertson is still doing it, third doctor, Bob Paxton still doing it. And we have conversations for over 20 years as a working great. And so that's our goal is to in these podcasts and each episode we'll be talking about one of the Six Lessons and break that down. And then that break down will be going through the literature that supports it and the literature that is absolutely essential to understand. And with that you can be made aware of your options to get further training with many of the dozens of masters that are teaching around the world right now. And so that's our goal. And in episode two, we'll start down that road till next time we'll see you get bonded, stay bonded.