What is Cosmetic Dentistry?

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.

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

Instagram
@david.alleman.dds
@davey_alleman_dmd
@allemancenter.com

YouTube
@allemancenter

Transcript

0:33

well, welcome to season three, episode three of the Six Lessons podcast. Today, our topic is cosmetic dentistry. Cosmetic dentistry has been in place since composite was around. And composites came in to, dental practice while I was in dental school, 1975 I started, dual cure composite materials were the composite that looked like a tooth, and you were able to bond them to enamel. And so a class three restoration was the option of choice. Since I started to come into dental school. But the larger aspects of cosmetic dentistry, where teeth could have all of their color changed and all of the facial services changed, that is really a phenomena that came into play the decade after I graduated from dental school in the 80s. One of my, fellow alumni from University of Pacific, Bill Dickerson, started with a group of dentist, Larry Rosenthal, Jeff Morley, one of his classmates at University Pacific. They started to embrace the technology of Colamia That was the first inventor of a porcelain veneer, and that was it. NYU, New York University Dental School. And Larry Rosenthal was, part of that early, development and became the cosmetic dentist to do veneers on the rich and famous of New York City. If you go to NYU Dental School today, you'll see the Larry Rosenthal Institute on Cosmetic Dentistry. I've been there. But, I know Morley. I know Bill Dickerson And I've spoken with them off and on over the years. But as Dickerson really got into the business of cosmetic dentistry, he established the Las Vegas Institute, where you would go there and get porcelain veneers whether you needed them or not. The dentist who brought you in as a patient would say you needed porcelain veneers to change your cosmetic, look. And then they would cut the teeth down, put the veneers on, charge them how much they charge them. And that's how dentists learned cosmetic dentistry at Las Vegas Institute. Now, are there other ways to make teeth look presentable? Of course. And the traditional way was braces. I've had braces. I had crooked teeth. I don't have crooked teeth. Now, braces didn't change the color of teeth. So the big breakthrough after orthodontists, became, established specialty stylists in the 50s, was, bleaching and bleaching was, pioneered by a man named Van Woodward at the University of North Carolina. And this bleaching was just a concentrated peroxide solutions. Other solutions were tried, but the peroxide, seemed to be the best. Didn't burn the gums too much, and the peroxide would be able to penetrate the enamel, and the enamel is penetrated through the grooves, in between the enamel rods. And there's usually about 3 to 4% water, that hydrates enamel. It keeps it from being less brittle and manages the stress fractures in enamel. But this, peroxide could go in in this, water filled, cracks in enamel that are natural and go into the dentin. That is a different actually, it is the part of the tooth that gives it color. Enamel is pretty translucent. There's no real value to it. In the world of art. You talk about hue. When you talk about value. These intense colors usually come from the dentin, which are more on the yellow brown shades. But this bleaching technique would take about a couple of weeks. But if you did this, bleaching home bleaching with trays, you could get a noticeable whiteness into the teeth. So bleaching became very popular. But the real. How should I say it? Cash cow moneymaker of a company who made a bleaching system was to take it out of the liquid form and put it into a gel form. Now, this was genius. And the genius who came up with that? His team. I actually know Dan Fisher. Dan Fisher's first invention was a hemostatic gel delivered in a syringe, plastic syringe tube with a brush tip. Roger Hicks, my first employer in Utah in 1981. Practice in the same dental professional office complex in salt Lake City with Dan Fisher. So Doctor Hicks introduced me to Dan Fisher, told me about this invention that he was using. When you do crowns and you can stop the bleeding, with this, syringe. It was very cool technique for taking impressions on traditional full coverage crowns. So Roger Hicks, you know, he's long since retired, but Dan Fisher was, my age. Exactly. Now he's 73.5, just like I am. And he continued his business acumen of developing products. And the big product that he developed and transformed was his bleaching from trays with liquid, but trays with gel, which were much easier to control. So you didn't have the peroxide burns on the gum tissue and he, Sold this product directly to the dentists, another genius, marketing method to cut out a middleman Dan Fisher's legitimate had a legitimate product that patients bought it. Cosmetic dentistry with bleach. Now, you had the option of just ortho and bleaching. Now, what if he had a little irregularly irregularity like a peg lateral or a fracture? On a central incisor class for. How would you handle those? Well, a full veneer, you can do it that way. But what do you do with full veneer? The preparation that were taught at Las Vegas Institute by Bill Dickerson and his people were based on a product that needed at least a millimeter, millimeter and a half to really look fantastic. And if you, you know, had a relationship with the company that made that ceramic, then all of a sudden you would think that, was the best way you should go. But a millimeter and a half restoration, thick veneers, like a half crown. You're preparing the tooth into dentin, usually. And so When this became a popular treatment, the same company that makes EMAX made this, original, product. the original product became so popular, based a lot of the market on LVI that, a lot of dentists, including myself, thought that was the best. But I at that time did not know anything about how to injure a tooth or not injure a tooth, because cutting crowns is something I did every day. Well, there were other more conservative ways to do porcelain veneers, and the original technique was with feldspathic, techniques, which is thin, and you can usually use feldspathic veneers in the thickness of a half to one millimeter instead of the 1.5mm. And then in that hands, the two millimeter preparations Killed pulps. I met one dentist who went to LVI and prepared 11 teeth for veneers using the Dickerson techniques and materials and, Ten of the 11 teeth went to endo Over preparation. Bad seals allowed re-infection and the pulps died. I mean, this is a fellow who told me this at a Ray Bertolotti seminar and, you know, he had no reason to exaggerate his failures. In fact, most people talking personally like to minimize their failures to people that they're just learning. But I was at a three day seminar with Rayburn and and Ray Bertolotti never embraced the more aggressive veneer preparations because he had a good lab that could use feldspathic veneers. And he and his practice over the years did 14,000. Conservative veneer preparations. And so the approach between Ray Bertolotti Ray Dickerson really is night and day. But Ray Bertolotti He didn't have a brick and mortar teaching center, you know, didn't have the business model of that. He Ray's always been teaching, seminars that, were pretty reasonably cost, and then he could teach you things that he felt like were the best way to go. And Ray Bertolotti brought the company Kuraray to the United States, almost single handedly brought caries detecting dyes to the United States at his own cost, a couple hundred thousand dollars to get FDA approval on caries detecting dye. I mean, Ray Bertolotti my first mentor did a lot of great things, but his conservative approach and veneers and cosmetic dentistry, made sense to me when Ray explained it. Because I knew Dickerson maybe I was biased against him just off the bat. one of his best students. In Las Vegas, Joe Willardson who took his training and wanted to be a cosmetic dentist and, did a lot of important cosmetic dentistry with his early materials, but eventually he came in contact. Joe Willardson did with Pascal Magne who also wanted to be a more conservative veneer preparation person. And so Pascal Magne chose the feldspathic veneer. Instead of the Empress veneer, Empress was the Ivoclar product that was pushed by LVI so hard and strong and empress was not the best veneer because it destroyed tooth structure. It looked pretty. But if the tooth goes to endo, patients don't want that anyway, Joe Willardson saw the light and he saw the business model. He was a businessman, a good businessman his whole life. Unfortunately, Joe Willardson died last week at age 53. He's buried here in Utah. His family roots are from Utah, but he grew up in Rialto, California. His father was a dentist, so Joe's a second generation dentist. went from Rialto, California, in the San Bernardino area to Las Vegas, where he established his practice, which is called true dentistry. And he built a teaching center there also when he built it, because he had a close relationship with an orthodontist, restorative dentist named Clayton Chan and Clayton Chan had a good program, still has a good program. Doesn't teach that true dentistry any longer. But they built a teaching center mainly to promote the teachings of Clayton Chan's Ortho and occlusal approaches that were based on a myomonitor technology, but, that teaching business and practice and cosmetics that Joe did brought both very important international reputation connections and national connections. And they both taught. And so in 1908, 1903, in 2003, when I started teaching biomimetic dentistry, my first real support from a company not financially in 2003, but with free products was from a company that I was recommending their products, and this was called Kuraray I was recommending these products because for eight years from 1995, when I learned about this company and their products from Ray Bertolotti to 2003, I'd been using Kuraray products, and cura products had the ability to bond a thin veneer and never have a debond. And like I said, Ray Bertolotti did 14,000 of them. He would know but the products were a dual cure product, total etch, dual cure product called Photo Bond. Photo bond is a great product for bonding to enamel. I mean, fantastic, I never had of debonded veneer where we had mostly enamel, but on some veneers, through restorative failures or new decay, there's dentin to bond to. So Ray Bertolotti had to teach a veneer technique which was conservative, that interacted with a restorative dentin replacement technique. And the products that he used were Kuraray for bonding to enamel. But the best bond in 1995 to dentin was not from a Kuraray product. So the first product I learned was made by Biscoe and was called all bond two. This is a lot of history. But, you know, if you if it boards because history board and you don't have to watch it, you know, you're not not paying for this. But the idea is that this evolution left cosmetic dentists who were the. Pupils of Jeff Morley or Bill Dickerson or Ray Bertolotti to decide what products are we going to use, what technique am I going to use? What materials I'm going to use all these three concepts are major in adhesive dentistry, but it really depends on where the tooth is on the arch. And what substrates are bonding to the further back and the arc that you get, the more stresses. So once you start putting a veneer on a covered or a first or a second bicuspid on a large smile, then you start having occlusal forces that stress the bonding technique that will cause the failures before the failures. On for interior veneers, on the maxillary arch. So Joe in his practice was negotiating these things. He's 20 years younger than me. So I'd been practicing 20 more years than he had, you know, from 1978 to 1998. I'm working these things out. But he is basically just starting in the late 90s. You know, probably like all children, sometimes, if your father is successful in one thing, you might want to be successful in, something's a little different than your dad's. I mean, that happens all the way. Every kid doesn't want to be an exact copy of their parents. But Joe, for whatever reason, moved from San Bernardino, Riverside, Rialto area to Las Vegas, make his own practice. Yet another brothers became a dentist. Actually, two other brothers became a dentist, one a periodontist and one the restorative dentist. and they, also, moved out of their dad's hometown. But as a second generation dentist, you kind of know more than somebody who just wants to be a dentist because their dentist was a great guy and had a nice car. You know? And so Joe Willardson found out about us in 2004. We'd been teaching for a year, and he called me 2004, 2005. It might have been 2006, 2007. Sometime in these early years before we had an Academy of Biomimetic Dentistry, or we were bringing in speakers like Simone Deliperi He called me up, introduce himself, and said, you know, I've been introduced to biomimetic dentistry, through the book, Pascal Magne which was published in 2002. And I said, well, you know, there's a little bit of reference to, some important concepts like immediate didn't ceiling. He uses a gold standard bonding system Optibond FL I mean, there's some good things in that book, but obviously if you have deep caries or any cracks, you're going to have a problem because there's no mention of any of that in his book. And there was only one adhesive only in the whole book. Everything else was interior veneers. And so all of a sudden, Joe Willardson in Las Vegas and saying, oh, so biomimetics doesn't mean mimicking how teeth look. And I said, well, yeah, our teeth look okay. They're white you know, they don't hurt. They last a long time. A patient looking at them, you know, isn't going to know if there's made out of Emax or feldspathic or composite because they look like a tooth. And more importantly, they act like a tooth. There's no sensitivity. And the long term that we've been doing this, which at that point was eight years in my hands from 1998 to 2003. I said, with these techniques and these products now, we expect to have decades longer success than traditional dentistry. Now, this explanation to Joe Willardson was new to him. He had never heard anything about posterior restorations being improved by adhesive dentistry. In fact, his posterior restorations were average, and most of his go to restorations on structurally compromised teeth were crowns. And so he asked me, he said, so you're not doing crowns on back teeth? And I said, no, Joe, I haven't dental crown on the back tooth for eight years And so he says, well, we really need to get together and get taught. And then he mentioned that he had a teaching center. I said, would you like to give a program here at the Teaching Center in Las Vegas? So ten. 12 years ago, 2012, I think 2013 maybe, we took our microscopes and took our equipment and he brought in ten of the doctors that he had been teaching cosmetic dentistry to. I know it was actually a larger class. I think we had 15, maybe 20. Anyway, we end up doing, three, six lessons courses in Las Vegas, partnering with Joe in a business partnership with Split Profits. And he would recommend our courses. We'd recommend his cosmetic courses and the courses by Clayton Chan with the myomonitors. We recommend those. I went through some training, but some, equipment for that. It's still a good a good approach to large cases where you're opening vertical dimension. But as I got to know Joe over the years, always very impressed with him. He liked what we were doing. And then he made me an offer. To videotape in a business model and sell the six lessons with online, recordings. it was the first time that online dental education was coming through, the company that he had been working with, was called Light Speed. And light Speed was a video taping company. That was the first one to do real big names like Tony Robbins. You know, you do the video and then he would sell it and but it's a production, you know, you have to have videographers, you have to have sound people. You have to have the editors with the expensive programs to do all that. Editing a video. You know, we've done a little bit of this, and Audrey is our expert and she does a great job. But all of these programs have history of beginning development and marketing. But anyway, this business that he built up had a lot of talent come in and you'd the talent would come in to the green room, and then you'd go and do your recording with the green screen behind you with they'll put on the pictures in the back, and then you'll have a teleprompter so you don't forget your lines. And then, you know, if you don't do it right, they'll say, okay, I was pretty good, but let's do it another time. And, you know, it's like you're in Hollywood and you know, that's the magic or the deceptions of Hollywood. But I did this green screen recording for four days in Las Vegas. It was grueling work for me, after four days, I was pretty exhausted. We got the editing done. We sold some some, courses, I mean, it was a very good educational experience for me. But Joe became convinced that biomimetic dentistry was the next evolution of adhesive dentistry, past cosmetic dentistry, and now into biomimetic dentistry. He always had that confidence and supported me over the years. The last time I saw him face to face was two years ago. And I, who are a key opinion leaders meeting in Florida, Davey and I were there and a guy came up behind me, put his hands over my eyes and gave me a big hug. Who's your who's your favorite student? That was the question that Joe asked, and, anyway, I peeked it was Joe. We had a great night. Just a good, good person, you know, father of three children. And the now is his his widow, Audrey has, you know, challenges that she didn't expect. I'm sure. And you know, none of us have, a lease on life that we can guarantee how long we live. And when we lose a friend, it's always, very hard. But the memories of a good friend, an honest friend, a friend that did things for you and you tried to do things for them. These are. These are friendships you will never forget in your life. And I had this kind of friendship with Joe Willardson And I'll always, try to, help everybody understand what a good person he was. And, in honor of Joe Willardson that we dedicate this lecture to, we hope we can all be good people like Joe Willardson was and is. And in our memory, we'll never forget what he what he did for us. till next time, get bonded, stay bonded.