 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2025, vol. 31, issue4
Subject Area: Dental Medicine
-
DOI: 10.5272/jimab.2025314.6542
Published online: 15 October 2025
Review article
J of IMAB. 2025 Oct-Dec;31(4):6542-6554
BIOMIMETIC STRATEGIES AND ADHESIVE PROTOCOLS IN THE RESTORATION OF SEVERELY COMPROMISED POSTERIOR TEETH - A CONTEMPORARY REVIEW STUDY
Nikoteta Nikolova1
, Miryana Raykovska2, Evgeni Koytchev3, Angela Gusiyska1,
1) Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University Sofia, Bulgaria.
2) Institute of Information and Communication Technologies, Bulgarian Academy of Sciences, Sofia, Bulgaria.
3) Institute of Mechanics, Department of Biomechanics, Bulgarian Academy of Sciences, Sofia, Bulgaria.
ABSTRACT:
Severely compromised distal teeth present significant challenges in restorative dentistry, necessitating innovative approaches that align with natural biological structures. Biomimetic principles offer a promising framework for reconstruction, emphasizing materials and techniques that mimic the mechanical and aesthetic properties of natural teeth. This review explores key biomimetic strategies, including advanced adhesive systems, dentin-enamel interface replication, and regenerative protocols that enhance long-term functionality. Additionally, biomimetic frameworks guide the selection of materials and methods that optimize tooth restoration while minimizing biological disruption. Stress-reducing techniques/protocols, such as improved occlusal design and reinforcement strategies, further contribute to the longevity and resilience of restorations. The role of matrix metalloproteinases (MMPs) in dentin degradation and adhesive failure is also examined, highlighting strategies for their inhibition to enhance restoration durability and longevity. By integrating these principles, clinicians can achieve restorations that closely resemble natural dentition, promoting durability and patient comfort.
Keywords: adhesion, biomimetic, cavity preparation, indirect restorations, posterior teeth,
- Download FULL TEXT /PDF 5078 KB/
Please cite this article as: Nikolova N, Raykovska M, Koytchev E, Gusiyska A. Biomimetic Strategies and Adhesive Protocols in the Restoration of Severely Compromised Posterior Teeth - A Contemporary Review. J of IMAB. 2025 Oct-Dec;31(4):6542-6554. [Crossref - 10.5272/jimab.2025314.6542]
Correspondence to: Nikoleta Nikolova, Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University- Sofia; 1, George Sofiyski Blvd., Sofia - 1606, Bulgaria; E-mail: niki.nikolova87@gmail.com
REFERENCES:
1. Samartzi T, Papalexopoulos D, Sarafianou A, Kourtis S. Immediate Dentin Sealing: A Literature Review. Clin Cosmet Investig Dent. 2021 Jun 21;13:233-256. [PubMed]
2. Bazos P, Magne P. Bio-emulation: biomimetically emulating nature utilizing a histo-anatomic approach; structural analysis. Eur J Esthet Dent. 2011 Spring;6(1):8-19. [PubMed]
3. Hegde VR, Joshi SR, Hattarki SA, Jain A. Morphology-driven preparation technique for posterior indirect bonded restorations. J Conserv Dent. 2021 Jan-Feb;24(1):100-104. [PubMed ]
4. Dionysopoulos D, Gerasimidou O. Biomimetic Dentistry: Basic Principles and Protocols. ARC J Dent Sci. 2020; 5(3):1-3. [Crossref]
5. Alleman DS, Nejad M, Alleman DS. The Protocols of Biomimetic Restorative Dentistry: 2002 to 2017. Inside Dentistry. 2017 Jun 1;13(6):64-73.[Internet ]
6. Deliperi S. Functional and aesthetic guidelines for stress-reduced direct posterior composite restorations. Oper Dent. 2012 Jul-Aug;37(4):425-31. [PubMed ]
7. Hassan KA, Khier SE. Decoupling with split-increment: An Alternative Biomimetic Protocol for Improving Pulpal Floor Adaptation of Direct Large Composite Restorations. J Clin Res Dent. 2022; 4(2):1-5. [Internet ]
8. Bijelic-Donova J, Bath AK, Rocca GT, Bella ED, Saratti CM. Can Fiber-reinforced Composites Increase the Fracture Resistance of Direct Composite Restorations in Structurally Compromised Teeth? A Systematic Review and Meta-analysis of Laboratory Studies. Oper Dent. 2025 Jan 1;50(1):E1-E29. [PubMed]
9. Mangoush E, Garoushi S, Lassila L, Vallittu PK, Säilynoja E. Effect of Fiber Reinforcement Type on the Performance of Large Posterior Restorations: A Review of In Vitro Studies. Polymers (Basel). 2021 Oct 26;13(21):3682. [PubMed]
10. Agrawal VS, Shah A, Kapoor S. Effect of fiber orientation and placement on fracture resistance of large class II mesio-occluso-distal cavities in maxillary premolars: An in vitro study. J Conserv Dent. 2022 Mar-Apr;25(2):122-127. [PubMed]
11. Jakab A, Volom A, Sáry T, Vincze-Bandi E, Braunitzer G, Alleman D, et al. Mechanical Performance of Direct Restorative Techniques Utilizing Long Fibers for "Horizontal Splinting" to Reinforce Deep MOD Cavities-An Updated Literature Review. Polymers (Basel). 2022 Apr 1;14(7):1438. [PubMed]
12.Radhakrishnan G, Mathialagan S. Effect of fiber orientation on mechanical behavior of glass fiber reinforced polyethylene terephthalate foam sandwich composite. Mat Today Proc. 2022; 6(2):624-628. [Crossref ]
13. Guimarães GF, Marcelino E, Cesarino I, Vicente FB, Grandini CR, Simões RP. Minimization of polymerization shrinkage effects on composite resins by the control of irradiance during the photoactivation process. J Appl Oral Sci. 2018 Jun 18;26:e20170528. [PubMed]
14. Susila A. Role of Composition on Polymerization Shrinkage and Shrinkage Stress in Dental Composites. J Oper Dent Endod. 2021; 6(1):31-44. [Crossref]
15. Yantcheva SM. Marginal Adaptation and Micropermeability of Class II Cavities Restored with Three Different Types of Resin Composites - A Comparative Ten-Month In Vitro Study. Polymers (Basel). 2021 May 20; 13(10):1660. [PubMed]
16. Deliperi S, Alleman D, Rudo D. Stress-reduced Direct Composites for the Restoration of Structurally Compromised Teeth: Fiber Design According to the "Wallpapering" Technique. Oper Dent. 2017 May/Jun; 42(3):233-243. [PubMed ]
17. Somani R, Som NK, Jaidka S, Hussain S. Comparative Evaluation of Microleakage in Various Placement Techniques of Composite Restoration: An In Vitro Study. Int J Clin Pediatr Dent. 2020 May-Jun;13(3):264-268. [PubMed ]
18. Paryani M, Bhojwani PR, Ikhar A, Reche A, Paul P. Evolution of Biomimetic Approaches for Regenerative and Restorative Dentistry. Cureus. 2023 Jan 18;15(1):e33936. [PubMed]
19. Zafar MS. A Comparison of Dental Restorative Materials and Mineralized Dental Tissues for Surface Nanomechanical Properties. Life Sci J. 2014; 11(10s):19-24.
20. Albeshir EG, Alsahafi R, Albluwi R, Balhaddad AA, Mitwalli H, Oates TW, et al. Low-Shrinkage Resin Matrices in Restorative Dentistry-Narrative Review. Materials (Basel). 2022 Apr 18;15(8):2951. [PubMed]
21. Seredin P, Goloshchapov D, Kashkarov V, Ippolitov Y, Vongsvivut J. The Molecular and Mechanical Characteristics of Biomimetic Composite Dental Materials Composed of Nanocrystalline Hydroxyapatite and Light-Cured Adhesive. Biomimetics (Basel). 2022 Mar 30;7(2):35. [PubMed ]
22. Bonchev A, Bogovska-Gigova R. Alkasites in restorative dentistry: a review of their performance and properties. J Dent. 2025 Sep;160:105916. [PubMed]
23. Zhou Z, Li A, Sun K, Guo D, Li T, Lu J, et al. Synthesis of a novel monomer "DDTU-IDI" for the development of low-shrinkage dental resin composites. Dent Mater. 2024 Apr;40(4):608-18. [PubMed]
24.de Kuijper MCFM, Cune MS, Özcan M, Gresnigt M. Clinical performance of direct composite resin versus indirect restorations on endodontically treated posterior teeth: a systematic review and meta-analysis. J Prosthet Dent. 2023 Sep;130(3):295-306. [PubMed ]
25. Gusiyska A, Dimova-Gabrovska M, Nikolova N. Biomimetic capabilities of lithium disilicate glass-ceramic restorations on posterior teeth: evaluation of the long-term survival rate – a 10-year follow-up. Appl Sci. 2024;14:9964. [Crossref]
26. Petrova-Pashova V. [Indirect restoration of severely damaged vital teeth with resin-based composite materials.] PhD thesis, Sofia. 2022, p.192. [in Bulgarian]
27. Hafez M, Abd El-Ghany A, Taha A, Amin A. In vitro assessment of fracture resistance of endodontically treated teeth restored with short fiber reinforced resin-based composite and ceramic overlays. BMC Oral Health. 2025 Feb 8;25(1):211. [PubMed ]
28. Alsayed B, Suliman A, Clark W, Cook R, Sulaiman T. Effect of photo-polymerization delay on the bond strength and microhardness of dual-polymerizing resin cements. Oper Dent. 2023;48(4):457–463. doi:10.2341/22-119-L. [PubMed ]
29. Yu M, Li J, Liu S, Xie Z, Liu J, Liu Y. Diagnosis of cracked tooth: Clinical status and research progress. Jpn Dent Sci Rev 2022 Nov;58:357-364. [PubMed]
30. Lassila L, Säilynoja E, Prinssi R, Vallittu P, Garoushi S. Bilayered composite restoration: the effect of layer thickness on fracture behavior. Biomater Investig Dent. 2020 Jun 2;7(1):80–85. [PubMed]
31. Hovander D, Chyz G, Shimada Y, Tagami J, Sadr A. Optical coherence tomography evaluation of deep dentin crack removal techniques. JADA Found Sci. 2022;1:100012. [Crossref ]
32. Magne P. Esthetic and Biomimetic Restorative Dentistry: Manual for Posterior Esthetic Restorations. Los Angeles, CA: USC School of Dentistry; 2006.
33. Magne P, Belser UC. Rationalization of shape and related stress distribution in posterior teeth: a finite element study using nonlinear contact analysis. Int J Periodontics Restorative Dent. 2002 Oct;22(5):425–433. [PubMed ]
34. Van Meerbeek B, Yoshihara K, Van Landuyt K, Yoshida Y, Peumans M. From Buonocore's Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology. J Adhes Dent. 2020; 22(1):7-34. [PubMed ]
35. Sofan E, Sofan A, Palaia G, Tenore G, Romeo U, Migliau G. Classification review of dental adhesive systems: from the IV generation to the universal type. Ann Stomatol (Roma). 2017 Jul 3;8(1):1-17. [ PubMed ]
36. Van Meerbeek B, Van Landuyt K, De Munck J, Hashimoto M, Peumans M, Lambrechts P, et al. Technique-sensitivity of contemporary adhesives. Dent Mater J. 2005 Mar;24:1-13. [PubMed ]
37. Brkanović S, Sever EK, Vukelja J, Ivica A, Miletić I, Krmek SJ. Comparison of Different Universal Adhesive Systems on Dentin Bond Strength. Materials (Basel). 2023 Feb 12;16(4):1530. [PubMed]
38. Muñoz MA, Luque I, Hass V, Reis A, Loguercio AD, Bombarda NH. Immediate bonding properties of universal adhesives to dentine. J Dent. 2013 May;41(11):404–411. [PubMed]
39. Meshki R, Khataminia M, Beigi S, Salehi Veisi M. Comparison of the Push-Out Bond Strength of 5th, 6th , 7 th and 8th Generation Bonding Agents to Intracanal Dentin of Primary Anterior Teeth. J Babol Uni Med Sci. 2023; 25(1):26-35. [Internet]
40. De Munck J, Mine A, Poitevin A, Van Ende A, Cardoso MV, Van Landuyt K, et al. Meta-analytical review of parameters involved in dentin bonding. J Dent Res. 2012 Apr;91(4):351-357. [PubMed]
41. Meng Y, Huang F, Wang S, Li M, Lu Y, Pei D, et al. Bonding performance of universal adhesives applied to nano-hydroxyapatite desensitized dentin using etch-and-rinse or self-etch mode. Materials (Basel). 2021 Apr 22;14(16):4746. [PubMed ]
42. Perdigão J. Current perspectives on dental adhesion: (1) Dentin adhesion - not there yet. Jpn Dent Sci Rev. 2020 Nov;56(1):190-207. [PubMed ]
43. Buonocore M. A Simple Method of Increasing the Adhesion of Acrylic Filling Materials to Enamel Surfaces. J Dent Res. 1955 Dec;34(6):849-853. [PubMed ]
44. Saikaew P, Sattabanasuk V, Harnirattisai C, Chowdhury А, Carvalho R, Sano H. Role of the smear layer in adhesive dentistry and the clinical applications to improve bonding performance. Jpn Dent Sci Rev. 2022 Nov;58:59-66. [PubMed ]
45. Gateva N, Gusyiska A, Stanimirov P, Kabaktchieva R, Raichev I. Effect of etching time and acid concentration on micromorphological changes in dentin of both dentitions. J of IMAB. 2016 Apr-Jun;22(2):1099-1110. [Crossref]
46. Frassetto A, Breschi L, Turco G, Marchesi G, Di Lenarda R, Tay FR, et al. Mechanisms of degradation of the hybrid layer in adhesive dentistry and therapeutic agents to improve bond durability: a literature review. Dent Mater. 2016 Feb;32(2):e41–53. [PubMed ]
47. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by the infiltration of monomers into tooth substrates. J Biomed Mater Res. 1982 May;16(3):265-273. [PubMed ]
48. Nakabayashi N. [Resin reinforced dentin due to infiltration of monomers into the dentin at the adhesive interface.] [in Japanese] JSDMD. 1982;1:78-81. [Internet ]
49. Betancourt DE, Baldion PA, Castellanos JE. Resin-Dentin Bonding Interface: Mechanisms of Degradation and Strategies for Stabilization of the Hybrid Layer. Int J Biomater. 2019 Feb 3;2019:5268342. [PubMed ]
50. Koytchev E, Takahashi Y, Suzaki N, Okamoto M, Hayashi M. Bonding performance of a newly developed one-step single-bottle adhesive on sound human dentin with different tubule orientations. Series on Biomechanics. 2020; 34(1):3-11. [Internet]
>
51. Pashley DH, Tay FR, Breschi L, Tjäderhane L, Carvalho RM, Carrilho M, et al. State of the art etch-and-rinse adhesives. Dent Mater. 2011 Jan;27:1–16. [PubMed ]
52. Tay FR, Hashimoto M, Pashley DH, Peters MC, Lai SCN, Yiu CKY, et al. Aging affects two modes of nanoleakage expression in bonded dentin. J Dent Res. 2003 Jul;82(7):537–41. [PubMed ]
53. Tjäderhane L, Nascimento F, Breschi L, Mazzoni A, Tersariol I, Geraldeli S, et al. Strategies to prevent hydrolytic degradation of the hybrid layer—a review. Dent Mater. 2013 Oct;29(10):999-1011. [PubMed ]
54. Fan-Chiang YS, Chou PC, Hsiao YW, Cheng YH, Huang Y, Chiu YC, et al. Optimizing Dental Bond Strength: Insights from Comprehensive Literature Review and Future Implications for Clinical Practice. Biomedicines. 2023 Nov 8;11(11):2995. [PubMed ]
55. Shruthi P, Krishna M, Reddy S, Dilip J, Rajani P. Biomimicry revolutionizing dentistry: a review. Int J Appl Dent Sci. 2024; 10(2):88–93. [Crossref]
56. Bourgi R, Kharouf N, Cuevas-Suárez CE, Lukomska-Szymanska M, Haikel Y, Hardan L. A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications. Appl Sci. 2024; 14(18):8111. [Crossref]
57. Henriques NYA, dos Santos Gonçalves RI, da Silva ARJ, Freire WP, de Vasconcelos Catão MHC, et al. Metalloproteinase inhibitors in the adhesion process dental. Caderno Pedagógico. 2024; 21(12):e10229. [Crossref]
58. Neves J, Marcato P, de Paula E Silva F, Mantovani C, Prado H, Aires C, et al. Synthesis and characterization of an experimental primer containing chitosan nanoparticles: effect on the inactivation of metalloproteinases, antimicrobial activity and adhesive strength. Arch Oral Biol. 2021 Jul;127:105148. [PubMed ]
59. Hardan L, Daood U, Bourgi R, Cuevas-Suárez CE, Devoto W, Zarow M, et al. Effect of collagen crosslinkers on dentin bond strength of adhesive systems: a systematic review and meta-analysis. Cells. 2022 Aug 4;11:2417. [PubMed ]
60. Bourgi R, Daood U, Bijle M, Fawzy A, Ghaleb M, Hardan L. Reinforced Universal Adhesive by Ribose Crosslinker: A Novel Strategy in Adhesive Dentistry. Polymers (Basel). 2021 Feb 26;13(5):704. [PubMed ]
61. Giacomini M, Scaffa P, Gonçalves R, Zabeu G, Vidal C, Carrilho M, at al. Profile of a 10-MDP-based universal adhesive system associated with chlorhexidine: Dentin bond strength and in situ zymography performance. J Mech Behav Biomed Mater. 2020 Oct;110:103925. [PubMed ]
62. Imazato S, Ehara A, Torii M, Ebisu S. Antibacterial activity of dentine primer containing MDPB after curing. J Dent. 1998 Mar;26(3):267-71. [PubMed ]
63. Imazato S, Kinomoto Y, Tarumi H, Ebisu S, Tay FR. Antibacterial activity and bonding characteristics of an adhesive resin containing antibacterial monomer MDPB. Dent Mater. 2003 Jun;19(4):313-9. [PubMed ]
64. Koytchev E. Long-term microtensile bond strength of universal adhesives with human dentin: a mini review. Series on Biomechanics. 2023; 37(2):43-48. [Crossref]
65. Tezvergil-Mutluay A, Mutluay MM, Gu LS, Zhang K, Agee KA, Carvalho RM, et al. The anti-MMP activity of benzalkonium chloride. J Dent. 2011 Jan;39(1):57-64. [PubMed ]
66. Cadenaro M, Josic U, Maravić T, Mazzitelli C, Marchesi G, Mancuso E, et al. Progress in Dental Adhesive Materials. J Dent Res. 2023 Mar;102(3):254-262. [PubMed ]
67. Fan J, Wang P, Wang S, Li R, Yang Y, Jin L, et al. Advances in macro-bioactive materials enhancing dentin bonding. Discov Nano. 2025 Feb 17;20(1):40. [PubMed]
68. Almeida G, Marques J, Meerbeek B, Ramos J, Falacho R. Particle abrasion as a pre-bonding dentin surface treatment: A scoping review. J Esthet Restor Dent. 2024 May;36(5):746-760. [PubMed ]
69. Politano G, Fabianelli A, Papacchini F, Cerutti A. The use of bonded partial ceramic restorations to recover heavily compromised teeth. Int J Esthet Dent. 2016 Autum;11(3):314-36.[PubMed ]
70. Szerszeń M, Higuchi J, Romelczyk-Baishya B, Górski B, Łojkowski W, Pakieła Z, et al. Physicochemical Properties of Dentine Subjected to Microabrasive Blasting and Its Influence on Bonding to Self-Adhesive Prosthetic Cement in Shear Bond Strength Test: An In Vitro Study. Materials (Basel). 2022 Feb 16;15(4):1476. [PubMed ]
71. Hardan L, Daood U, Bourgi R, Cuevas-Suárez C, Devoto W, Zarow M, et al. Effect of Collagen Crosslinkers on Dentin Bond Strength of Adhesive Systems: A Systematic Review and Meta-Analysis. Cells. 2022 Aug 14;11(15):2417. [PubMed ]
72. Elbishari H, Elsubeihi S, Alkhoujah T, Elsubeihi H. Substantial in-vitro and emerging clinical evidence supporting immediate dentin sealing. Jpn Dent Sci Rev. 2021 Mar;57:101–110. [PubMed ]
73. Samartzi T, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz M. Deep Margin Elevation: A Literature Review. Dent J (Basel). 2022 Mar 14;10(3):48. [PubMed ]
74. Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz M. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel). 2024 Mar 17;9(3):182. [ PubMed ]
75. Bresser R, Naves L, van der Made S, Cune M, Gresnigt M. Deep margin elevation. Int J Esthet Dent. 2023;18(2):142-160. [PubMed ]
76. Varadan P, Balaji L, Manaswini D, Rajan R. Reinforced Immediate Dentin Sealing vs Conventional Immediate Dentin Sealing on Adhesive Behavior of Indirect Restorations: A Systematic Review. J Contemp Dent Pract. 2022 Oct 1;23(10):1066-1075. [PubMed ]
77. Ghiggi P, Steiger A, Marcondes M, Mota E, Burnett L Júnior, Spohr A. Does immediate dentin sealing influence the polymerization of impression materials? Eur J Dent. 2014 Jul;8(3):366-372. [PubMed ]
78. Magne P, Douglas W. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont. 1999 Mar-Apr;12(2):111-21. [PubMed ]
79. Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: A literature review. J Prosthodont Res. 2018 Jul;62(3):273-280. [PubMed ]
80. Eggmann F, Ayub J, Conejo J, Blatz M. Deep margin elevation-Present status and future directions. J Esthet Restor Dent. 2023 Jan;35(1):26-47. [PubMed ]
Received: 24 June 2025
Published online: 15 October 2025