Article
Application of appropriate language and nomenclature in any scientific discipline is crucial for accurate communication, understanding and the progression of knowledge. In dentistry, as with other medical disciplines, terminology plays a pivotal role in conveying complex concepts and practices for professionals and patients. Recently, terms such as ‘biomimetic’ and ‘bio-emulation’ have gained popularity within the dental community. They often describe techniques and treatments that preserve natural tooth structure and function. However, at times, these terms may be inaccurate (often for attention-grabbing purposes), potentially misrepresenting the scientific basis and principles of the treatments to which they are meant to refer. The term ‘minimally invasive dentistry’ may offer a more precise and appropriate descriptor, especially given the potential medico-legal implications.
Understanding biomimetic and bio-emulation concepts
The concept of biomimicry originates from biology and engineering, where it refers to the design and production of materials, structures and systems that are modelled on biological entities and processes. The term was popularized by Janine Benyus in her 1997 book, Biomimicry: Innovation Inspired by Nature, which described how various human designs can be inspired by principles observed in nature.1 Biomimetic approaches in science and engineering seek to emulate nature's efficiency, sustainability and adaptability.
Bio-emulation, on the other hand, is closely related but slightly different in its emphasis. Bio-emulation suggests the imitation of the appearance and function of biological structures, while biomimicry emphasizes the functional and systemic reproduction of natural processes. Bio-emulation also leans more towards replicating the aesthetic and superficial qualities of natural entities.
The appropriation of biomimetic and bio-emulation in dentistry
These terms have been appropriated in dentistry in recent years, particularly in restorative, aesthetic and cosmetic practices. ‘Biomimetic dentistry’ often refers to techniques that aim to restore teeth in a way that closely mimics their natural form and function. This might include advanced bonding techniques using materials with structural and optical properties similar to natural dentine and enamel, and methods that aim to preserve as much of the original tooth structure as possible.2 Similarly, ‘bio-emulation’ is used to describe practices that replicate the natural appearance and function of teeth, often focusing on the aesthetic or cosmetic outcome.3
The appeal of these terms is understandable. They suggest a high-tech, cutting-edge approach that aligns with contemporary trends towards more natural and holistic forms of healthcare. However, using these terms in dentistry is problematic for several reasons. These are discussed below.
The scientific misalignment of terms
First, the terms biomimetic and bio-emulation are scientifically misleading when applied to dental treatments. Biomimicry, in its true sense, involves a deep integration of biological principles into the design and function of human-made systems. In fields like robotics, materials science and sustainable design, biomimicry involves studying and replicating complex biological mechanisms. The processes in dentistry that are labelled biomimetic are often simply advanced restorative techniques that do not involve the deep biological integration that true biomimicry entails. For example, using a dental material that mimics the hardness or translucency of enamel is a step towards replicating the material properties of a tooth. Still, it does not equate to a biomimetic approach in the broader scientific sense.
Similarly, the term bio-emulation might imply a level of replication and simulation of biological processes that exceeds what current dental materials and techniques can achieve. While advances in dental materials and adhesive techniques allow for restorations that closely match the natural appearance and some of the mechanical properties of teeth, they do not fully emulate the complex, dynamic biological processes that take place in a living tooth.4
The importance of accurate terminology
The misuse of these terms is not merely a semantic issue; it has practical implications for the field of dentistry. Misleading terminology can set unrealistic expectations for both patients and practitioners. Patients may be led to believe that certain treatments offer more natural or biologically integrated outcomes than is the case. For practitioners, the misuse of these terms can blur the lines between scientifically rigorous approaches and marketing-driven language, which can undermine the credibility of the profession.5,6,7
The term ‘minimally invasive dentistry’, which accurately describes the principles behind these advanced restorative techniques, is a more appropriate term that reflects the true nature of these treatments. Minimally invasive dentistry emphasizes the preservation of healthy tooth structure, the use of conservative techniques and the integration of preventive strategies.8 It is a well-established concept that encompasses the principles of reducing patient trauma, enhancing long-term outcomes and focusing on the patient's overall wellbeing. By using the term minimally invasive dentistry, dental professionals can more effectively communicate the essence of these techniques without resorting to the potentially misleading implications of biomimetic and bio-emulation terminology.
Medico-legal implications of terminology misuse
The inappropriate use of terminology in dentistry also carries significant medico-legal implications. As per the General Dental Council's (GDC) Standards for the Dental Team, registered dental professionals must be honest and act with integrity.6 The legal and professional frameworks surrounding dental practice also require practitioners to provide good-quality care based on the current evidence and authoritative guidance, with evidence of the attainment of informed consent.6 The latter requires clear and accurate communication and a proper understanding of the nature of the treatments being offered. When terms like biomimetic and bio-emulation are used without an accompanying clear, full and accurate explanation, there is a risk that patients may be misled into giving consent for procedures under false pretences, believing that they are receiving more advanced or biologically integrated treatments than what is provided.
In the event of a legal dispute or a regulatory challenge, where a patient feels that the treatment did not meet their expectations or was misrepresented, the terminology used by the practitioner can be a key factor in determining the liability or the outcome of a regulatory investigation. Using terms such as biomimetic may risk implying a certain standard of care or a level of innovation that exceeds what was delivered. This can expose practitioners to claims of misrepresentation or even negligence if the outcomes do not align with the expectations of the terminology used.
Furthermore, the GDC in the UK, as well as other regulatory bodies globally, stress the importance of maintaining high standards of professional communication and avoiding any form of misleading information in patient interactions and promotional materials.6 Misuse of technical terms can be seen as a breach of these professional standards and a failure to attain consent.
The case for minimally invasive dentistry
Minimally invasive dentistry represents a paradigm shift from traditional dental approaches that often involve the more extensive removal of tooth structure. This shift is based on a better understanding of dental caries as well as other hard tissue conditions, such as tooth wear, material science advances and the importance of preserving as much natural tooth structure as possible for the longevity and health of the tooth.9,10,11
For example, techniques such as air abrasion, atraumatic restorative treatment and adhesive materials that bond directly to enamel and dentine are all components of minimally invasive dentistry. These techniques are rooted in scientific research and clinical evidence, and they align with the principles of preserving natural tooth structure, reducing patient discomfort and improving the longevity of restorations.
The term minimally invasive dentistry accurately captures the essence of these approaches without overpromising or misrepresenting the scientific basis of the techniques involved. It is a term that emphasizes the clinical philosophy and goals of these treatments, namely, to provide effective dental care while minimizing harm and preserving natural structures. In the experience of the authors (and owing to the authors' special interest in tooth wear management), promoting and applying the concept of rehabilitating worn dentitions using directly bonded resin composite restorations to try to meet the patient's functional and aesthetic expectations, alongside occlusal adaptation involving relative axial tooth movements, align well to this minimally invasive concept.12
In the opinion of the authors, the use of the terms biomimetic and bio-emulation in dentistry, while popular, is not scientifically or clinically appropriate. These terms are borrowed from other fields and applied in ways that do not fully align with their original meanings. While they may serve as effective marketing tools, they risk creating confusion and setting unrealistic expectations among patients and practitioners, and the medico-legal implications of misusing these terms are significant.
The term minimally invasive dentistry is more accurate and scientifically grounded. It also better reflects the true nature of the treatments it describes. It focuses on the preservation of tooth structure, the use of conservative techniques, and the promotion of long-term oral health. By adopting and promoting the term minimally invasive dentistry, the dental community can ensure that its language remains precise, its practices remain evidence-based and its communication with patients remains clear and accurate, concomitantly aligning with the overarching goals of modern dental care, safeguarding both patient outcomes and the profession's legal and ethical standing.