Biomimetics and Beyond: The Future of Dentistry with Dr. Fran Brelsford and Dr Lydia Sharples

Are you ready to demystify the world of biomimetic dentistry? You're in luck, as we're joined by Dr. Fran Brelsford, ahead of the BACD Annual Conference in November, who is going to reveal the secrets of this fascinating area of cosmetic dentistry. We dive right into the heart of biomimetics, a technique that takes us back to the basics, restoring teeth to their natural state by understanding the biomechanics and properties of each layer of a tooth. We explore the proof in the pudding with evidence-based protocols and delve into the predictability and reproducibility biomimetics brings to dental practice.

We're not just talking theory here. Dr. Brelsford walks us through how to handle deep lesions, and we debate on who exactly makes the perfect delegate for the BACD Annual Conference. We also touch on the challenges newcomers face in understanding biomimetic dentistry and the vital role of acronyms to simplify the process.

In this fast-paced world, it's easy to feel overwhelmed. That's why we round off our discussion by reflecting on the unique aspects of dentistry as a career and the lessons we can learn from other disciplines. We also chat about how podcasts can be a useful tool to decompress while gaining new insights. 

So, join us to explore, learn, and grow with Dr. Fran Brelsford as we navigate the exciting world of biomimetic dentistry. You wouldn't want to miss it!

For the video versions of all BACD Podcasts head to https://youtube.com/playlist?list=PL_QEFI0rmiaNYJmACUGLq8Re3uZ0icAOU&si=qw2NCg1iBZ7iKBkU

Transcript

Speaker 1: 0:01

Welcome to the official podcast of the British Academy of Cosmetic Dentistry. Whether you're a seasoned dental professional, an eager student or simply someone curious about the intricacies of cosmetic dentistry, you're in the right place. Here at the BACD, we bring together the brightest minds, groundbreaking research and innovative practices from across the UK and beyond. In each episode, we aim to delve deep, offering insights, sharing stories and demystifying the beautiful world of cosmetic dentistry. I'm Simon Chard, president of the BACD. I'm thrilled to have you join us on this enlightening journey. Let's dive right in.

Speaker 2: 0:42

Hello everybody and welcome to this podcast. My name's Lydia, I'm one of the directors at the BACD and we're recording this podcast with Dr Fran Ralsford with today head of our BACD annual conference in November. Fran, thank you so much for joining us and spending the time this evening to chat. Thanks for having me. You're very, very welcome. So, fran, I feel like I've not seen or heard much from you lately, because I know you have done so much. Sabbatical from social media.

Speaker 3: 1:11

Instagram, I know.

Speaker 2: 1:13

All of my updates from you, so what?

Speaker 3: 1:15

have you been up?

Speaker 2: 1:15

to. How are you?

Speaker 3: 1:17

I'm good. Yeah, it was a bit of a spur of the moment thing. I just decided to take a few months off just dental Instagram, just to have a breather from it. I've been quite busy with friends' weddings and going away and finishing off a couple of other courses. I've kind of taken it upon myself to go and visit everybody I refer to as well, so I've just been doing little bits in the background. Oh, that's really nice.

Speaker 3: 1:40

It has been. Yeah, it's been a bit of a nice breather. I'm ready to start posting things again now, but yeah, it gets a lot sometimes.

Speaker 2: 1:50

But you have a huge amount of cases to post and show us.

Speaker 3: 1:55

It was quite a few. It'd be good to be back Good for you.

Speaker 2: 2:00

So, fran, yeah, absolutely, it'll be good to have you back. So, fran, for anyone who doesn't know you and hasn't come across you yet, could you just give us a brief introduction and tell our audience a little bit about yourself?

Speaker 3: 2:15

Of course. So, yeah, hi everyone, I'm Fran. I graduated from dental school in Sheffield in 2013. So literally 10 years ago last month Did Maxfax SHO year up there in VT and then decided I really wanted to do a restorative course. So I moved to London to do a MSC in restorative at Eastman, which kind of brought me into lockdown, and our final year was pretty much when we went into full lockdown in the beginning. And, yeah, I set up an Instagram page around that time because everybody was doing it, it was the in thing and I didn't have really much to post in the way of clinical cases because we were closed and we weren't working in that way. So I started reading all the recommended reading from the masters that I'd never done and posted some of the papers with like simplified breakdowns on them just as something to do. I'm not very good at sitting still.

Speaker 3: 3:21

And, yeah, I started tagging the authors of them and talking to a few people that actually written the papers on on Instagram, which was lovely. And then I got in touch with David Allerman, who was one of the authors of the papers I was reading, and he said, oh, you need to come and do this biometric master ship program. So it was all online in the middle of lockdown. I think we were the second group ever to do it and there's like 12 people from around the world, so there was people from like shooting in from California and Calcutta, belgium. It was really lovely.

Speaker 3: 3:56

It's like quite nice to have that connection when you're in the middle of craziness. And yeah, I kind of found my love for this little niche of restorative dentistry called biomemetics or advanced adhesive bio inspired, I think they're calling it. Now met Stuart on that little group of 12. Weirdly, me and Stuart Beggs were the only ones in the UK on it and we lived down the road, so we ended up chatting, starting off an emulate course, and yeah, that's. The rest is history.

Speaker 2: 4:31

That's the rest of history. So how interesting that it all actually came from networking online through lockdown and that seems to have really transformed the direction of your career.

Speaker 3: 4:46

Yeah, definitely Instagram. I was a bit apprehensive about joining it but it really. I can only say positive things about it. I know it gets a little bit of hate sometimes, but I've met some of my most esteemed people, people admire, on there and they're just at the drop of a hat. I can message them a clinical question and they reply. I think it's. It's amazing. We live in a nature where you can do that now.

Speaker 1: 5:13

They're not just the office on a piece of paper.

Speaker 3: 5:15

They're literally DM them.

Speaker 2: 5:18

Exactly so accessible. I remember the BACD Young Dentist Day last year. Simon Chard did a talk and one of his take home messages was slide into the DMs and it sounds like actually that's something that you would probably agree with from a dental point of view. Yeah, definitely.

Speaker 1: 5:35

I feel like you need to clarify Amazing.

Speaker 3: 5:39

And you mentioned Just dentistry, just dentistry.

Speaker 2: 5:44

You mentioned biomemetics, fran. Having been on your course, I feel fairly well acquainted with biomemetics. But for anyone who isn't sure what you mean when you say biomemetics, could you kind of summarize the topic? In a sentence or a few sentences.

Speaker 3: 6:03

Sure, yeah, it gets a few different definitions from different groups but in essence it's evidence-based protocols used to restore a tooth, via indirect or direct means, back to its natural state, trying to mimic the natural sand tooth as far as possible. So it's going that little bit deeper into the biomechanics, the properties of each layer of a tooth. So mango, animole or mimosid mentioned changes. That means you don't want to supermarket their own pieces of teeth layers in like a considered systematic approach.

Speaker 2: 6:49

You've summarized biomimetics really clearly there, fran, and I'm really curious to know for you and your dentistry, what is it that makes you so passionate about biomimetics and why is it so important for you as a dentist?

Speaker 3: 7:04

I was thinking about this all week since you sent me the questions and it's something I've been talking about with my nurse this week a lot because we've had a quieter one August is always quiet at our practice. I was thinking, you know we all get told that if you have 10 dentists in a room you get 10 different opinions or treatment plans, and I know that's probably referring to bigger cases, but I do find it amazing that that still is the case. It always used to frustrate me as a student or a young dentist when that was said, because I just wanted to know the way of doing something, and I know some people everyone has a different way of how their mind works, but I just I'm someone who likes, like, attention to detail, I like a step to follow and I love the like how specific it is and evidence-based. So down to like, when we take a photo, what loops, what lighting is best, what bond is best, materials, how best to bevel is like I don't know getting into the real nitty gritty of something, but when you, I think what I always I've always found frustrating as a dentist is that that kind of it's the best and the worst thing I think about a profession that you could.

Speaker 3: 8:31

Literally you've got you're in charge of that tooth and you can do whatever you like in your chair. You've got that autistic and professional license and we all do things ever so slightly differently. But then I quite like being on the same page with a group of people that we're all doing this very similar stages and feedback with each other all over the world. That oh well. Has this kind of we started using this bond? How do you find this and are you putting an extra layer here? And I think it's that consensus I like and that predictability. I think it the same thing.

Speaker 2: 9:12

That's it. Predictability that's what successful dentistry comes down to, I think. Is it predictable and is it reproducible? And it sounds like with the biomimetic approach you really can be reproducible and almost standardized the way that you're doing your restorations and your work, so everything is. There's no deviation from that, or you can minimize deviation, which probably, but it just leaves back to me.

Speaker 3: 9:38

There's so many little questions and decisions you're making with every case, more than we imagined subconsciously and consciously, and it takes away a little bit of that so you can really focus, I find, on your technique and the practical side of it, because I know what's next every time and I find that less stressful. I know some people I think you're a certain character or the way your mind works on you. I like that. Some people prefer to. You know, oh, I'm gonna try this approach today and maybe this one and I really like that. Just know I know I'm doing before I get to work almost Just sit down and relax into it.

Speaker 2: 10:19

And I think that it also allows you to really critically appraise your work as well, and if there's something if you're introducing or if you're having any issues with your work, you can introduce changes one by one until you eliminate that, and it can almost help you identify, maybe, what's not working quite as well.

Speaker 3: 10:39

Yeah, definitely. You know we all get going on about this word protocol, but without realising everybody has their own protocol at work and following a protocol is better than nothing, because you quickly realise that, oh, that doesn't work. So I'm gonna try this and tweak this. And I think it puts people off at the beginning when they see all of this biomimetic stuff, when there's literally it might seem like there's 30 steps, but when you break it down, you can start off and take five and start putting those into your work and then, as you we call it habit, stacking on that course. As you get those underway, then you can pop another one on, and I think that's another way of getting a satisfaction from your work. It keeps it interesting that there's always something else that you can try and tweak or add in, just to make the practical side of it a bit more interesting.

Speaker 2: 11:31

Absolutely, and is this what you'll be focusing on on your hands-on session at the conference in November? You're doing the Young Dentistry, aren't you? Yeah?

Speaker 3: 11:40

Yeah, the Young Dentistry is a hands-on. On posterior composites, I mean thinking a lot of how I'd like to approach it as a session. But a lot of industries I listen to a lot of podcasts and some things I keep probably referring to them here but a lot of industries have something called a cheat sheet and it's not something that exists in dentistry. I don't think they could ever call it a cheat sheet. But I think that's what I want to kind of do it as, as this hands-on session is, that you know you have a typical posterior composite in everyday situation we're all faced with and I want to get as much information and the steps involved in how I do that workflow as possible into that session. So down to like how the drawer is organised and at what stages you take a photo, what the settings are the notes, as well as all the substrate, control, isolation, step-by-step with materials.

Speaker 3: 12:36

But, especially as a young dentist, a lot of this, I'm very aware, looks very intimidating if you're being thrown in there at the deep end. Or you see these cases on Instagram and, of course, everyone posts their most beautiful ones and the ones where the steps are clearly shown. But when you break it down, those little questions that are going in your head, if it is on a sheet and you're referring back to it, you know I'm gonna take a photo here. When you're pressed for time, that's when these protocols getting come into their own, because those you're not questioning yourself, you're just second second nature. Oh, I take a photo here and you know, down to medical legal reasons, it's like we need this one, this one, this one. That's what they're after. You need to put this in your notes.

Speaker 3: 13:22

I think I'm just gonna try and use use that session to come up with the sheet that you need To do these kind of restorations and it's that reproducibility and efficiency every day that you can refer back to and think oh yeah, that's when. I would take a photo, and soon it becomes second nature. I might even do like a standard one and then advanced on the other side.

Speaker 2: 13:44

I Love that idea. I think that's such a good way to approach any type of dentistry, but especially what you're going to be teaching on the day. And I love that you're going to go through how to set up the draw and what goes in your notes, because it's all very well when we go on these courses and you learn how to do beautiful anatomy and layering and.

Speaker 2: 14:08

You know you get all your cusps beautifully and you can fish a stain, but actually how Reproducible is that day to day when you first go back into clinic? I love going on courses that you can implement things straight away, so that sounds fantastic.

Speaker 3: 14:25

Yeah, it's. I think Organization is key when you're busy. For me, anyway, I couldn't work without having some kind of set plan and my drawers are ridiculously organized and things like that. You know, order sheets and all sorts of things. But If you yeah, it's anything to take the stress out of it, because dentistry can be stressful, so any little thing to it takes a little bit off. I think is so important.

Speaker 2: 14:54

Hmm, and for anyone who has already booked onto your course for November or who's really thinking about booking onto your hands-on session, is that anything they could be doing now, anything that they could buy or implement, or Anything that would give them a little bit of a head start ahead of the day in November?

Speaker 3: 15:15

Yeah, I know I'm like a broken record. Everyone laughs at me. Can you go on about Kerry's die book Kerry's die definitely.

Speaker 3: 15:23

So I would say you self, get yourself a little bit of cure. Cura ray, kerry's die, the pink stuff, it's cure, a clear fill, kerry's detecting die. And there is one paper to read alongside it which, as you know, lady on that course, is the first one we recommend, and it's the Kerry's removal endpoints paper by Pascal manier and David Allerman from 2012. We can put the link in, I'm sure, and it's a breakdown of it on my Instagram page. But, yeah, that shows you exactly how to use it. And I would just say, start to get a feel for that and looking at, you know, scrubbing it in for 10 seconds, washing away, removing, trying to get this peripheral seal zone and I will go into all of this on the day, but it is in the paper Just trying to get a feel for that.

Speaker 3: 16:15

And you keep reapplying it until you're happy with how the bottom of the cavity looks. And again, there's photos, color photos and step-by-step in that paper showing you how. But when we're trying to push a DC of dentistry to the limits that we do in this, this kind of dentistry, the most important thing and I do think sometimes it's overlooked is is that initial control of what you're bonding to. We could use the best bond in the world and, as you say, do the nicest looking restoration, but unless you're aware of what strength you have or you've achieved at the bottom, we just want something to work initially, like that is paramount important. So I would say that is the first thing to really and look into and rub it down if you're not, but that's a given.

Speaker 2: 17:02

I hope so. I thought that was coming in the Careers die. I think that when well, it was for me a massive turning point because when I did your course emulate with the one that you won with Stuart, that was a game changer for me in my posterior restorations and I hadn't really used Careers die much before and then, after the course, I had the bottle. I was using it routinely and now I could not live without it. I couldn't do dentistry without it.

Speaker 2: 17:31

It's almost as important as loops are, and I really couldn't believe what a difference it made, and one of the issues I was having sporadically before your course was some post-op sensitivity after composites and I have to say, since doing the course, that is now just not a concern and not an issue and I really think that by understanding the methods and the bonding and all of the biomimetic principles that you both taught, it made such a difference not only to how enjoyable it is to do the dentistry, but also the outcomes as well.

Speaker 3: 18:07

Yeah, and that's another stressful thing, isn't it? You don't want your patients coming back, particularly when you place as many posterior composites as I. It's very, very rarely happens. If ever I have a patient come in with post-op sensitivity it's when I've left occlusion too high, but it's rare. And again, that's investing a little bit, yeah, yeah, investing in how you're doing it on the actual day, the procedure. It's false economy, almost not doing these things because you don't want your diary coming in with reviews and problems. You want to know that you're doing good quality work that's pain-free when they leave and functions.

Speaker 3: 18:50

Had a lady today who in for a normal checkup and I did an E-max on-lay on her low right seven about nine months ago and I was like, oh, this looks lovely. And she said it's been perfect. But I know how much you put into that on the day and I think that's what is hard at the beginning is you are dealing with patients who aren't used to all of these extra steps and rubber down and it probably did seem like a hell of a lot to her, but it's also great that she's not that lovely. You see it coming back, never had a problem, really deep lesion. But, yeah, it's that predictability that I like about it.

Speaker 2: 19:34

So with deep lesions, is that something that you will touch on at the conference? Because I think sometimes there's a bit of a what's the best way to approach this. So there's a bit of there are mixed opinions out there.

Speaker 3: 19:50

Yeah, I will touch on deep lesions. There are actually mixed opinions of slight variations on how different biomimetic dentists, for example, deal with micro pulp exposures, that kind of thing. So a lot of it is proper diagnosis and at the beginning and trying to avoid exposures as much as possible because they are micro exposures are very tricky to deal with. But yeah, I'll go into deep carries definitely.

Speaker 2: 20:24

So who would you say is the most ideal delegate to come on your course.

Speaker 3: 20:34

I would say anybody who is doing a lot of posterior work, for sure, but particularly new graduates. I'd love to see some new graduates. I think I wish I knew what I know now a lot earlier Is that first bit, when you're out suddenly after VT and again, this is where this kind of cheat sheet thing comes in, that you wanna take a little bit of the guesswork off your shoulders and focus on getting the experience in good techniques and you can really focus on your practical skills applying it. So, yeah, I'd like to see some fresh graduates, but, yeah, anybody who does a lot of posterior work and has seen this on Instagram and is interested with Perfect as well.

Speaker 2: 21:24

That's great you did. The Young Dentist Day. Was that in 2021,? I want to say in London? Yeah, a couple of years ago now.

Speaker 3: 21:33

And you did a talk.

Speaker 2: 21:35

Yeah, you did a biomemetrics so quickly. I can't believe that that's nearly two years ago, but you did an hour-long introduction to biomemetrics and there were just, you know, jewels dropping throughout the audience and I think mine's being boggled, because a lot of the delegates on that day were either students or foundation dentists, very young graduates, and it is a completely different way of restoring teeth compared to what we taught at university.

Speaker 3: 22:08

Yeah, yeah, it is. I almost liken it to going from like GCSE science to A level and you've heard these kind of phrases used, but then you've never really understood them or they've been oversimplified and that is what you needed to you know, it's like learning to drive, isn't it BDS?

Speaker 3: 22:26

really, you do it, then you get out there, and that's when you really learn, when you're doing case after case but yeah, I was, I think I was calling it debunking myths, wasn't I almost? But they're not quite myths, but things that are oversimplified. And once you do understand them, everything starts to slot together, and that's when it's like oh, that's a light bulb moment, now that makes sense, and there's a lot of that in it. Yeah, I forget these things when you are doing it. You forget how bamboozled you were at the beginning, just like wow, oh, hang on, I want to know more. I want to know more.

Speaker 2: 23:02

And it's the acronyms as well. In biomemetrics, there are so many acronyms.

Speaker 3: 23:09

There's almost. Yeah, I think it puts people off and I can see why it's almost like this you know different language or some kind of cult that only certain people know what they stand for. But yeah, it's because there's so many stages, as people put in these acronyms into, to simplify work, writing out what you've done and once you do get a swing of it, you'll know, you realize, what they all mean. But, yeah, we absolutely. I'll explain all the acronyms on the day.

Speaker 2: 23:41

That would be good to go along with the cheat sheet, I think.

Speaker 3: 23:44

Yeah, cheat, yeah translation.

Speaker 2: 23:49

So I think November is gonna come around really quickly. You must be looking forward to the conference.

Speaker 3: 23:58

Yeah, I am. It's almost the end of summer now, isn't it? So I keep thinking why I need to get this AOK sorted now, ready for the session.

Speaker 2: 24:11

Is there anyone else at the conference that you're particularly interested to see and listen to?

Speaker 3: 24:22

I would have quite liked to have done some of the other hands-on sessions myself, but I know I'm doing the hands-on. But yeah, I'm gonna be there the whole three days. I'll be at everything I can catch and it's always really fun.

Speaker 2: 24:36

And every social I'm sure as well the garlic dinner, the Thursday night party. I'm sure there'll be one of those again.

Speaker 3: 24:45

It's great that it's here in London, isn't it? We're quite, I feel, quite smug this year. Yes yeah, absolutely A couple of years ago. That was my first. That was great to all these conferences. It was really good with Manjea Amazing.

Speaker 2: 25:03

What was your highlight of the Edinburgh Conference a couple of years ago?

Speaker 3: 25:08

Definitely hearing Pascal Manjea in person for the first time. I've seen a lot of online work but he has such a presence and a character about him and we met him after they explained that we're, you know, teaching some of his stuff and he's so lovely. He still checks in on us, sees how we're doing every so often. But, yeah, his lecture in particular I love because it was on something I'm so interested in. But the way he presents and his cases, they are very inspiring. You go home and just want to do pick up and try some of the things that he's talking about.

Speaker 2: 25:46

So true. I bet that was a real meet your heroes moment for you and Stuart.

Speaker 3: 25:52

I know, like fangirling, I know he's trying to say like I have like normal not normal, but non-dental friends on following Instagram and they're always like who is this guy? And like, oh, it's like the beyond today of my work world. It's hard to explain, isn't it? He really is the only guy. He's the only guy.

Speaker 2: 26:14

He's the only guy. Yeah, really good, great lecture.

Speaker 3: 26:20

Yeah, great stuff.

Speaker 2: 26:24

Brilliant, Great. Well, I feel like we've covered loads about the upcoming hands on day that you're running in November at the conference. I suppose a great question to finish on that. I think the other podcasts are finishing on as well. If you could be remembered for one thing in dentistry outside of dentistry, what would that be? And you can't say, care is die again.

Speaker 3: 26:53

No, no, I'd go cringy bit if that is what I go down in history. I don't know. I'd say just I'd love for somebody to remember me as like someone that was a pleasure to work with, a joy to work alongside or be taught by. Yeah, just like good person, integrity, and if you learn something little that you can take away and there's a bit of what I've taught you in your restorations, that's really cool.

Speaker 3: 27:22

I do listen to, like I said, a lot of podcasts. I was listening to one this morning on the way to work and it was, weirdly enough, mike Tyson and he was. He was talking about the difference between greatness and goodness and he was saying the two don't often go hand in hand and I thought I was so, so interested. It resonated a little bit. I think we sometimes like dentistry don't get me wrong is a science and an art, but at the end of the day there's a patient attached to what we're doing and I think sometimes we're so focused on doing these great, great restorations, you know, almost to perfection, and I'm sure all of us have got a bit of that perfectionism in us and sometimes we it's hard to keep that up all the time and it's like he was talking about being good over being great. So it's like if you can't be great that day and you've, you know, just be a good person and that's your greatness in itself. I thought that was so lovely and a bit cheesy, but I like a bit of cheese.

Speaker 2: 28:25

What a nice message. Well, whilst we have you here, fran, I really would love to ask your podcast recommendations.

Speaker 3: 28:32

Oh gosh, I listened to so many All sorts of variations. All the classic ones like Diary of a CEO. I listened to Happy Plays. There's one called Big Fish. Spencer Matthews just started. He does some nice things. I love autobiographical things, a little bit of the Daily Stoic and Jay Shetty, and then, like some of the trendier ones, go around. I know I've listened to a bit of Amrata recently. She's got some interesting topics on and guests yeah, oh, I like Abhi Khan see and Peter Crouch as well. Like therapy crouched. I listened to so many things. I know my mood therapy that's good. Yeah, no, anything and everything I love zoning out on the way to work. Do you listen to them in the car or?

Speaker 2: 29:20

are you walking to work? I walk and get the overground, so it's about half an hour.

Speaker 3: 29:25

I'm quite lucky in that respect. Nice, but yeah, I, I do love a walk and a podcast. It's my meditation kind of thing. What a nice way to start and end the day.

Speaker 3: 29:41

Yeah, and I think it is good not constantly thinking about teeth. It's so easy to when you do love your job. But and there's so many little traits and lessons, I think, from different disciplines and different industries that apply, that it's good to kind of take those on board as well. We are a bit of a unique job. I think there's so many elements to dentistry that I can't think of a different career that would be so so many roles in one. Like you know, there's art and science and healthcare. You're self-employed. There's a business side finding materials for yourself. Marketing cost is. There's a lot to a communication, the medical, legal side. So I think any, any help is much appreciated. Little lessons you can learn from other people yeah, absolutely.

Speaker 2: 30:34

Well, that seems like a great way to kind of end our podcast today Lessons you can learn from other people because I'm sure there will be so many lessons that our members will be learning from you in November at the hands on day, and I'm really looking forward to seeing you in the next video, and I'm really looking forward to seeing you there, catching up with everyone and yeah, I love you so much. It's been a good fun.