Cosmetic dentists have been using porcelain veneers for smile makeovers for more than 30 years. While the prognosis of porcelain veneers was uncertain at the beginning, abundant dental literature can be found that reports about the clinical longevity of porcelain veneers.
Porcelain veneers have become the most used component at offices that focus on cosmetic dentistry. Many times, patients wonder whether they want to take the risk of having their teeth "shaved" to receive beautiful porcelain veneers. While these concerns are understandable, tooth reduction is necessary to create anatomically correct teeth. For the same reason, so-called lumineers are rarely applicable. Lumineers are placed on unprepared teeth, which causes them to be overcontoured and too bulky. In addition, they do not permit the integration of natura; internal characteristics that are typical for young looking teeth. In short, while the word "lumineers" sounds beautiful, they are a huge compromise when it comes to aesthetics. Porcelain veneers are always the first choice.
There are many different ways to prepare teeth for porcelain veneers. Each clinical situation requires a different design. The cosmetic dentist needs to be familiar with his craft to provide for his patient the most conservative and most appropriate preparation design before placing porcelain veneers. While is is desired to prepare teeth minimally and remain in the enamel for superior bonding strength, it is sometimes necessary to prepare teeth into the dentin. This may be required when correcting severely misaligned teeth or when prior dental restorations are being replaced. However, a skilled cosmetic dentist knows how to provide an optimum preparation for any situation. In addition, an experienced cosmetic dentist understands the chemistry of his products and knows how to work with them to obtain optimum bonding results and superior longevity of porcelain veneers.
One study reported that all veneers evaluated after 48 months were still clinically acceptable (The Clinical Longevity of Porcelain Veneers. A 48-month clinical evaluation. Kihn PW et al., JADA, Vol. 129, 1998).
Other studies (listed below) demonstrated the same reliability of porcelain veneers. However, it became evident that the quality and longevity of porcelain veneers depends on the experience of the operator. Cosmetic dentists who are accredited by the American Academy of Cosmetic Dentistry have proven that that have a high level of experience and understanding of all aspects of cosmetic dentistry. It is therefore logical to conclude that porcelain veneers placed by an accredited cosmetic dentist are more likely to be reliable and highly satisfactory for a long time.
References and Abstracts
Clinical evaluation of 546 tetracycline-stained teeth treated with porcelain laminate veneers.
Chen JH, Shi CX, Wang M, Zhao SJ, Wang H. J Dent. 2005 Jan;33(1):3-8.
Department of Prosthodontics, The Fourth Military Medical University, Dental College, 7 Kang Fu Road, Xian 710032, China.
OBJECTIVE: The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth restored with a porcelain laminate veneer system (Cerinate, Den-Mat, USA) for aesthetic reasons. METHODS: Tetracycline-stained teeth (546) were restored with a porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5, 1.5 and 2.5 years, respectively. Modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction of the colour of the restorations. RESULTS: This study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers required rebonding in the first 6 months; the colour of the veneers was stable and no evident staining was found. Almost all patients were satisfied with the colour match of their restorations 1 year after placement. CONCLUSIONS: The research indicated that the porcelain veneer restoration system under investigation provided a reliable and highly satisfactory choice for the aesthetic restoration of tetracycline-stained teeth.
Predictable, precise, and repeatable tooth preparation for porcelain laminate veneers.
GŸrel G. Pract Proced Aesthet Dent. 2003 Jan-Feb;15(1):17-24
Center for Continuing Education, New York University College of Dentistry, New York, New York, USA.
Advances in dental materials and techniques have enabled porcelain laminate veneers to evolve into the treatment of choice for minimally invasive aesthetic dentistry. Treatment planning and tooth preparation are crucial for optimal function and aesthetics. While minimal invasion is important, sufficient space must be provided for the appropriate porcelain buildup. Various preparation guidelines have been advocated for porcelain veneers, yet they vary in accuracy and by indication. This article provides a simple, precise technique for veneer preparation regardless of tooth position and condition.
Midterm results of a 5-year prospective clinical investigation of extended ceramic veneers.
Guess PC, Stappert CF. Dent Mater. 2008 Jun;24(6):804-13.
Department of Prosthodontics, School of Dentistry, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg, Germany.
OBJECTIVES: Midterm-evaluation of a prospective 5-year clinical study on long-term performance and success rate of pressed-ceramic veneers with two extended preparation designs. METHODS: Anterior teeth of 25 patients were restored with 66 extended veneers. Forty-two overlap veneers (OV) (incisal-edge-reduction 0.5-1.5mm, butt-joint) and 24 full veneers (FV) were inserted. Both veneer designs were similar in buccal (0.5mm) and proximal (0.5-0.7mm) chamfer preparation, but differed in palatal extension. Ceramic veneers were fabricated with IPS Empress* and adhesively luted with dual-polymerizing composite Variolink II* (*Ivoclar Vivadent). Clinical reevaluations were performed 6, 12, 25, 39, 45, and 62 months after insertion of the veneers according to the modified USPHS-criteria. Absolute failures were recorded as survival-rate, relative failures demonstrated by Kaplan-Meier success-rate. RESULTS: After an observation time up to 5 years, survival-rate of full veneers was 100%, of overlap veneers 97.5% due to one severe fracture. Kaplan-Meier-analysis of relative failures resulted in a success-rate of 85% for FV and 72% for OV. Reasons for relative failures were cracks, ceramic-cohesive-fractures, and loss-of-adhesion. No significant differences were found between the two veneer groups. Secondary caries and endodontic complications did not occur. Increased clinical service time resulted in enhanced marginal discoloration and decrease of marginal adaptation. SIGNIFICANCE: Extended pressed-ceramic veneers (both OV and FV) proved to be reliable procedures to restore larger deficits in anterior teeth. Pronounced palatal extension of full veneers was not linked to a higher failure probability. Reliable adhesive bonding, as well as ceramic fatigue and fracture resistance are considered key factors for long-term success of extended-veneer restorations.
An up to 16-year prospective study of 304 porcelain veneers.
Layton D, Walton T. Int J Prosthodont. 2007 Jul-Aug;20(4):389-96.
Faculty of Dentistry, University of Queensland, Australia.
PURPOSE: This study aimed to prospectively analyze the outcomes of 304 feldspathic porcelain veneers prepared by the same operator, in 100 patients, that were in situ for up to 16 years. MATERIALS AND METHODS: A total of 304 porcelain veneers on incisors, canines, and premolars in 100 patients completed by one prosthodontist between 1988 and 2003 were sequentially included. Preparations were designed with chamfer margins, incisal reduction, and palatal overlap. At least 80% of each preparation was in enamel. Feldspathic porcelain veneers from refractory dies were etched (hydrofluoric acid), silanated, and cemented (Vision 2, Mirage Dental Systems). Outcomes were expressed as percentages (success, survival, unknown, dead, repair, failure). The results were statistically analyzed using the chi-square test and Kaplan-Meier survival estimation. Statistical significance was set at P .05. RESULTS: The cumulative survival for veneers was 96% +/- 1% at 5 to 6 years, 93% +/- 2% at 10 to 11 years, 91% +/- 3% at 12 to 13 years, and 73% +/- 16% at 15 to 16 years. The marked drop in survival between 13 and 16 years was the result of the death of 1 patient and the low number of veneers in that period. The cumulative survival was greater when different statistical methods were employed. Sixteen veneers in 14 patients failed. Failed veneers were associated with esthetics (31%), mechanical complications (31%), periodontal support (12.5%), loss of retention >2 (12.5%), caries (6%), and tooth fracture (6%). Statistically significantly fewer veneers survived as the time in situ increased. CONCLUSIONS: Feldspathic porcelain veneers, when bonded to enamel substrate, offer a predictable long-term restoration with a low failure rate. The statistical methods used to calculate the cumulative survival can markedly affect the apparent outcome and thus should be clearly defined in outcome studies.
Porcelain laminate veneers. A retrospective evaluation after 1 to 10 years of service: Part II--Clinical results.
Dumfahrt H, SchŠffer H. Int J Prosthodont. 2000 Jan-Feb;13(1):9-18.
Clinical Department of Prosthetic Dentistry, University of Innsbruck, School of Medicine, Innsbruck, Austria.
PURPOSE: The objective of this study was to evaluate the clinical quality of 191 porcelain laminate veneers and to explore the gingival response in a long-term survey. MATERIALS AND METHODS: The clinical examination was made by two calibrated examiners following modified California Dental Association/Ryge criteria. In addition, margin index, papillary bleeding index, sulcus probing depth, and increase in gingival recession were recorded. Two age groups were formed to evaluate the influence of wearing time upon the clinical results. The results were statistically evaluated using the Kaplan-Meier survival estimation method, Chi-squared test, and Kruskal-Wallis test. RESULTS: A failure rate of 4% was found. Six of the total of seven failures were seen when veneers were partially bonded to dentin. Marginal integrity was acceptable in 99% and was rated as excellent in 63%. Superficial marginal discoloration was present in 17%. Slight marginal recession was detected in 31%, and bleeding on probing was found in 25%. CONCLUSION: Porcelain laminate veneers offer a predictable and successful treatment modality that preserves a maximum of sound tooth structure. An increased risk of failure is present only when veneers are partially bonded to dentin. The estimated survival probability over a period of 10 years is 91%.
Five-year clinical performance of porcelain laminate veneers.
Aristidis GA, Dimitra B. Quintessence Int. 2002 Mar;33(3):185-9. Department of Fixed Prosthodontics, University of Athens, Athens, Greece.
OBJECTIVE: The clinical performance of porcelain laminate veneers was evaluated at 5 years. METHOD AND MATERIALS: One hundred eighty-six porcelain laminate veneers were placed in 61 patients, aged 18 to 70 years, by a single operator following the same clinical procedure. At the 5-year recall, esthetics, marginal integrity, marginal discoloration, fracture rate, and patient satisfaction were recorded. RESULTS: At recall 98.4% of the veneers were satisfactory without intervention. The retention rate was excellent, the fracture rate was very low, and the maintenance of esthetics was superior. Patient satisfaction was very high. CONCLUSION: Porcelain laminate veneers offer a reliable and effective procedure for the conservative and esthetic treatment of anterior teeth.
Influence of operator skill on microleakege of total-etch and self-etch bonding systems.
Giachetti L, Scaminaci Russo D, Bambi C, Nieri M, Bertini F. J Dent. 2008
Jan;36(1):49-53. Department of Dentistry, Faculty of Medicine and Surgery, University of Florence, Florence, Italy.
OBJECTIVES: To evaluate the influence of operator skill on microleakage in class V restorations using simplified bonding systems. METHODS: Two cavities were carried out on the buccal and lingual surfaces of 50 human bicuspid teeth. The teeth were randomly a