Abstract
Statement of problemThe esthetics of anterior lithium disilicate restorations can be enhanced if the buccal aspect is layered with a feldspathic ceramic. However, whether fractures and chipping of this layer are a prevalent complication is unclear. PurposeThe purpose of this retrospective study was to evaluate the incidence of incisal fracture of a specially designed lithium disilicate reinforcement of the incisal edge for indirect anterior bilayered restorations on both teeth and implants. Material and methodsA total of 924 anterior bilayered pressed lithium disilicate restorations in 324 patients and made in one dental laboratory were delivered by 4 restorative dentists. The restorations had the palatal side of the incisal edge in monolithic lithium disilicate and the facial side in feldspathic porcelain. The restorations were evaluated for survival and the occurrence of fracture or chipping. Survival analyses were performed by using the Kaplan-Meier and log rank (Mantel-Cox) tests (α=.05). ResultsOf the 924 restorations, 798 (236 complete crowns, 562 partial restorations) were placed on teeth and 126 on implants. The mean observation time was 38 months (3 to 72 months). The survival rate was 96.5%, with 14 failures occurring. The failures were fracture after dental trauma (n=5), ceramic fracture (n=1), debonding (n=6), poor shade match (n=1), and tooth loss (n=2). Restorations in patients with parafunctional habits and endodontically treated teeth showed a significant decrease in survival rate (P=.018). No significant differences were found between the survival of restorations on teeth and implants and between complete crowns and partial restorations (P=.021). No chipping was observed on any restorations in the study. ConclusionsModified anterior bilayered ceramic restorations showed good survival rates, and no chipping was observed up to 6 years of follow-up. Parafunctional habits and endodontic treatment had a negative effect on the survival rate of restorations. The support of tooth or implant and the restoration type had no effect on the survival.
Highlights
Parafunctional habits and endodontic treatment had a negative effect on the survival rate of restorations
Survival rates of lithium disilicate complete anterior bilayered crowns have been reported to range between 86.1% and 97.5% after 5 to 11 years,[7,11,12,13] and for veneers, between 87% and 100% after an average of 9 years
A total of 141 of 798 teeth had been endodontically treated before restoration placement, 329 restorations were placed in patients who had been noted to have parafunctional habits, and 186 restorations were placed in patients who received an occlusal appliance after delivery because of suspected parafunctional habits
Summary
A total of 924 anterior bilayered pressed lithium disilicate restorations in 324 patients and made in one dental laboratory were delivered by 4 restorative dentists. The restorations had the palatal side of the incisal edge in monolithic lithium disilicate and the facial side in feldspathic porcelain. Survival analyses were performed by using the Kaplan-Meier and log rank (Mantel-Cox) tests (a=.05). This retrospective study investigated the survival and incidence of fracture of bilayered ceramic restorations with reinforcement of the incisal edge with lithium disilicate by evaluating the patient records in 4 private dental offices. All restorations consisted of a lithium disilicate framework with reinforcement of the incisal edge and veneering ceramic on the facial aspect. Periodontal, restorative, or functional prognosis were excluded from the study. Nonvital teeth were not excluded from the study, and the endodontic therapy was retreated when indicated
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