Ceramic Veneers Research Articles

Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques.

To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface. Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1min and 40s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1min and 40s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin. According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups. Tack-curing for 1s or 5s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin. The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1s or 5s is recommended to mitigate the excess resin cement.

AESTHETIC AND FUNCTIONAL REHABILITATION BY ASSOCIATING INJECTION-MOLDED, IMMEDIATE-LOADED, TWO-PIECE ZIRCONIA IMPLANTS AND CERAMIC VENEERS

The present case describes the clinical and radiographic results of 24 months of two-piece injection-molded zirconia implants with immediate loading, as well as the aesthetic and functional planning performed in the anterior maxilla. Case presentation: A 36-year-old female patient was referred to a dental school due to dissatisfaction with the aesthetics of her smile and the absence of dental elements 22 and 24. Prosthetic rehabilitation of the anterior maxilla was performed, including implant-supported prosthesis with zirconia implants and ceramic veneers, using a digital workflow. The patient was followed up for 24 months, with good clinical and radiographic results. Conclusions: The aesthetic and functional rehabilitation performed in the patient's maxilla, with veneers and ceramic crowns, was successful and contributed to the patient's psychological and emotional well-being, in addition to restoring occlusal stability, through the orientation of the canine and the adequate protrusion of the anterior teeth.

Effect of a modified laminate veneer preparation design on absolute margin discrepancy and marginal overhang

Veneer preparation designs impact veneer accuracy. However, whether a modified design could reduce absolute margin discrepancy and marginal overhangs is unclear. The purpose of this in vitro study was to investigate whether a modified veneer preparation design enhances the absolute margin discrepancy and marginal overhang. The absolute margin discrepancy and the marginal overhang of 3 different veneer preparation designs on a typodont tooth (n=20): feather edge, shoulder, and shoulder with wings were measured. The feather edge design was prepared first and subsequently modified to create the shoulder and shoulder with wings preparations. Ceramic veneers were fabricated using computer-aided design and computer-aided manufacture with each veneer assessed for fit before cementation. Ten specimens were cut vertically, and 10 were cut horizontally in each group. The absolute margin discrepancy and marginal overhangs were measured for each cross-section with scanning electron microscopy. Descriptive data analysis and hypothesis testing were conducted using the nonparametric Kruskal Wallis test (α=.05). On the vertical sections, the shoulder with wings preparation had the best absolute margin discrepancy and overhang. The design was also best for mesial overhang and mesial absolute margin discrepancy when measuring horizontally. The shoulder with wings preparation design produced the smallest cervical absolute margin discrepancy and overhang. This design also produced absolute margin discrepancy and overhangs comparable with those of the shoulder design in the proximal areas.

Influence of Immediate Dentin Sealing on Marginal Gaps of Laminate Veneers: Machinable Monolithic Zirconia Versus Pressable Lithium Dislocate. An In Vitro Study.

To investigate the influence of immediate dentin sealing (IDS) vs delayed dentin sealing (DDS) on the marginal gaps of machinable monolithic zirconia (MMZ) vs pressable lithium disilicate (PLD) laminate veneers. A total of 40 maxillary lateral incisors were used and received butt-joint laminate veneer preparation. The samples were divided into two groups (n = 20 each) according to ceramic material: PLD ceramic was used in the first group, and MMZ was used in the second. Each group was then divided into two subgroups according to the bonding protocol: IDS was employed in one, and DDS in the other (n = 10 each). The marginal gap widths were measured using digital microscopy and statistically analyzed. The smallest marginal gaps were observed in MMZ-DDS (57.2 ± 8.4 μm), followed by PLD-DDS (62.4 ± 2.7 μm) and MMZ-IDS (63.5 ± 1.9 μm). The largest marginal gaps were observed in PLD-IDS (81.5 ± 6.3 μm). Two-way ANOVA revealed that the bonding technique (P < .001) and ceramic material (P < .001) both showed significant differences. MMZ produced beIer marginal accuracy than PLD. IDS seems to have a predisposition to significantly wider marginal gaps than DDS, but these gaps are within the clinically acceptable range. The marginal accuracy of ceramic veneers appears to be related to the bonding technique as well as the material of construction.

Restoration of Discoloured Incisors with Ceramic Veneers: A Workflow Case Report

This case reports the treatment of two discoloured incisors with feldspar ceramic veneers using an integrated work approach, and the active participation of a dental technician. The patient presented an upper left central incisor with a composite restoration, and a lateral incisor with discolouration after trauma and endodontic treatment. Planning was developed in collaboration with the technician, the decision was to perform ceramic veneers on the discoloured teeth. Central incisor previous restoration was included in preparation, and lateral preparation was limited to create enough space for the veneer. This case highlights the importance of communication between patient, clinician, and technician to achieve excellent results in restorative dentistry. CPD/Clinical Relevance: Feldspar ceramic veneers might be a good option for masking light and mediumly discoloured substrates.

Lithium disilicate ceramic veneers as an alternative for aesthetic rehabilitation in upper anterior teeth: Case report

Ceramic dental veneers are currently a solution for long-term aesthetic rehabilitation of anterior teeth. As a conservative treatment, it allows maintaining a significant amount of dental tissue and at the same time achieving an acceptable aesthetic result. The clinical case of a 39-year-old female patient, professional, with no personal or family clinical pathological history, who came to the consultation due to presenting dissatisfaction with her smile and color of the teeth in the upper anterior sector, is presented. As an alternative for aesthetic rehabilitation, he was offered the application of lithium disilicate ceramic veneers on the upper anterior teeth. The technique was performed using lithium disilicate, allowing a reliable aesthetic restoration with minimal preparation of the dental tissue structure. Ceramic veneer restorations are highly durable and safe procedures when appropriate adhesive protocols are used. Lithium disilicate, in particular, exhibits superior strength to feldspathic ceramics and possesses superior optical properties to zirconium. For this reason, it is considered an ideal material for anterior aesthetic rehabilitation using ceramic veneers. The application of lithium disilicate ceramic veneers allows successful rehabilitation by combining desirable characteristics for both the professional and the patients, including aesthetics, high resistance and ease of use

In Vitro Aging and Fracture Tests on Differently Veneered Partially Stabilized Zirconia Anterior Crowns.

Objectives: To evaluate the fracture resistance of veneered incisor crowns made from highly translucent zirconia frameworks. Materials and Methods: Ninety-six all-ceramic single crowns were based on either a coping with minimum wall thickness or a cutback framework fabricated from highly translucent zirconia (5Y-PSZ). Each one-third of the specimens was finalized with different veneering ceramics using standardizations and glaze firing. Crowns were luted to cobalt-chromium dies with MDP-containing composite cement. Half of the entire sample underwent artificial aging (chewing simulation and thermocycling) before fracture load tests were conducted using a 6 mm steel sphere applied in a 90° angle to the oral aspect of the crowns with 1.3 mm distance to the incisal edge. Besides descriptive presentation of recorded forces at first damage (F1d) and fracture (Fu), Kruskal Wallis and Mann-Whitney U tests were used to analyze data at α = 0.05. Results: Directly after manufacturing, incisor crowns of all test groups showed sufficient mean fracture resistances. After artificial aging, crack formation was observed in a high percentage for fully veneered crowns of all test groups, but only for one veneering ceramics with cutback crowns. Mean test forces of unaged crowns were F1d,mean ≥ 422 N | Fu,mean ≥ 749 N (fully veneered) and F1d,mean ≥ 644 N | Fu,mean ≥ 706 N (cutback) dropped significantly to F1d,mean ≥ 131 N | Fu,mean ≥ 223 N (fully veneered) and F1d,mean ≥ 324 N | Fu,mean ≥ 524 N (cutback) . Conclusions: Within the limitations of this laboratory study, 5Y-PSZ based anterior crowns can be a viable treatment option. Framework design, choice of the veneering ceramics and artificial aging show relevant effects on the fracture resistances. Concerted veneering ceramics should be used and partially veneering of the zirconia frameworks should be favored over full veneers.

Ultrathin Feldspathic Ceramic Veneers: A Pilot SEM Evaluation of Etched Intaglio Surfaces.

Ultrathin ceramic veneers are a viable therapeutic option to manage esthetic challenges in the anterior zone. Proper conditioning of the intaglio surface of porcelain veneers is essential to achieve an adequate bonding. In clinical practice, this is typically done with chemical etching using an acid-containing agent, such as hydrofluoric acid. While it is well established that the etching effect is dependent on etching time and the acid concentration, little is known about the impact of etching time and the veneer fabrication method. The purpose of this pilot study was to evaluate, using scanning electron microscopy (SEM), the effect that different etching-time protocols have on the intaglio surface characteristics of ultrathin ceramic veneers fabricated with either the platinum foil technique or the refractory die technique. Several replicas of an ultrathin feldspathic ceramic veneer for a maxillary central incisor were fabricated. Individual specimens were processed according to different intaglio surface-etching protocols: no etching, etching for 90 seconds, etching for 120 seconds, and etching for 150 seconds (9.6% hydrofluoric acid used for all etching groups). It was observed that the 120-second etching protocol resulted in a favorable microroughness surface pattern in the platinum foil group. This pattern was comparable to that obtained by etching for 90 seconds with hydrofluoric acid the intaglio surface of veneers fabricated with the refractory die technique. Increasing the etching time to 150 seconds did not result in a more favorable roughness pattern.

Redesigning the smile using veneers

Abstract Veneer is one of the most esthetic, conservative, and durable form of restoration. Case selection, tooth preparation, and cementation of veneer on maxillary anterior teeth have been thoroughly discussed in this case report. Here, we present a case of a 26-year-old male patient with a complaint of fracture of 21 for the past 1 year. On examination, the tooth was vital, and the treatment option given to the patient was veneer. Veneer is one of the breakthrough treatments when it comes to restoring the esthetic with minimal invasiveness. A proper case selection with a precise treatment results in the excellent outcome. Hence, ceramic veneers is the better option compared to the conventional approach.

Marginal chipping factor in machinable zirconia and lithium disilicate ceramic veneer restorations

Background:The marginal edges of the laminate veneer ceramic restorations are very critical areas that play a very determinant role in the success of this type of esthetic restorations.Aim:To evaluate the marginal chipping factor of laminate veneer restorations prepared from both zirconia lithium disilicate materials. Materials and methods:Two typodont teeth representing the upper central incisors were used to prepare laminate veneers with an overlapping incisal design. These veneers were fabricated in two thicknesses (0.5 mm and 0.3 mm) using three types of multilayer zirconia materials with varying yttria percentages (3Y, 5Y, and 3Y/5Y) as well as lithium disilicate computer-aided-design (CAD) blocks. The veneers were divided into four groups based on the yttria percentage and further subdivided into two subgroups for the thickness. Top-view images of the veneer margins were captured and imported into the Image Pro Plus software. The average periphery of each veneer margin was 30 mm. The lengths of the chipped margins were measured under a stereomicroscope, and the CF was calculated.Results: One-way ANOVAsuggested significant differences among the ceramics. e.max CAD ceramic veneers exhibited the highest mean CF values (4.72, 5.9), whereas 3Y/5Y zirconia veneers demonstrated the lowest mean CF values (0.74, 1.54) for 0.5 mm and 0.3 mm thicknesses, respectively. Independent t-tests indicated no significant difference in the CF between 0.5 mm and 0.3 mm thicknesses for each ceramic material.Conclusion:Different ceramic materials exhibited varying levels of marginal chipping, with zirconia ceramics demonstrating lower CF than lithium disilicate ceramics. Reducing the veneer thickness from 0.5 mm to 0.3 mm did not significantly affect the CF.

Rehabilitation of Worn Anterior Teeth with Ceramic Veneers

Abstract The use of porcelain laminate veneers to solve esthetic and functional problems has proven to be a valid management option, especially in the anterior esthetic zone. Veneers are a reliable treatment option to modify the appearance of tooth position and form, to close diastema or cervical embrasures, or to change the tooth shade. Porcelain veneers are one of the best corrective options available considering biological, functional, mechanical, and esthetic points of view.

Effect of Immediate Dentin Sealing on Bond Strength of Two Ceramic Occlusal Veneers after Thermodynamic Loading

Effect of Immediate Dentin Sealing on Bond Strength of Two Ceramic Occlusal Veneers after Thermodynamic Loading

Fracture Resistance of Chairside CAD/CAM Lithium Disilicate-reinforced Ceramic Occlusal Veneers With and Without Margin and Full Coverage Crowns.

The aim of this investigation was to compare the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate-reinforced ceramic occlusal veneers with and without margin and traditional full coverage premolar crowns. A total of 60 chairside CAD/CAM lithium disilicate-reinforced ceramic (Amber Mill, Hass Bio) restorations were designed and fabricated with a chairside CAD/CAM system (CEREC Dentsply Sirona). The restorations were divided into three groups (n=20): 1) occlusal veneer with 1.0-mm uniform occlusal thickness and with chamfer margin; 2) occlusal veneer with 1.0-mm uniform occlusal thickness and without margin; and 3) full coverage crown with uniform occlusal thickness and gingival margin. Occlusal veneers and crowns were cemented with dual cured resin luting cement (Multilink, Ivoclar Vivadent) to printed resin dies, load cycled (5 million load cycles at 1 Hz with 275 N force), and then loaded until fracture. Load at break (LB) and peak load (PL) until fracture were recorded. Scanning electron microscope images of the tested restorations on the abutments were obtained. Fracture strengths were different depending on the design of the restoration. There was no significant difference in fracture strength between the two types of occlusal veneer (LB: 1132.45 N; PL: 1143.30 N for veneers with margin; LB: 1149.25 N; PL: 1219.05 N for veneers without margin). Full coverage crowns showed the lowest fracture resistance (LB: 936.26 N, PL: 976.42 N), which was significantly lower than both designs of occlusal veneer. The fracture resistance of the CAD/CAM lithium disilicate-reinforced ceramic restorations was influenced by the design. Occlusal veneers with and without margin displayed higher fracture resistance than traditional crowns.

Clinical Longevity of Ceramic Veneers Bonded to Teeth with Aged Composite Restorations (Literature Review)

In this study the literature was reviewed to investigate the clinical outcome and longevity of anterior ceramic laminate veneers bonded to prior existing composite restorations. Clinical studies had investigated the survival of anterior ceramic laminate veneers adhered to teeth structures for at least 5 years of follow-up. This review has traced the studies which recorded the clinical longivity of porcelain laminate veneers bonded over old composite restorations; also the main reasons associated with restorations failure were searched. Sources in PubMed, Scopus, and Cochrane databases were searched in English language and without restriction on date. three reviewers screened titles and/or abstracts of 195 studies, all screened articles did not met the inclusion criteria of this review; which to have five years and more follow up in clinical retrospective or prospective studies, for that reason we have selected the most In vivo could possibly more related and the related In vitro studies. Within the limitation of this review, the clinical evidence for the practice of ceramic laminate veneers bonded over prior aged composite restorations is not strong. There is information lack about the long duration follow up for such treatment modality. The approach of replacing the prior existing composite restoration with new ones could be a wise option but using extended veneer design might be a wiser alternative. We recommend more clinical trials for long enough duration to evaluate the long success of ceramic laminate veneers that will be adhered to prior existing composite restorations.

Quo vadis, esthetic dentistry? Part II: Composite resin overtreatment and social media appeal.

This article presents case reports highlighting over-treatments with resin composites, often misconceived as minimally invasive procedures. Tooth-colored restorative materials, such as ceramics and composites, have found widespread application to correct problems related to tooth color, shape, and alignment. When composite resin is used, these procedures can be done in a very conservative, cost-effective, and timely fashion. However, it is noteworthy that contemporary dental esthetic expectations are based on standards propagated by social media and other marketing and communications platforms. The abuse of and addiction to social media impacts can lead to unrealistic esthetic expectations and standards for both patients and dentists. After a critical discussion on ceramic veneers published in part I of this 2-part series, this article directs attention towards what has become a trendy fashion, i.e., the use of direct composite resins as "non-prep" veneers in clinical situations that arguably required no restorative intervention at all. We further explore how social media influences the decision-making processes of both professionals and patients.

A comparative study of translucency and color perception in monolithic zirconia and lithium disilicate veneers

Ceramic laminate veneers which are a conservative approach to restoring anterior teeth, combining minimal preparation and esthetics. This study aims to evaluate the impact of the thickness of monolithic zirconia laminate veneers on their optical properties and color perception, comparing them to lithium disilicate. A total of 60 laminate veneers were prepared using two ceramic materials, divided into three groups for each material (n = 10) with thicknesses of 0.5, 0.7, and 1.0 mm. CIELab color parameters of the veneers were measured using a spectrophotometer and translucency parameters were calculated. The veneers were cemented onto uniform dies and final L, a, b values of the restorations were measured. The color difference between the different thicknesses was calculated using the CIEDE2000 formula. Two-way ANOVA and Bonferroni HSD post hoc tests were conducted to compare the color parameters (α = 0.05). The results showed that both material type (p < 0.001) and thickness (p < 0.001) influenced translucency values. The translucency values of zirconia veneers were significantly lower than those of lithium disilicate. The color differences (ΔE00) resulting from thickness changes (0.5–1.0 mm) were near or below the perception threshold for lithium disilicate, but distinct for zirconia restorations. In conclusion, monolithic zirconia veneers demonstrated lower translucency compared to lithium disilicate. Changing the material thickness affected the translucency of both materials, but not the color perception only for zirconia.

Shear bond strength of the ceramic veneer to additively manufactured titanium.

The objective of this in vitro study was to evaluate the shear bond strength between the ceramic veneer and additively manufactured titanium with different surface treatments, and to compare with milled titanium. Also, to characterize the surface and the presence of an α-case layer of additively manufactured and milled titanium. Sixty additively manufactured titanium grade 23, and 20 milled titanium grade 4 cylindrical specimens were divided into four groups based on surface treatments, air-particle abrasion and grinding. After ceramic veneering half of each group were thermocycled. The bond strength was analyzed using a shear bond strength test. The surfaces were analyzed using interferometry and scanning electron microscopy. The grinding procedure and air-particle abrading pressure had no significant effect on the shear bond strength (p = .264 and p = .344). Thermocycling showed a tendency towards an effect but not significant (p = .052). The group with the highest air-abrading pressure showed the highest surface roughness. No presence of an α-case layer was detected in any of the groups. Additively manufactured titanium grade 23 may be veneered with ceramics without prior grinding of the surfaces.

The CAD/CAM Technology and Digital Smile Design for Fabricated Ceramic Veneers

Nowadays, the application of digital technologies and devices are widely used in dentistry. The explanation of the innovative and advanced digital technology for designing and fabricating the provisional restorations transfers to final restorations. Computer-aided design/computer-aided manufacturing (CAD/CAM) in digital dentistry has numerous advantages and greater efficiency and accuracy over the conventional techniques. The digital smile design (DSD) is used for esthetic dentistry especially in case of veneer and can be improved the effectiveness and efficiency of dentist to patient and dentist to technician communication. However, the applications of DSD and CAD/CAM require an understanding of the principal concept and digital technology to create the precise and esthetic outcome of the final restoration.

3D printing of ultra-thin veneers made of lithium disilicate using the LCM method in a digital workflow: A feasibility study.

This article highlights the feasibility of the additive fabrication of ultra-thin veneers made of lithium disilicate using the lithography-based ceramic manufacturing (LCM) method. An esthetical appealing restoration of anterior teeth with thin ceramic veneers is considered one of the ultimate challenges in restorative dental prosthetics. These sophisticated restorations can be fabricated in different ways. Both analog and digital subtractive manufacturing processes have been used to date. Either of the methods is highly demanding for the dental technician and dental engineering due to the required low ceramic layer thickness. Modern additive manufacturing methods, for example LCM technology, enable the production of ultra-thin lithium disilicate veneers with layer thicknesses of down to 0.2 mm and could therefore represent a viable alternative for this indication in the future. Digital technologies can help streamline workflows, make the outcome more predictable and reproducible, and even further optimize therapeutic restorative options such as highly esthetic veneers for anterior teeth. The reduced material thickness allows for a true non-prep solution or minimally invasive preparation.

Printed Digital Wax-up Model as a Blueprint for Layered Pressed-ceramic Laminate Veneers: Technique Description and Case Report.

This article presents a clinical technique for transferring Digital Smile Design (DSD) information and a digital wax-up to fabricate highly personalized ceramic laminate veneers. The hybrid workflow of digitally designed wax-up and conventional hand-crafted veneers is showcased in a female adult who sought to improve her smile due to maxillary anterior incisal wear. The ceramic veneers, layered by feldspathic porcelain, followed the contours and shade blueprint planned with the digital wax-up. The DSD improved the harmony of the facial-and-smile relationship, and the ceramic restorations fulfilled the patient's esthetic and functional demands. Guides based on the printed model with the digitally designed wax-up can provide a reference for pressed lithium disilicate veneers layered with feldspathic porcelain.