Journal of Dentistry 43 (2015) 1330–1336

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Journal of Dentistry
journal homepage: www.intl.elsevierhealth.com/journals/jden

Direct anterior composite veneers in vital and non-vital teeth: A

retrospective clinical evaluation
Fábio Herrmann Coelho-de-Souzaa , Daiana Silveira Gonçalvesb , Michele Peres Salesb ,
Maria Carolina Guilherme Erhardta , Marcos Britto Corrêac, Niek J.M. Opdamd ,
Flávio Fernando Demarcoc,*
a
Department of Conservative Dentistry, Federal University of Rio Grande do Sul, RS, Brazil
b
Private Practitioner, Porto Alegre, RS, Brazil
c
Post-Graduate Program in Dentistry, Federal University of Pelotas, RS, Brazil
d
Department of Restorative and Preventive Dentistry, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

A R T I C L E I N F O A B S T R A C T

Article history: Objectives: This retrospective, longitudinal clinical study investigated the performance of direct veneers
Received 2 July 2015 using different composites (microfilled  universal) in vital or non-vital anterior teeth.
Received in revised form 18 August 2015 Methods: Records from 86 patients were retrieved from a Dental School clinic, comprising 196 direct
Accepted 21 August 2015
veneers to be evaluated. The FDI criteria were used to assess the clinical evaluation. The survival analysis
was done using Kaplan–Meier method and Log–Rank test. The multivariate Cox regression with shared
Keywords: frailty was used to investigate the factors associated with failure.
Clinical trial
Results: A total of 196 veneers were evaluated, with 39 failures. The mean time of service for the veneers
Longevity
Anterior Restorations
was 3.5 years, with a general survival rate of 80.1%. In the qualitative evaluation of the restorations,
Dental Veneers microfilled composite showed slighty better esthetics. The annual failure rates (AFR) were 4.9% for
Non-vital teeth veneers in vital teeth and 9.8% for non-vital teeth with statistical significance (p = 0.009). For microfilled
and universal veneers the respective AFRs were 6.0% and 6.2% (p > 0.05). Veneers made in non-vital teeth
Keywords: had a higher risk of failure over time compared to those made in vital teeth (HR 2.78; 95% CI 1.02–7.56),
Clinical trial but the type of material was not a significant factor (p = 0.991). The main reason for failure was fracture of
Longevity the veneer.
Anterior restorations
Conclusion: Direct composite veneers showed a satisfactory clinical performance. Veneers performed in
Dental veneers
vital teeth showed a better performance than those placed in non-vital teeth. No difference in the survival
Non-vital teeth
rate for different composites was found, although microfilled composites showed a slightly better
esthetic appearance.
Clinical significance: Direct composite veneers show good results in esthetic dentistry nowadays.
Composite veneers in vital teeth have a lower risk of failure than those in non-vital teeth.
ã 2015 Elsevier Ltd. All rights reserved.

1. Introduction Many clinical situations such as tooth discoloration, extensive

In the last decades there was a continuous evolution of
composite resins, adhesive systems and restorative techniques that
contributed to a significant improvement of esthetic dentistry
[1,2]. The main advantages of composite restorations are related to
their adhesive properties, the minimal preparation size, the
reinforcement of remaining teeth and the esthetic appearance
[3,4].
* Corresponding author at: Federal University of Pelotas – R. Gonçalves Chaves,
457, 5th floor, Pelotas, RS CEP 96015-560, Brazil. Fax: +55 53 32256741  130.
E-mail address: ffdemarco@gmail.com (F.F. Demarco).
fractures, misaligned teeth or dental caries lesions may cause an
important impairement in esthetic appearance and smile harmo-
ny, causing impact in the quality of life [1,4]. The use of direct
composite veneers may be an interesting option to recover the
esthetic appearance of damaged teeth [4,5], especially because
indirect techniques require more removal of sound tooth structure
and have a higher cost, due to the laboratory procedures involved
[6,7]. In fact, in a minimal invasive approach direct composite
veneers seem to be the first choice [4]. The esthetic appearance of
endodontically treated anterior teeth is often compromised by
staining. Discolored teeth can be treated with different restorative
approaches, including tooth bleaching, ceramic crowns, ceramic
veneers and direct composite veneers [2,8]. However, for

http://dx.doi.org/10.1016/j.jdent.2015.08.011
0300-5712/ ã 2015 Elsevier Ltd. All rights reserved.
 F.H. Coelho-de-Souza et al. / Journal of Dentistry 43 (2015) 1330–1336
endodontically treated teeth there is some controversy in relation
to the results obtained, especially when considering direct
composite veneers [2,9,10].
A large number of studies have demonstrated long lasting good
results for composite restorations in posterior teeth [11–13]. A
recent meta-analysis of prospective studies on anterior composite
restorations showed a median overall estimated survival of 95% for
class III and 90% for class IV, after 10 years [14]. Although the
widespread clinical use of composite resins for anterior teeth
restorations, there is a lack of scientific evidence regarding the
longevity of direct composite veneers, especially when placed in
non-vital teeth [3,6,10,15]. So far, few studies have evaluated the
performance of direct composite veneers over a longer period of
time [3,5,15]. Since esthetical appearance is the main concern for
veneers in anterior teeth, some professionals have recommended
the use of a composite resin with smaller filler size (microfilled or
nanofilled composites), in order to produce a smoother surface,
resulting in a better esthetic appearance [16]. However, there is a
lack of clinical data supporting this assumption, and a systematic
review of in vitro studies was not able to show better surface
smoothness when comparing nanofill or submicron composites to
mycrohybrid ones [17].
Therefore, the aim of this retrospective longitudinal study was
to investigate the clinical behavior of direct veneers performed
with different types of composite (microfilled and universal) in
vital and non-vital anterior teeth.
2. Methods
2.1. Study characteristics, participants and design
The database with clinical records from the Operative Dentistry
Clinic at the Federal University of Rio Grande do Sul, School of
Dentistry, Porto Alegre was used in the present evaluation. From
this database, all placed direct composite veneer restorations were
selected for this retrospective analysis. The study had the approval
of the local Ethics Committee (N. 21736) and the patients signed a
written consent to participate in the study.
2.2. Inclusion and exclusion criteria
All restorations that were placed either by final year under-
graduate dental students or by postgraduate students during
Operative Dentistry courses (certificate program) between January
1999 and January 2012 with minimum observation time of
6 months were selected from the files. Veneers were placed in
vital or non-vital teeth, using microfilled or universal hybrid
composite resins, which are described in Table 1. Patients were
excluded when heavy smokers, when they had also received
indirect ceramic or composite veneers, had severe parafunctional
habits or poor oral hygiene. In total, 118 patients fulfilled the
inclusion criteria and were invited by phone calls to come to the
Dental clinic for examination, of which 86 patients agreed to
participate. From the files, the type of the composite, the tooth
Table 1
Characteristics of the composites evaluated
Composite Manufacturer Inorganic filler classification E-modulus (GPa)
Durafil VS Heraeus Kulzer Microfill 6.15
Charisma Heraeus Kulzer Microhybrid 14.06
4Seasons Ivoclar Nanohybrid 9.05
Z350 XT 3M/ESPE Nanofill 13.3
Opallis FGM Nanohybrid 9.1
* Information in relation to the materials provided by the manufacturers.
1331
vitatily (vital or non-vital) date of placement, date of failure and
reason for failure were collected.
2.2.1. Restorative procedures
The dentin-bonding agent used in all composite veneers was an
etch-and-rinse 3-step adhesive system (Scotchbond Multipurpose,
3M ESPE, St Paul, MN, USA). The veneer restorations were placed
using either a microfilled [Durafil VS (Heraeus Kulzer, Hanau,
Germany)] or a universal composite [Charisma (Heraeus Kulzer,
Hanau, Germany); 4Seasons (Ivoclar-Vivadent, Elwangen,
Germany); Filtek Z350XT (3M ESPE, St. Paul, MN, USA); Opallis
(FGM, Joinville, SC, Brazil]. The applied materials are shown in
Table 1. Composite veneers were placed under rubber dam or
retraction cord with a multi-layer technique using different shades
for dentin and enamel reproduction and were light-cured using an
LED polymerization unit. The restorations were finished and
polished in the same session using fine diamond burs and abrasive
discs (Sof-lex, 3M ESPE, St. Paul, MN, USA).
2.2.2. Evaluation procedures
The restorations were clinically evaluated between August and
November 2013 by one trained and calibrated examiner using
dental explorer and mirror, in accordance with FDI criteria [18],
including several items on aesthetic, functional and biological
properties. The calibration procedures considered the analysis of
some veneers twice, randomly distributed, for Cohen’s Kappa
calculation.
All scores 4 and 5 by FDI were considered as failure (restoarions
requiring repair – code 4- or replacement – code 5 being
considered clinically unacceptable, Tables 3 and 4), with both
codes being considered as failure for analysis. Whenever necessary,
a radiographic examination was done to evaluate the endodontic
treatment by another member of the clinical staff. Those patients
who presented a treatment need during clinical evaluation were
referred for treatment. When restorations had failed before the
examination, date and reason for failure was recorded from the
patient file.
2.2.3. Statistical analysis
The main outcome of this study was the survival of direct
veneers. Additionally, the associated factors with failures were
investigated and the qualitative evaluation of the restoration was
also observed. Data were tabulated twice and statistical analysis
was carried out using the Stata 11.0 software package (StataCorp
LP; College Station, TX, USA). To report the frequency distribution
for the evaluated criteria descriptive statistics was used. Data were
subjected to non-parametric statistical analysis by the Mann-
Whitney test (for qualitative analysis using FDI criteria). Survival
curves were obtained using the Kaplan-Meier method and Log-
Rank test for comparison between groups. There were multiple
observations per patients in some cases (multiple restorations). To
account for that, multivariate Cox regression analysis with shared
frailty was used to verify the factors associated with failure. For
survival analysis, data was censored after 8 years of follow-up.
Inorganic filler percentage Mean particle size Clinical indication N veneers
37.5 vl 0.04 mm Anterior teeth 41
59.4 vl 0.7 mm Universal 55
76 wt 0.6 mm Universal 37
63.3 vl 20–75 nm Universal 24
58 vl 0.5 mm Universal 39
1332 F.H. Coelho-de-Souza et al. / Journal of Dentistry 43 (2015) 1330–1336

Hazard Ratios and respective 95% Confidence Intervals were
determined. For all analyses a significance level of 5% was set.
3. Results
The distribution of restorations according to the independent
variables is shown in Table 2. In total, 196 restorations were
evaluated in 86 adult patients (mean age 44 years old), with an
overall success rate of 80.1%. The majority of patients were females
(69.8%). 83.2% of veneers were placed in upper central incisors.
Patients had from 1 up to 8 restorations each (all veneers of the
same patient were from the same follow-up period). The follow-up
time varied from 6 months up to 15 years with a mean observation
time of 3.5 years (95% CI: 3.02–3.83). Almost 80% of the evaluated
veneers were performed using universal composites and 73% of the
restorations were placed in vital teeth.
vital teeth (log-rank: p = 0.005). There was no significant difference
between survival curves for microfilled and universal composites
veneers (Fig. 2) (log-rank: p = 0.654).
In Table 5, the adjusted Cox Regression analyses showed that
veneers performed in non-vital teeth had a risk of failure of
2.78 times (1.02; 7.56) higher than those veneers placed in vital
teeth. The annual failure rate (AFR) for non-vital teeth was 9.8%
(95% CI: 5.9; 14.7) and for vital teeth was 4.9% (95% CI: 2.5; 9.2).
Regarding the restorative materials, when comparing microfilled
and universal composites, there was no significant difference
between materials. The AFRs for microfilled veneers and universal
veneers were 6.0% (95% CI: 3.2; 10.5) and 6.2% (95% CI: 3.2; 10.5),
respectively.
The most common reason for failure was fracture of the
restoration, occurring in 30 cases (15.3% out of the 19.9% of general
failures).

3.1. Qualitative analysis 3.3. Clinical images

In Table 3, the qualitative evaluation using FDI criteria for those Figs. 3 and 4 show some examples of the investigated
restorations still in situ are shown. In this evaluation, all restorations. In Fig. 3a and b, there are images of microfilled
restorations were considered acceptable, but veneers in vital and universal veneers, which failed due to fracture of the
teeth had a better performance for the criteria fracture and restorations. In Fig. 4a and b, some examples of microfilled and
retention and color match while for surface luster a borderline universal composites veneers with good clinical performance are
significance was found. In Table 4, the qualitative evaluation shown.
comparing veneers made with microfilled or universal composites
is shown. Even though almost all restorations could be classified as 4. Discussion
clinically acceptable, especially in relation to the esthetic proper-
ties, microfilled veneers had a significantly better performance This retrospective clinical study investigated the performance
than veneers made with universal composites (p < 0.001). Also, of veneers placed by undergraduates and graduated dentists at a
microfilled restorations had better marginal adaptation and university clinic. A satisfying clinical performance was observed
patient’s acceptance. for direct composite veneers, with an annual failure rate of 4.9% for
vital and 9.8% for veneers on non-vital teeth after a mean
3.2. Survival analysis observation of 3.5 years. The retrospective methodology was also
used in other clinical studies [3,15,19,20], and collects data of
In Fig. 1, the Kaplan–Meier survival graph shows a better clinical restorations already placed, showing results that reflect more
performance for composite veneers in vital teeth compared to non- closely the situation in real life clinical practice [12,21,22]. The
present design included a clinical evaluation by an independent
Table 2 observer like in some other retrospective analysys [11,12,20,23],
Distribution of composite veneer restorations. which ensures the fact that at the end of the observation period, all
restorations are evaluated in an independent way, like in a
Independent variables n %
prospective study. The independent observer also enables the
Sex
present qualitative analysis according to defined criteria which is
Male 26 30.2
Female 60 69.8 absent in those studies that rely on the judgement of the treating
Total 86 100 dentist [21,24–26].
For a retrospective dataset, the multivariate character requires a
Tooth type multivariate statistical method. For the survival analysis the
Central incisor 88 44.9
Kaplan Meyer method is the gold standard but the according Log–
Lateral incisor 82 41.8
Canine 26 13.3 Rank test has limitations in a multi-variate dataset as in this study.
Total 196 100 Therefore the appropriate analysis for the survival of the veneers is
a multivariate Cox Regression. The shared frailty was applied in the
Follow-up time (years)
present study and it enables to compensate for the fact that more
0.5–2 65 33.2
2–3.9 56 28.6
than one restoration could be present in the same individuals,
4–5.9 32 16.3 creating a cluster effect.
6–7.9 18 9.2 When comparing the present results with previous studies,
More than 8 125 12.7 the overall survival rate observed in our study (80.1%) is less then
Total 196 100
in the studies by Frese et al. [3], showing 84.6% of success in 5
Composite type years, and Gresnigt et al. [5], showing 87.5% of success in
Microfilled 41 20.9 3.5 years. This may be explained by the fact that the present study
Universal 155 79.1 evaluated restorations performed by many operators including
Total 196 100
undergraduate students, which may be a factor influencing the
Tooth vitality
longevity of the restorations [22]. When evaluating anterior
Vital 143 73.0 restorations performed by final year dental students, Moura et al.
Non-vital 53 27.0 [27] observed considerably higher survival for class III than for
Total 196 100 class IV restorations (91.8% and 77.8%, respectively). The value
found for class IV restorations is comparable to the overall failure
 F.H. Coelho-de-Souza et al. / Journal of Dentistry 43 (2015) 1330–1336 1333

Table 3
Clinical evaluation of composite veneers: comparison between vital and non-vital teeth, according to the FDI criteria.

Vital teeth Non-vital teeth Mann–

Whitney
Restorations scoresa n Restorations clinically Restorations scores n Restorations clinically p
(1/2/3/4/5) acceptable (1/2/3/4/5) acceptable
Aesthetics Surface lustre 142 (95/43/4/0/0) 100% 45 (23/20/2/0/0) 100% 0.057
properties
Surface staining 142 (68/57/17/0/0) 100% 45(16/19/10/0/0) 100% 0.074
Marginal staining 142 (50/66/26/0/0) 100% 45 (10/26/9/0/0) 100% 0.198
Color match 142 (119/21/2/0/0) 100% 45 (29/13/3/0/0) 100% 0.004
Anatomic form 142 (88/43/11/0/0) 100% 45 (24/15/6/0/0) 100% 0.241

Functional Fracture and retention 143(105/14/8/12/4) 88.8% 53 (33/3/3/4/10) 73.6% 0.038

properties
Marginal adaptation 142 (57/76/8/0/1) 99.3% 45 (18/18/7/1/1) 95.6% 0.343
Patient’s view 143 (116/21/5/0/1) 99.3% 46 (34/5/5/1/1) 95.7% 0.191

Biological Recurrence of caries, erosion 142 (133/2/1/6/0) 95.8% 45 (44/0/0/1/0) 97.8% 0.292
properties and abfraction
Postoperative sensitivity 142 (135/4/1/2/0) 98.6% 45 (45/0/0/0/0) 100% 0.130
a
For each evaluation criterion a score from 1 to 5 is given: 1–3 when the restoration is clinically acceptable, while 4 and 5 designate failure (Kappa = 0.87).

Table 4
Clinical evaluation of composite veneers: comparison between the composite types (microfilled and universal composites), according to the FDI criteria:

Microfill Universal Mann–

Whitney
Restorations scoresa n (1/ Restorations clinically Restorations Restorations clinically p
2/3/4/5) acceptable scores n (1/2/3/ acceptable
4/5)
Aesthetics Surface lustre 41 (41/0/0/0/0) 100% 146 (77/63/6/0/ 100% 0.001
properties 0)
Surface staining 41 (34/6/1/0/0) 100% 146 (50/70/26/ 100% 0.001
0/0)
Marginal staining 41 (23/15/3/0/0) 100% 146 (37/77/32/ 100% 0.001
0/0)
Color match 41 (39/2/0/0/0) 100% 146 (109/32/5/ 100% 0.004
0/0)
Anatomic form 41 (37/3/1/0/0) 100% 146 (75/55/16/ 100% 0.001
0/0)

Functional Fracture and retention 41 (33/0/3/4/1) 87.8% 155(105/17/8/ 83.9% 0.150

properties 12/13)
Marginal adaptation 41 (30/11/0/0/0) 100% 146 (45/83/15/ 97.9% 0.001
1/2)
Patient’s view 41 (38/3/0/0/0) 100% 148 (112/23/10/ 98.0% 0.014
1/2)

Biological Recurrence of caries, erosion and 41 (37/1/0/3/0) 92.7% 146 (140/1/1/4/ 97.3% 0.156
properties abfraction 0)
Postoperative sensitivity 41 (41/0/0/0/0) 100% 146 (139/4/1/2/ 98.6% 0.154
0)
a
For each evaluation criterion a score from 1 to 5 is given: 1–3 when the restoration is clinically acceptable, while 4 and 5 designate failure (Kappa = 0.87).

rate observed for the veneers in the present study. Further, the
patients included in the present survey were from Dental School
attendants, which originate from lower socioeconomic levels
which is a factor associated with higher restoration failure rates
[28].
Regarding the qualitative analysis, all kinds of failures were
detected under FDI evaluation process, considering all clinical
criteria. The most frequent reason for failure was related to fracture
and retention (fracture of the veneer—30 cases), followed by
recurrence of caries (7 cases). In the Frese et al. [3] study, more than
90% of the in situ restorations were rated as clinically acceptable
when using the FDI/USPHS criteria, which was similar to the
findings of our study. In a recent systematic review of anterior
composite restorations was observed that the main reason for
restoration failure was fracture of restorations, followed by
esthetic reasons [29], as detected in our study.
Even though vital and non-vital teeth presented good perfor-
mance, there was significant difference in relation to the survival
rates, and the statistical analysis demonstrated that the veneers
made in non-vital teeth showed two times higher risk of failure
than veneers placed in vital teeth. The AFR for non-vital teeth
(9.8%) was almost double the AFR for vital teeth (4.9%). The lack of
tooth vitality was considered as a possible risk factor for posterior
composite restorations [22]. A retrospective practice based
research on restorations performed in endodontically treated
teeth showed that these restorations could present a good clinical
behavior, but the authors observed AFRs higher than those
expected for restorations in vital teeth [10]. Furthermore, in the
qualitative evaluation, vital teeth showed a better performance on
the criteria fracture and retention, color match, while a borderline
significance was found for surface luster. When the pulp is
removed and endodontically therapy is carried out, there is a
1334 F.H. Coelho-de-Souza et al. / Journal of Dentistry 43 (2015) 1330–1336

color match, anatomic form, better marginal adaptation and scored

better on the patients’ view criterion. Microfilled composites have
a better lustre and smoother surface [32], also when tooth
brushing procedures were applied [33]. The differences in esthetic
appearance compared to the universal materials can be easily
explained from the lower average particle size for microfilled. In
the present study, also 24 restorations were included in the
universal composite group made by Filtek Z350 xt, which is
comparable to Filtek Supreme outside South America. According to
the nanofillers, also for this material a high luster could be
expected. However, due to the limited number of Z350 xt veneers
in the sample of this study, it was not possible to do a separate
analysis on this material and added it to the group universal
composites, which is dominated by Hybrid materials with an
average particle size of 0.6 micron and higher. Moreover, a recent
systematic review of in vitro studies has not demonstrated any
superiority of nanofilled or submicronfilled composites compared
to microhybrid composites, when evaluating surface smoothness
Fig. 1. Kaplan–Meier survival curves for composite veneers in vital and non-vital
teeth (log-rank: p = 0.005). [17]. The better performance observed in the qualitative evaluation
for microfilled composites could be interesting for application in
individuals with a high esthetic demand or patients that easily
have their teeth subject to staining. In a survey among dentists in
Southern Brazil (the same region where the present study was
carried out), only 26% of the dentists selected microfilled
composite as the first choice for anterior restorations, while
microhybrid (universal) composites were the most selected
material [16]. A clinical trial evaluated after 41 months 96 direct
microhybrid composite veneers (Enamel Plus HFO and Miris2),
according to modified USPHS criteria and this resulted in a survival
rate of 87.5%, with no statistically significant difference between
the two composites [5].
Most of the failures found in our survey were related to the first
years in service. We could speculate that in a future analysis and
follow-up of these veneers, the AFR can change. In the present
study, the general percentage of failures considering the scores
4 and 5 of the FDI method was 19.9%, and most of them were
fractures of the veneer (15.3%) [34]. Restorations involving the
incisal edge are subjected to masticatory loads and parafunctions
like grinding and nail-biting. Heintze et al. [14] showed in their
Fig. 2. Kaplan–Meier survival curves for microfilled and universal composites’
systematic review a higher risk of failure for the restorations with
veneers (log-rank: p = 0.654).
the incisal edge involved (class IV against class III). Further, all
restorations considered failed in this survey were referred to the
Table 5 dental clinic for retreatment. For those restorations classified with
Cox regression analysis with adjusted Hazard Ratio (HR) for independent variables the score 4, a repair was performed and the restorations remained
and failures of composite veneers. in situ. However, for analysis such restorations were classified as
Independent variables HRc 95% CI p-value failures. Demarco et al. [22] have pointed out that we should
Sex (female vs male) 4.32 0.805–23.16 0.804
rediscuss this classification, because the repaired restorations
remain in function and therefore, could not be considered a
Tooth type (vs central incisors) complete failure. In fact, those authors have observed in their
Lateral incisors 0.71 0.31–1.62 0.575 review that if the repaired restorations were not classified as
Canines 0.47 0.08–2.63
failures, the annual failure rate for posterior composite restoration
Material (universal vs microfilled) 1.07 0.23–5.08 0.933
Tooth vitality (non-vital vs vital) 2.78 1.02–7.56 0.045 could drop from 1.9 to 0.7. Thus, repairability is a factor extending
the survival for composite restorations and this should be taken
into account when evaluating results of clinical studies investigat-
significant removal of tooth structure and as a consequence lower ing restoration longevity.
resistance to fracture in these teeth exist [30]. Moreover, Most studies on veneers report the results of porcelain veneers.
endodontically treated front teeth often show discolorations that Indirect porcelain laminate veneers have a good survival rate,
may result in the patients wish for replacing a veneer restoration. showing a survival of 90% after 3–5 years service [7,35,36]. Clinical
Also, bonding to tooth structure in endodontically treated teeth studies assessing the long-term direct composite veneers are rare,
seems to be reduced when compared to the adhesive procedures especially including non-vital teeth [34]. This indicates the clinical
performed in vital teeth [31]. relevance of our study, which investigated situations often occurring
Concerning the two types of composites evaluated (microfilled in clinical practice. The determination of risk factors that can impair
and universal), both presented satisfying performance, with no the clinical performance of restorations in daily practice is an
significant differences in relation to the survival rates. However, ultimate goal for dentistry, in order to increase the longevity of
the veneers made with microfilled composite showed statistically restorative procedures and reducing the costs of dental treatment
better surface lustre, lower marginal and surface staining, better [37]. Another important aspect to highlight is related to the lack of
 F.H. Coelho-de-Souza et al. / Journal of Dentistry 43 (2015) 1330–1336
Fig. 3. Representative pictures of failed veneers: (A) chip fracture of the veneer (score 4 – repairable). (B) Bulk fracture of the veneer (score 5).
Fig. 4. Representative pictures of successful veneers: (A) microfilled composite veneer after 9 years in the lateral incisor. (B) Composite veneers after 02 years in the central
incisors.
important information provided from clinical studies as reported in
the systematic review [29], which can impair the comparison of
different studies. Clinical studies should follow the guidelines for
reporting different study designs, which certainly would improve
the quality of the published papers and their transparency [38]. In the
present study we tried to follow these guidelines in order to provide
the most relevant information when describing our study.
5. Conclusion
Within the limitations of this current work, it is possible to
conclude that:
- In general, the composite veneers evaluated showed a satisfac-
tory clinical performance and the survival rate was 80.1% after
3.5 years.
- Direct composite veneers performed in vital teeth showed a
better performance compared to those in non-vital teeth for
color match, fracture and retention outcomes.
- Veneers in non-vital teeth have two times higher risk of failure
than the veneers placed in vital teeth.
- There was no difference in survival rate between veneers placed
with microfilled or universal composites. However, microfilled
composite veneers showed a slightly better performance for
esthetic properties.
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