Journal

of
Dentistry
Journal of Dentistry 28 (2000) 163–177
www.elsevier.com/locate/jdent
Review

Porcelain veneers: a review of the literature

M. Peumans*, B. Van Meerbeek, P. Lambrechts, G. Vanherle
Department of Operative Dentistry and Dental Materials, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven,
Kapucijnenvoer 7, B-3000 Leuven, Belgium
Received 15 April 1999; received in revised form 25 June 1999; accepted 10 September 1999

Abstract
Objectives: Porcelain veneers are steadily increasing in popularity among today’s dental practitioners for conservative restoration of
unaesthetic anterior teeth. As with any new procedure, in vitro and in vivo investigations are required to assess the ultimate clinical efficacy
of these restorations. The current literature was therefore reviewed in search for the most important parameters determining the long-term
success of porcelain veneers.
Data sources: Laboratory studies focusing on parameters in prediction of the clinical efficacy of porcelain veneers such as the tooth
preparation for porcelain veneers, the selection and type of the adhesive system, the quality of marginal adaptation, the resistance against
microleakage, the periodontal response, and the aesthetic characteristics of the restorations have been reviewed. The clinical relevance of
these parameters was then determined by reviewing the results of short and medium to long-term in vivo studies involving porcelain veneers
performed during the last 10 years.
Conclusions: The adhesive porcelain veneer complex has been proven to be a very strong complex in vitro and in vivo. An optimal bonded
restoration was achieved especially if the preparation was located completely in enamel, if correct adhesive treatment procedures were
carried out and if a suitable luting composite was selected. The maintenance of aesthetics of porcelain veneers in the medium to long term
was excellent, patient satisfaction was high and porcelain veneers had no adverse effects on gingival health inpatients with an optimal oral
hygiene. Major shortcomings of the porcelain veneer system were described as a relatively large marginal discrepancy, and an insufficient
wear resistance of the luting composite. Although these shortcomings had no direct impact on the clinical success of porcelain veneers in the
medium term, their influence on the overall clinical performance in the long term is still unknown and therefore needs further study. q 2000
Elsevier Science Ltd. All rights reserved.
Keywords: Porcelain veneers; Adhesion; Clinical effectiveness; Laboratory performance; Literature review

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
1.1. The adhesion complex: tooth/luting composite/porcelain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
1.1.1. Tooth surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
1.1.2. Porcelain veneer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
1.1.3. Luting composite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
1.1.4. The adhesion complex: tooth/luting composite/porcelain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
1.2. Marginal adaptation of the porcelain veneer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
1.3. Microleakage at the tooth/luting composite/porcelain interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
1.4. Periodontal response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
1.5. Aesthetic characteristics of porcelain veneers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
2. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174

* Corresponding author. Tel.: 132-16-332432; fax: 132-16-332440.

0300-5712/00/$ - see front matter q 2000 Elsevier Science Ltd. All rights reserved.
PII: S0300-571 2(99)00066-4
164 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
1. Introduction
The patients’ demand for treatment of unaesthetic
anterior teeth is steadily growing. Accordingly, several
treatment options have been proposed to restore the
aesthetic appearance of the dentition. For many years,
the most predictable and durable aesthetic correction of
anterior teeth has been achieved by the preparation of
full crowns. However, this approach is undoubtedly most
invasive with substantial removal of large amounts of
sound tooth substance and possible adverse effects on
adjacent pulp and periodontal tissues. The great progress
in bonding capability to both enamel and dentine made
with the introduction of multi-step total-etch adhesive
systems [1–3], along with the development of high-
performance and more universally applicable small-
particle hybrid resin composites has led to more conser-
vative restorative adhesive techniques to deal with
unaesthetic tooth appearance. Resin composite veneers
can be used to mask tooth discolorations and/or to
correct unaesthetic tooth forms and/or positions.
However, such restorations still suffer from a limited
longevity, because resin composites remain susceptible
to discoloration, wear and marginal fractures, reducing
thereby the aesthetic result in the long term [4,5]. In
search for more durable aesthetics, porcelain veneers
have been introduced during the last decade. Glazed
porcelain veneers were proposed to be durable anterior
restorations with superior aesthetics. The idea of porce-
lain veneers is not a new one. In 1938, Dr Charles
Pincus [6] described a technique in which porcelain
veneers were retained by a denture adhesive during cine-
matic filming. The fragile restorations had to be
removed after filming because no adhesive system
existed at that time to permanently attach them. Simon-
sen and Calamia [7] as well as Horn [8] reactivated the
interest in porcelain veneers by introducing special acid-
etching procedures that substantially improved the long-
term porcelain veneer retention. They demonstrated that
the bond strength of an hydrofluoric acid-etched and
silanated veneer to the luting resin composite is routi-
nely greater than the bond strength of the same luting
resin to the etched enamel surface [9]. From the moment
porcelain veneers could be adhesively luted, the clinical
and laboratory techniques have continued to be refined.
As with any new procedure, in vitro studies are required
to analyse the different aspects of this new system, which
are important for clinical functioning. And finally, in vivo
studies are needed to assess the ultimate clinical efficacy of
these restorations. Therefore, laboratory studies focusing on
the most important parameters in prediction of the clinical
efficacy of porcelain veneers have been reviewed. The
clinical relevance of these parameters was then determined
by reviewing the results of short and medium to long-term in
vivo studies involving porcelain veneers performed during
the last 10 years.
1.1. The adhesion complex: tooth/luting composite/
porcelain
The porcelain veneer technique includes the bonding of a
thin porcelain laminate to the tooth surface using adhesive
techniques and a luting composite in order to change the
colour, form and/or position of anterior teeth. The success of
the porcelain veneer is greatly determined by the strength
and durability of the formed bond between the three differ-
ent components of the bonded veneer complex, as there are
the tooth surface, the luting composite and the porcelain
veneer.
1.1.1. Tooth surface
Concepts regarding the preparation of teeth for porcelain
veneers have changed over the past few years. Although
early concepts suggested minimal or no tooth preparation
[8,10–13], current beliefs support removal of varying
amounts of tooth structure [10,14–19].
Enamel reduction is required to improve the bond
strength of the resin composite to the tooth surface [20–
22]. Doing so, the aprismatic top surface of mature unpre-
pared enamel, which is known to offer only a minor reten-
tion capacity, is removed. In addition, care must be taken to
maintain the preparation completely in enamel to realise an
optimal bond with the porcelain veneer [23]. Although the
results of the newest generation dentin adhesive systems are
very promising, the bond strength of porcelain bonded to
enamel is still superior when compared with the bond
strength of porcelain bonded to dentin [24,25].
The vast majority of teeth receiving porcelain laminate
veneers should have some enamel removal, usually approxi-
mately 0.5 mm, which allows for the minimal thickness of
porcelain. Christensen [26] states that 0.75 mm is the opti-
mum amount of enamel that should be removed. According
to Ferrari et al. [27], however, the extent and thickness of
enamel in the gingival area of anterior teeth does not permit
a reduction of 0.5 mm without encroaching upon the
dentine. In addition, Natress et al. [28] found that in case
of freehand preparation, the proximal and cervical enamel
was reduced more than 0.5 mm in the vast majority of cases
with exposure of dentine in most teeth.
If dentine is exposed, protection is recommended for the
period between preparation and cementation in order to
prevent post-operative sensitivity and bacterial invasion
[29,30]. The temporary materials (resin composite or acrylic
resin) currently in use only partially seal the surface [31,32].
More effectively, the exposed dentine can be protected by
means of a primer, which is a hydrophilic reactive monomer
in an organic solvent [33,34]. The use of these primers or
desensitisers after preparation seems not to deteriorate adhe-
sion to dentine when the exposed dentine surface is adequately
re-treated at the final appointment prior to the actual cementa-
tion [35]. Paul and Schärer [36] even proposed the application
of the dentin bonding agent immediately after completion of
tooth preparation. This new dentin bonding agent application
 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
Fig. 1. Field-emission SEM photomicrograph of a GC Cosmotech porcelain surface etched with 9.5% hydrofluoric acid (Porcelain Etch gel, Ultradent) for 60 s
and ultrasonically cleaned. The etched porcelain surface showed an amorphous micro-structure with numerous micro-porosities. (Bar ˆ 10 mm;
Magnification ˆ 10 000 × ).
technique may prevent the development of bacterial leakage
and dentin sensitivity during the temporary phase, and the
technique is associated with improved bond strength in vitro.
If temporary resin veneers must be placed because of aesthetic
and/or phonetic reasons, it is indicated to use an eugenol
free temporary cement in order to maintain the original bond
strength [37]. Alternatively temporary veneers may be
constructed in composite, held in place by a small area of
etched enamel [14,17].
Regarding the incisal preparation, three basic types of
preparation have been described namely, the window or
intra-enamel preparation, the overlapped incisal edge
preparation and the feathered incisal preparation. Several
authors favoured the overlapped incisal preparation
[16,17,26]. With this type of incisal preparation, the
dental technician has more control on the aesthetic char-
acteristics of the incisal part of the porcelain veneer. In
addition, this preparation will make the restoration more
resistant to incisal fractures. Highton et al. [38]
confirmed this latter statement in vitro using a two-
dimensional photo-elastic stress analysis. This type of
preparation distributed the occlusal load over a wider
surface area and, consequently, reduced stress concen-
tration within the veneer. On the contrary, an in vitro
study by Hui et al. [39] and Gilde et al. [40] demon-
strated that an overlap porcelain veneer design will
transmit maximum stress on the veneer and increases
the risk of cohesive fracture. A window design prepared
entirely into enamel withstood axial stress most favour-
ably in this investigation. They concluded that where
strength is an important requisite, the most conservative
type of veneer, namely the window preparation, was the
design of choice. However, in the clinical study of
Meijering et al. [41] no relation was seen between
survival and incisal preparation design (no incisal over-
lap versus incisal overlap) for both indirect resin
165
composite and porcelain veneers after 2.5 years of clin-
ical functioning. Further in vivo studies have to point
out if a similar result would be noticed in the long
term.
1.1.2. Porcelain veneer
Veneers are mainly fabricated from conventional low
fusing feldspathic porcelain. Two methods for fabrication
of these porcelain veneers have been described: the plati-
num foil technique [8,11,14,42] and the refractory die tech-
nique [14]. At present, the refractory die technique is
preferred to the platinum foil technique in most laboratories
[43].
By etching the inner side of the porcelain veneer with
hydrofluoric acid and subsequently silanizing the etched
surface, the bond strength of a luting composite to the
etched porcelain surface has been measured to be higher
than the bond strength of a luting composite to etched
enamel and even exceeding the cohesive strength of the
porcelain itself [9,22,44–47]. Etching the inner side of the
porcelain veneer with hydrofluoric acid creates a retentive
etch pattern. SEM of the etched porcelain surface showed an
amorphous micro-structure with numerous porosities
[44,47–50] (Fig. 1). These micro-porosities increase the
surface area for bonding and lead to a micro-mechanical
interlocking of the resin composite. Several factors like
the etching time, concentration of the etching liquid, fabri-
cation method of the porcelain restoration [7,44], and type
of porcelain [51,52] determine the micro-morphology of the
etch pattern and consequently the bond strength of the resin
composite to the etched porcelain.
In addition to micro-porosities, micro-cracks were
observed that grow when the etching time increases [49].
These cracks can act as sources of crack initiation and
slightly, although not significantly, decrease the flexural
strength of the etched porcelain. Weakening of the
166 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177

Fig. 2. The interface tooth/luting composite/porcelain of a bonded to tooth porcelain veneer shows the interdigitation of the luting composite into the etched-
and-silanized porcelain surface and the etched enamel surface. (Bar ˆ 25 mm; Magnification ˆ 625 × ) Center: Magnification of the luting composite (Opal
Luting Composite, 3M). At the luting composite/porcelain interface, the luting composite is diluted with unfilled resin (u) (Scotchbond Multi-Purpose, 3M).
The undiluted luting composite contains densely packed rounded filler particles of different sizes. (Bar ˆ 1 mm; Magnification ˆ 5000 × ).

porcelain by etching was also noted in other in vitro studies
[53,54].
Ultrasonic cleaning of etched porcelain in 95% alcohol,
acetone or distilled water is indicated to remove all residual
acid and dissolved debris from the surface. Inadequate
rinsing after etching the porcelain surface may leave re-
mineralised salts, which can be recognised as a white resi-
due or deposit [55]. Some authors [50,56] studied the etch
patterns of hydrofluoric acid on feldspathic porcelain with
SEM and concluded that the best surface, in terms of pene-
trability, was obtained by immersion of the etched porcelain
in an ultrasonic bath. Aida et al. [57], however, observed no
significant differences in surface morphology and bond
strength between etched (5% GC Hydrofluoric Acid, GC
Corp., Tokyo, Japan) feldspathic porcelain with and without
ultrasonic cleaning.
Silanization of etched porcelain with a bi-functional
coupling agent provides a chemical link between the luting
resin composite and porcelain. A silane group at one end
chemically bonds to the hydrolysed silicon dioxide at the
ceramic surface, and a methacrylate group at the other end
copolymerises with the adhesive resin. Single-component
systems contain silane in alcohol or acetone and require
prior acidification of the ceramic surface with hydrofluoric
acid to activate the chemical reaction. With two-component
silane solutions, the silane is mixed with an aqueous acid
solution to hydrolyse the silane, so that it can react directly
with the ceramic surface. If not used within several hours,
silane will polymerise to an unreactive polysiloxane [58].
Several authors reported differences in bond strength depen-
dent on the silane treatment used [45,46,51,56]. In addition,
heating of the silane-coated porcelain to 1008C resulted in a
bond strength twice as high than if no heating was used [52].
The bond strength of resin composite to a pre-treated
ceramic restoration has been described to be negatively
influenced by external factors like water sorption [52], ther-
mocycling [22,59], and fatigue [60]. Contamination of the
pre-treated surface with die stone [61], latex gloves [62],
saliva [46,59], silicone-based fit-checker paste [63,64], and
try-in paste [65] will also lower the bond strength. Several
cleaning methods were proposed to restore the original bond
strength. In case of contamination with saliva, re-etching the
inner side of the porcelain with 37% phosphoric acid
restored the bond strength [46,66]. Acetone cleaning, after
removal of the try-in paste, produced a marked reduc-
tion in bond strength [61,65]. This cleaned surface had
to be silanated again to restore the original bond
strength [65]. A decreased bond strength due to contam-
ination with fit-checker paste was restored by re-etching
and silanizing the porcelain surface [64], whereas Sheth
et al. [63] reported that the original bond strength could
not be restored due to chemical contamination of the
porcelain surface.
1.1.3. Luting composite
For cementation of porcelain veneers a light-curing luting
composite is preferred [55]. A major advantage of light-
curing is that it allows for a longer working time compared
with dual cure or chemically curing materials. This makes it
easier for the dentist to remove excess composite prior to
curing, and greatly shorten the finishing time required for
these restorations. In addition, their colour stability is super-
ior compared with the dual-cured or chemical-cured
systems. Nevertheless, it is important that there is enough
light transmittance throughout the porcelain veneer to poly-
merise the light-curing luting composite. The porcelain
veneer absorbs between 40–50% of the emitted light. The
thickness of the porcelain veneer is the primary factor
Table 1
Descriptive statistics of clinical trials involving porcelain veneers (evaluation criteria*: color (1), surface texture (2), wear (3), marginal adaptation (4), marginal discoloration (5), caries (6), fracture (7), retention
(8), post-operative sensitivity (9), gingiva response (10), patient satisfaction (11))

Author Number of veneers Number of patients Porcelain/adhesive-system Type of preparation Observation-period Evaluation criteria*

Clyde and Gilmoure [42] 200 Not specified Chameleon(Terec)/Duo-cure Feathered incisal edge 1–30 months 1,7,8,9,10
(Terec) Incisal bevel
Palatal overlap

Calamia [89] 115 17 Chameleon (Terec)/ No preparation 2–3 y 4,5,6,7,8,10

Comspan 1 Ultrabond Slight incisal overlap (USPHS criteria)
(Den-Mat)

Jordan et al. [90] 80 12 Not specified/dual cure Conventional 4y 1,2,3,4,6,8,9,10

(not specified) (no incisal overlap) (modified Ryge criteria)

M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177

Rucker et al. [84] 44 16 Vitadur-N(Vita)/ Incisal bevel 2y 1,4,7,8,10,11
Heliolink 1 Dual cement
(Vivadent)
Feathered incisal edge
Christensen and Christensen 163 45 Cerinate (Den-Mat)/ Feathered incisal egde 3y 1,4,5,6,7,10,11
[91] Ultrabond (Den-Mat)
Nordbq et al. [85] 135 41 Ceramco (Ceramco Inc.)/ Conventional 3y 3,4,5,7,8
Porcelite LC (Kerr) (no incisal overlap)
Jäger et al. [86] 80 25 Mirage/Mirage Palatal overlap 1–7 y 4(SEM),5,6,7,10,11
FLC 1 Mirage Bond (FA
Mirage)
(10 veneers .4 y)
Strassler and Nathanson [83] 291 60 Cerinate (Den-Mat)/ No preparation 18–42 months 1,4,5,7,8
Ultrabond (Den-Mat) Conventional (modified USPHS criteria)
(no incisal overlap)

Strassler and Weiner [92] 115 21 Cerinate (Den-Mat)/ No preparation 7–10 y 1,4,5,6,7,8
Ultrabond (Den-Mat) Conventional (modified USPHS criteria)
(no incisal overlap)

Walls [93] 54 12 Fiber reinforced porcelain Special preparation for 5y 5,7,8,10

(not specified)/Heliolink worn teeth
(Vivadent) 1 Gluma (Bayer)
Meijering [41] 56 Not specified Flexo-ceram (Elephant Conventional 2.5 y 1,4,5,6,7,8,9,10,11
Ceramics)/not specified (no incisal overlap) (modified USPHS criteria)
Palatal overlap
Peumans et al. [87] 87 25 GC Cosmotech Porcelain/GC Palatal overlap 5–6 y 1,2,4,5,6,7,8,10,11
Cosmotech Bonding Set
(GC) 1 Scotchbond 2 (3M)
Kihn et al. [88] 59 12 Ceramco Colorlogic/ Conventional (no 48 months 1,4,5,6,9,10
Ceramco Colorlogic Bonding incisal overlap)
System Palatal overlap

167
 168
M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
Table 2
Results of clinical trials involving porcelain veneers

Author Retention 1 Fracture rate (%) Excellent margins (%) Microleakage (%) Caries (%) Periodontal health Maintenance of aesthetics (%) Patient satisfaction

Clyde and Gilmoure [42] 1 – – – Excellent (not specified) – –

Calamia [89] 3 93 17 1 Acceptable 100 –
Jordan et al. [90] 3 83 – 0 Excellent 100 –
Rucker et al. [84] 0 100 – – Excellent (not specified) 100 100% excellent
Christensen and Christensen 13 65 8 1 Slight gingival irritation 100 87% excellent
[91]
Nordbq et al. [85] 5 Not specified Negligible – – 100 –
Jäger et al. [86] 1 55 1 1 Excellent – 84% excellent
Strassler and Nathanson [83] 1.7 96 0 0 – 100 –
Strassler and Weiner [92] 7 88 14 1 – 100 –
Walls [93] 14 Not specified 28 – Excellent – –
Meijering et al. [41] Not specified 98 22 0 Excellent 100 93% excellent
Peumans et al. [87] 1 14 25 2 Slight gingival irritation 100 80% excellent
Kihn et al. [88] 0 85 2 0–1 No gingival response 100 /
 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
determining the light transmittance available for polymer-
isation [67–73]. The colour and the opacity of the porcelain
would have less influence on the amount of absorbed light
[69,72,73]. Linden et al. [72] reported that the opacity of
porcelain became more important for facings with a thick-
ness of 0.7 mm or more. Consequently, the presence of a
porcelain veneer increases the setting time of the resin
composite used beneath the veneer [69–72]. O’Keefe et al.
[73] argued that it was necessary to double the recom-
mended exposure time.
In case of porcelain with a thickness of more than 0.7 mm
[72], light-cured resin composites do not reach their maxi-
mum hardness. A dual-cured luting composite, which
contains the initiation systems for both chemically and
light-cured composites, is advisable in these situations.
With these latter luting agents a stronger bond can be
obtained with the porcelain [68]. Also higher values of hard-
ness were reported for the dual-cure resin cements than for
the light-cured luting composites because of their higher
degree of polymerisation [72,74].
Regarding the classification of luting composites, Albers
[55] ranked these luting composites following the classifi-
cation of resin composites for restorative purposes proposed
by Lutz and Phillips [75]. According to Inokoshi et al. [76],
it is difficult to classify the luting composites following
these criteria because their high content of small particles
requires that many of them would be classified as hybrid
resins or heavily filled resins. A classification of 14 dual-
cure luting composites was made according to their maxi-
mum filler size. This maximum filler size varied extremely
from less than 1 to 250 mm. The predominant filler size for
all products was much smaller than the maximum filler size.
The filler weight varied from 36 to 77%. No correlation was
observed between filler loading, maximum filler size and
consistency of these dual-cured luting composites, whereas
a strong correlation was found between the consistency and
the film thickness of the luting agents. This relation was
supported by the temperature dependence of the film thick-
ness reported for these dual-cure luting composites [77].
The great diversity in the currently available products
makes clear specification for luting composites urgently
needed.
1.1.4. The adhesion complex: tooth/luting composite/
porcelain
The adhesion complex porcelain/luting composite/tooth
was studied by Stacey [22]. He reported that a very strong
complex was obtained in vitro by luting the porcelain
veneer. The strength of the combined porcelain/luting
composite/enamel bond (63 MPa) was significantly higher
than the separate composite/etched enamel (31 MPa) and
luting composite/etched-and-silanized porcelain (33 MPa)
bond strengths. This assumes that a close apposition of the
enamel and the porcelain surface synergistically influences
the bond strength of the luting composite/enamel and luting
composite/porcelain bonds. In addition, Andreasen et al.
169
[78] and Stokes and Hood [79] noted that extracted incisors
restored with porcelain veneers were recovered to their
original strength. A laboratory investigation analysing
ultra-morphologically the adhesive interface of porcelain
veneers bonded to tooth structure confirmed the high reten-
tion of bonded porcelain veneers [50]: FE-SEM photo-
graphs showed a strong micro-mechanical interlocking of
the luting composite in the micro-retentive pits of the acid-
etched tooth surface at one side and in the etch pits of the
acid-etched porcelain surface at the other side (Fig. 2).
Magne and Douglas [80] also demonstrated that porcelain
veneers restore the mechanical behaviour and microstruc-
ture of the intact tooth in vitro even when they are bonded to
an extensive dentin surface using an optimised application
mode of dentine adhesives. Nevertheless, significant cyclic
temperature changes can induce the development of flaws in
porcelain veneers. A sufficient and even thickness of cera-
mic combined with a minimal thickness of luting composite
will provide the restoration with a favourable configuration
with regard to crack propensity, namely, a ceramic and
luting composite thickness ratio above 3 [81]. This ratio
also appears to have a relevant influence on the stress distri-
bution in porcelain laminates. Restorations that are too thin,
combined with poor internal fit, resulted in higher stresses at
both the surface and interface of the restoration [82].
Ultimately, the clinical relevance of these in vitro results
must be determined in vivo. A review of clinical trials invol-
ving porcelain veneers, that were conducted during the last
10 years, is summarised in Table 1 with their respective
descriptive statistics (Table 1) and results (Table 2). These
in vivo results confirmed the strong bond between a porce-
lain veneer and the underlying tooth tissue as most short and
medium-term clinical studies reported a very low failure
rate (0–5%) due to loss of bonding and fracture [42,83–
88]. Somewhat higher failure rates were noted by Christen-
sen and Christensen [91], 13% after three years and by
Strassler and Weiner [92], 7% after 7–10 years. Walls
[93] also observed a high number of fractures and/or loss
of porcelain veneers (14%) after five years of clinical func-
tioning. Unfavourable occlusion and articulation seemed to
have been a determining factor for the high failure rate of
porcelain veneers as the latter restorations were placed
for aesthetic and functional reconstruction of fractured
and worn anterior teeth in patients with a history of
bruxism. The large exposed dentine surfaces to be
bonded in these fractured and worn teeth (using a
third generation dentin adhesive) may also have contrib-
uted to the high failure rate.
Some authors [94,95] reported higher failure rates in vivo
when porcelain veneers were partly bonded to underlying
composite restorations. This bonding is based on delayed
resin-to-resin bonding, which may decrease the bond
strength of the porcelain veneer–tooth complex.
As a conclusion, in vitro and in vivo studies indicated that
porcelain veneers are strong and durable restorations in the
medium to long term when enough intact tooth tissue is left
170 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
Fig. 3. SEM photomicrograph of the cervical margin of a 5-year old porcelain veneer (P) showing a small marginal defect and a border of roughened porcelain
(arrows). (G, gingiva; C, luting composite) (Bar ˆ 250 mm; Magnification ˆ 52 × ).
to bond the porcelain veneer and when occlusion and articu-
lation are not pathological.
1.2. Marginal adaptation of the porcelain veneer
For any cemented restoration the weak link is at the
restoration-cement–tooth interface. In porcelain veneers
the composite luting agent is the weak link in the system.
When used as a luting agent, the bulk of composite resin is
greatly reduced. However, there is still polymerisation
volumetric shrinkage in the amount of 2.6–5.7% [96],
which may create a marginal opening or loss of the
marginal seal. The thermal expansion coefficient (TEC) is
also different from the tooth tissues and the porcelain.
Finally, composite resins may wear and the wear will be
greater in case of larger gap widths compared to smaller
ones [97]. In addition, in vitro studies have demonstrated
a dissolution of the resin matrix of composite resin in oral
fluids [98–100]. Therefore it is desirable to minimise the
composite component and maximise the porcelain compo-
nent by having as close an adaptation of the porcelain
veneer as possible.
Sorensen et al. [101] compared in vitro the marginal fit of
porcelain veneers fabricated by the two procedures
described above: the platinum foil technique and the refrac-
tory die technique. They reported that the mean vertical
marginal discrepancy (for all positions combined) for plati-
num foil veneers (187 mm) was significantly less than that
for veneers made with the refractory die technique
(242 mm). The same observation was done by Sim and
Ibbetson [102] (60 versus 290 mm) and Wall et al. [103]
(74 versus 132 mm), although they reported smaller
marginal gap widths. This finding seems however incongru-
ous, considering that the platinum foil occupies 25 mm. Lim
and Ironside [104] reported that divesting with aluminium
oxide abrasive may account for inadvertent abrasion of the
delicate inner porcelain surface and causes larger marginal
discrepancies (114 mm with sandblasting versus 97 mm
without sandblasting).
With the refractory die technique, the importance of
matching the thermal expansion coefficient between the
refractory die and the ceramic must be emphasised in
order to fabricate restorations with a significantly improved
marginal accuracy [105]. Intermixing of individual ceramic
and refractory products seems to be commonplace in many
laboratories with some combinations having different
thermal expansion coefficients [43].
For both fabrication techniques, the marginal openings at
the gingivo-proximal corners were two to four times larger
than at the mid-labial position [101,102,106]. This is prob-
ably the result of the shrinkage of porcelain towards the
region of greatest bulk (the centre) and the geometry of
the margins. Clinically this poorer fit at the gingivo-
proximal corners of the veneers would be further
compounded by the difficulty in access for finishing of the
luted veneers in these regions.
When luting porcelain veneers it is important that the
marginal discrepancies are completely filled with the luting
composite, in order to polish the cement layer to a smooth
margin. Harasani et al. [106] observed after finishing of the
veneers still a considerable amount of excess luting agent at
the veneer margins. Also Coyne and Wilson [107] reported
that only a small proportion of the margins of each porcelain
veneer was found to have an ideal marginal adaptation
microscopically. Hannig et al. [108] noted that especially
the cervical region seems to be a problematic area to achieve
perfect marginal adaptation.
Tay et al. [109] advised to remove the excess of non-
polymerised composite cement with a brush moistened
with bonding resin. This will reduce the dragging out
tendency of the resin out of the marginal gap and ensure a
smoother margin that is polishable.
 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177 171

Fig. 4. Field-emission SEM photomicrograph of the luting composite/etched enamel interface of a bonded to tooth porcelain veneer. At the most cervical
enamel area, the luting composite is bonded to aprismatic enamel. Atypically shaped prisms are present. (C, Luting composite; E, Enamel, u, unfilled resin)
(Bar ˆ 2 mm; Magnification ˆ 5000 × ).

Finishing of the veneer margins corrects the inherent
marginal defects but results in removal of the glaze from
the porcelain [87] (Fig. 3). This will cause increased plaque
retention and gingival reaction on the one hand and wear of
the antagonistic elements on the other hand, unless the
porcelain can be polished to a smooth surface.
Some authors showed that polishing procedures can
produce a polished surface, which is equal to a glazed
porcelain surface [110–112]. While these polishing instru-
ments perform satisfactorily on flat accessible surfaces at
high speeds, none of them are well suited for finishing
crucial gingival or interproximal regions of a bonded
veneer. Haywood et al. [113] evaluated finishing and
polishing in these crucial areas in vitro. According to
these authors, a finish equal or superior in smoothness to
glazed porcelain was achieved through the use of a series of
finishing grit diamonds (Micron Finishing System) followed
by a 30-fluted carbide bur and diamond polishing paste.
Other finishing combinations produced surface textures,
which were not as smooth as glazed porcelain. Polishing
under waterspray produced also a smoother surface for a
given diamond sequence than did dry polishing [114].
However, the effect of all these finishing procedures at
the cervical margins of the veneer with their difficult
accessibility for polishing instruments, must be evaluated
in vivo.
Regarding the marginal adaptation of porcelain veneers
after several years of clinical functioning, most in vivo

Fig. 5. Field-emission SEM photomicrograph of the luting composite/etched enamel interface of a bonded to tooth porcelain veneer at the area of prismatic
enamel. The enamel prismata are longitudinally sectioned. The perifery of the enamel prisms is preferentially dissolved forming macro-tags with a depth of
approximately 5 mm (large arrows). Micro-tags are present between the hydroxyapatite crystals (small arrows). The macro-tags and micro-tags contribute to an
enormous increase in surface area for bonding. (C, Luting composite; E, Enamel) (Bar ˆ 2 mm; Magnification ˆ 5000 × ).
172 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177

Fig. 6. Field-emission SEM photomicrograph of the luting composite/etched dentine interface at the cervical third of a bonded to tooth porcelain veneer. The
dentine tubules (arrows) are longitudinally sectioned. The dark area represents the hybrid layer and the layer of unfilled adhesive resin (H). No loss of bonding
is observed in this area using a modern total etch dentine adhesive system (Scotchbond Multi-Purpose, 3M). (C, Luting composite; D, dentine) (Bar ˆ 10 mm;
Magnification ˆ 1000 × ).

studies reported a relatively high number of restorations
with an excellent marginal adaptation (65–98%)
[41,83,84,88–92], while only few clinical studies reported
that small marginal defects were frequently observed along
the entire outline of the porcelain veneer after five years of
functioning [86,87] (Table 2). SEM examination showed
that these small marginal defects were due to the wearing
out of the composite luting agent and loss of bonding
[86,87]. A similar phenomenon was reported as submargina-
tion in several in vivo studies of porcelain inlays [115–117].
Further research should be directed towards improve-
ment of marginal adaptation of the porcelain veneers.
Attention must be given to the laboratory procedure to
reduce the marginal gap width and to the finishing
procedure to diminish the excess of resin composite at the
margins. Finally more wear-resistant luting composites
should be developed.
1.3. Microleakage at the tooth/luting composite/porcelain
interface
The polymerisation shrinkage of the luting composite and
the difference in thermal expansion coefficient between the
luting composite and both the tooth and the porcelain veneer
causes stress at the tooth/luting composite/porcelain inter-
face. According to the theories by Feilzer et al. [118], there
is only a limited potential for relaxation of polymerisation
stress due to flow because the luting composite is bonded at
all sides in a narrow “gap” with only a limited area of
unbonded surface. Consequently, Feilzer et al. [119] found
that when the thickness of the resin composite is thinned
down, as in the case of a luting agent, the wall-to-wall
polymerisation shrinkage might be three times the normal
linear contraction of bulk resin composite. Residual poly-
merisation stress could then be expected to be even greater

Fig. 7. The oblique sectioned dentine tubules at the luting composite/etched dentine interface are filled with resin tags (arrow). No loss of bonding is observed
in this area using a modern total etch dentine adhesive system (Scotchbond Multi-Purpose, 3M). (C, Luting composite; D, dentine; H, hybrid layer and layer of
unfilled adhesive resin) (Bar ˆ 5 mm; Magnification ˆ 2000 × ).
 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
than that reported for resin composite restorations. Due to
this contraction stress there exists a competition between the
adhesive forces of the two bonded interfaces: the porcelain/
luting composite interface and the luting composite/tooth
interface. The interface with the lowest adhesive forces
will fail namely the luting composite/tooth interface. Micro-
leakage will occur at this interface and may then lead to
staining, post-operative sensitivity and recurrent caries.
Microleakage at the luting composite/porcelain interface
was negligible [101,120,121]. At the interface luting
composite/tooth the microleakage was minimal when the
preparation margins were located completely in enamel
[101,120–123]. Only at the cervical margin, microleakage
was more pronounced. This would be due to the presence of
aprismatic enamel in the cervical region [50,124] (Figs. 4
and 5). Porcelain veneer preparations generally end in this
region of aprismatic enamel, which therefore may be largely
responsible for the poor marginal sealing reported at the
cervical margins of porcelain veneers in vitro [101,120–
123]. When the cervical preparation margin was located in
dentine, significantly greater microleakage was recorded at
the luting composite/tooth interface [125]. The use of a third
generation dentine bonding agent can reduce the occurrence
of microleakage according to several authors [120,125] in
contrast with the results obtained by Sim et al. [123],
who reported that none of the tested (third generation)
dentine bonding agents significantly reduced microleak-
age at the dentine margins. Dietschi et al. [126]
reported an obvious reduction in marginal leakage of
ceramic inlays when bonded to dentin using two
modern dentine adhesives, although the integrity of
the adhesive interface did not yet appear optimal in
dentine bonded ceramic restorations because bonding
failures occurred mainly between the hybrid layer and
the overlaying resin. In another in vitro study debonding
was never noticed along the luting composite/dentin
interface when a modern multi-step total-etch dentin
adhesive system was used [50] (Figs. 6 and 7). Magne
and Douglas [80] noticed in vitro that the method of
dentin adhesive application during placement of the
porcelain veneer had an influence on the quality of
the luting composite dentin/interface. Their scanning
electron microscope observations demonstrated that the
traditional application of a multi-step total etch dentin
adhesive (dentin adhesive applied when proceeding to
luting the veneer) was associated with bonding failures
between the hybrid layer and the overlaying resin,
whereas unbroken and continuous interfaces were
obtained with a new method using the same dentin
adhesive (dentin adhesive applied to dentin and cured
before taking the impression of the veneer). However,
none of the modern adhesive systems appears yet to be
able to guarantee hermetically sealed restorations with
margins free of discoloration for a long time [25].
Another effective method to reduce microleakage is by
post-finishing sealing the margins of the veneer with a
173
bonding resin [125]. Further research is necessary to evalu-
ate the retention of the sealer.
In addition to the location of the preparation margins, the
type of luting composite determines the occurrence of
microleakage as the thermal expansion coefficient and the
amount of polymerisation shrinkage vary among the type of
resin composite. A high filler loading reduces the thermal
expansion coefficient and polymerisation shrinkage.
Because of these reasons, a luting composite with an opti-
mal filler loading is preferred to lute the porcelain veneers
[101,121,122,123]. However, the viscosity of such cements
is high and hence the positioning of the veneer during the
luting procedure may be delicate. The luting procedure with
these highly filled luting composites can be simplified by
using an ultrasonic insertion technique [127]. Clinical
confirmation of this method is however required.
Light-cured and dual-cured luting composites show a
similar leakage pattern at the luting composite/tooth inter-
face according to Zaimoglu et al. [122], whereas Jankowski
et al. [128] observed less microleakage when using dual-
cured luting composites.
In clinical studies, microleakage was more frequently
observed when dentine was exposed during preparation
for porcelain veneers [89], even when a third generation
dentine adhesive system was used [87,93]. In other clinical
studies of porcelain veneers with complete intra-enamel
preparations, microleakage was reported less frequently
[83,85,88,91,92]. Finally, microleakage was rarely asso-
ciated with the presence of caries in vivo [41,83,86–92].
As a conclusion, microleakage can be minimised by
locating the preparation margins of the veneer in enamel
and by selecting a highly filled luting composite.
1.4. Periodontal response
Porcelain is considered as the most aesthetic and biocom-
patible material in dentistry with the ability to imitate sound
enamel. Several studies showed that porcelain retains
plaque less than other restorative materials or enamel
[129–132], that the plaque is removed more rapidly from
porcelain surfaces and/or that the bacterial plaque vitality on
these surfaces was smaller [133]. The low surface roughness
of the glazed porcelain may to a large part be responsible for
this phenomenon [134]. Based on these observations one
would expect no or even a positive reaction of the marginal
gingival tissues towards porcelain veneers.
Several short-term [89,135] and medium-term
[88,93,136] clinical studies of porcelain veneers confirmed
this expectation. They reported no increase of even a
decrease in plaque accumulation on these restorations.
Kourkata et al. [135] even described a significant lower
bacterial plaque vitality immediately after placement of
the porcelain veneers. Peumans, however, observed a slight
increase in plaque retention at the cervical margins of 5-year
old porcelain veneers [137]. This slight increase was
explained by the increased surface roughness at the cervical
174 M. Peumans et al. / Journal of Dentistry 28 (2000) 163–177
border of the restoration caused by removal of the glaze of
the porcelain during finishing with microfine finishing
diamonds (Fig. 3). In addition to this roughened cervical
border, the presence of small cervical marginal defects
can lead to an increased plaque retention [87].
Concerning the gingival response, most clinical studies
observed no change in gingival health at the restored teeth
[41,42,84,86,88–90,93,136] (Table 2). Only a few clinical
studies reported a slight gingival inflammation at the
restored teeth [91], especially in patients with a moderate
or bad oral hygiene [137].
According to Pippin et al. [136], the location of the cervi-
cal extension of the restoration in location to the gingival
margin also plays an important role in the reaction of the
gingival tissues. They reported that the gingival reaction
increased as the extension was located closer to or below
the gingival margin, however, the gingival reaction for
porcelain veneers was at the same location lower than for
the metal ceramic restorations.
In conclusion, no or a minimal periodontal response can
be expected at teeth restored with porcelain veneers. An
optimal oral hygiene of the patient and smoothly finished
margins are important factors to maintain an optimal period-
ontal health around the restored teeth.
1.5. Aesthetic characteristics of porcelain veneers
There is a general agreement among the practitioners that
porcelain veneers will continue to play a vital role in elec-
tive dental aesthetics. This places high demands on predict-
ability, especially with colour matching and masking
methods. The final shade of the veneers depends not only
on the colour, opacity and thickness of the porcelain but also
on the colour of the underlying tooth and the colour and
thickness of the luting composite [138–143].
Colour matching of one discoloured tooth with a porce-
lain veneer to the surrounding natural teeth must be consid-
ered as most difficult. It is impossible to mask a strong
discoloration by a thin layer of porcelain (0.3–0.7 mm)
without making the restoration opaque and lifeless. Conse-
quently, the restored tooth will never have the same trans-
lucency as the surrounding natural teeth. [14,15,42,55,87].
Regarding the aesthetics (colour stability and surface
smoothness) of porcelain veneers after several years of clin-
ical functioning, all clinical studies confirmed the mainte-
nance of aesthetics of porcelain veneers in the short term
and in the medium to long term (Table 2). In addition,
patient acceptance of porcelain veneers in these clinical
studies was high. The percentage of patients that were
completely satisfied with the porcelain veneers varied
from 80 to 100% (Table 2). Some studies even reported
an increase in patient satisfaction after several years
[91,144]. This increase was explained by the habituation
of the patients to the aesthetic improvement of their denti-
tion with porcelain veneers.
2. Conclusion
The adhesive porcelain veneer complex appeared to be a
very strong complex in vitro and in vivo. An optimal bond
was obtained if the preparation was located completely in
enamel, if correct surface treatment procedures were carried
out and if a suitable composite luting agent was selected.
However, from an aesthetic and periodontal point of view a
complete intra-enamel preparation cannot always be
realised. The quality of the restoration was inferior if
dentine was exposed to a large extent, as the current dentin
bonding agents are not yet able to prevent microleakage at
the dentin margins in the long term.
The periodontal response to porcelain veneers varied
from clinically acceptable to excellent. Regarding the
aesthetic properties of the porcelain veneers, these restora-
tions maintained their aesthetic characteristics in the
medium to long term and patient satisfaction was high.
The major shortcoming of porcelain veneers was the rela-
tively wide marginal discrepancy. At these marginal open-
ings the luting composite was exposed to the oral
environment and the wear resistance of the composite luting
agents was not yet optimal.
Nevertheless, these shortcomings had no direct impact on
the success of porcelain veneers in the medium term,
however, their influence on the overall clinical performance
in the long term is still unknown.
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