Durability of porcelain veneers

DIACONU Elena1, NICULICIOIU Ștefania2

1
5th year student , Lucian Blaga University Sibiu , Faculty of Medicine
2
5th year student , Lucian Blaga University Sibiu , Faculty of Medicine

Key words:
PVL, enamel, durability, ceramic veneers, conservative

ABSTRACT:
At the moment, in order to have an aesthetic and lasting restoration, the method of chioce will be
the one with dental porcelain veneers.Regarding the pre-prosthetic stage, they require a
minimum reduction of the dental structure, the adhesion being based on the enamel engraving,
these making them coservative preparations.
As far as that goes, the materials and techniques used for their manufacture, there are a variety of
possibilities on the market, from traditional techniques, manual, to computerized CAD-CAM
techniques. The latter are currently preferred, benefiting from a wide range of colors with opacity
and translucency close to natural teeth. At the same time, modern computerized techniques have
the advantage of a single session in the dental office and the elimination of laboratory steps,
providing comfort to patients.
This study will determine the resistance of dental veneers against time and the chances of
success, these having a questionable longevity starting from 5 to 25 years according to the
related studies.

INTRODUCTION
Over time, dental complete crowns have proven a predictable and durable option for the
restauration of unesthetic anterior teeth. Despite this resistance over time, this procedure involves
significant removal of tooth structure.[1,2] As an alternative method to recreate the estethic of
anterior teeth was the porcelain veneers.
The application of porcelain veneers has been practiced in dentistry since 1980 when it was
discovered that one could etch the inside of a porcelain restoration and get micromechanical
retention similar to that achived on engraved enamel. It was also possible to treat the surface
with silane and thereby and increase bond strength. Surface treatments with etching and silane
achieved bond strengths of over 2000 pounds per square inch (psi) whereas, without these steps
only about 230 psi was possible. A further discovery was that thin layers of porcelain could be
bonded to tooth structures. This was far better than having to remove significant tooth structure
for a thicker restoration in order to attain the retention and resistance, and like that being more
conservative. It was possible to maintain the maximum amount of natural tooth structure and still
achieve the results the patient wanted in terms of esthetics dentistry. Surface improvements
included better color, apparent angulation and positioning (i.c., making teeth that were not
entirely straight look straight), and the closing of spaces without orthodontic treatment. It
became possible to do these things without removing extensive amounts of tooth structure.
Sometimes none was removed at all, like in the cases where patients have marked dental spaces.
[3]
Bonding to enamel is more durable than to dentin[4] and intact enamel provides the most reliable
substrate for etched porcelain laminate veneers (PLVs).[5] PLVs provide a dependable treatment
option that is conservative and more durable than composite resin veneers[1,6] and provides
excellent esthetics, mimicking the natural translucency and structure of teeth[1]. The reason the
thin layers of porcelain veneers work, even in functional areas, is because of the lamination
process. Ceramics are inherently brittle, but when supported, their strength is considerable. An
example is a piece of floor tile, a strong man can break it in his hands, but once is laminated to
the floor, it generally never breaks as long as the adhesive stays intact[3].

PURPOSE: The
purpose of this
clinical study was to
demonstrate the
clinical performance
and longevity of
PVL over time and
to highlight their
benefits.

Fig.1: A. placement of depth orientation grooves and preparation for

PLV. B.Completed teeth preparation after gingival retraction.
C.Polyvinyl siloxane impression D.veneers on the master cast

MATERIALS AND METHODS

In order to present the techniques and materials used for the restoration with dental veneers,
information from 7 articles was used, having as exclusive source the SIENCEDIRECT website.

Impression-taking for porcelain veneers

Impression-taking for porcelain veneers A vinyl poly-siloxane-based impression material is

typically used in a personalized or stock tray for veneer impression preparation. The retraction
wire is positioned to expose the finish line. For computer-aided-designed and computer-aided-
manufactured (CAD-CAM) veneers, a digital impression is made with an intraoral scanner. The
temporization of tooth preparation for porcelain laminate veneers is sustained in order to
maintain the patient’s appearance unaltered and for the overall success of  the restoration.[20]
However, in some cases, supplying provisional restorations may be optional. Since the
preparations involve enamel only, the risk of postoperative sensitivity is non-existent, and since
contacts between the teeth are not always rifted during the preparation, the risk of tooth shifting
is remote. Anyhow, when a case dictates the use of provisional restorations, these should be
made as one piece, with no attempt to separate individual provisional veneers. This ensures
better retention by engaging the interproximal areas, and at the same time maintains the strength
of  the restorations, which are rather thin and delicate. One technique for cementing temporary
porcelain veneers involves spot-etching at the center of  the facial surface, followed by enforcing
a bonding resin at the etched point only and using a small amount of a resin cement for
attachment. The use of ordinary temporary cements, which are naturally opaque, adversely
affects the final esthetic result of temporary veneers due to their ultra-thin nature, which allows
the cement opacity to show through.[7]

Types of porcelain used for porcelain veneer fabrication

Traditionally, veneers are fabricated using

the manual layering technique from
feldspathic porcelain. This procedure needs
the use of refractory dyes to support the
condensed layers of  the porcelain slurry.
[8]This technique permits the use of layers
with multiple levels of opacity, resulting in
optimum esthetics. However, the process is
sensitive, and manual mixing and layering
of the porcelain may result in the incorporation Fig. 2. Failed specimens in occlusal view showing the
of small voids.[9] These voids may cause crack failure mode: I = Extensive crack formation within
lines or even a fracture to occur over time. restoration. II = Cohesive fracture within
restoration. III = Fracture within restoration and
As another option, pressed porcelain has been tooth structures. IV = Longitudinal restoration and
used for the fabrication of veneers.[11]The tooth fracture involving root.
main advantages of pressed porcelain are that the resulting veneers have a high level of accuracy
and minimal internal structural defects.[10]

Recently, CAD-CAM veneers from glass-ceramic blocks have become available, and their
utilization is on the rise. While such veneers are significantly stronger than feldspathic porcelain
ones, the color of many of the blocks available is of  single opacity.[12]

RESULTS AND DISSCUSIONS

The long-term success of  porcelain veneers depends on careful case selection, the design
of tooth preparation, the material, the laboratory fabrication, and the insertion procedure. Several
studies reporting on the longevity of porcelain veneers have been published. Fradeani et al. stated
that feldspathic porcelain and glass-infiltrated ceramic veneers presented survival rates ranging
from 96% to 98% at a 5-year evaluation.[13] Similarly, Della Bona and Kelly reported overall
failure rates for ceramic veneers of less than 5% at 5 years.[14]

D’Arcangelo et al. reported that 119 porcelain veneers had a longevity rate of 97.5% at a 7-year
evaluation.[15] In a retrospective study by Gurel et al., evaluating 580 porcelain veneers with
various preparation designs for a 12-year period, an overall survival rate of  86% was observed.
[16]
Beier et al. stated that porcelain veneers offer predictable and successful restoration with an
estimated survival rate of more than 10 years.[17]Layton and Walton reported the longevity
of feldspathic porcelain veneers as up to 12 years; at 5 years, the survival rate was 96%,
dropping to 93% at 10 years and to 91% at 12 years.[18] A  cumulative success rate of approx.
93% was reported after a 15-year retrospective clinical trial.[19] In a 10-year prospective clinical
trial that involved 87 porcelain veneers, none of the veneers were lost. At 5 years, 92% remained
in use without the need for clinical intervention; however, at 10 years, the percentage dropped to
64%.[5] Large marginal defects were the main failure mode (20%), particularly when the veneer
ended on an existing composite restoration; a porcelain fracture (11%) was the next most often
encountered failure. Only 4% of the veneers needed to be replaced at the 10-year distance.
Calamia and Calamia enumerated keys to success for porcelain veneers that may lead to their
resistace for up to 25 years.[20] These included proper treatment planning, preparations
terminating in enamel, proper selection of the ceramic to be used, and proper cementation.

CONCLUSSIONS
In conclussion, PLV has been used for more than 30 years and they rezisted over time by
incrasing the methods and materials that are used.
They are characterized by minimal enamel reduction that why is considered a conservative
restoration.
Several studies has been demonstrated that they have a high rate to survive over the time.
Acording to them for about 10 years, PLV lasts without massive changes. For a long term
resistance they need proper treatment planning, preparation terminating in enamel, proper
material selection and proper cementation. The most common reason for failure is veneer
fracture.

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21. https://www.sciencedirect.com/science/article/pii/S0377123714001580#fig1
22. https://www.sciencedirect.com/science/article/pii/S1751616117302515#f0020