Retrospective Long-Term Clinical Outcome of Feldspathic Ceramic Veneers

Abstract

The purpose of this study was to evaluate the clinical outcome of feldspathic ceramic laminate veneers over a 7-year period using minimally invasive techniques, such as vertical preparation (without prosthetic finish line), or no preparation (no-prep). A total of 170 feldspathic ceramic veneers were cemented in the anterior region, including 70 maxillary and 100 mandibular veneers, after special conditioning of the teeth and restorations. The veneers were evaluated using the FDI World Dental Federation criteria evaluation kit after recalling all the patients between February and June 2021. In total, 14 feldspathic veneers failed and were replaced with lithium disilicate because of core fracture, and 10 cases of chipping occurred on the ceramic surface and were polished. The overall survival rate was 91.77% for up to 7 years of function, with a failure rate of 8.23%. In this retrospective survival analysis, the failures, including the fracture of veneers and dental hard tissue, occurred both in prep and no-prep teeth. No failures were observed in veneers with a maximum thickness of 0.5 mm compared to those with a maximum thickness of 1 mm, 1.5 mm, 2 mm, and 2.5 mm.

Keywords: feldspathic ceramic; minimally invasive treatment; no-prep veneers; vertical prep.

Figure 1

Esthetic and functional analysis of a patient: (a) facial analysis; (b) dento-gingival analysis.

Figure 2

Diagnostic wax-up in which minimally invasive corrections with wax have been made. In all cases, the first option was an additive wax-up instead of substrative.

Figure 3

Direct mock-up: (a) initial situation; (b) silicon index made by diagnostic wax-up; (c) intraoral fabricated with a temporary resign material and silicon index; (d) clinical aspect of mock-up after finishing.

Figure 3

Direct mock-up: (a) initial situation; (b) silicon index made by diagnostic wax-up; (c) intraoral fabricated with a temporary resign material and silicon index; (d) clinical aspect of mock-up after finishing.

Figure 4

A microdontia of the lateral incisor: (a) initial situation; (b) additive direct mock-up, with enough space for final restoration; (c) no-prep technique applied by removing the composite from the natural teeth and preparing for impression.

Figure 5

Color matching with: (a) VITA classical shade guide and (b) polar_eyes cross-polarization filter (Bio-Emulation™, Freiburg im Breisgau, Germany).

Figure 6

Minimally invasive preparation (vertical preparation) in central incisors for closing a diastema.

Figure 7

Noninvasive restorations without preparation of teeth: (a) a double veneer technique using feldspathic ceramic; (b) final clinical result with feldspathic double veneer ceramic restorations.

Figure 8

(a) Conditioning the feldspathic veneers with hydrofluoric acid applied for 60 s then (b) washed and rinsed with water and dried; (c) crystalline debris precipitate at the ceramic surface was removed with 36% orthophosphoric acid; (d) the etched surfaces were silanized with Monobond Plus for 60 s; and (e) dried to obtain a monolayer of silane.

Figure 9

Intraoral cementation: (a) the rubber dam was applied; (b) the tooth was etched with 36% orthophosphoric acid for 45 s; (c) adhesive was applied and dried until a monolayer was obtained; (d) the veneers were cemented; (e) the excess cement was removed with a brush; (f) the margins were finished to obtain a good adaptation after cementation.

Figure 9

Intraoral cementation: (a) the rubber dam was applied; (b) the tooth was etched with 36% orthophosphoric acid for 45 s; (c) adhesive was applied and dried until a monolayer was obtained; (d) the veneers were cemented; (e) the excess cement was removed with a brush; (f) the margins were finished to obtain a good adaptation after cementation.

Figure 10

Survival functions for different (a) veneer thicknesses and (b) preparation methods.

Figure 11

(a) When the thickness of the veneers exceeded 2 mm, future fractures could result because of unsustained ceramic; (b) chipping of the feldspathic ceramic veneers was observed.

Figure 12

(a) Minor chipping on the central right upper incisor; (b) the chipping was managed by finishing and polishing.