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Purpose: To evaluate the clinical performance of porcelain laminate veneers (PLVs) after 2 years.
Materials and Methods: Twenty-eight patients were treated with 125 PLVs. The experimental variables were
preparation design (incisal overlap [IO] and incisal bevel [IB]) and adhesion surface (enamel [E], enamel with
minimal dentin exposure [MDE], and enamel with severe dentin exposure (SDE)]. Marginal adaptation, marginal
discoloration, secondary caries, postoperative sensitivity, and patient satisfaction were assessed according
to the modified United States Public Health Service criteria. Each restoration was examined for fractures and
debonding. In addition, gingival tissue health by gingival plaque, bleeding, and recession was recorded. An experienced clinician evaluated the restorations at baseline and after 6, 12, and 24 months, and survival rates
evaluating relative and absolute failures were calculated (p = 0.05).
Results: Eleven (8.8%) veneers failed, and the overall cumulative survival rate was 91.2% after 2 years of followup. IB and IO preparation designs exhibited survival rates of 94% and 85.7%, respectively, but this difference
was not statistically significant (p > 0.05). PLVs bonded to SDE were more likely to fail than those bonded to E
and MDE (p < 0.05). There was no significant difference between the failure rate of PLVs bonded to E and those
bonded to MDE (p > 0.05).
Conclusions: PLVs have high survival rates when bonded to enamel only, as well as to enamel with minimal dentin exposure. However, extensive dentin exposure should be avoided during the preparation.
Keywords: porcelain laminate veneers, dentin exposure, preparation design.
J Adhes Dent 2014; 16: 481489.
doi: 10.3290/j.jad.a32828
Assistant Professor, Department of Restorative Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey. Experimental design, clinical
applications, wrote the manuscript.
Table 1
Brand name
Type
Manufacturer
Composition
Lot No.
IPS e.max
Press
Lithium disilicate
glass-ceramic
Ivoclar Vivadent;
Schaan, Liechtenstein
M13076
Variolink Veneer
Light-curing resin
cement
Ivoclar Vivadent
P38760
Total-Etch
Phosphoric acid
Ivoclar Vivadent
K27710
Porcelain
etchant
Hydrofluoric acid
Bisco; Schaumburg,
IL, USA
5% hydrofluoric acid
1000003009
Syntac Primer
Primer
Ivoclar Vivadent
K16326
Syntac Adhesive
Adhesive
Ivoclar Vivadent
K30345
Heliobond
Bonding agent
Ivoclar Vivadent
K30706
Monobond
Plus
Silane coupling
agent
Ivoclar Vivadent
K30207
Porcelain inner
surface
Etching
5% HF for 60 s
Adhesive
RESULTS
Twenty-eight patients were treated with 125 PLVs with a
2-year follow-up. All patients came for a follow-up evaluation after 1 week (baseline), 6, 12, and 24 months. No
patient was lost during this 2-year follow-up. The number of restorations evaluated at each of the follow-up
phases is summarized in Table 3.
484
DISCUSSION
In the present study, we evaluated the clinical success
of PLVs of different preparation designs bonded to tooth
tissues prepared at different levels after 2 years. Longitudinal studies have some disadvantages, such as the
withdrawal of certain dental materials and loss of a proportion of patients over time. In this study, no patients
were lost to follow-up, and the materials used remain
available. Therefore, the results of this study were presented after a relatively short period.
The results of the present study suggest that PLVs are
favorable restorations, withstanding 2 years of clinical
service and demonstrating promising survival rates. The
survival rates determined in this study are comparable
The Journal of Adhesive Dentistry
Table 3 Summary of the modified United States Public Health Service criteria and evaluation of porcelain laminate
veneers during follow-up
USPHS criteria
Score
Characteristics
Baseline
6 months
Marginal
adaptation
Alfa
Bravo
Charlie
Delta
Marginal
discoloration
12 months 24 months
Smooth margin
Minor voids/defects at margin
Obvious crevice at margin
Debonded
125
-
124
-
124
-
124
-
Alfa
Bravo
Charlie/Delta
No discoloration
Slight staining/acceptable
Large staining/unacceptable
125
-
124
-
124
-
124
-
Secondary
caries
Alfa
Bravo
Charlie
Delta
No caries
Caries at the margin
N/A
N/A
125
-
124
-
124
-
124
-
Postoperative
sensitivity
Alfa
Bravo
Charlie
Delta
No symptoms
Slight sensitivity
Moderate pain
Severe pain
125
-
124
-
124
-
124
-
Patient
satisfaction
Alfa
Bravo
Charlie/Delta
High
Moderate
Not satisfied
125
-
124
-
124
-
124
-
Fracture
Alfa
Bravo
Charlie
Delta
None
Small/acceptable
Moderate/unacceptable
Large/unacceptable
125
-
124
-
122
1
1
124
-
Retention
Alfa
Bravo
Charlie
Delta
None
N/A
N/A
De-bonded
125
-
124
1
124
-
124
-
Gingival
response
Alfa
Bravo
Charlie
Delta
Healthy
Calculus or gingivitis
Moderate pocketing and bleeding present
Severe periodontitis
125
-
116
8
-
124
-
124
-
a
Vol 16, No 5, 2014
485
Survival Function
Survival
Function
0
1.0
0.8
0.8
Cum Survival
Cum Survival
Survival
Function
0
1.0
0.6
0.4
0.2
0.6
0.4
0.2
0.0
0.0
.00
5.00
10.00
15.00
20.00
25.00
.00
5.00
Time_So
20.00
25.00
Survival Function
Survival
Function
0
PREPARATION
DESIGN
1.0
IO
IB
IO-censored
IB-censored
0.8
Cum Survival
0.8
Cum Survival
15.00
Time_Sr
Survival Function
1.0
0.6
0.4
0.6
0.4
0.2
0.2
0.0
0.0
10.00
.00
5.00
10.00
15.00
20.00
25.00
Time_Sf
.00
5.00
10.00
15.00
20.00
25.00
Time_So
Fig 5 Kaplan-Meier overall survival curve for preparation design. IO: incisal overlap; IB and incisal bevel.
486
1.0
Parameter
Original
restoration
(Sr)
Functional
(Sf)
Overall
(So)
0.6
All
98.4%
92.7%
91.2%
0.4
Tooth
tissue
E
MDE
SDE
98.5%a
100%a
94.4%a
95.5%b
97.4%b
70.6%c
94.1%d
97.4%d
66.7%e
Preparation
design
IB
IO
98.8%f
97.6%f
95.1%g
87.8%g
94%h
85.7%h
0.8
Cum Survival
0.2
0.0
.00
5.00
10.00
15.00
20.00
25.00
Time_So
487
CONCLUSIONS
y Preparation depth is an important factor for the success of PLVs. Minimal dentin exposure on the cervical
third of the prepared tooth surface may be insufficient
to influence the clinical success of restorations.
y Incisal preparation design does not affect PLV survival.
ACKNOWLEDGMENTS
This investigation was supported in part by Hacettepe University
Scientific Research Projects Coordination Unit (Project Number: 07
A 201 003). The authors would like to thank Dr. Altay Uludamar
and Dr. Merih Baykara for their contribution. The authors also acknowledge Mr. Ali Ylmaz for his work in fabricating the porcelain
laminate veneers.
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Within the limitations of this study, the following conclusions can be drawn:
y The So, Sf and Sr rates of PLVs after 2 years were
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y PLV restorations can continue to function successfully even after clinically acceptable relative failure
with treatment according to failure type.
488
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Clinical relevance: Avoiding extensive dentin exposure during preparation is the key factor for the
long-term success of PLVs. With restricted indications
and the careful application of clinical procedures,
porcelain laminate veneers are extremely reliable restorations.
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