In: International Journal of Clinical Dentistry

Volume 4, Number 2

ISSN: 1939-5833
2011 Nova Science Publishers, Inc.

LAMINATE VENEERS - A REVIEW

AND CLINICAL CASE
Carlos Marcelo Archangelo1*, Eduardo Passos Rocha2, Manoel Martin Jr.1,
Rodolfo Bruniera Anchieta2and Renato Herman Sundfeld2
1

University of Ing, Departament of Dental Materials and Prosthodontics, Uninga,

Parana, Brazil;
2
Sao Paulo State University-UNESP, Faculty of Dentistry of Araatuba, Department of
Dental Materials and Prosthodontics, Sao Paulo, Brazil;

Abstract
The laminate veneers are great choice for rehabilitation for anterior segment of the
mouth. Actually, due the employment of dental cements and bonding to dentin, the uses
of laminate veneers is an effective and conservative treatment, showing a high rate
success rate. This paper presents a clinical case of 50 years old male, J.C.H, who have a
chief complaint of an unattractive smile. After the diagnosis and planning, 10 laminate
veneers were placed from the second bicuspid (15) to the second bicuspid (25). The
correct indication of laminate veneers allows restorations with appropriate esthetic and
patients satisfaction with immediate effect on quality of life.

Keywords: laminate veneer, dental ceramic, dental aesthetics

Introduction
The field of esthetic restorations has substantially developed over the last two
decades in an effort to achieve the patients expectances[[1]].
Recently, the evolution of dental ceramics associated to enamel and dentin bonding
systems increased the options for rehabilitation including porcelain laminate veneers [1].
The porcelain laminate veneers are conservative dental restorations using thin porcelain
laminates with high esthetic outcome. These restorations provide rehabilitation with great
color stability, brightness and surface smoothness, with functional effectiveness during a
clinically acceptable period [2].
However, the indication of laminate veneers in Dentistry is limited to the anterior
region of mouth[3] while full-coverage restorations are recommended for esthetic
rehabilitation in posterior regions. Nevertheless, this treatment requires more invasive
*

Corresponding author: Departamento de Materiais Odontolgicos e Prtese, Faculdade de Odontologia de

Araatuba-UNESP. Street: Rua Jose Bonifacio, 1193, Vila Mendona; Zip Code: 16015-000;
Araatuba-SP, Brazil E-mail: eduardo_rocha@foa.unesp.br

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Carlos Marcelo Archangelo, Eduardo Passos Rocha, Manoel Martin Jr. et al.

tooth preparation in comparison to laminate veneers, which significantly reduces the

quantity of remaining tooth and may cause adverse effects on pulp and periodontal
tissues [4].
According to this, the aim of this study is to evaluate the effectiveness of ceramic
laminate veneers through a literature review and demonstrate their indication for both
anterior and posterior regions of mouth with a case report.

Literature Review
The rehabilitation with ceramic laminate veneers was developed in the 80s and has
been frequently indicated in Dentistry. The laminates are considered a conservative
treatment that provides favorable esthetics for restoration of anterior teeth [5].
Although the indication is variable, the laminate veneers are usually planned for
correction of teeth positioning when orthodontic treatment is not available or when loss
of dental structure occurred including fractures and color alteration [6].
The main advantages of laminate veneers are appropriate color stability provided by
ceramics and reproduction of enamel translucency and dentin opalescence. In addition, a
conservative technique is used for tooth preparation [7]. A successful esthetic result can
be achieved with tooth reduction from 0.3mm to 0.7mm according to the characteristics
of each case [8].
It is suggested that preparations for laminates should be performed on enamel due to
better bond strength in comparison to dentin [[9],[10]]. However, other authors
demonstrated that even preparations with minimal reduction (0.5mm in thickness)
exhibited dentin exposure in cervical and proximal regions, which jeopardizes bonding
[[11]].
Considering the bonding procedures, a resin cement is recommend for cementation of
laminate veneers.[[12]]
Currently, several techniques and products are used for cementation of laminate
veneers.[[13]] However, the conventional cementation with adhesive agent, silane and
cement is recommended to provide appropriate bond strength between teethcement
ceramic [[14],[15]].
According to literature, the conditioning of enamel and dentin with phosphoric acid
followed by hybridization with one- or two-bottle adhesive systems presents the best
results on bonding and longevity [[16],[17]]. Similarly, the ceramic conditioning with
hydrofluoric acid followed by silanization also demonstrated the best results with
predictable long-term success [[13],[18]].
So, several longitudinal studies have been developed to evaluate the success rate of
laminate veneers [[1],2,4], demonstrating high success rate up to 10 years following
cementation [4].

Laminate Veneers - A Review and Clinical Case

173

Clinical Case
Patient J.C.H, 50 years old came to the private clinic with the main complaint that his
teeth were crooked and dark.
After the anamnesis and meticulous intra buccal exam, it was noticed a of lack
proportion and symmetry among the superior teeth, of 2nd premolar to 2nd premolar (15
to the 25), evidencing an inverted smile of the same, as well as a certain degree of
darkening of these elements due to pigmentation of an old composite resin restorations
(Figure 1).

Figure 1. Initial case, evidencing a shy smile with a lack of proportion and symmetry between the 15 to
25 dental elements.

After the initial molding, and with the diagnostic cast and of ownership, it was made
the final diagnosis and the planning of the case (Figure 2). In agreement with the
treatment options and the patient's longings, rehabilitation was proposed from 25 to 15
using for this a laminate veneers, in way to recover the aesthetics and function of the
same ones.

Figure 2. Diagnostic cast and silicon index.

It was done by the diagnostic cast, a mock-up through the making a provisional
laminate of acrylic resin, in order to facilitate predictable, helping the patient in his
decision about the treatment.
After the mock-up, the customer decided for the execution of the treatment.

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Carlos Marcelo Archangelo, Eduardo Passos Rocha, Manoel Martin Jr. et al.

In another clinical session, the treatment started, through reductions of all the dental
elements of the area from 15 to 25 for the laminate porcelain veneers (IPS e.max, Ivoclar
Vivadent, Schaan, Liechtenstein).
After the reductions of the elements (Figure 3), it was made the impression using for
this the double thread technique with a addition silicon based material (Express 3M ESPE - St. Louis, USES). After the impression the temporary facets in acrylic resin were
installed.

Figure 3. Dental reduction of 15 to 12 (right); Reduction of 11 and 21 (center); Reduction of 22 to 25

(left).

In the next clinical session, the 10 laminates veneers were ready for the cementation.
Initially, the preparation of the ceramic elements was accomplished, being for this
done the conditioning of the intern surface of the veneers with hydrofluoric acid to 10%
for 20 seconds (Figure 4A), for treating of pressed ceramic based in lithium disilicate
[[19]].

(a)

(b)

(c)
Figure 4. Conditioning of porcelain surface with hydrofluoric acid (A); Application of silane agent;
Application adhesive system to conditioned porcelain (C).

Laminate Veneers - A Review and Clinical Case

175

After washing with water abundantly and drying, the silane agent was applied (RelyX
Silano 3M/ESPE, St Louis, USA) and waited about 5 minutes for good interactions
between the ceramic and silane (Figure 4B). The last step was a one bottle adhesive
agent's application (Figure 4C) (Adper Single Bond 2, 3M/ESPE, St Louis, USA) and
light curing with halogen light for 20 seconds.
The treatments of the teeth were made with phosphoric acid to 37% by 30 seconds in
enamel and 15 in dentin (Figure 5A), followed by wash with water, and drying,
maintaining the dentin moisture.[[20]] It was applied a one bottle adhesive system (Adper
Single Bond 2, 3M/ESPE, St Louis, USA) (Figure 5B) followed by light curing for 20
seconds.

(a)

(b)

Figure 5. Dental conditioning with phosphoric acid 37% (A); Application of adhesive system to enamel
and dentin (B).

For the cementation of laminate veneers, the paste base of a resinous cement was
used (Variolink II, Ivoclar Vivadent, Schaan, Liechtenstein), being the cementation done
in pairs, proceeding of the medium line for subsequent posterior region (Figure 6).

Figure 6. Cementation phase. The cementation started with to central incisors (in pairs).

Therefore after the cementation, it is observed that the porcelain veneers returned the
height proportion and width among the previous and subsequent teeth (Figure 7), as well
as the parallelism of the incisal lines with the contour of the inferior lip (Figure 8),
recovering the aesthetics and the patient's function (Figure 9).

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Carlos Marcelo Archangelo, Eduardo Passos Rocha, Manoel Martin Jr. et al.

Figure 7. Frontal view of the recently cemented laminate veneers.

Figure 8. Parallelism of the incisal lines with the lip.

Figure 9. After the cementation of all the laminate veneers. Note the good appearance of concluded
case.

Discussion
The development of restorative materials allowed the high success rate for treatment
with porcelain laminate veneers. The laminate veneers present some advantages in
comparison to the direct restorative composites as reproducibility of enamel translucency,
reduced risk to incisal fractures, and long-term color stability of restorations [[21]].
However, accurate tooth preparation is essential to allow reproduction of anatomical,
functional and optical characteristics of natural teeth. So, the quantity of dental reduction
depends on the inherent characteristics of each case such as level of dental staining and
presence of restorations to be removed.
Although the preparation for porcelain laminate is variable and presents correct
indication for each case, the preparation margins should remain on enamel since dentin
exposure in cervical region is frequently exhibited [[11]].

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177

So, some modifications of tooth preparation for porcelain veneers are reported in
literature. Rouse [[22]] suggested an extension to lingual or palatal regions to improve
esthetics for diastema closure or tooth discoloration. However, this alteration is in
disagreement with other authors [[23]] that established conventional preparation without
rupture of contact point to place the laminate on enamel and improve adhesion.
Additionally, Magne and Douglas [[24]] demonstrated that incisal reduction is
extremely important. Nevertheless, its extension to lingual or palatal surface with
minimum chamfer to decrease the risk to fracture is unnecessary. According to the
authors, this alteration only increases the dental reduction since the ideal preparation
would be obtained using a bur with 45 of angulation to palatal surface [[24]].
Independent of the preparation, all authors suggests rounded internal angles to reduce
stress on these points and prevent generation of ceramic crack [[25]].
Currently, the treatment of ceramic is important and should follow the
manufacturers recommendations. In addition, it is suggested that the association of
techniques as aluminum oxide sandblasting, conditioning with hydrofluoric acid and
silanization increases bond strength between porcelain and tooth [[26]].
So, a resin cement is recommended since this integration between porcelain and
cement has been reported to reinforce both substrates and reduce microleakage at the
restoration-tooth interface [[27]]. Furthermore, reduced postoperative sensitivity;
marginal staining and recurrent caries are also observed.
However, the professional should be aware on the sensibility of the technique using
this cement. Failures during this procedure, as contamination by saliva, may decrease
adhesion between tooth, cement and porcelain up to 3 times [[28]].

Conclusion
The laminate veneers are an effective and conservative treatment for teeth presenting
discoloration, malformation or necessity for extensive morphological alterations in
posterior and anterior regions. The retention of the laminates is excellent, which
decreases the risk to fracture. So, the correct indication of laminate veneers allows
restorations with appropriate esthetic and patients satisfaction with immediate effect on
quality of life.

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