Porcelain laminate veneer restorations bonded with a three-liquid silane bonding agent and a dual-activated luting composite.
ABSTRACT This clinical report describes the fabrication and bonding of porcelain laminate veneer restorations in a patient with anterior open spaces. Laminate veneer restorations made of feldspathic porcelain were etched with 5% hydrofluoric acid, rinsed under tap water, ultrasonically cleaned with methanol, and primed with a chemically activated three-liquid silane bonding agent (Clearfil Porcelain Bond). The enamel surfaces were etched with 40% phosphoric acid, rinsed with water, and primed with a two-liquid bonding agent (Clearfil New Bond) that contained a hydrophobic phosphate (10-methacryloyloxydecyl dihydrogen phosphate; MDP). The restorations were bonded with a dual-activated luting composite (Clapearl DC). The veneers have been functioning satisfactorily for an observation period of one year. Combined use of the Clearfil bonding agents and Clapearl DC luting composite is an alternative to conventional materials for seating porcelain laminate veneer restorations, although the system is inapplicable to dentin bonding.
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ABSTRACT: The purpose of this study was to use finite element stress analysis to examine the relative importance of variables such as porcelain laminate veneer (PLV) extensions, loading angle, and loading level for the case of feldspathic ceramic veneering of teeth to manage diastema. A 3D maxillary central incisor including its internal anatomy and morphology was constructed with ANSYS software for different extensions of PLV. Internal boundaries defining the dentinoenamel junction, the pulp-dentinal junction, the interface between the enamel-luting cement, and the porcelain-luting cement were well defined. The von Mises stresses distribution and stress intensity were analyzed on the free extension of PLV for varying extensions, various angulations (0 degrees , 30 degrees , and 60 degrees ) on the incisal edge, and for different loading levels (50, 150, and 250 N). The numerical values of stress were recorded. A significant difference in stress was observed. Increased stresses occurred with increased extensions, angulations, and loading levels. At 0 degrees angulation, compressive stresses were visualized in finite element analysis for various magnitudes of force. Higher stress values of 182 MPa and 211 MPa were obtained for the 2.5-mm extension in the mesial surface and in both proximal surfaces for 0 degrees angulation at 250 N magnitude of force. The stress occurring at 30 degrees and 60 degrees angulations was the combination of compressive and tensile stress. Higher values of 261 MPa and 232 MPa were observed when forces were applied on the mesial extension of the PLV and on both the proximal surfaces for 2.5 mm at 30 degrees , 250 N magnitude of force. A maximum stress value of 507 MPa was observed when PLV were increased in mesial width by 2.5 mm for 60 degrees angulation at 250 N magnitude of force. The extensions of PLV in diastema closure have more of an esthetic than functional consideration, but critical factors such as angulations and the loading level acting on the free extension of PLV are important.Journal of Prosthodontics 07/2009; 18(7):577-81. · 0.68 Impact Factor
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ABSTRACT: The aim of this study was to assess the surface microhardness (SMH) of intracoronal dentin exposed to 38% hydrogen peroxide (HP) light-activated or not and to 2% sodium fluoride gel (F2%) or 5% varnish (F5%). Intracoronal dentin specimens were exposed to bleaching (B), bleaching and light activation (BL), or no bleaching (NB), followed by F2%, F5%, or no exposure (NF). SMH test was performed. Four specimens of each group were analyzed by scanning electron microscopy (SEM). Analysis of variance and Tukey test (α = 5%) showed higher SMH of NB than BL or B. Specimens exposed to F5% presented the highest SMH and differed from F2% and NF. BL + NF yielded inferior SMH and was similar to B + NF, BL + F2%, B + F2%, BL + F5%, and NB + NF. NB + F5% showed superior values and did not differ from NB + F2%, B + F5%, and NB + NF. Bleaching with 38% HP, light-activated or not, reduced the SMH of intracoronal dentin. F5% provided SMH to the level of unbleached specimens.Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 07/2011; 112(5):e1-5. · 1.50 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the clinical performance of laminate porcelain veneers bonded with a light-cured composite. Thirty patients were restored with 119 porcelain laminate veneers. The veneers were studied for an observation time of 7 years. Marginal adaptation, marginal discoloration, secondary caries, color match, and anatomic form were clinically examined following modified United States Public Health Service (USPHS) criteria. Each restoration was also examined for cracks, fractures, and debonding. Pulp vitality was verified. In addition, plaque and gingival indexes and increase in gingival recession were recorded. Survival rate evaluating absolute failures and success rate describing relative failures were statistically determined, using both restoration and patient-related analyses. On the basis of the criteria used, most of the veneers rated Alfa. After 7 years, the results of the clinical investigation regarding marginal adaptation and marginal discoloration revealed only 2.5% and 4.2% Bravo ratings, respectively, among the 119 initially placed veneers. Using the restoration as the statistical unit, the survival rate was 97.5%, with a high estimated success probability of 0.843 after 7 years. Using the patient as the statistical unit, the survival rate was 90.0% and the estimated success probability after 7 years was 0.824. Gingival response to the veneers was all in the satisfactory range. Porcelain laminate veneers offer a predictable and successful treatment modality giving a maximum preservation of sound tooth. The preparation, cementation, and finishing procedures adopted are considered key factors for the long-term success and aesthetical result of the veneer restorations.Clinical Oral Investigations 07/2011; 16(4):1071-9. · 2.20 Impact Factor
Abstract: This clinical report describes the
fabrication and bonding of porcelain laminate veneer
restorations in a patient with anterior open spaces.
Laminate veneer restorations made of feldspathic
porcelain were etched with 5% hydrofluoric acid,
rinsed under tap water, ultrasonically cleaned with
methanol, and primed with a chemically activated
three-liquid silane bonding agent (Clearfil Porcelain
Bond). The enamel surfaces were etched with 40%
phosphoric acid, rinsed with water, and primed with
a two-liquid bonding agent (Clearfil New Bond) that
contained a hydrophobic phosphate (10-
methacryloyloxydecyl dihydrogen phosphate; MDP).
The restorations were bonded with a dual-activated
luting composite (Clapearl DC). The veneers have been
functioning satisfactorily for an observation period of
one year. Combined use of the Clearfil bonding agents
and Clapearl DC luting composite is an alternative to
conventional materials for seating porcelain laminate
veneer restorations, although the system is inapplicable
to dentin bonding. (J. Oral Sci. 48, 261-266, 2006)
Keywords: acid; bonding; hydrofluoric acid;
Over the last decade, bonding agents have been
increasingly used for fixing porcelain laminate veneer
restorations. This trend is mainly attributed to the
development of surface preparation techniques for both the
porcelain materials and tooth structure. Current bonding
systems consist of both surface preparation techniques
for mechanical retention and chemical bonding agents.
Etching feldspathic porcelain with hydrofluoric acid is
effective in mechanically retaining resin-based bonding
agents (1-5). Application of a methacrylate-based silane
monomer enhanced the bonding between acrylic resin
and feldspathic porcelain materials (6-9). The improvement
in bonding of acrylic resin to enamel by phosphoric acid
etching was reported more than 50 years ago (10). A
hydrophobic phosphate monomer (11), 10-
methacryloyloxydecyl dihydrogen phosphate (MDP), was
also shown to effectively bond tooth structure (12). Based
on the fact that both porcelain and enamel can be bonded
with an appropriate bonding agent after etching, a luting
system specially formulated for porcelain bonding
(Clapearl, Kuraray Medical Inc., Tokyo, Japan) was
Due to the development as well as disappearance of
numerous resin-based bonding systems within several
years, it is difficult for clinicians to select a reliable system
for seating tooth-colored restorations. The purpose of this
report is to present a standardized fabrication and bonding
technique for porcelain laminate veneer restorations applied
Journal of Oral Science, Vol. 48, No. 4, 261-266, 2006
Correspondence to Dr. Hideo Matsumura, Department of Fixed
Prosthodontics, Nihon University School of Dentistry, 1-8-13
Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
Porcelain laminate veneer restorations bonded with a three-
liquid silane bonding agent and a dual-activated luting
Hideo Matsumura1,2), Yukiko Aida1), Yumi Ishikawa3)and Naomi Tanoue4)
1)Department of Fixed Prosthodontics, Nihon University School of Dentistry, Tokyo, Japan
2)Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry,
3)Nihon University Graduate School of Dentistry, Tokyo, Japan
4)Department of Specialized Dentistry, Nagasaki University Hospital of Medicine and Dentistry,
(Received 20 October and accepted 6 November 2006)
to a patient with anterior open spaces.
A 27-year old male patient presented with the chief
complaint of dissatisfaction derived from unesthetic spacing
between the maxillary anterior teeth (Fig. 1). On
examination, there were no dental caries detected in the
maxillary anterior dentition. Among the treatment options
provided, the patient preferred insertion of four porcelain
laminate veneer restorations with minimal reduction of
enamel surfaces. Prior to treatment, diagnostic casts and
wax models simulating the porcelain laminate veneers
were prepared (Fig. 2), and consent to the treatment
protocol was obtained from the patient.
The facial, mesial, and distal surfaces of the four
maxillary incisors were minimally reduced with a high-
speed diamond rotary instrument (ISO 199/014 and
199/016, Shofu Inc., Kyoto, Japan) under water coolant.
The reduction was limited to within enamel (Figs. 3 and
4). Using a shade guide (Vita Lumin Vacuum, Vita
Zahnfabrik, Bad Säckingen, Germany), shades A3.5 and
B4 were selected for the patient. An impression of the
maxillary dentition was made with silicone elastomeric
materials (Exafine Putty and Injection, GC Corp., Tokyo,
Japan) using a stock tray, and poured with die stone and
lab stone (Fuji Rock and New Plastone, GC Corp.). Before
mounting the working cast, an impression of the working
cast was made with a silicone material (Fig. 5) and poured
with refractory material (Fig. 6). Although the four anterior
incisors were restored, the restoration on the left central
incisor had to be re-fabricated. The laboratory and bonding
procedures of this single restoration are presented here.
Both the working and opposing casts were mounted on a
semi-adjustable articulator (Spacy Articulator, YDM Corp.,
Tokyo, Japan) with an intercuspal position record (Fig. 7).
The sagittal and lateral condylar paths were adjusted using
three pieces of check-bite records.
A porcelain laminate veneer restoration was fabricated
with feldspathic porcelain material (Vintage, Shofu Inc.),
according to the manufacturer’s instructions (Figs. 8-12).
After try-in of the restoration, the surface to be bonded was
etched with 5% hydrofluoric acid (HF-Gel, GC Corp.) for
60 seconds (4), washed under tap water, ultrasonically
cleaned in methanol, dried with an air syringe, and primed
with a three-liquid ceramic bonding agent (Clearfil
Porcelain Bond, Kuraray Medical Inc.) (7,9) (Figs. 13-18).
The reduced enamel surface was etched with 40%
phosphoric acid (K-Etchant, Kuraray Medical Inc.) for 30
seconds, washed, dried with an air syringe, and primed with
a two-liquid bonding agent (Clearfil New Bond, Kuraray
Medical Inc.) (Figs. 19-22).
The laminate veneer restoration was bonded with a
dual-curable composite luting agent (Clapearl DC,
Universal, Kuraray Medical Inc.) (Figs. 23-24). Light-
polymerization was performed with a hand-held unit
(Quicklight, J. Morita Corp, Suita, Japan) for 60 seconds
each on the incisal, mesial, and distal surfaces (Fig. 25).
The marginal areas of the enamel-composite-porcelain
interface were ground with a diamond rotary instrument
and polished with a rotary silicone instrument filled with
fine diamond particles (CompoMaster, Shofu Inc.). Figs.
26 and 27 show the post-operative view of the restorations.
The patient was satisfied with the esthetics and function
of the restoration after treatment. As part of the
maintenance, the patient was recalled at 6-month intervals
for reinforcement of oral hygiene and evaluation of oral
function. The laminate veneer restorations have been
functioning satisfactorily for 12 months (Figs. 28 and 29).
Fig. 30 summarizes the surface preparation and bonding
procedures of the restorations.
Porcelain laminate veneer restorations were placed in
a patient with maxillary anterior open spaces. All
restorations were bonded with the Clearfil-Clapearl bonding
system. The restorations have been functioning satisfactorily
for over a year. As porcelain veneers were used, the
restorative procedure could be performed without exposing
dentin. This procedure is especially useful for patients
with diastema, open spaces with low caries activity, and
A feldspathic porcelain material (Vintage) was used in
fabrication of the laminate veneer restorations. Vintage is
a representative tooth-colored material suitable for both
laminate veneer and porcelain-fused-to-metal restorations.
When considerable modification of tooth color is required,
another feldspar-based coloring porcelain (Lamina, Shofu
Inc.) can be used in combination with Vintage. The Lamina
porcelain is especially useful for laminate veneer
restorations consisting of dentin with varying opacities.
The advantages of using feldspathic porcelain include;
1) reproducibility of tooth color with a thin layer of the
material, 2) low laboratory cost compared to other ceramic
restorative systems, 3) excellent mechanical retentive
characteristics after etching with hydrofluoric acid, and
4) excellent bonding characteristics with the use of
appropriate silane bonding agents.
In the present case, mechanical retention was achieved
by etching the porcelain with 5% hydrofluoric acid (4).
The restorations were ultrasonically cleaned with methanol
using a polyethylene cup. Ultrasonic cleaning after
hydrofluoric acid etching effectively removes precipitates
Fig. 13Etching the porcelain with 5%
hydrofluoric acid gel for 60
Fig. 14Rinsing under tap water.
Fig. 15Ultrasonic cleaning in a plastic
cup with methanol.
Fig. 10Over-spread enamel porcelain
material for compensation of
Fig. 11Sintered restoration before
Fig. 12A completed porcelain laminate
veneer restoration on the
Fig. 7 A working cast and opposing
cast mounted on an articulator.
Fig. 8 Application of the primary layer
of dentin porcelain.
Fig. 9 Application of the secondary
layer of porcelain with staining
Fig. 4 Occlusal view. Reduction was
limited to within enamel.
Fig. 5 Impression for refractory cast.
Fig. 6 Refractory cast to be used for
porcelain firing procedure.
Fig. 1 Pre-operative view. Maxillary
open spaces are evident.
Fig. 2 A diagnostic cast and wax
models simulating the porcelain
laminate veneer restorations.
Fig. 3 Facial view after abutment
Fig. 28Facial view of the restorations
12 months after seating.
Fig. 29Occlusal view of the restorations
12 months after seating.
Fig. 25Light curing with a hand-held
Fig. 26Facial view of the seated
Fig. 27Occlusal view of the seated
Fig. 22Application of a two-liquid
agent (Clearfil New Bond).
Fig. 23A dual-polymerizable luting
composite (Clapearl DC).
Fig. 24Removing excess luting
material before light-exposure.
Fig. 19Etching enamel surface with
40% phosphoric acid gel for 30
Fig. 20Rinsing with water. Fig. 21Frosty appearance of etched
Fig. 16Air-dried restoration. Fig. 17A three-liquid porcelain
bonding agent (Clearfil
Fig. 18Application of the three-liquid
bonding agent with sponge
and acid from the etched surface (14). Also, the water that
penetrated onto the etched surface is probably replaced by
methanol, which is more volatile than water. Thus, after
air-drying, the wetting ability of the bonding agent may
be enhanced in the case of etched and methanol-treated
porcelain, compared to the etched and water-sprayed
porcelain. The use of polymer cup during the ultrasonic
cleaning is beneficial for the porcelain laminate veneer
restorations, as it might reduce the possibility of micro-
fracture in thin marginal areas of the brittle porcelain
restorations. It is difficult to etch other ceramic materials
such as alumina and zirconia with hydrofluoric acid; hence
the mechanical retentive ability is inadequate.
The use of a methacrylate-based silane monomer is
essential for bonding feldspathic porcelain. Based on
previous reports evaluating in vitro bond strength (9,15-
17), the three-liquid Clearfil Porcelain Bond material was
selected for seating the restorations. The advantages of the
Clearfil three-liquid system are that the acidic MDP
monomer is effective for bonding tooth structure and for
activating silane couplers, and the composition is self-
polymerizing. Application of this composition facilitates
consistent bonding between the dual-curable luting agent
and tooth structure.
This work was supported in part by grants from the Japan
Dental Association, the Dental Research Center of Nihon
University School of Dentistry, and a grant-in-aid (B
18390525) from the Japan Society for the Promotion of
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Fig. 30Surface preparation and bonding procedures for
porcelain laminate veneer restorations.