A Systematic Review and Meta-Analysis of the Survival of Non-Feldspathic Porcelain Veneers Over 5 and 10 Years

The International journal of prosthodontics (Impact Factor: 1.46). 03/2013; 26(2):111-24. DOI: 10.11607/ijp.3202
Source: PubMed


This systematic review aimed to report and explore the survival of dental veneers constructed from non-feldspathic porcelain over 5 and 10 years.

Materials and methods:
A total of 4,294 articles were identified through a systematic search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers, and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent researchers. There were no language limitations. One hundred sixteen studies were identified for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence interval [CI]) were extracted or recalculated. A failed veneer was one which required an intervention that disrupted the original marginal integrity, had been partially or completely lost, or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress veneers was completed, with an assessment of statistical heterogeneity and publication bias. Clinical heterogeneity was explored for results of all veneering materials from included studies.

Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2, Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/CAM) materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and 66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic porcelain materials were lacking, with only a single study each reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis showed data from one study had an influencing and stabilizing effect on the 5-year pooled estimate.

The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is sparsely reported in the literature. This systematic review indicates that the 5-year cumulative estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may prove clinically acceptable with time, but evidence remains lacking and the use of these materials for veneers remains experimental.

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    • "Many clinical situations such as tooth discoloration, extensive 22 fractures, misaligned teeth or dental caries lesions may cause an 23 important impairement in esthetic appearance and smile harmo- 24 ny, causing impact in the quality of life [1] [4]. The use of direct 25 composite veneers may be an interesting option to recover the 26 esthetic appearance of damaged teeth [4] [5], especially because 27 indirect techniques require more removal of sound tooth structure 28 and have a higher cost, due to the laboratory procedures involved 29 [6] [7]. In fact, in a minimal invasive approach direct composite 30 veneers seem to be the rst choice [4]. "
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    ABSTRACT: This retrospective, longitudinal clinical study investigated the performance of direct veneers using different composites (microfilled x universal) in vital or non-vital anterior teeth. Records from 86 patients were retrieved from a Dental School clinic, comprising 196 direct veneers to be evaluated. The FDI criteria were used to assess the clinical evaluation. The survival analysis was done using Kaplan-Meier method and Log-Rank test. The multivariate Cox regression with shared frailty was used to investigate the factors associated with failure. A total of 196 veneers were evaluated, with 39 failures. The mean time of service for the veneers was 3.5 years, with a general survival rate of 80.1%. In the qualitative evaluation of the restorations, microfilled composite showed slighty better esthetics. The annual failure rates (AFR) were 4.9% for veneers in vital teeth and 9.8% for non-vital teeth with statistical significance (p = 0.009). For microfilled and universal veneers the respective AFRs were 6.0% and 6.2% (p>0.05). Veneers made in non-vital teeth had a higher risk of failure over time compared to those made in vital teeth (HR 2.78; 95% CI 1.02-7.56), but the type of material was not a significant factor (p=0.991). The main reason for failure was fracture of the veneer. Direct composite veneers showed a satisfactory clinical performance. Veneers performed in vital teeth showed a better performance than those placed in non-vital teeth. No difference in the survival rate for different composites was found, although microfilled composites showed a slightly better esthetic appearance. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Aug 2015 · Journal of dentistry
    • "Most studies on veneers report the results of porcelain veneers. Indirect porcelain laminate veneers have a good survival rate, showing a survival of 90% after 3–5 years service [7] [35] [36]. Clinical studies assessing the long-term direct composite veneers are rare, especially including non-vital teeth [34]. "
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    ABSTRACT: There is little information in the literature regarding the relationship between preparations made for direct and indirect veneers and the loss of tooth structure required for each technique. This in vitro study sought to quantify the different mass losses from preparation techniques used for direct and indirect veneers. Thirty artificial teeth were weighted using a digital balance and placed in a dental manikin in the position corresponding to the right maxillary central incisor. Five clinicians-all experts in esthetic dentistry-were asked to perform conventional preparations for both a direct composite resin veneer and an indirect ceramic veneer. After preparations, specimens were weighted again in the same digital balance. Teeth undergoing veneer preparations demonstrated a statistically significant mass loss compared to unprepared teeth. Indirect ceramic veneer preparations produced more mass loss than direct composite veneer preparations (P < 0.01).
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