The impact of laminate veneer restoration on oral health-related quality of life: A case series study

Abstract

Abstract
BACKGROUND AND AIM: Laminate veneer restorations exhibit excellent ability to reproduce the natural teeth regarding
esthetic and biomechanics. The aim of the present study was to determine the impact of laminate veneers on oral
health-related quality of life (OHQoL).
METHODS: In this case series study, the impact of treatment on OHQol was measured using the standard questionnaire
OHIP-14. This tool was applied to 19 patients who visited the private office of restorative and cosmetic specialist before
and six months after treatment.
RESULTS: The maximum score recorded by Oral Health Impact Profile-14 was 34 before treatment, with 31 after treatment.
The average score decreased from 13.1 ± 9.44 (before treatment) to 12 ± 10.6 (after treatment). Comparison of the frequencies
of patient’s responses to OHQoL suggested that changes in OHQoL for question number 4 (uncomfortable to eat food) and
question number 9 (difficult to relax) were significant, respectively (P = 0.03, P = 0.02) and for question number 10 (feeling
embarrassed) were nearly significant (P = 0.07). Nineteen subjects in this study exhibited improvement in OHQoL.
CONCLUSION: Esthetic dental treatment using laminate veneers would significantly affect OHQoL enhancement in
some aspects.

Full text

Received: 23 Jan. 2016 Accepted: 23 Jun. 2016
1- Assistant Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center
AND Department of Aesthetic and Restorative Dentistry, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
2- PhD Student, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center,
Kerman University of Medical Sciences, Kerman, Iran
3- Assistant Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center
AND Department of Oral and Dental Diseases, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
4- Epidemiologist, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center,
Kerman University of Medical Sciences, Kerman, Iran
Correspondence to: Raha Habib-Agahi DDS
Email: raha2979@yahoo.com
http://johoe.kmu.ac.ir, 5 June
134 J Oral Health Oral Epidemiol / Summer 2016; Vol. 5, No. 3
The impact of laminate veneer restoration on oral health-related
quality of life:
A case series study
Faezeh Hamzeh DDS, MSc
1
, Raha Habib-Agahi DDS
2
, Nader Navabi DDS, MSc
3
,
Shiva Pouradeli MSc
4
Abstract
BACKGROUND AND AIM:
Laminate veneer restorations exhibit excellent ability to reproduce the natural teeth regarding
esthetic and biomechanics. The aim of the present study was to determine the impact of laminate veneers on oral
health-related quality of life (OHQoL).
METHODS:
In this case series study, the impact of treatment on OHQol was measured using the standard questionnaire
OHIP-14. This tool was applied to 19 patients who visited the private office of restorative and cosmetic specialist before
and six months after treatment.
RESULTS:
The maximum score recorded by Oral Health Impact Profile-14 was 34 before treatment, with 31 after treatment.
The average score decreased from 13.1 ± 9.44 (before treatment) to 12 ± 10.6 (after treatment). Comparison of the frequencies
of patient’s responses to OHQoL suggested that changes in OHQoL for question number 4 (uncomfortable to eat food) and
question number 9 (difficult to relax) were significant, respectively (P = 0.03, P = 0.02) and for question number 10 (feeling
embarrassed) were nearly significant (P = 0.07). Nineteen subjects in this study exhibited improvement in OHQoL.
CONCLUSION:
Esthetic dental treatment using laminate veneers would significantly affect OHQoL enhancement in
some aspects.
KEYWORDS:
Oral Health; Quality of Life; Cosmetic Dentistry; Laminate Veneer
Citation: Hamzeh F, Habib-Agahi R, Navabi N, Pouradeli S. The impact of laminate veneer restoration on
oral health-related quality of life: A case series study. J Oral Health Oral Epidemiol 2016; 5(3): 134-40.
ral health-related quality of life
(OHQoL) represents a personal
assessment of how much and how a
person’s social life and its functional
and emotional aspects are affected by the health-
related issues of their mouth.
1
In other words,
OHQoL is considered to be a measure that
shows the impact of oral and dental changes on
various aspects of life, including eating,
sleeping, socializing and self-esteem.
2
Nowadays, reliable standard devices are
available to researchers for measuring OHQoL,
but the majority of studies in this field are
dedicated to the impact of chronic disease
conditions (e.g. oral cancers) on quality of life.
1-3
However, it appears that professional
treatments and cosmetic restorative dentistry
can have a significant impact on OHQoL
through their impact on the quality aspects of
life, such as an increase in confidence and
improved smiling, speech and facial
appearance. White teeth have been positively
correlated with high ratings of social
competence, intellectual ability, psychological
O
P
Original Article

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J Oral Health Oral Epidemiol/ Summer 2016; Vol. 5, No. 3
135
adjustment and relationship status.
4
Alternatively, untreated dental caries, non-
aesthetic or discolored anterior teeth restorations
and missing anterior teeth usually lead to
dissatisfaction with dental appearance.
5,6
Furthermore, treatments improving dental
aesthetics have been found to increase patient
quality of life and psychological status.
7,8
Makino-Oi et al. showed the effect of
prosthesis on quality of life in patients with
shortened dental arch.
9
Another study reported
the effect of using denture during nights on
OHQoL of the patients.
10
All studies have
shown that despite the diversity of modern
research carried out in terms of dental
interventions, the cosmetic domain of quality of
life among patients has received less attention
in comparison to all the other domains of
quality of life.
11-16
Laminate veneer treatment is
among these treatments with cosmetic and
conservative mechanical properties in relation
to health and beauty and is ideal for use in
anterior teeth.
17,18
Conservation of more tooth
structure and its integrity are the most
important features and the success rate of these
cosmetic restorations is around 94%‒96%.
Therefore, laminate veneer treatment is highly
favorable for dentists and patients due to its
excellent imitation of natural tooth
characteristics such as color, translucency,
shape and surface characteristics.
19, 20
Assessment of the success rate of dental
treatments is carried out through clinical
criteria (such as CPITN index) in the
treatment of periodontal diseases,
radiography (alveolar bone healing after
surgical treatment) and photography and
casts and corrected occlusion after
orthodontic treatment; but in cosmetic
treatments, patient’s satisfaction with
treatment in certain aspects of his life is
particularly important.
21
Therefore, more
measuring OHQoL following cosmetic
dentistry treatments is highly important. This
study aimed to evaluate OHQoL in patients
following laminate veneer treatments.
Methods
In this case series study, the OHQoL was
evaluated for 19 patients who visited a private
office of restorative and cosmetic specialist,
before and 6 months after laminate veneer
treatments for anterior teeth (canine to canine).
Sampling was carried out consecutively.
The inclusion criterion for patients was an
age of 14 years and over. Patients with known
systemic diseases and those unable to
complete the questionnaire for whatever
reason were excluded from the study.
For resin composite veneering of the teeth,
at the first step, the desired shade was selected
using day light as well as dental unit light
source (according to the adjacent teeth, two or
more composite shades was seleted from the
following list: Vit-l-escence shade B1, A1, A2,
A3, Pearl Neutra (PN), Pearl Frost (PF) or Pearl
Amber (PA), (Ultradent, USA) or Z350 shades
Enamel A1, A2 or A3 and Dentin A1, A2 or A3,
3M, (Ultradent, USA). Afterwards, all the caries
affecting hard tissues were removed while in
cases without any caries, surface roughening
was done by a high speed hand piece in order
to increase the bond strength. Prior to acid
etching (35% phosphoric acid gel, Ultradent,
USA) and bonding (Universal bond, 3M, USA),
the field was isolated by cotton roll. The
selected resin composites were incorporated
subsequently using layering technique while
each 2 mm thick layer was light cured for 40
seconds (LED 695C, Dentamerica, Taiwan).
Finally, occlusal adjustment, finishing and
polishing were accomplished using diamond
bur (Dia, Swiss), silicon carbide disks (Soflex,
3M, U.S.A), polishing rubbers (Jiffy, Ultradent,
U.S.A) and diamond paste (Diamond composite
polishing paste, Ultradent, U.S.A) in a rubber
cup (Jiffy, Ultradent, U.S.A), respectively.
Oral Health Impact Profile-14 (OHIP-14),
which is the most available tool for assessing
OHQoL changes following dental treatment
interventions, was used in this study.
1,2,22
The
original OHIP-14 was in English which had
been translated into Farsi and the validity and

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136 J Oral Health Oral Epidemiol / Summer 2016; Vol. 5, No. 3
reliability of the Persian version has been
confirmed by Navabi et al.
23
A standardized Persian version of this tool
consists of 14 questions and was filled out for
all study participants in separate (before and
after) sessions in the form of an interview.
OHIP-14 measures quality of life in seven
domains (2 questions for each domain) of
functional limitation, physical discomfort,
psychological discomfort, physical disability,
psychological disability, social disability and
physical disability.
The structure of questionnaire
is in a way
that each two consecutive questions are
related to one of the seven domains, for
example, questions 1 and 2 are related to the
first domain and questions 5 and 6 are related
to the third domain.
Each question on OHIP-14 is designed in
such a way that respondents should answer a
particular problem in relation to the recent
experience with the teeth or mouth. For
example, question 1 runs as follows: Have you
had any trouble pronouncing any words
because of problems with your teeth or mouth?
Replies were recorded in Likert scale with zero
for (never), one for (rarely), two for
(sometimes), three for (often), and four for
(almost always). The final total score of OHIP-
14 ranged from zero to 56. A lower total score
and closer to zero indicated a higher level of
quality of life and a better OHQoL.
16,17
The aim
of the study was explained to the patients and
patients participated in the study voluntarily.
Oral consent was obtained from all patients.
Purpose of the study was explained for the
patients and they were given a choice to exit
from the study whenever they want. Patients’
data were kept confidential. Demographic data
of the patients as well as information obtained
from OHIP-14 at the two time points were
analyzed with SPSS (version 22.0, SPSS Inc.,
Chicago, IL, USA) using descriptive statistics.
Shapiro-Wilk test was used to check the
normality of data and Wilcoxon test was used
to compare the average scores of the
questionnaire before and after treatment.
Results
A total of 19 patients participated in the study.
Table 1 shows the demographic data of the
patients. The age of the patients ranged from
14 to 61 years with a mean of 27.7 ± 12.8 years.
The maximum score recorded by OHIP-14
was 34 before treatment and 31 after
treatment. The average score decreased from
13.1 ± 9.44 (before treatment) to 12 ± 10.6
(after treatment).
Table 1. Demographic characteristics of the patients
Independent variable Variable
levels
Frequency
[n(%)]
Sex Male
4 (21.1)
Female 15 78.9 ()
Age (Years) Under 20 6 (31.6)
20 to 40 11 (57.9)
Above 40 2 (10.5)
Education Student
6 (31.6)
Diploma 4 (21.0)
Above 9 (47.4)
In figures 1 and 2, patients’ clinical status
before and after the laminate veneer
restorations are visible.
Figure 1. Patient’s clinical status before and
after laminate veneer restorative

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137
OHIP-14 scores were not significantly
associated with sex and education (P = 0.64 and
P = 0.16, respectively) but were significantly
associated with age (P = 0.02). Laminate
treatment had greatest impact on patients’
quality of life at the age range of 20 to 40 years.
Figure 2. Patient’s clinical status before and
after laminate veneer restorative
Shapiro-Wilk test showed that the
distribution of mean scores before and after
treatment were not normal. Therefore,
Wilcoxon analysis showed that despite lower
average score of OHIP-14 after the laminate
veneer treatment, the average reduction was
not significant (P = 0.40). Table 2 shows the
distribution of participants’ responses to
questions of OHIP-14 before and after
treatment. As can be seen, comparison of the
frequencies of these responses suggested that
after treatment, changes in OHQoL for
question number 4 (uncomfortable to eat food)
and question number 9 (difficult to relax) were
significant (P = 0.03, P = 0.02, respectively) and
for question number 10 (feeling embarrassed)
was marginally significant (P = 0.07).
Discussion
This study confirmed the improvement of
OHQOL-14 in the psychological disability
domain. After cosmetic dental treatment,
significant and nearly significant results were
achieved regarding question number 9 and 10,
respectively, which were related to
psychological disability domain. This finding
has considerable importance and shows the
impact of cosmetic dental treatments to
improve quality of life in the psychological
aspects that certainly will affect the patient's
general mental health. In other words, the
majority of patients in this study had
confirmed that the laminate treatment
increased their comfort and confidence which
showed the depth of this cosmetic treatment
impact on patient’s quality of life.
The role of dental treatments on health-
related and functional aspects of quality of life
is more than the cosmetic aspect of dental
treatments; for example van Eekeren et al.
reported the effect of implant therapy on
OHQoL of the patients with different occlusion
classes.
24
da Silva et al. reviewed the impact of
metal-ceramic restorations on 50-year-old
women’s OHQoL and concluded that OHIP-14
score decreased from 28 (before treatment) to
zero (after treatment).
25
While the study was
conducted on one patient, evaluation of 19
patients in our study provided the possibility of
a closer examination of the quality of life after
dental treatments.
In this study, OHQoL level after laminate
veneer treatment improved but this change
was not statistically significant. In our study,
OHQoL changes were assessed in a group of
patients and each patient was compared with
himself/herself. Meireles et al. evaluated the
OHQoL changes subsequent to bleaching
treatment in a randomized, double-blind
study and showed that tooth whitening had a
positive impact on the quality of life of some
patients but negative effect on some others.
26
Our results were similar to Meireles et al.
study in terms of overcoming embarrassment
of showing teeth, but their study showed
some hygiene problems and sensitivity in
some patients following treatment, which
were not reported in the present study. The
differences are justified in two ways:

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Table 2. The comparison of OHIP-14 scores in 19 patients before and after laminate veneer treatment
Questions Before treatment After treatment P
Never Rarely Sometimes Frequently Almost
always Never Rarely Sometimes Frequently Almost
always
Have you had trouble pronouncing any words because of
problems with your teeth, mouth or dentures? 18 1
0 0 0 15 3
1 0 0 0.15
Have you felt that your sense of taste has worsened
because of problems with your teeth, mouth or dentures? 17 1 1 0 0 17 0 0 1 1 0.56
Have you had painful aching in your mouth? 10 3 4 1 1 9 6 3 0 2 0.60
Have you found it uncomfortable to eat any foods
because of problems with your teeth, mouth or dentures? 12 2 2 1 2 6 4 7 0 4 0.03*
Have you been self-conscious because of your teeth,
mouth or dentures? 7 5 4 2 1 8 3 2 2 1 0.45
Have you felt tense because of problems with your teeth,
mouth or dentures? 8 4 4 3 0 5 6 4 3 1 0.32
Has your diet been unsatisfactory because of problems
with your teeth, mouth or dentures? 14 1 2 2 0 12 3 0 2 1 0.83
Have you had to interrupt meals because of problems
with your teeth, mouth or dentures?
13 3 1 2 0 12 3 0 2 1 0.13
Have you found it difficult to relax because of problems
with your teeth, mouth or dentures?
9 4 4 1 1 3 6 3 3 5 0.02*
Have you been a bit embarrassed because of problems
with your teeth, mouth or dentures
6 5 3 2 3 3 1 6 5 4 0.07
Have you been a bit irritable with other people because of
problems with your teeth, mouth or dentures?
3 4 3 6 3 3 3 4 7 0 > 0.99
Have you had difficulty doing your usual jobs because of
problems with your teeth, mouth or dentures?
12 3 2 0 2 11 4 3 1 0 0.55
Have you felt that life in general was less satisfying
because of problems with your teeth, mouth or dentures?
12 4 0 2 1 12 5 1 1
0 0.35
Have you been totally unable to function because of
problems with your teeth, mouth or dentures?
14 3 1 1 0 19 2 1 0 0 0.39
*
Significant

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1. Meireles et al. tool for measuring
OHQoL was OIDP (Oral Impacts on Daily
Performances), which was somewhat
different to the tool used in this study (OHIP-
14) in terms of domains of quality of life. For
example, aspects of the problem in the dental
hygiene are not included in OHIP-14.
2. Bleaching treatment has potential side
effects such as tooth sensitivity; such
complications of treatment did not exist in
this study (laminate veneer).
In the present study, some aspects of
OHQoL, such as feeling relaxed improved
significantly following the intervention of
cosmetic dentistry, which was consistent with
the study by da Silva.
25
Likewise, in Meireles
et al. study, the cosmetic treatments caused
significant changes in the patient’s
discomfort in relation to their appearance.
26
The impact of cosmetic dental treatments on
OHQoL was expected to affect the response
to question 5 (self-consciousness), 6 (feeling
tense), 9 (difficult to relax) and 10 (feeling
embarrassed). The results of this study
showed significant changes in two of these 4
questions. For a closer look at the impact of
dental cosmetic treatments on OHQoL,
clinical trials in two groups (or more) are
recommended in future studies so that the
effects of different cosmetic treatments can be
compared and more effective treatment in
relation to OHQoL can be identified.
Nowadays, due to increased awareness of
people about beauty and importance of beauty
in the community, many patients are seeking
cosmetic restorations, natural tooth color and
correction of dental problems with cosmetic
treatments to change their appearance in an
attempt to achieve improvements in their
quality of life. Actually, regarding to the
decreased prevalence of dental caries in
modern societies, the mandatory demand in
referring to dental clinics has been gradually
shifted from functional needs toward esthetic
dentistry.
4
Accordingly, it has been frequently
documented that the esthetic dentistry could
improve the individual’s self-confidence.
26
Based on this, resin composite laminate veneers
are increasingly popular due to their numerous
advantages compared to other esthetic
treatments such as orthodontic therapy and
even ceramic veneers. In view of that, resin
composite veneers could be accomplished in a
single visit treatment while is it categorized as a
quite non-invasive protocol, since there is no
need for tooth preparation as it is discussed in
in-direct ceramic veneers.
19
Therefore, resin
composite veneers are becoming widespread
among dentists.
Conclusion
The present study showed that proper cosmetic
treatments such as laminate veneer may impact
on the OHRQoL of younger adults, may
improve their satisfaction with dental
appearance and decrease embarrassment.
Conflict of Interests
Authors have no conflict of interest.
Acknowledgments
We wish to express our gratitude to Kerman
Social Determinants on Oral Health Research
Center, Kerman University of Medical
Sciences, Kerman, Iran, and also our
appreciation goes to all the participants.
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