Survival Rates for Porcelain Laminate Veneers: A Systematic Review

Abstract

The aim of this systematic review was to analyze and compare the most up-to-date information available on long-term, medium-term, and short-term survival rates of porcelain laminate veneers (PLVs) and investigate the homogeneity in current stud- ies or lack of it. An electronic search was performed using PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, EBSCO, Science Direct, Wiley, and Scopus databases. Based on the PRISMA guidelines, the main inclusion criteria consisted of research arti- cles published after the year 2000, in vivo studies with a follow-up period of at least 1 year and reporting of the Kaplan–Meier estimated cumulative survival rates. Quality assessment of the included studies was performed using the modified systematic assessment list consisting of 24 items. Thirty full-text articles were reviewed in detail. A total of 30 articles met the inclusion criteria and were selected for qualitative syn- thesis. The remaining 27 publications were retained to discuss the heterogeneity in the current literature and reported longevity of veneer restorations. A conclusive esti- mation of the longevity of PLVS beyond 20 years is lacking. The availability of evidence in the current literature is limited in terms of sample size and duration of follow-up. However, the majority of studies have concluded that PLVs have high-success rates and predictable patient outcomes. The present literature indicates an increased heteroge- neity among research study designs. Researchers should aim for homogeneous study designs that can be included in systematic reviews and meta-analyses.

Full text

THIEME
Review Article 1
Survival Rates for Porcelain Laminate Veneers: A
Systematic Review
Yousra H. AlJazairy1
1Department of Restorative Dental Sciences, College of Dentistry,
King Saud University, Riyadh, Saudi Arabia
Address for correspondence Dr. Yousra Hussain AlJazairy, BDS,
MSc, Department of Restorative Dental Sciences, College of
Dentistry, King Saud University P.O. Box, 60169, Riyadh 11426,
Saudi Arabia (e-mail: yousra.aljazairy@gmail.com).
The aim of this systematic review was to analyze and compare the most up-to-date
information available on long-term, medium-term, and short-term survival rates of
porcelain laminate veneers (PLVs) and investigate the homogeneity in current stud-
ies or lack of it. An electronic search was performed using PubMed, Ovid MEDLINE,
Cochrane Library, Web of Science, EBSCO, Science Direct, Wiley, and Scopus databases.
Based on the PRISMA guidelines, the main inclusion criteria consisted of research arti-
cles published after the year 2000, in vivo studies with a follow-up period of at least
1 year and reporting of the Kaplan–Meier estimated cumulative survival rates. Quality
assessment of the included studies was performed using the modified systematic
assessment list consisting of 24 items. Thirty full-text articles were reviewed in detail.
A total of 30 articles met the inclusion criteria and were selected for qualitative syn-
thesis. The remaining 27 publications were retained to discuss the heterogeneity in
the current literature and reported longevity of veneer restorations. A conclusive esti-
mation of the longevity of PLVS beyond 20 years is lacking. The availability of evidence
in the current literature is limited in terms of sample size and duration of follow-up.
However, the majority of studies have concluded that PLVs have high-success rates and
predictable patient outcomes. The present literature indicates an increased heteroge-
neity among research study designs. Researchers should aim for homogeneous study
designs that can be included in systematic reviews and meta-analyses.
Abstract
Keywords
►porcelain laminate
veneers
►longevity
►follow-up
►failure
►ceramic
►restorations
►homogeneity
DOI https://doi.org/
10.1055/s-0040-1715914
ISSN 1305-7456.
©2020 Dental Investigation
Society
Introduction
In modern dentistry, porcelain veneer restorations (PVRs)
have garnered a reputation as one of the most successful
modalities of treatment.1 Porcelain restorations, specifically
porcelain laminate veneers (PLVs), are popular among both
dentists and patients due to their ability to replicate the life-
like appearance and luster of natural teeth.
The success of PLVs can be attributed to the ability of these
veneer restorations to closely mimic the balanced relation-
ship between biological, mechanical, functional, and esthetic
parameters of natural teeth.2 Some of these parameters include
predictable outcomes, superior esthetics, long-lasting color
stability, life-like translucency, high-abrasion resistance, out-
standing resistance of fluid absorption, practical compressive,
tensile and shear strengths, exceptional marginal integrity,
biocompatibility with gingival tissue, greater conservation of
tooth structure with minimal tooth reduction, and excellent
long-term durability.1,3 The last two parameters are highly
debatable topics among researchers.
Researchers have credited this success to a clinician’s abil-
ity to properly, plan a case, select appropriate ceramics to use,
select the materials and methods of cementation, conservative
preparation of teeth, implement high-caliber finishing and
polishing, and effectively plan for the continuing maintenance
of the restorations.1 When applied correctly, these guidelines
have been highly effective in remedying clinical defects such as
correcting tooth forms and position, closing diastemata, replac-
ing old composite restorations, restoring teeth with incisal
Eur J Dent

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European Journal of Dentistry
Survival Rates for Veneers AlJazairy
abrasions or tooth erosion, masking enamel defects, and cover-
ing or reducing tooth discolorations such as fluorosis and tetra-
cycline staining.4
Despite their successful reputation and similar to other
alternative restorative treatments, PLVs are also prone
to failure. Several clinical trials, systematic reviews, and
meta-analyses have reported a wide range of survival rates
over the past few decades.5-9 These reported survival rates,
although extremely valuable, are still considered inconclu-
sive or contradictory when viewed by the general consen-
sus of the scientific community. For example, studies with a
follow-up period of less than 5 years have reported survival
rates ranging from 80.1 to 100%.10-17 Studies with a follow-up
from 5 years up to 7 years have reported a range of 47 to
100%.18-28 Studies from 10 to 12 years have stated survival
rates ranging from 53 to 94.4%.4,29-33
Two of the longest studies conducted to conclude the
survival rates of veneers are worth mentioning separately.
Friedman in 1998 conducted the longest retrospective
cohort study with a follow-up period of up to 15 years.34
The study reported a straight percentage outcome of 93%
for 3,255 veneers. Layton & Walton35 in 2007 reported the
results of their prospective cohort with a Kaplan–Meier esti-
mated cumulative survival rate of 73%. The study included
100 patients treated with 304 veneers with a maximum fol-
low-up period of up to 16 years. However, there is a lack of
long-term studies and the wide range of inconsistent results
can be observed in some of the studies conducted previously
to evaluate the clinical success of PLVs. These varying results
can be blamed on the overall heterogeneity of the study
designs. More specifically, the conflicting results depend
on several influencing factors. The definition of “failure” is
the most basic of these factors. The main difference being,
some researchers count a veneer as a failure only when it
is “irreparable,”4,31 while others mark a restoration a fail-
ure even if it is “reparable.”29,30 The use of different evalu-
ation criteria (California Dental Association (CDA)/Ryge,34
US Public Health Service (USPHS),23,24 FDI,10,15 Walton's Six
Field35) is another influencing factor. Other factors that make
different reports hard to compare are reporting of survival
rates in straight percentages19,26-28,34 or using a Kaplan–Meir
analysis,29,30,35,36 taking into account or ignoring clustered
outcomes20,21, prospective12,14,16 versus retrospective17,29,30,
direction of trials, and inconclusive or missing information.
Finally, use of “modified” criteria (Modified CDA/Ryge,4,11,31
Modified USPHS12,13,18,19,25) and methodologies (modified
Kaplan–Meier35) have further increased the heterogeneity of
the conducted studies.
Despite the heterogeneity of these studies, it can be safely
stated that there are ample short- to medium-term stud-
ies with high-success rates. However, according to some
researchers, the survival rate of PLVs should be no less than
100%, especially for short-term studies.8 To assess the true
longevity of the PLVs, it is perhaps acceptable to describe
the overall clinical success of PLVs on the basis of short-,
medium-, and long-term definitions. Therefore, this review
has focused on investigating studies with a follow-up period
of a minimum of 1 year up to more than 20 years. The aim of
this systematic review was to analyze and compare the most
up-to-date information available on short-, medium-, and
long-term survival rates of PLVs and investigate the homoge-
neity in current studies or lack of it.
Materials and Methods
Standard of Reporting and PICOS Principle
The present systematic review followed the preferred report-
ing items for systematic reviews and meta-analysis (PRISMA)
guideline. The studies were identified using the following
PICOS principle: Patients = patients who received ceramic
veneers, Intervention = PLVs, Control (not applicable in
the present study), Outcome = estimation of Kaplan–Meier
cumulative survival rate and Study design = prospective or
retrospective studies.
Study Selection
The main inclusion criteria consisted of articles published in
the English language, foreign language articles with readily
available translations, in vivo studies with a follow-up of at
least 1 year, both retrospective and prospective randomized
controlled trials (RCTs) in humans, and reporting of a Kaplan–
Meier estimated cumulative survival rate. Studies were not
considered if studies did not report adequate description
related to the preparation of PLVs or their bonding proce-
dures, review articles, case reports, abstracts or unpublished
data.
Data Sources
An extensive electronic search was performed using PubMed,
Ovid MEDLINE, Cochrane Library, Web of Science, EBSCO,
Science Direct, Wiley, and Scopus databases from 1970 to
2020. The search was conducted using different combina-
tions of the following terms: “dental,” “porcelain,” “ceramic,”
“laminate,” “veneers,” “PLVs” “survival,” “rate,” “longevity,”
“follow-up,” “failure,” “clinical,” “performance,” “retrospec-
tive,” “prospective,” and “longitudinal.”
No manual or hand search was conducted. During the
initial screening process, all duplicates were identified and
removed. Other exclusions included research abstracts,
posters, case reports, commentaries, critical appraisals,
letters to editors, editorials, conference papers, and review
articles. The references of all full-text articles including
systematic reviews and meta-analyses were inspected for
additional relevant sources. Unpublished studies (gray
literature) were identified by searching the Open-GRAY
database, and references of the included studies (cross
referencing) were performed to obtain new studies. One
reviewer (YHA) screened the titles and the abstracts of
all the results identified through the electronic searches.
Full articles were collected for titles requiring detailed
inspection.
Quality Assessment
Quality of all the studies were assessed using a modified sys-
tematic assessment list consisting of 24 items.37 The 24-item
list was developed according to the guidelines of publication.

3Survival Rates for Veneers AlJazairy
European Journal of Dentistry
The items consisted of points including the reporting of
hypothesis, aims, setting/study design, distribution of study
population by age and gender, adequate eligibility criteria,
description of treatment, sample size, main outcomes, use
of control group, randomization and blinding, calibration
performed, adequate statistical analyses, reporting of con-
fidence intervals, adverse effects, and conclusions. For each
item, a single mark “x” was given. A percentage value of qual-
ity items was analyzed for individual study.
Results
Study Selection
Out of the total 120 full-text articles, 65 articles were excluded
for various reasons including in vitro studies, extracted teeth,
CAD/CAM, materials unclear or not ceramic/porcelain, no
Kaplan–Meier analysis, missing or unclear data, and miss-
ing or unclear conclusions. Another 25 publications were
removed, as they were systematic reviews or meta-analyses.
The remaining 30 full-text articles were reviewed in depth
and used to discuss the heterogeneity in current literature
and reported longevity of veneer restorations. The corre-
sponding steps for initial screening and selection of studies
are shown in the PRISMA diagram (►Fig.1).
General Description of the Included Studies
The general characteristics of the selected studies are
reported in ►Table1. Out of all the studies included, a total of
16 studies were retrospective, while a total of 14 studies were
prospective cohort studies. On the basis of follow-up period,
nine clinical trials had long-term follow up period ranging
from 10.5 years to 50 years. Eight studies had medium-term
follow-up ranging from 6 years to 10 years, while 13 short-
term studies reported a follow-up period of < 6 years. The
included studies initiated from the year 1966 to the year
2016. A total of 2473 patients were included in the included
clinical trials. The total number of PLVs studied in the clinical
trials were 11,465.
Main Outcomes of the Studies
Long-term Clinical Trials
All long-term clinical trials reported their outcomes based on
the Kaplan–Meier analysis. The criteria used for assessing sur-
vival were variable. Three studies were author-defined,29,38,39
two studies used Walton’s Six Field35,36 and modified CDA/
Ryge,4,31 while only one study used CDA/Ryge.34 The overall
survival rate ranged from 100% to 73% in the included long-
term trials. A general trend of reduced survival rate was
observed among four studies who reported their survival
rates at different time points.29,31,35,39
Medium-term Clinical Trials
Four clinical trials reported the survival outcomes based
on the Kaplan–Meier analysis.18,22,23,32 One study reported
mean percentage of survival rate,19 while outcomes from the
three studies were either unclear or had missing data.20,21,33
Fig. 1 PRISMA flowchart for the study selection process.

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European Journal of Dentistry
Survival Rates for Veneers AlJazairy
Three studies used their own criteria,21,22,33 two studies used
modified USPHS,18,19 while one study used USPHS criteria.23
The overall survival rate ranged from 100% to 47% in medi-
um-term clinical trials.
Short-term Clinical Trials
A total of eight trials were of short-term, which esti-
mated the survival rate of PLVs using the Kaplan–Meier
analysis.10-13,15-17,25 Three trials reported the survival rate using
Table 1 Characteristics of selected articles
#Author Period Max.
follow-up
Patients PLV s Survival rate Criteria Survival
method
Study
design
Long-term trials
1 Olley et al (2018)38 1966–2016 50 years * 22 100% A KM RC
2 Layton & Walton (2012)36 1990–2010 21 years 155 499 96% W KM PC
3 Beier et al (2012)39 1987–2009 20 years 84 318 94.4%–5 years
93.5%–10 years
82.93%–20 years
AKM RC
4 Layton & Walton (2007)35 1988–2003 16 years 100 304 96%–5 to
6 years93%–10 to
11 years91%–12 to
13 years73%–15 to
16 years
WKM PC
5 Friedman (1998)34 * 15 years * 3500 93% C % RC
6 Gurel et al (2013)29 1997–2009 12 years 66 580 92%–6 years86%–
12 years
AKM RC
7 Fradeani et al (2005)41991–2002 12 years 46 182 94.40% MC KM RC
8 Granell-Ruiz et al (2009)30 1995–2003 11 years 70 323 94%–simple85%–
functional
*KM RC
9Dumfahrt & Schäer
(2000)31
1986–1997 10.5 years 65 191 97%–5 years91%–
10.5 years
MC KM RC
Medium-term trials
10 Burke & Lucarotti (2009)32 1991–2001 10 years 1177 2562 53% * KM RC
11 Peumans et al (2004)33 1990–2000 10 years 25 87 64% A * PC
12 D’Arcangelo et al (2012)18 2002–2008 7 years 30 119 97.50% MU KM PC
13 Shao-Ping et al (2012)19 2005–2012 7 years 32 206 97.60% MU % RC
14 Smales & Etemadi (2004)20 1993–2000 7 years 50 110 95.8%–incisal
85.5%–nonincisal
* * RC
15 Magne et al (2000)21 1995–1999 7 years 16 48 100% A * RC
16 Shaini et al (1997)22 1984–1992 6.5 years 102 372 47% A KM RC
17 Fradeani (1998)23 1991–1997 6 years 21 83 99% U KM PC
Short-term trials
18 Aykor & Ozel (2009)24 1991–1997 5 years 30 300 94–95%* U * PC
19 Guess & Stappert (2008)25 1999–2006 5 years 25 66 100%–full
97.5%–overlap
MU KM PC
20 Murphy et al (2005)26 1996–2001 5 years 29 62 89% * % RC
21 Aristidis & Dimitra
(2002)27
1993–1998 5 years 61 186 98.40% A % PC
22 Peumans et al (1998)28 1990–1995 5 years 25 87 93% A % PC
23 Coelho-de-Souza et al
(2015)10
* 3.5 years 86 196 80.10% F KM RC
24 Fabbri et al (2014)11 2006–2010 3.5 years * 318 97.91% MC KM PC
25 Gresnigt et al (2013)12 2007–2010 3.3 years 20 92 94.60% MU KM PC
26 Rinke et al (2013)13 2008–2010 3 years 37 130 95.10% MU KM RC
27 Nordbø et al (1994)14 1990–1993 3 years 41 135 98.50% * * PC
28 Karagözoğlu et. al.
(2016)15
* 2 years 12 62 100% F KM PC
29 Öztürk & Bolay (2014)16 2008–2011 2 years 28 125 91.20% MU KM PC
30 Çötert et al (2009)17 1999–2005 1.5 years 40 200 99.50% A KM RC
Abbreviations: %, straight percentage; A, author-defined; C, CDA/Ryge, F, FDI; KM, Kaplan–Meier analysis; MC, modified CDA/Ryge; MU, modified USPHS; P,
prospective cohort; R, retrospective cohort; U, USPHS; W, Walton’s six field.
(*) Unclear or missing data.

5Survival Rates for Veneers AlJazairy
European Journal of Dentistry
mean percentage,26-28 four studies used the modified USPHS
criteria,12,13,16,25 three studies using author-defined,17,27,28 two
studies using FDI,10,15 while one study each using modified
CDA/Ryge11 and USPHS.24
Quality Assessment
The majority of studies achieved > 75% on the quality assess-
ment. The percentage range of the trials selected in the qual-
ity estimation ranged from 58% to 96% (►Table2).
Discussion
Systematic reviews and meta-analyses are the core of evi-
dence-based dentistry.40 Clinical trials are, in turn, critically
fundamental in supporting the quality of evidence synthe-
sis for both systematic reviews and meta-analyses.41 The
homogeneity of studies is therefore of utmost importance
in conducting beneficial systematic reviews. Researchers
have suggested that reporting in systematic reviews can
be improved by universally agreed upon standards and
guidelines.42 For instance, it is worth noting that previously
in 2007, Hickel et al43 have called for evidence-based stud-
ies to follow homogeneous study designs in order for future
RCTs to be subsequently included in systematic reviews and
meta-analyses. In their publication, the authors promoted
the use of the FDI criteria and laid out a detailed framework
for researchers to follow in designing and conducting their
research.
Carrying out RCTs with large sample sizes and over lengthy
follow-up periods are often difficult. As an alternative, well-de-
signed systematic reviews can provide reliable answers to
research questions by analyzing several RCTs.44 For example,
the questions of longevity of PLVs and precisely predicting their
treatment outcomes. On the other hand, researchers find it dif-
ficult to combine RCTs with incomparable statistical variables.
The studies examined in this literature review (►Table1)
clearly demonstrated that studies with contradistinctive
reporting factors are difficult to combine usefully for sys-
tematic reviews or meta-analyses. Without inspecting the
detailed methods and materials, and only observing three
basic factors such as definition of failure, evaluation criteria
and statistical methodology, a wide range of disparity can be
noticed.
Out of the total 27 studies, 13 studies were designed as
prospective clinical trials and 14 studies were retrospec-
tive cohorts. Failure was defined as “irreparable” in 13
studies,4,11-13,15,18,22,23,25,27,31,34,35 and “reparable but counted
as a failure” in nine studies.10,14,16,17,28-30,32,33 The remain-
ing five studies either did not state or unclearly stated the
definition of failure.19,20,21,24,26 In terms of evaluation crite-
ria, seven studies17,21,22,27-29,33 used an author-defined crite-
ria, six studies12,13,16,18,19,25 used the modified USPHS criteria,
three studies4,11,31 used the modified CDA/Ryge criteria, two
studies10,15 used the FDI criteria and another two23,24 used
the USPHS criteria, one study34 each used the CDA/Ryge
criteria and35 the Walton’s Six Field criteria, while five
studies14,20,26,30,32 did not report a clear criteria. In utilizing
proper survival estimation methodology, five studies19,26-28,34
used straight percentages, and another five studies reported
unclear or undefined statistical analyses.14,20,21,24,33 Overall,
17 studies, being a definite majority, did utilize the Kaplan–
Meier analysis and reported a precise cumulative survival
estimation.4,10-13,15-18,22,23,25,29-32,35
At the very basic, if the definitions of failure were stan-
dardized, the survival times would be the same conceptu-
ally. If the studies used the Kaplan–Meier analysis instead
of straight percentages, then the statistical results can be
aggregated into information, leading to a higher statisti-
cal power and conclusions that are more robust. Finally,
using the same evaluation criteria could aid in decreasing
the researcher bias in judging the state of a restoration and
could provide results that could be compared in depth,
according to a detailed breakdown of esthetic, functional,
and biological properties.
The same can be observed for the three studies retained
for qualitative synthesis. All the authors defined their own
evaluation criteria. Even though Walton’s Six Field classifi-
cation has been standardized, it has not been employed in
any other study. The only use that can be seen in the current
literature is in studies conducted by the same authors.7,35,36
Survival rate estimations were calculated using the Kaplan–
Meier analysis by all three of the studies. However, Layton
& Walton36 used a slightly modified version of the analysis,
and Olley et al38 did not state clearly whether the methodol-
ogy was used to calculate the survival rate of the veneers or
only the crowns, rather defined failure in detail but ambigu-
ously, while the remaining two studies defined failure as an
irreparable problem. The specifics of the three studies can be
observed in more detail below.
Beier et al39 in their retrospective study conducted a long-
term analysis of up to 20 years. The study was conducted at
the Innsbruck Medical University in Innsbruck, Austria. Two
associate professors placed 318 silicate glass ceramic veneers
in 84 patients (38 males, 46 females). The study population
consisted of 42 patients (50%) with bruxism and 23 smokers
(27.28%). The restorations were placed between November
1987 and December 2009. The fabrication of PLVs varied
according to the placement period and included feldspathic
porcelain, leucite heat pressed ceramic, or lithium disilicate
heat-pressed ceramic. The veneers were evaluated between
March 2010 and July 2010 by using the modified CDA/Ryge
criteria. In addition, a papilla bleeding index (PBI) assessment
and a customer satisfaction survey were conducted. Out of the
total 318 veneers, 152 veneers were observed over 10 years, 75
veneers were observed over 17 years, and only three veneers
were observed over 20 years.
Failure was defined as an “irreparable problem.” Twenty
veneers failed before the evaluation in 2010 and no clinical
data using modified CDA/Ryge was recorded. However, since
the type of failure was recorded, the veneers were not cen-
sored from the Kaplan–Meier analysis. The authors did pro-
vide a breakdown of failures according to CDA/Ryge criteria

6
European Journal of Dentistry
Survival Rates for Veneers AlJazairy
Table 2 Quality assessment of the included studies
Author H S A/G IC EC TMO SS SSJ CG RA MRA B E ECL SM FR FR80% LF MAN CI AE C%*
Olley et al
(2018)38
x x – x x x x x x – x x x x x x – x x x x – – x 79
Layton &
Walton
(2012)36
x x x x x x x x x x x x – x x x x x x x x – – x 87
Beier et al
(2012)39
x x x x x x x x x x x x – x x x x x x x x – – x 87
Layton &
Walton
(2007)35
x x – x x x – x x – x x – – x x – x x x – – – x 62
Friedman
(1998)34
x x – x x x – x x – x – – – x x – x x x – – – x 58
Gurel et al
(2013)29
x x – x x x x x x – x x x x x x – x x x x – – x 79
Fradeani
et al
(2005)4
x x – x x x – x x – x x x x x x – x x x x – – x 75
Granell-Ruiz
et al
(2009)30
x x x x x x x x x x x x x x x x x x x x x – – x 92
Dumfahrt
& Schäer
(2000)31
x x – x x x – x x – x x – – x x – x x x – – – x 67
Burke &
Lucarotti
(2009)32
x x – x x x x x x – x x – x x x – x x x x – – x 75
Peumans
et al
(2004)33
x x – x x x x x x – x x x x x x – x x x x – – x 79
D’Arcangelo
et al
(2012)18
x x x x x x x x x x x x x x x x x x x x x – – x 92
Shao-Ping
et al
(2012)19
x x – x x x x x x – x x – x x x – x x x x – – x 75
Smales &
Etemadi
(2004)20
x x – x x x x x x – x x – x x x – x – x x – – x 71
Magne
et al
(2000)21
x x x x x x – x x x x x – – x x x x x x – – – x 75
Shaini
et al
(1997)22
x x x x – x – x x x x x – – x x x x x x – – – x 77
Fradeani
(1998)23
x x – x x x – x x – x x – – x x – x x x – – – x 62
Aykor &
Ozel
(2009)24
x x – x x x x x x – x x – x x x – x x x x – x x 79
Guess &
Stappert
(2008)25
x x – x x x x x x – x x x x x x – x x x x – x x 83
Murphy
et al
(2005)26
x x x x x x – x x x x x – – x x x x x x – – – x 75
Aristidis
& Dimitra
(2002)27
x x x x x x x x x x x x – x x x x x x x x – – x 87
Peumans
et al
(1998)28
x x – x x x – x x – x x – – x x – x x x – – – x 62
(continue)

7Survival Rates for Veneers AlJazairy
European Journal of Dentistry
evaluated using the Walton’s Six Field criteria and grouped
into 5-year intervals. A total of 145 veneers were in situ
for 1 to 5 years, 115 veneers were in situ from 10 to 15 years,
157 veneers were in situ for 10 to 15 years, 77 veneers were
in situ from 15 to 20 years, and only five veneers survived
more than 21 years.
Failure was defined as, when part or all of the prosthe-
sis was lost, when marginal integrity was compromised,
or when the veneer fell off more than twice. Walton’s Six
Field classification designates an outcome as “repair,” when
a veneer needs repair without interfering with the original
marginal integrity of the restoration. Thus, it can be assumed
that “failure” was defined as an irreparable problem. Eleven
patients with 56 veneers experienced more than one out-
come from Walton’s criteria.
Kaplan–Meier survival rates were analyzed twice. First,
for the entire sample of 499 veneers without accounting for
clustering and then the outcome was analyzed for one ran-
domly chosen veneer from each patient. This study was one
of the very few studies that have emphasized and analyzed a
survival rate while accounting for clustered outcomes. For the
entire sample, Kaplan–Meier cumulative survival rates were
reported for 5 years (98%), 10 years (96%), 15 years (91%),
and 20 years (91%). For the randomly selected subsample,
survival rates were reported as 5 years (98%), 10 years (96%),
15 years (96%), and 20 years (96%). The authors reported that
survival rates were not significantly different for both groups.
Olley et al in their retrospective study investigated the
outcome of indirect restorations with a follow-up of up to
50 years.38 The study was conducted at a mixed National
by percentages, and the most frequent reason for failure was
fracture of the ceramic (44.83%).
The study also reported a significantly higher marginal
discoloration among smokers and a significantly higher
failure rate among bruxers. In total, approximately 12% of
veneers were cemented without dentine bonding, and the
authors attributed this to some of the restoration failures.
Kaplan–Meier cumulative survival rates were reported for
5 years (94.4%), 8 years (94.1%), 10 years (93.5%), 15 years
(85.74%) and 20 years (82.93%).
The authors used the Cox proportional hazards model to
study influence of various risk factors for failures. Instead of
accounting for clustering, the authors computed robust stan-
dard errors by estimating a correlation between the observa-
tions from the same patient using methods described by Lin
and Wei.45
Layton & Walton36 in their prospective cohort study ana-
lyzed the survival rates of feldspathic porcelain veneers
with a follow-up of 21 years. The restorations were placed
in a private practice in Australia, by a single prosthodontist,
between 1990 and 2010. A total of 499 veneers were placed in
155 patients. Patients with extensive loss of tooth structure
through parafunction and unfavorable periodontal prognosis
were excluded. Feldspathic porcelain veneers from refractory
dies were etched, silanated and bonded. Only teeth with at
least 80% enamel remaining were veneered. A total of 499
veneers were observed for the first 5 years, 354 veneers were
observed up to 10 years, 239 veneers were observed up to
15 years, 82 veneers were observed up to 20 years, and only
five veneers were observed for 21 years. The veneers were
Table 2 (continue)
Author H S A/G IC EC TMO SS SSJ CG RA MRA B E ECL SM FR FR80% LF MAN CI AE C%*
Coelho-
de-Souza
et al
(2015)10
x x x x x x – x x x x x x – x x x x x x – – – x 79
Fabbri et al
(2014)11
x x x – x x – x x x x x – – x x x x x x – – x x 75
Gresnigt et
al (2013)12
x x x x x x – x x x x x x – x x x x x x – – – x 79
Rinke et al
(2013)13
x x x x x x x x x x x x – x x x x x x x x – – x 87
Nordbø et al
(1994)14
x x – x x x x x x – x x – x x x – x x x x – – x 75
Karagözoğlu
et. al.
(2016)15
x x x x x x x x x x x x x x x x x x x x x – x x 96
Öztürk
& Bolay
(2014)16
x x x x x x x x x x x x x x x x x x x x x – – x 83
Çötert et al
(2009)17
x x x x x x x x x x x x – x x x x x x x x – – x 87
Abbreviations: A/G, age/gender distribution described; AE, adverse events stated; AN, results stated in absolute numbers; B, blinding performed; C,
conclusions stated; CG, use of control group; CI, confidence intervals stated; E, more than one examiner for outcome assessment; EC, exclusion criteria;
ECL, examiner calibration; FR, follow-up rate mentioned; FR80%, follow-up rate greater than 80%; H, hypothesis/aim described; IC, inclusion criteria; LF,
lost to follow-up; M, main outcomes clearly described; MO, main outcomes to be measured; MRA, method of random allocation described; RA, random
allocation to treatment used; S, study setting described; SM, statistical methods described; SS, sample size; SSJ, sample size justified; T, treatment
described; x, yes.
*% of questions answered yes.

8
European Journal of Dentistry
Survival Rates for Veneers AlJazairy
Health Service (NHS)/private dental practice in London,
United Kingdom. One operator placed 223 restorations in
47 patients between 1966 and 1996. The restorations con-
sisted of metal-ceramic crowns (154), gold crowns (25),
ceramic crowns (22), and ceramic veneers (22). However,
only the 22 ceramic veneers placed in 10 patients are of
importance for this review.
Only patients with excellent oral hygiene and favorable
periodontal prognosis were included in this study. The only
material detail given was that the restorations were felds-
pathic porcelain laminate veneers. Failure was defined as
“issues that affected the survival of the restoration.” Failures
also included pulp infections or other periapical complica-
tions. The authors did not identify if a standard evaluation
criterion was used, nor did they clearly state their own eval-
uation criteria. The Kaplan–Meier analysis was performed
on all restorations, and the authors stated 100% veneers had
survived at 50 years. However, it was unclear if the Kaplan–
Meier estimated cumulative survival rate for the 22 veneers
was 100% or if it was stated as a straight percentage.
The most critical observation that was made in all three
of the studies was the small number of restorations eval-
uated beyond 20 years. It is evident that even though PLVs
might have a longevity of 20 to 50 years, the dropout rate
in RCTs over these periods is exceedingly high, and the out-
comes reported represent a significantly small sample size.
Although inconclusive in exact percentages, the majority of
studies have concluded that porcelain laminate veneers have
high-success rates and predictable patient outcomes.
Conclusion
A conclusive estimation of the longevity of porcelain
laminate veneers beyond 20 years is lacking. The avail-
ability of evidence in the current literature is limited in
terms of sample size and duration of follow-up. The pres-
ent literature indicates an increased heterogeneity among
research study designs. Researchers should aim for homo-
geneous study designs that can be included in systematic
reviews and meta-analyses.
Conict of Interest
None declared.
Acknowledgement
The author wish to thank the College of Dentistry Research
Center at King Saud University, Saudi Arabia, for support-
ing this research project (project no. #FR 0478).
References
1 Sá TCM, de Carvalho MFF, de Sá JCM, Magalhães CS,
Moreira AN, Yamauti M. Esthetic rehabilitation of ante-
rior teeth with different thicknesses of porcelain laminate
veneers: An 8-year follow-up clinical evaluation. Eur J Dent
2018;12(4):590–593
2 Malchiodi L, Zotti F, Moro T. De Santis D, Albanese M. Clinical
and esthetical evaluation of 79 lithium disilicate multilayered
anterior veneers with a medium follow-up of 3 years. Eur J
Dent 2019;13(4):581–588
3 Beltrami R, Ceci M, De Pani G, et al. Effect of different surface
finishing/polishing procedures on color stability of esthetic
restorative materials: a spectrophotometric evaluation. Eur J
Dent 2018;12(01):049–56
4 Fradeani M, Redemagni M, Corrado M. Porcelain laminate
veneers: 6- to 12-year clinical evaluation–a retrospective
study. Int J Periodontics Restorative Dent 2005;25(1):9–17
5 Morimoto S, Albanesi RB, Sesma N, Agra CM, Braga MM.
Main clinical outcomes of feldspathic porcelain and glass-ce-
ramic laminate veneers: a systematic review and meta-anal-
ysis of survival and complication rates. Int J Prosthodont
2016;29(1):38–49
6 De, FA, da, Costa, G, Borges, BCD, de, Assunção, IV. . Clinical
performance of porcelain laminate veneers with minimal
preparation: a systematic review. Int J Experiment Dent Sci
2016;5(1):56–59
7 Layton DM, Clarke M, Walton TR. A systematic review and
meta-analysis of the survival of feldspathic porcelain veneers
over 5 and 10 years. Int J Prosthodont 2012;25(6):590–603
8 Burke FJ. Survival rates for porcelain laminate veneers with
special reference to the effect of preparation in dentin: a liter-
ature review. J Esthet Restor Dent 2012;24(4):257–265
9 Kreulen CM, Creugers NHJ, Meijering AC. Meta-analysis
of anterior veneer restorations in clinical studies. J Dent
1998;26(4):345–353
10 Coelho-de-Souza FH, Gonçalves DS, Sales MP, et al. Direct
anterior composite veneers in vital and non-vital teeth:
a retrospective clinical evaluation. J Dent 2015;43(11):
1330–1336
11 Fabbri G, Zarone F, Dellificorelli G, et al. Clinical evaluation
of 860 anterior and posterior lithium disilicate restorations:
retrospective study with a mean follow-up of 3 years and a
maximum observational period of 6 years. Int J Periodontics
Restorative Dent 2014;34(2):165–177
12 Gresnigt MM, Kalk W, Ozcan M. Randomized clinical trial of
indirect resin composite and ceramic veneers: up to 3-year
follow-up. J Adhes Dent 2013;15(2):181–190
13 Rinke S, Lange K, Ziebolz D. Retrospective study of extensive
heat-pressed ceramic veneers after 36 months. J Esthet Restor
Dent 2013;25(1):42–52
14 Nordbø H, Rygh-Thoresen N, Henaug T. Clinical performance
of porcelain laminate veneers without incisal overlapping:
3-year results. J Dent 1994;22(6):342–345
15 Karagözoğluİ,ToksavulS,TomanM.3Dquantificationofclin-
ical marginal and internal gap of porcelain laminate veneers
with minimal and without tooth preparation and 2-year clin-
ical evaluation. Quintessence Int 2016;47(6):461–471
16 Oztürk E, Bolay S. Survival of porcelain laminate veneers with
different degrees of dentin exposure: 2-year clinical results.
J Adhes Dent 2014;16(5):481–489
17 Cötert HS, Dündar M, Oztürk B. The effect of various prepa-
ration designs on the survival of porcelain laminate veneers.
J Adhes Dent 2009;11(5):405–411
18 D’Arcangelo C, De Angelis F, Vadini M, D’Amario M. Clinical
evaluation on porcelain laminate veneers bonded with light-
cured composite: results up to 7 years. Clin Oral Investig
2012;16(4):1071–1079
19 Xu SP, Luo XP, Shi YJ. [Esthetic restoration for anterior teeth
with the hot pressed porcelain laminate veneers]. Shanghai
Kou Qiang Yi Xue 2012;21(5):572–575
20 Smales RJ, Etemadi S. Long-term survival of porcelain laminate
veneers using two preparation designs: a retrospective study.
Int J Prosthodont 2004;17(3):323–326
21 Magne P, Perroud R, Hodges JS, Belser UC. Clinical perfor-
mance of novel-design porcelain veneers for the recovery of
coronal volume and length. Int J Periodontics Restorative Dent
2000;20(5):440–457

9Survival Rates for Veneers AlJazairy
European Journal of Dentistry
22 Shaini FJ, Shortall ACC, Marquis PM. Clinical performance of
porcelain laminate veneers. A retrospective evaluation over
a period of 6.5 years. J Oral Rehabil 1997;24(8):553–559
23 Fradeani M. Six-year follow-up with Empress veneers. Int J
Periodontics Restorative Dent 1998;18(3):216–225
24 Aykor A, Ozel E. Five-year clinical evaluation of 300 teeth
restored with porcelain laminate veneers using total-
etch and a modified self-etch adhesive system. Oper Dent
2009;34(5):516–523
25 Guess PC, Stappert CF. Midterm results of a 5-year prospective
clinical investigation of extended ceramic veneers. Dent Mater
2008;24(6):804–813
26 Murphy E, Ziada HM, Allen PF. Retrospective study on the per-
formance of porcelain laminate veneers delivered by under-
graduate dental students. Eur J Prosthodont Restor Dent
2005;13(1):38–43
27 Aristidis GA, Dimitra B. Five-year clinical performance of por-
celain laminate veneers. Quintessence Int 2002;33(3):185–189
28 Peumans M, Van Meerbeek B, Lambrechts P, Vuylsteke-Wauters
M, Vanherle G. Five-year clinical performance of porcelain
veneers. Quintessence Int 1998;29(4):211–221
29 Gurel G, Sesma N, Calamita MA, Coachman C, Morimoto S.
Influence of enamel preservation on failure rates of porce-
lain laminate veneers. Int J Periodontics Restorative Dent
2013;33(1):31–39
30 Granell-Ruiz M, Fons-Font A, Labaig-Rueda C,
Martínez-González A, Román-Rodríguez JL, Solá-Ruiz MF. A
clinical longitudinal study 323 porcelain laminate veneers.
Period of study from 3 to 11 years. Med Oral Patol Oral Cir
Bucal 2010;15(3):e531–e537
31 Dumfahrt H, Schäffer H. Porcelain laminate veneers. A ret-
rospective evaluation after 1 to 10 years of service: Part II–
Clinical results. Int J Prosthodont 2000;13(1):9–18
32 Burke FJT, Lucarotti PSK. Ten-year outcome of porcelain lam-
inate veneers placed within the general dental services in
England and Wales. J Dent 2009;37(1):31–38
33 Peumans M, De Munck J, Fieuws S, Lambrechts P, Vanherle G,
Van Meerbeek B. A prospective ten-year clinical trial of porce-
lain veneers. J Adhes Dent 2004;6(1):65–76
34 Friedman MJ. A 15-year review of porcelain veneer fail-
ure–a clinician’s observations. Compend Contin Educ Dent
1998;19(6):625–628, 630, 632 passim, quiz 638
35 Layton D, Walton T. An up to 16-year prospective study of
304 porcelain veneers. Int J Prosthodont 2007;20(4):389–396
36 Layton DM, Walton TR. The up to 21-year clinical outcome and
survival of feldspathic porcelain veneers: accounting for clus-
tering. Int J Prosthodont 2012;25(6):604–612
37 Hoy D, Brooks P, Woolf A, et al. Assessing risk of bias in preva-
lence studies: modification of an existing tool and evidence of
interrater agreement. J Clin Epidemiol 2012;65(9):934–939
38 Olley RC, Andiappan M, Frost PM. An up to 50-year follow-up
of crown and veneer survival in a dental practice. J Prosthet
Dent 2018;119(6):935–941
39 Beier US, Kapferer I, Burtscher D, Dumfahrt H. Clinical perfor-
mance of porcelain laminate veneers for up to 20 years. Int J
Prosthodont 2012;25(1):79–85
40 Guyatt G, Cairns J, Churchill D, et al; Evidence-Based
Medicine Working Group. Evidence-based medicine. A
new approach to teaching the practice of medicine. JAMA
1992;268(17):2420–2425
41 Slavin RE. Best-evidence synthesis: an alternative to meta-an-
alytic and traditional reviews. Educ Res 1986;15(9):5–11
42 Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG.
Epidemiology and reporting characteristics of systematic
reviews. PLoS Med 2007;4(3):e78
43 Harhash AY, ElSayad II, Zaghloul AGS. A comparative in
vitro study on fluoride release and water sorption of dif-
ferent flowable esthetic restorative materials. Eur J Dent
2017;11(2):174–179
44 Linhares LA, Pottmaier LF, Lopes GC. Fracture resistance of
veneers in premolars. Eur J Dent 2018;12(2):191–198
45 Lin DY, Wei LJ. The robust inference for the proportional haz-
ards model. J Am Stat Assoc 1989;84:1074–1078