Extended porcelain veneers in the maxillary anterior region. A retrospective study with an up to 27-year follow-up

AIM: The aim of the present retrospective study was to evaluate the long-term results, including technical and biologic outcomes, of maxillary extended porcelain veneers with an incisal edge thickness above 2 mm. MATERIALS AND METHODS: Patients treated with extended porcelain veneers performed by a single clinician at University of Geneva between 1990 and 2003 were identified and invited to an examination. Of the 37 identified patients, 10 patients with 50 veneers agreed to be examined and were included. A clinical examination was performed to assess survival rates as well as technical and biologic outcomes (modified United States Public Health Services criteria). Patient records were also reviewed to retrieve patient and reconstruction data and every complication event. Patient-reported outcome measures (PROMs) were evaluated using a visual analog scale to measure esthetic satisfaction, functional and phonetic comfort, masticatory improvement, tooth sensitivity, and acceptance of restoration replacement in case of failure. Data were descriptively analyzed, and Kaplan-Meier survival estimators were computed for survival rates and complication events. RESULTS: The survival rate of the veneers was 96% after a mean follow-up of 20.7 ± 3.7 years in function. The technical complication rate amounted to 30%, including two failures, nine repairable fractures, three cracks, and one displacement due to trauma. No cavitated caries lesions or endodontic complications were registered. PROMs were very high for esthetic satisfaction and phonetic comfort. CONCLUSIONS: Within the limitations of the present retrospective study, extended porcelain veneers appear to be a successful long-term treatment option in terms of clinical outcomes and patient satisfaction.

Influence of symmetry and balance on visual perception of a white female smile.

STATEMENT OF PROBLEM: Clinicians and dental technicians may underestimate what is deemed esthetic by laypersons and dental professionals. PURPOSE: The purpose of this study was to define the relative importance of symmetry, visual tension, and balance in the smile. MATERIAL AND METHODS: Images of a white woman were altered to reproduce symmetry, various visual tensions, distinct tooth shapes, and color changes. A 12-question survey was presented to 128 individuals, including 81 dental professionals and 47 laypersons. The survey asked individuals to choose the most desirable and beautiful image in a choice of images. RESULTS: Raters were most influenced by the maxillary central incisors and then the canines and were more forgiving on visual tensions of the maxillary lateral incisors. Square-shaped teeth were preferred over ovoid and triangular ones. The more upright the canines, the more the smile was perceived as masculine. Teeth whiter than the sclera of the eyes were preferred, with lay individuals choosing the lightest shade available and dental professionals choosing the shade slightly lighter than the sclera. Although participants mostly preferred a symmetrical smile, they opted for the natural face as opposed to symmetrical ones. CONCLUSIONS: Location of visual tension plays a role in perceiving beauty. Symmetrical smiles were considered more pleasant but not symmetrical faces. Imperfections play an essential role in perceiving beauty because they express life, individuality, charisma, and charm.

Porcelain veneer post-bonding crack repair by resin infiltration.

Ceramic laminate veneer restorations are indicated in several clinical situations. Indirect restorations are usually chosen if the less-invasive options - bleaching, resin infiltration, or composite resin restorations - are not possible, or when it is too difficult to achieve an esthetically pleasing result in the long term. Bonded indirect partial restorations are highly dependent on their adhesive interface, as these thin restorations have a relatively low cohesive strength. Therefore, preservation of sound enamel, conditioning of the restorations and of the substrate, and luting procedures are of paramount importance for a successful outcome. Even when utmost care is taken during every step of the procedure, failures such as fractures, chipping, or marginal discoloration and defects sometimes occur. Only very few of these cases of failure are presented or are a subject of interest. In this case presentation, a fracture repair is performed using an infiltration technique with a resin composite material.

Lip Lifting: Unveiling Dental Beauty.

The focus for the achievement of complete success in the esthetic zone has traditionally been on addressing deficiencies of intraoral hard and soft tissue. Often, these deficiencies are accompanied by esthetic concerns regarding the lips that are routinely neglected by the dental team. A predictable plastic surgery technique - the lip lift - has been used for decades to enhance lip esthetics by shortening the senile upper lip to achieve a more youthful appearance. Over the years, this technique has been refined and used in many different ways, allowing its routine incorporation into full facial esthetic planning. Through restoration of the upper lip to its optimal position, the artistry of the dentist and dental technician can truly be appreciated in the rejuvenated smile. By the introduction of this minimally invasive surgical technique to the dental community, patients stand to benefit from a comprehensive orofacial approach to anterior dental esthetic planning.

The non-vital discolored central incisor dilemma.

The restoration of anterior teeth is frequently a demanding mission. Patients generally have high expectations for the anterior region, which makes the emotional side of treatment especially important. When this involves discolored endodontically treated teeth, consensus can hardly ever be found as to the chosen approach. Bleaching with direct composites is undoubtedly the most conservative choice for these cases. However, this may require more maintenance (touch-up bleaching and repairs) in the long term, which is an important issue for adult patients. On the other hand, bonded porcelain veneers represent a more 'high-end' option, as they recover the original biomechanics of the intact tooth, allow an optimal masking of the substrate, remain stable, and have a reasonable biological cost when compared to full-coverage crowns. This strategy is explained in this article and documented with a clinical case. We describe treatment planning based on the biomimetic concept, taking into consideration what is possible with current materials and techniques when combined with the patient's particular needs, including the introduction of an innovative step during dentin sealing--the microsuction. The laboratory work was totally accomplished by 'teledentistry', with no direct contact between the dental technologist and the patient.

An approach to biomimetics: the natural CAD/CAM restoration: a clinical report.

Those in the dental field have always pursued the perfect dental material for the treatment of compromised teeth. Gold, amalgam, composite resin, glass ionomer, and porcelain have been used. Tooth-like restorative materials (composite resin and porcelain) combined with an effective hard tissue bond have met the growing demand for esthetic or metal-free restorations in the past 15 to 20 years. However, none of those materials can fully mimic the unique properties of dentin (compliance and crack-stopping behavior) and enamel (wear resistance, function). The aim of this article is to report the restoration of an extensively damaged tooth with a natural restoration obtained by milling an extracted third molar tooth with a computer-aided design and computer-aided manufacturing (CAD/CAM) system. The main benefit of this novel technique is the replacement of lost tissues by actual enamel and dentin, with the potential to recover mechanical, esthetic, and biologic properties. The indication for extracting third molars and premolars because of impaction or for orthodontic reasons makes these posterior teeth readily available. The innovation of the method presented here is the optimal use of the extracted tooth substrate thanks to its positioning technique in the CAD/CAM milling chamber.

The case for moderate "guided prep" indirect porcelain veneers in the anterior dentition. The pendulum of porcelain veneer preparations: from almost no-prep to over-prep to no-prep.

In a historical pendulum of porcelain veneer preparation concepts, an oversimplified version of the so-called "no prep" approaches has resurfaced. A case from the USC student clinics is presented, which could be easily considered by many as a "no prep" veneer case. Moderate tooth preparations guided by natural morphology were used instead with a great benefit on the final outcome. While it is widely accepted that minimally invasive restorative approaches should be favored, a certain controversy exists regarding strictly noninvasive approaches. The purpose of this article is to re-emphasize the concept of guided tooth preparations, based of natural tooth morphology (given by a wax-up and a mock-up), a customized and sensible approach to indirect ceramic veneer tooth preparations.

Fatigue resistance and failure mode of novel-design anterior single-tooth implant restorations: influence of material selection for type III veneers bonded to zirconia abutments.

OBJECTIVES: This study assessed the fatigue resistance and failure mode of type III porcelain and composite resin veneers bonded to custom zirconia implant abutments. MATERIAL AND METHODS: Twenty-four standardized zirconia implant abutments were fabricated. Using the CEREC 3 machine, type III veneers of standardized shape were milled in ceramic Vita Mark II or in composite resin Paradigm MZ100. The intaglio surfaces of the restorations were hydrofluoric acid etched and silanated (Mark II) or airborne-particle abraded and silanated (MZ100). The fitting surface of the abutments was airborne-particle abraded, cleaned, and inserted into a bone level implant (BLI RC SLActive 10 mm). All veneers (n=24) were adhesively luted with a zirconia primer (Z-Prime Plus), adhesive resin (Optibond FL) and a pre-heated light-curing composite resin (Filtek Z100). Cyclic isometric chewing (5 Hz) was simulated, starting with a load of 40 N, followed by stages of 80, 120, 160, 200, 240, and 280 N (20,000 cycles each). Samples were loaded until fracture or to a maximum of 140,000 cycles. Groups were compared using the life table survival analysis (Logrank test at P=.05). RESULTS: Mark II and MZ100 specimens fractured at an average load of 216 N and 229 N (survival rate of 17% and 8%), respectively, with no difference in survival probability (P=.18). Among the fractured samples, 40% of the failures were at the abutment level for Mark II and 27% were at the abutment level for MZ100. No exclusive adhesive failures were observed. CONCLUSIONS: Type III Mark II and Paradigm MZ100 veneers showed similar fatigue resistance when bonded to custom non-retentive zirconia implant abutments. The bond was strong enough to induce abutment fractures. MZ100 presented a higher percentage of "friendly" failures, i.e. maintaining the restoration-abutment adhesive interface and the abutment itself intact.

The parallel stratification masking technique: an analytical approach to predictably mask discolored dental substrate.

Discolored dental substrates continue to challenge the restorative team when ultraconservative treatment modalities are chosen. An innovative laboratory concept--the parallel stratification masking technique--has been developed in order to achieve maximum preservation of dental hard tissues and predictably accomplish a desirable esthetic outcome. The major advantages of this technique are that the ceramist is able to: a)identify and map the discolored dental substrate, b)predictably mask the discolored dental substrate, and c) assess the appropriate masking efficacy of the fabricated restoration prior to laboratory delivery to the dentist in cases of bonded porcelain restorations.

An esthetic solution for single-implant restorations - type III porcelain veneer bonded to a screw-retained custom abutment: a clinical report.

A new esthetic solution to restore dental implants in combination with limited interdental, facial or labial, or interocclusal space is presented. This article describes the translational application of novel-design porcelain veneers and adhesive restorative principles in the implant realm. A patient is presented who was treated with a single implant-supported restoration replacing a missing mandibular lateral incisor and partially collapsed interdental space. A screw-retained custom metal ceramic abutment was combined with a bonded porcelain restoration. This unique design was motivated by the limited restorative space and subgingival implant shoulder. It was also developed as a solution to the interference of the screw-access channel with the incisal edge, therefore providing the surgeon with more options during implant axis selection. The porcelain-to-porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment.

Adhesive restorations, centric relation, and the Dahl principle: minimally invasive approaches to localized anterior tooth erosion.

The purpose of this article is to review biomechanical and occlusal principles that could help optimize the conservative treatment of severely eroded and worn anterior dentition using adhesive restorations. It appears that enamel and dentin bonding, through the combined use of resin composites (on the palatal surface) and indirect porcelain veneers (on the facial/incisal surfaces) can lead to an optimal result from both esthetic and functional/biomechanical aspects. Cases of deep bite combined with palatal erosion and wear can be particularly challenging. A simplified approach is proposed through the use of an occlusal therapy combining centric relation and the Dahl principle to create anterior interocclusal space to reduce the need for more invasive palatal reduction. This approach allows the ultraconservative treatment of localized anterior tooth erosion and wear.

Uso de enceramento por acréscimo e ensaio direto intraoral para preservação de esmalte com facetas laminadas de porcelana / Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers

A erosão e o desgaste dental resultam no adelgaçamento progressivo do esmalte, e geram, ao final, maior flexibilidade dental e deformações maiores da superfície do esmalte. A restauração do volume do dente com facetas adesivas de porcelana não restabelece apenas a aparência original e jovial do sorriso, permite também a recuperação biomimética da coroa. A força motriz desse processo deve ser a preservação do esmalte remanescente. As abordagens tradicionais para o preparo de faceta podem levar à exposição de grandes áreas de dentina. A preservação do esmalte pode ainda ser obtida com facetas de porcelana, desde que seja feita uma abordagem correta para o preparo dental. Este artigo descreve um roteiro de tratamento que inclui o uso de uma guia de diagnóstico. Essa técnica, aqui apresentada em um caso clínico com perda moderada de esmalte, integra um enceramento por acréscimo e um ensaio restaurador direto intraoral de acrílico. Usando essa estratégia, os clínicos podem executar preparos mais precisos e também de maior qualidade, de maneira extremamente rápida, em comparação com métodos tradicionais.

Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers.

Erosion and surface wear result in the progressive thinning of enamel, ultimately generating increased crown flexibility and higher enamel surface strains. The restoration of tooth volume through the use of bonded porcelain veneers not only reestablishes the original and youthful appearance of the smile, but also allows biomimetic recovery of the crown. The driving force of this process should be the preservation of the remaining enamel. Traditional approaches to veneer preparation can lead to major dentin exposures. Enamel preservation can still be achieved with bonded porcelain veneer restorations, however, given a proper approach to tooth preparation. This article describes a treatment rationale that includes the use of a diagnostic template. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive waxup and a direct intraoral acrylic mock-up. Using this strategy, clinicians should be able to perform tooth preparations that are both more accurate and also higher in quality in an extremely time-efficient fashion compared with traditional methods.

Treatment of extended anterior crown fractures using Type IIIA bonded porcelain restorations.

Novel-design bonded porcelain restorations, the so-called Type IIIA BPRs, represent a reliable and effective procedure when restoring large parts of the coronal volume and length in the anterior dentition. While traditional treatment approaches involve the removal of large amounts of sound tooth substance (with adverse effects on the pulp, gingivae and crown biomechanics, as well as serious financial consequences), the use of adhesive technology instead can provide maximum preservation of tissues and limited costs. Considerable advantages, such as the economical and noninvasive treatment of crown-fractured teeth, are inherent to Type IIIA bonded porcelain restorations, reducing the need for preprosthetic interventions (e.g., root canal therapy and crown-lengthening) and the use of intraradicular posts. This article, illustrated with cases with up to eight and 10 years' follow-up, sets the scientific foundations of this concept, as well as important considerations about function, strength, tooth preparation, laboratory technique, and bonding optimization.