Durability of porcelain veneers

DIACONU Elena1, NICULICIOIU Ștefania2 , MITARU Gabriela3

1
5th year student , Lucian Blaga University Sibiu , Faculty of Medicine
2
5th year student , Lucian Blaga University Sibiu , Faculty of Medicine
3
Sef lucr., medic primar

Key words:
PVL, enamel, durability, ceramic veneers, conservative

ABSTRACT:
At the moment, in order to have an aesthetic and lasting restoration, the method of chioce will be
the one with dental porcelain veneers.Regarding the pre-prosthetic stage, they require a
minimum reduction of the dental structure, the adhesion being based on the enamel engraving,
these making them coservative preparations.
As far as that goes, the materials and techniques used for their manufacture, there are a variety of
possibilities on the market, from traditional techniques, manual, to computerized CAD-CAM
techniques. The latter are currently preferred, benefiting from a wide range of colors with opacity
and translucency close to natural teeth. At the same time, modern computerized techniques have
the advantage of a single session in the dental office and the elimination of laboratory steps,
providing comfort to patients.
This study will determine the resistance of dental veneers against time and the chances of
success, these having a questionable longevity starting from 5 to 25 years according to the
related studies.

INTRODUCTION
Over time, dental complete crowns have proven a predictable and durable option for the
restauration of unesthetic anterior teeth. Despite this resistance over time, this procedure involves
significant removal of tooth structure.[1,2] As an alternative method to recreate the estethic of
anterior teeth was the porcelain veneers.
The operation of porcelain veneers has been rehearsed in dentistry since 1980 when it was
discovered that one could etch the inside of a porcelain restoration and get micromechanical
retention analogous to that achived on engraved enamel. It was also possible to treat the surface
with silane and thereby and increase bond strength. Surface treatments with engraving and silane
achieved bond strengths of over 2000 pounds per forecourt inch (psi) whereas, without these way
only about 230 psi was possible. A farther discovery was that thin layers of porcelain could be
linked to tooth structures.This was far better than having to remove significant tooth structure for
a thicker restoration in order to attain the retention and resistance, and like that being more
conservative. It was possible to maintain the maximum quantum of natural tooth structure and
still achieve the results the case wanted in terms of esthetics dentistry. Face advancements
included better color, apparent angulation and positioning (i.c., making teeth that weren't entirely
straight look straight), and the ending of spaces without orthodontic treatment. It came possible
to do these effects without removing expansive quantities of tooth structure. Occasionally none
was removed at each, like in the cases where cases have marked dental spaces. [3]
Relating to enamel is more durable than to dentin [4] and complete enamel provides the most
dependable substrate for etched porcelain laminate veneers (PLVs). [5] PLVs give a reliable
treatment option that's conservative and more durable than compound resin veneers [1,6] and
provides excellent esthetics, mimicking the natural translucence and structure of teeth [1]. The
reason the thin layers of porcelain veneers work, indeed in functional areas, is because of the
lamination process. Pottery are innately brittle, but when supported, their strength is
considerable. An example is a piece of floor tile, a strong man can break it in his hands, but once
is laminated to the floor, it generally never breaks as long as the adhesive stays intact[3].

PURPOSE: The
purpose of this
clinical study was to
demonstrate the
clinical performance
and longevity of
PVL over time and
to highlight their
benefits.

Fig.1: A. placement of depth orientation grooves and preparation for

PLV. B.Completed teeth preparation after gingival retraction.
C.Polyvinyl siloxane impression D.veneers on the master cast

MATERIALS AND METHODS

In order to present the techniques and materials used for the restoration with dental veneers,
information from 7 articles was used, having as exclusive source the SIENCEDIRECT website.

Impression-taking for porcelain veneers

Impression-taking for porcelain veneers A vinyl poly-siloxane- grounded impression material is

generally used in a substantiated or stock tray for veneer impression preparation. The retraction
wire is deposited to expose the finish line. For computer- aided- designed and computer- aided-
manufactured (CAD-CAM) veneers, a digital impression is made with an intraoral scanner. The
temporization of tooth preparation for PVL is sustained in order to maintain the case’s
appearance unaltered and for the overall success of the restoration. [20] Still, in some cases,
supplying provisional restorations may be voluntary. Since the preparations involve enamel only,
the threat of postoperative perceptivity is missing, and since connections between the teeth aren't
always rifted during the preparation, the threat of tooth stirring is remote. Anyhow, when a case
dictates the use of provisional restorations, these should be made as one piece, with no attempt to
separate individual provisional veneers. This ensures better retention by engaging the
interproximal areas, and at the same time maintains the strength of the restorations, which are
rather thin and delicate. One method for cementing temporary porcelain veneers involves spot-
etching at the center of the facial surface, followed by requiring an adhesion resin at the etched
point only and using a small quantum of a resin cement for attachment. The use of ordinary
temporary cements, which are naturally opaque, negatively affects the final esthetic result of
temporary veneers due to their ultra-thin nature, which allows the cement opacity to show
through. [7]

Types of porcelain used for porcelain veneer fabrication

Traditionally, veneers are fabricated using

the manual layering method from feldspathic
porcelain. This procedure needs the use
of refractory dyes to support the condensed
layers of  the porcelain slurry.[8]This method
permits the use of layers with multiple levels
of opacity, resulting in optimum esthetics.
However, the process is sensitive, and
manual mixing and layering of the porcelain
may result in the incorporation of small voids. Fig. 2. Failed specimens in occlusal view showing the
[9] These voids may cause crack lines or even failure mode: I = Extensive crack formation within
a fracture to occur over time. restoration. II = Cohesive fracture within
restoration. III = Fracture within restoration and
As an anternative, pressed porcelain has been tooth structures. IV = Longitudinal restoration and
used for the fabrication of veneers.[11]The tooth fracture involving root.
main advantages of pressed porcelain are that the resulting veneers have a high position
of delicacy and minimal internal structural defects.[10]

Lately, CAD-CAM veneers from glass-ceramic blocks have become available, and their
application is on the rise. While such veneers are significantly stronger than feldspathic porcelain
ones, the color of many of the blocks available is of  single opacity.[12]

RESULTS AND DISSCUSIONS

The long-term success of  porcelain veneers depends on careful case selection, the design
of tooth preparation, the material, the laboratory fabrication, and the insertion procedure. Several
studies reporting on the durability of porcelain veneers have been published. Fradeani et al.
stated that feldspathic porcelain and glass-infiltrated ceramic veneers presented survival rates
ranging from 96% to 98% at a 5-year evaluation.[13] Also, Della Bona and Kelly reported
overall failure rates for ceramic veneers of lower than 5% at 5 years.[14]

D’Arcangelo et al. reported that 119 porcelain veneers had a life rate of 97.5% at a 7-year
evaluation.[15] In a retrospective study by Gurel et al., assesing 580 porcelain veneers with
various preparation designs for a 12-year period, an overall survival rate of  86% was observed.
[16]
Beier et al. stated that porcelain veneers offer predictable and successful restoration with an
estimated survival rate of further than 10 years.[17]Layton and Walton reported the durability
of feldspathic porcelain veneers as up to 12 years; at 5 years, the survival rate was 96%,
dropping to 93% at 10 years and to 91% at 12 years.[18] A  cumulative success rate of approx.
93% was reported after a 15-year retrospective clinical trial.[19] In a 10-year prospective clinical
trial that involved 87 porcelain veneers, none of the veneers were lost. At 5 years, 92% remained
in use without the need for clinical intervention; however, still 10 years, the chance dropped to
64%.[5] Large marginal defects were the main failure mode (20%), particularly when the veneer
ended on an being composite restoration; a porcelain fracture (11%) was the next most often
encountered failure. Only 4% of the veneers demanded to be replaced at the 10-year distance.
Calamia and Calamia enumerated keys to success for porcelain veneers that may lead to their
resistace for over 25 years.[20] These included proper treatment planning, preparations
terminating in enamel, proper selection of the ceramic to be used, and proper cementation.

CONCLUSSIONS
In conclussion, PLV has been used for more than 30 years and they rezisted over time by
incrasing the methods and materials that are used.
They are characterized by minimal enamel reduction that why is considered a conservative
restoration.
Several studies has been demonstrated that they have a high rate to survive over the time.
Acording to them for about 10 years, PLV lasts without massive changes. For a long term
resistance they need proper treatment planning, preparation terminating in enamel, proper
material selection and proper cementation. The most common reason for failure is veneer
fracture.

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21. https://www.sciencedirect.com/science/article/pii/S0377123714001580#fig1
22. https://www.sciencedirect.com/science/article/pii/S1751616117302515#f0020