dental materials 38 (2022) 898–906

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journal homepage: www.elsevier.com/locate/dental

10-year practice-based evaluation of ceramic and

direct composite veneers
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⁎
Thais Mazzetti a, , Kauê Collares b, Bruna Rodolfo c,
Paullo Antônio da Rosa Rodolpho c, Françoise Hélène van de Sande a,
Maximiliano Sérgio Cenci a,d
a
Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
b
Postgraduate Program in Dentistry, Dental School, University of Passo Fundo, Brazil
c
Private Dental Practitioner, Caxias do Sul, Brazil
d
Radboudumc University Medical Center, Department of Dentistry, Nijmegen, Netherlands

ar ti cl e i n f o ab stra ct

Article history: Objectives: This 10-year practice-based study aimed to compare survival and success of
Received 30 September 2021 direct resin composite and ceramic veneers placed in a private dental practice, between
Received in revised form 26 January January 2008 and March 2014.
2022 Methods: Data were retrieved from a clinical practice’s records and were anonymized typed
Accepted 15 March 2022 into electronic files. All veneer information was recorded, including previous restorations,
repairs or failures, materials used, dates, patient, and age.
Keywords: Results: We analyzed 1459 veneer restorations, of which 1043 (71.5%) were direct compo­
Risk factors site, and 416 (28.5%) were ceramic, placed in 341 patients. The mean patients’ age was 47.8
Electronic dental records years, and the mean number of restorations per patient was 4.3 restorations. During all
Dental materials follow-up, 957 (65.6%) veneers were successful without any repair, 252 (17.3%) were re­
Dental restoration failure paired and still in place, and 250 (17.1%) had a failure that resulted in replacement.
Dental restoration repair Replacements were usually carried out with the same material placed at first. Considering
Survival analysis success analysis, annual failure rates (AFR) for veneers in 5 and 10 years were 9.1% and 10%
Survival rate for direct composite and 2.9% and 2.8% for ceramic, respectively. Survival analysis showed
AFR of 3.9% and 4.1% for composite and 1.4% and 1.2% for ceramic at the same periods. Cox
regression was made for both success and survival outcomes. Composite veneers pre­
sented a higher risk of failure than ceramic veneers with higher hazard ratios for survival
(HR) [HR 4.00 (2.74–5.83)] and success [HR 5.16 (2.65–10.04)].
Significance: Ceramic veneers had superior longevity than direct composite veneers in both
success and survival analysis.
© 2022 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

⁎
Correspondence to: Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, 457 Gonçalves Chaves St,
Pelotas, RS 96015-560, Brazil.
E-mail addresses: thais.mazzetti@ufpel.edu.br (T. Mazzetti), maximiliano.cenci@ufpel.edu.br,
max.cenci@radboudumc.nl (M.S. Cenci).

https://doi.org/10.1016/j.dental.2022.03.007
0109-5641/© 2022 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.
 dental materials 38 (2022) 898–906 899

Epidemiology (STROBE) [22]. Ethical approval was granted by

1. Introduction
the Local Ethical Committee (3.777.697). The population in­
cluded was a convenience sample comprised of all patients
Aesthetical standards constantly influence many people,
that met the inclusion criteria and were treated in the dental
especially how their body, hair, and skin should be attractive
practice during the inclusion period. Almost all patients were
[1]. Nowadays, their teeth are also included in that list.
from a middle or high socioeconomic status, with good oral
Therefore, dental veneers are treatment patients seek to
hygiene, few dental losses, and bilateral stabilized occlusion.
improve the form, shape, and color of teeth [2]. The main
Most of them returned annually to the dental clinic for
materials used for this type of restoration are ceramic and
check-ups.
resin composite.
Data were accessed across clinical records and typed into
Resin composite is a versatile material [3], with good
anonymized Excel files. All patients who attended the dental
clinical performance when placed directly or indirectly over
clinic during the inclusion period and who received dental
the tooth, for both posterior [4,5] and anterior restorations
veneers were included in the sample, except for the following
[6–10]. However, few studies with more than three years of
cases: (1) patients whose veneers had less than one check-up
observation [6,11,12] report on the survival of direct resin
appointment after placement of the restoration; (2) veneers
composite veneers, with only one study presenting a 10-year
placed over dental implants; (3) veneers attached to adhesive
survival rate of 52% [12]. On the other hand, ceramic veneers
prostheses; (4) veneers placed in patients under 18 years of
have a long list of studies showing higher longevity, with
age at the time of the restorations’ placement; (5) veneers
survival rates ranging from 93.5% in 10, to 83.0% in 20 years
placed on posterior teeth; (6) veneers placed on deciduous
[13–15]. Despite the predictable behavior of ceramic veneers,
teeth, and (7) veneers whose records had incomplete data
these treatments have a higher cost and require at least some
which impaired precision on data collection and reporting.
degree of tooth preparation for the veneer's adaptation
[16,17]. Therefore, ceramic veneers may not be the best op­
2.2. Data extraction, exposure variables
tion for all patients. On the other hand, direct composite
veneers have the advantage of being placed usually at a
Data extracted from clinical registers were: patient’s sex and
single appointment, resulting in lower costs than indirect
age, date of placement, tooth type (central or lateral incisor,
techniques [18].
canine), tooth vitality, jaw (upper or lower), the dental sub­
A systematic review appraising veneers placed by direct
strate (tooth, restoration covering partially or entirely the
and indirect techniques, including composite and ceramic,
vestibular tooth surface, or ceramic), materials (composite
concludes that there is a lack of evidence for or against the
and adhesive, or cement), last date (in case of censorship
clinical indication of one of the types of veneers [19]. The
date) of patient’s visit to the dental clinic. When there was an
only long-term study evaluating composite and ceramic ve­
absence or lack of information of any variable, data was set to
neers assesses only indirect veneers, showing a better per­
null. The characteristics cited were also collected for all new
formance in survival for ceramic veneers, and a better quality
interventions, as repairs or replaced restorations. Therefore,
of the remaining restorations, mainly due to surface de­
all the intercurrences with the included restorations were
gradation and loss of gloss of the indirect resin composite
monitored throughout the patient's clinical history until
veneers [10]. Comparison of ceramic and direct composite
eventual failure. Replaced (new) veneer restorations that met
veneers is scarce, even considering short-term follow-ups. To
the inclusion criteria were included. There was no restriction
our best knowledge, only one study compared direct and in­
to access the dataset, and other studies have already been
direct resin composite veneers with ceramic, and it has only
developed in the same dental setting. A researcher extracted
2.5 years of follow-up [20]. Aiming to provide information to
and typed all data into Excel files and double-checked, com­
fill this knowledge gap in the literature, this retrospective
paring the data typed and the original records. Any incon­
study proposes to compare the survival and success of
sistencies found were resolved. The exposure variables,
ceramic and resin composite veneers placed in a private
patient’s sex and age, type of tooth, tooth vitality, jaw, and
clinic in Southern Brazil. The tested hypothesis was that
veneer material were considered on the analysis as potential
ceramic veneers have a lower annual failure rate compared
confounders due to the possibility to exert influence on sur­
to direct composite veneers.
vival and success rates. The remaining variables and those
with incomplete data were considered only for the descrip­
2. Methods tion of the sample.

2.1. Experimental design, inclusion criteria, and data
selection
This practice-based study evaluated data collection of direct
and indirect veneers placed by an expert clinician on a pri­
vate clinic between Jan 2008 and March 2014 in Southern
Brazil. This study is reported following the RECORD state­
ment (Reporting of Studies Conducted Using Observational
Routinely Collected Health Data) [21], an extension of
Strengthening the Reporting of Observational Studies in
2.3. Outcome measures and definitions
Success was defined as a restoration without any interven­
tion from placement until the last appointment when it was
considered censored data [23]. In contrast, survival was de­
scribed as a still-functioning restoration and was at least
partially in place during the follow-up time, even with repairs
[23]. Procedures such as finishing and polishing were not
considered interventions. For the category repair, the same
criteria were used for both resin composite and ceramic
900 dental materials 38 (2022) 898–906
veneers. Recementation of the same veneer was considered
repair. Chippings or small fractures of the original veneer
(resin composite or ceramic) were considered as repair, and
treated with resin composite. Also, new direct restorations,
such as Class III, IV, and V, which did not cover all dental
surfaces previously restored with the assessed veneer, were
considered as repair. Failures were defined as any entirely
replaced veneer restorations. The last check-up visit dates
were recorded and deemed censored for the restorations'
success and survival analyses. Annual Failure Rates (AFR)
and cumulative survival rates were calculated for both sur­
vival and success.
2.4. Clinical procedures
All restorations and reinterventions were carried out by the
same clinician, specialist, and expert on aesthetic dental re­
storations. Restorations were placed for several reasons,
mainly to improve the teeth' aesthetic, including correcting
the shape and/ or color and/or correcting fractures, among
others. For all veneer restorations, teeth with pre-existing
restorations placed by the same clinician were maintained.
When old restorations were present and placed by another
dentist, the adopted protocol removed the old restoration
before the new veneer's placement. In almost all the cases,
the clinical procedures were carried out under a rubber dam
isolation, for both ceramic and resin composite veneers.
During the check-up appointments, the same clinician
observed intervention needs through clinical and radio­
graphical exams. Patients' aesthetical requirements could
also be a reason for repairs or replacements. For example,
correction of minor fractures or chipping, slight color differ­
ences, small anatomical corrections, caries, and debonding of
indirect restorations were treated as repairs.
For all veneers placed, the dentist recommended a return
for evaluation every six months. In exceptional cases, where
the patient needed to improve hygiene skills, the dentist re­
commended return every three months.
2.4.1. Direct resin composite veneers
Most of these restorations did not require any dental pre­
paration on the sound teeth. Enamel was acid conditioned
with 37% phosphoric acid, and an adhesive was applied in all
the tooth surface. The clinician used mainly a conventional
two-step-etch-and-rinse adhesive (Adper Single Bond 2–3 M
ESPE, St. Paul, MN, USA) between 2008 and 2012, and a uni­
versal adhesive (Single Bond Universal - 3 M ESPE, St. Paul,
MN, USA) between 2012 and 2014. The composite materials
most used during the period were a micro-hybrid (4 Seasons
Ivoclar Vivadent, Schaan, Liechtenstein) between 2008 and
2011 and a nano-hybrid (IPS Empress Direct, Ivoclar Vivadent,
Schaan, Liechtenstein) composite between 2011 and 2014.
Repairs of resin composite restorations usually consisted
of a shallow preparation of the vestibular surface, surface
cleaning with sodium bicarbonate jet and air-abrasion using
50 µm aluminum oxide particles (ERC Microetcher; Danville
Engineering, San Ramon, CA, USA), acid conditioning with
37% phosphoric acid, adhesive application, followed by the
addition of a new increment of the composite. The light-
curing units used were Radii Plus 800 mW/cm² (SDI,
Bayswater, VIC, Australia) between 2008 and 2012, and from
2013, Valo 1000 mW/cm² (Standard mode) (Ultradent, South
Jordan, UT, USA), both for 20 s for each tooth face. Materials’
application followed manufacturers’ instructions. After re­
storation or repair placement, finishing and polishing proce­
dures were carried out using fine multi-laminated drills (KG
Sorensen, Barueri, SP, Brazil) and FlexiDisc and FlexiBuff
discs (Cosmedent Inc, Chicago, IL, USA) with aluminum oxide
paste (Enamelize; Cosmedent). FlexiDisc and FlexiBuff discs
and abrasive strips (3 M ESPE, St. Paul, MN, USA) were used in
proximal sites.
2.4.2. Indirect ceramic veneers
Conservative teeth preparations were carried out for all-
ceramic veneers whenever possible, with a 1 mm preparation
at 45° at the incisal edge, and a supragingival margin when­
ever possible. The preparation extension was variable de­
pending on factors related to the dental substrate, such as
color and presence and extension of restorations, dental
planning, and waxing. All restorations were manufactured in
the same dental laboratory by the same technician. Pressable
lithium-disilicate glass-ceramic was used for all veneer re­
storations. Enamel and dentin were acid conditioned with
37% phosphoric acid in all teeth, and the adhesive was ap­
plied according to the manufacturer’s instructions. Ceramic
pieces were cleaned with alcohol, etched with 10% hydro­
fluoric and 37% phosphoric acid, and adhesive and silane
were applied. The adhesives used were the same from resin
composite veneers, Adper Single Bond 2 and Single Bond
Universal, the cement of first choice was Variolink Veneer
(Ivoclar Vivadent Schaan, Liechtenstein), and the silane was
Monobond N (Ivoclar Vivadent Schaan, Liechtenstein). The
light-curing units used were the same from direct resin
composite veneers, Radii and Valo, however the time was
40 s for each tooth face.
In the case of debonding, before a recementation, the
tooth surface was cleaned, and all remaining cement was
removed with sodium bicarbonate jet and air-abraded using
50 µm aluminum oxide particles (ERC Microetcher; Danville
Engineering, San Ramon, CA, USA). After that, cementation
was performed as already described. In the case of chippings,
those were treated with resin composite repairs after air
abrasion and silane application, followed with the use of the
same adhesives and composites described. Extensive frac­
tures were treated with the replacement of the veneer.
2.5. Data analysis
Statistical analyses were performed with STATA 14 software
package (StataCorp LP) and SPSS v.23.0 (IBM Corp.)
Descriptive analysis was used to summarize the data and
report frequency distributions of restorations by independent
variables. Survival and Success Kaplan-Meier graphs were
generated to present curves for ceramic and composite ve­
neers up to 11 years. AFRs were calculated from life tables
according to the formula (1 – y)² z = (1 – x), in which y ex­
presses the mean AFR and x, the total failure rate at z years.
The evaluation of associated factors to failures considering
success or survival was carried out by multivariate Cox’s re­
gression with shared frailty (patient) was used (α = 0.05).
 dental materials 38 (2022) 898–906
Teeth that received ceramic or composite
veneers
(nr = 1,970, np = 413)
(Jan 2008 to March 2014)
Included
(nr = 1,459, np = 341)
Direct composite Indirect ceramic
nr = 1,043 nr = 416
Fig. 1 – Flow chart with the total of placed dental veneers and excluded with reasons.
Hazard ratios (HRs) with 95% confidence intervals (CIs) were
determined for all variables included on Cox-Regression (pa­
tient’s sex and age, type of tooth, jaw, and materials).
3. Results
One thousand nine hundred and seventy veneer restorations
placed during the inclusion period were screened. Of these,
511 restorations were excluded (Fig. 1). A total of 341 patients
and 1459 veneer restorations were included in the study.
From these, 1043 (71.5%) were direct composite and 416
(28.5%) ceramic. Patients’ age ranged from 18 to 83 years old
(mean, 47.8 years), and most of them were female (71.3%).
The number of restorations per patient ranged from 1 to 22
(mean, 4.3). Table 1 shows the distribution of the sample by
veneer type. The variable dental vitality was not included in
the analysis since only 15.1% of the restored teeth had this
data available. Not all clinical records had information about
brands of materials used (Appendix Table A.1). The list of the
materials used and the characteristics are available in
Appendix Table A.2.
3.1. Success
Nine hundred and fifty-seven (65.6%) veneer restorations did
not receive any repair before the censored data. The number
of successful composite veneers was 610 (48.5%), and ceramic
was 347 (83.4%), with the mean observation time was 4.9 (SD,
3.7) and 6.3 years (SD, 4.0), respectively. Thus, composite and
ceramic veneers had 35% and 75% cumulative success rates
in 10 years, respectively (Appendix Table A.3). The Cox re­
gression analysis identified the factors associated with suc­
cess (Table 2): tooth type, jaw, and restoration material. Fig. 2
shows the Kaplan-Meier curves of these factors and the AFR
of ceramic and composite veneers.
3.2. Survival
Considering all veneers, 1209 (82.9%) were still in place even
when a repair was needed. In the composite veneers group,
901
Excluded due to exclusion
criteria. (nr)
Implant: 1
Adhesive prostheses: 7
Less than one follow-up: 102
Incomplete records: 5
Less than 18-year-old: 19
Palatine:5
Posterior: 374
Deciduous teeth: 3
Excluded of Cox-Regression
analysis due to the absence of
patient age data
nr = 26
825 (79.1%) restorations survived, and the mean observation
time was 5.6 years (SD, 3.7). For ceramic veneers, 384 (92.3%)
restorations survived, with the mean observation time being
6.6 years (SD, 4.0). Thus, the cumulative survival of the ve­
neers in 10 years was 66% to composite and 89% to ceramic
veneers (Appendix Table A.3). The Cox regression analysis
suggested an increased risk in the survival in the factors sex,
jaw, and material (Table 2). According to the material, the
survival graphs with the associated factors are available in
Fig. 2, such as the AFR of veneers.
3.3. Failure
The number of failed restorations that were replaced was 250
(17.1%), and they were replaced by new composite veneers
(70.0%), ceramic veneers (27.6%), crowns (2.0%), and one im­
plant (0.4%). Fig. 3 shows the distribution of replacement
procedures according to the original material used in the
veneer. Forty-two (16.8%) replaced restorations that had a
previous repair before the failure, while 208 (83.2%) were re­
placed without any prior repair. The failure events for com­
posite veneers were 218 (20.9%), and 32 (7.7%) in ceramic.
4. Discussion
This study presents the first long-term clinical evaluation
comparing ceramic and direct composite veneers to the best
of our knowledge. This study's results are in accordance with
the existing literature, with ceramic veneers presenting a
superior performance compared to resin composite.
Therefore, the study hypothesis was accepted.
Gresnigt showed in a 10-year split-mouth randomized
clinical trial comparing indirect composite veneers and
ceramic survival rates favoring ceramic veneers [10]. Another
10-year study, with a retrospective design, evaluating
ceramic veneers on a general dental service in England, re­
veals that 53% of 2562 placed ceramic veneer restorations
survived without re-intervention [24]. A prospective clinical
trial expressed success of 92% at 5 years and 64% at 10 years
[25]. However, other studies show higher survival rates for
902 dental materials 38 (2022) 898–906

Table 1 – Distribution of composite and ceramic veneers (n = 1459) by patients and restorations characteristics.
Resin composite Ceramic Total
n = 1043 n = 416 n = 1459

n % n % n %

Age, years
18–30 117 11.2 34 8.2 151 10.4
31–45 240 23.0 115 27.6 355 24.5
46–64 634 60.8 255 61.3 889 61.4
≥ 65 52 5.0 12 2.9 64 4.4

Sex
Female 799 76.6 274 65.9 1073 74.1
Male 244 23.4 142 34.1 386 26.6

Number of restorations, per patient

< 6 508 48.7 153 36.8 661 45.6
6 < 10 410 39.3 237 57.0 410 28.3
≥ 10 125 12.0 26 6.3 151 10.4

Tooth type
Central incisor 417 40.0 175 42.1 592 40.9
Lateral incisor 372 35.7 130 31.3 502 34.6
Canine 252 24.2 111 26.7 365 25.2

Jaw
Upper 884 84.8 372 89.4 1256 86.7
Lower 159 15.2 44 10.6 203 14.0

Substrate
Tooth 590 56.6 225 54.1 815 56.2
Partially composite 123 11.8 61 14.7 184 12.7
Total composite 322 30.9 118 28.4 440 30.4
Ceramic 8 0.8 12 2.9 20 1.4

Year of placement
2008 124 11.9 16 3.8 140 9.7
2009 88 8.4 92 22.1 180 12.4
2010 183 17.5 81 19.5 264 18.2
2011 191 18.3 66 15.9 257 17.7
2012 204 19.6 95 22.8 299 20.6
2013 227 21.8 50 12.0 277 19.1
2014a 26 2.5 16 3.8 42 2.9

a
Data collected until March 2014

Table 2 – Cox regression analyses on factors related to ceramic and direct composite veneers failures (n = 1433).
Success Survival
HR (95% CI) p-value HR (95% CI) p-value
Patient-related variables
Age (Continuous variable) 1.00 (0.98–1.01) 0.580 1.01 (0.98–1.04) 0.530
Sex (Ref = Female)
Male 1.31 (0.90–1.90) 0.162 2.31 (1.08–4.92) 0.030
Tooth related variables
Tooth (Ref = Lateral incisor)
Central Incisor 1.49 (1.20–1.86) < 0.001 1.23 (0.89–1.70) 0.201
Canine 0.87 (0.66–1.13) 0.288 0.75 (0.51–1.11) 0.146
Jaw (Ref = Lower)
Upper 1.90 (1.29–2.80) 0.001 2.31 (1.23–4.32) 0.009
Material (Ref = Ceramic)
Resin composite 4.00 (2.74–5.83) < 0.001 5.16 (2.65–10.04) < 0.001

Abbreviations: HR: Hazard ratio; CI: Confidence interval.

 dental materials 38 (2022) 898–906 903

Fig. 2 – Kaplan-Meier graphs showing for success tooth type (a), jaw (c) and restorations material (e), and, for survival patient
sex (b), jaw (d), and restoration material (f).
904 dental materials 38 (2022) 898–906

RC VENEER C VENEER CROWN IMPLANT

45

Number of replacement procedures 40

35

30

25

20

15

10

0
RC C RC C RC C RC C RC C RC C RC C RC C RC C RC C RC C RC C
0 1 2 3 4 5 6 7 8 9 10 11
Year after the procedure

Fig. 3 – Distribution of replacement procedures after the failure of resin composite (RC) and ceramic (C) veneers by year after
placement of the veneer.

ceramic veneers, up to 95% at 10 years and up to 87% in a 20- composites, this was mainly associated with the color and
year evaluation [14,15]. A systematic review of non-felds­ translucence of the old material. Furthermore, the present
pathic ceramic veneers indicated a cumulative survival of study data were collected in a referral practice for aesthetic
ceramic veneers over 90% and ranging between 66% and 94% restorations. Therefore, all patients had high demands for
(95% CI: 55–99%) for 10 years [26]. Variations between survival their teeth, which probably impacted the number of re­
rates should be interpreted with caution due to different interventions observed. Besides, the procedures made after
criteria of failure that could be adopted by the authors [26]. failure indicate that most replacements were new veneers
Unfortunately, data from direct veneers are scarce com­ (97.6%), while more invasive procedures such as crown and
pared to ceramic veneers restorations. An interim evaluation implant represented only 2.4% of the new interventions. This
of direct, indirect composite veneers and ceramic showed a also means that very few catastrophic failures demanding
superiority of survival favoring ceramic veneers at a 2.5-year tooth extraction were observed, corroborating that treatment
follow-up [20]. However, these authors did not publish a with veneers may be considered safe for the patient.
longer evaluation, similar to most studies with direct ve­ The main limitation of this study concerns the absence of
neers, which are clinical cases with short follow-up periods. reasons for failure, since it was not possible to determine
In a retrospective clinical evaluation, Coelho-de-Souza de­ whether the failures occurred due to fractures and chippings,
monstrated a survival rate of 80% at 3.5 years for direct ve­ or simply because the patients desired to improve aesthetic
neers placed by postgraduate students [11], which could aspects, such as changing color or form of the veneers.
explain the drop in survival compared to our study, where an Although these aspects may be related to both materials, it
experienced dentist placed all the restorations. Conversely, a can overestimate the failures of resin composite veneers,
4-year evaluation of direct and indirect composite veneers, where patients may choose to replace composite with
direct veneers demonstrated the survival of 87.5% (AFR = ceramic veneers for a variety of reasons, such as being more
3.2%) [6]. In our knowledge, only one study, conducted at the sophisticated or more aesthetically appealing material.
same clinical practice, presented survival rates of a 10-year Another limitation of this study is the absence of information
evaluation of direct composite veneers, and it had a cumu­ due to a lack of data on dental records, as tooth vitality,
lative survival of 85% (AFR = 3.2%) at 5 years and 52% (AFR = which is an essential factor to increase failure of restorations
6.3%) at 10 years, and success of 74% (AFR = 5.8%) and 38% [11,20], and this variable was not analyzed due to lack of data.
(AFR = 9.2%) respectively [12]. Despite the similar results Data about dental substrate was also not used in the analysis
found between the two studies, some differences could be because it was collected from dental records of previous re­
explained by the different years of data collection of the first storations of the patients. So, it was impossible to know for
study, 1994–2009, and the minimum follow-up time of 4 sure about the presence or absence of old restorations for all
years. patients. Only a single operator and the patient observed the
Even though this study does not explore the reasons for failures, which could affect the number of repairs or re­
failure, because this information was not available in most placements.
clinical records, it is recognized that failure in anterior teeth Also, whereas most of the patients return to the dental
may occur mainly due to aesthetical requirements [7,27,28]. clinic frequently, as the dental practice from which these
Mostly, veneers with both materials were replaced due to data were retrieved is a referral practice for aesthetic den­
fracture or according to the patient’s demands for an im­ tistry, some patients only go seeking a qualified specialist for
proved apparency of their anterior teeth. In the case of resin the aesthetic procedure, represented by the placement of
 dental materials 38 (2022) 898–906
these veneers, and did not attend annually for follow-ups.
Therefore, we considered these patients’ veneers as censored
data to minimize bias in the analysis. It is also important to
call the attention that some patients can choose one treat­
ment for many reasons. For example, a patient could opt for
direct composite veneers, mainly for cost-related issues, and
exchange all restorations for ceramic veneers a few years
later. Besides, despite direct veneers' lower survival and
success than ceramic, this does not contraindicate direct
composite veneers' placement. Direct veneers represent a
procedure with lower biological and monetary costs and high
survival rates over the years. Well-informed patients should
evaluate the best treatment option for their case with their
clinicians, considering the available evidence.
Regardless of this study's limitations, it brings a more
realistic approach showing the reality of clinical practice,
where patients have personal requirements that will influ­
ence survival and success rates. It is essential to highlight
this dental office's main characteristics, where the clinician
has continuing education on procedures, materials, and
techniques and has a significant number of faithful patients.
Continuing education in aesthetic dentistry has two sides,
good restoration maintenance across eventual repairs and
may act as a patient’s motivation to experience even greater
aesthetical results with these innovations.
5. Conclusion
Within the limitations of this clinical retrospective study, it
can be concluded that ceramic veneers present higher long­
evity than direct resin composite veneers. However, both
treatments still deliver high survival rates and may be used
in clinical practice.
CRediT authorship contribution statement
Thais Mazzettia: Contributed to conception, design, Data
acquisition, and interpretation, Drafted and critically revised
the manuscript. Kauê Collares: Contributed to design, Data
interpretation, Performed part of the statistical analyses,
drafted and critically revised the manuscript. Bruna Rodolfo:
Contributed to data acquisition, and critically revised the
manuscript. Paullo Antônio da Rosa Rodolphoc: Contributed
to data acquisition and interpretation, and critically revised
the manuscript. Françoise Hélène van de Sande: Contributed
to conception, design, data interpretation, performed part of
the statistical analyses, drafted and critically revised the
manuscript. Maximiliano Sérgio Cenci: Contributed to con­
ception, design, data interpretation, Drafted and critically
revised the manuscript. All authors gave their final approval
and agree to be accountable for all aspects of the work.
Acknowledgments
To Marina Christ Franco, Karen do Nascimento Lopes, and
Rômulo Patias for the contribution with data collection at the
beginning of this study. This research received no specific
grant from any funding agency in the public, commercial, or
not-for-profit sectors. TM acknowledges to Coordenação de
905
Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES
– Finance Code 001) for the financial support through scho­
larship. MSC acknowledges to UFPel, Coordenação de
Aperfeiçoamento de Pessoal de Nível Superior (CAPES -
Finance Code 001), Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq) and Brazilian Ministry of
Health for partial financial support. All the authors of this
study have no conflicts of interest to declare.
Appendix A. Supporting information
Supplementary data associated with this article can be found
in the online version at doi:10.1016/j.dental.2022.03.007.
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