2. Anterior Veneer Restorations – An
Evidence-based Minimal-Intervention
Perspective
Edson Araujo / Jorge Perdigão
Dr Archana B
3rd year postgraduate
J Adhes Dent 2021; 23: 91–110.
doi: 10.3290/j.jad.b1079529
3. INTRODUCTION
Patients’ demand for esthetic dental treatments have led to
the introduction of techniques aimed at reestablishing or
enhancing the natural appearance of the human dentition,
with special focus on anterior segment
7. GLASS MATRIX CERAMIC
• According to Gracis et al,these are nonmetallic inorganic
ceramic materials that contain a glass phase
• Feldspathic glass-CER, the original dental porcelain, was
based on the naturally occurring feldspar.
• more recent glass-CER, such as fluorapatite, leucite, or
lithium-disilicate
8. PROPERTIES
• Inert,hence biocompatible
Biological properties
• Doesn’t adhere chemically to dental cements
Interfacial properties
• HF & SF can cause increase in surface roughness
Chemical properties
• Brittle
• Low tensile & flexural strength
Mechanical properties
9. LITHIUM-DISILICATE GLASS-CER
• Lithium-disilicate glass-CER is currently the most popular ceramic material
for laboratory-made veneers, inlays, on lays, and anterior crowns
• the press technique - IPS e.max Press, Ivoclar Vivadent
• CAD/CAM version - IPS e.max CAD
• Recent type of lithium silicate glass-CER is zirconia-reinforced lithium-
disilicate glass-CER Vita Suprinity and Celtra Duo
( It is basically a material with lithium metasilicate crystallites and 10% dispersed
zirconia grains)
10. ETCHING
• All glass-CER, can be etched with
HF to create microretentive
features onto the intaglio surface
for the adhesive Luting system
• the HF concentration and etching
time are different for each glass-
CER material as a result of their
different structures
• 9 to 10% HF for 90
s
feldspathic glass-
CER
• 5% HF for 60 s
leucite-reinforced
glass-CER
• 5% HF for 20s
lithium-disilicate
glass-CER
11. INFERENCE
Lithium-disilicate glass-CER is used for single-unit crowns
anterior veneer restorations have resulted in excellent survival rates
the use of lithium-disilicate glass-CER for fixed partial dentures (FPDs or bridges)
has not been as successful
lithium-disilicate should be used as bridge material only up to the second
premolar
12.
13. ZIRCONIA
•Due to a phenomenon called “transformation
toughening,the material we know as zirconia or 3Y-
TZP (3 mol% yttria stabilized tetragonal zirconia
polycrystal,is the strongest tooth-colored material
currently available and the most durable tooth-
colored material in clinical practice
14. • A new type of zirconia-based material known as translucent zirconia has
gained popularity recently. Translucent zirconia contains less amount of
alumina and more yttria (5-9 mol%) than 3Y-TZP
•The higher yttria content introduces a higher percentage of the cubic
zirconia phase at the expense of the tetragonal phase. For this reason,
translucent zirconia has also been known as cubic zirconia
•Increasing the yttria content enhances the translucency of yttria-
stabilized zirconia but lowers the strength of the material because of
the reduced transformation toughening. Translucent zirconia is
therefore weaker and more brittle than the original opaque 3Y-TZP
15. INFERENCE
polycrystalline ceramics do not contain glass. For this reason, zirconia
restorations are not etchable with HF using conventional methods.
Unfortunately, translucent zirconia is more opaque than lithium-
disilicate glass-CER
polycrystalline ceramics are not indicated for anterior veneer
restorations
16. POLYMER-INFILTRATED CERAMIC NETWORK
(PICN) MATERIALS
• Vita Enamic is the most popular PICN material.
• It is composed of a dual-network structure of polymer-
infiltrated ceramics. The organic part is UDMA and TEG-
DMA (14 wt%), while the inorganic part is a feldspathic
ceramic network (86 wt%).
• Vita Enamic was developed to replace glass-CER materials
17. PROPERTIES
• Some physical properties, such as elastic modulus are more favorable
than lithium-disilicate glass-CER.
• PICN veneers result in lower compression strength and higher plastic
deformation after one million thermal cycles compared to lithium-
disilicate veneers
• the discoloration of Vita Enamic is more intense than that of glass-CER
materials.
• PICN material is more translucent than several other materials,
including the lithium-disilicate
18. • lack of adhesion between the ceramic particles and the polymeric
matrix causes significant gloss decrease of Vita Enamic (27%
reduction)
• Concomitantly, there is a significant increase in surface roughness
after brushing for resin-matrix hybrid materials
• resin-matrix hybrid materials are not ideal for occlusal veneers
19. COMPOSITE RESINS
• The first commercial composite resin was Addent (3M) in 1964, a
chemically-cured material that was based on the bis-GMA resin
molecule developed by Dr. Bowen
• most changes in composite resin technology have been focused on the
filler particle size and distribution rather than on the resin matrix,
which is still based mostly on bis-GMA
• MICROFILLED COMPOSITE RESINS:
• 35% to 50% filler by weight with 0.04 μm silica filler particles
• prepolymerized resin fillers to compensate for their low filler content
• Durafill VS , Heliosit , and Silux Plus
20. HYBRID COMPOSITE RESINS:
• 70%-82% filler by weight, which made them stronger than microfilled
composites, but more difficult to obtain a smooth surface
• higher flexural strength than microfilled composite resins
• Herculite, Point 4 (Kerr)
Hybrid composite resins have excellent flexure
strength and fracture toughness even when compared
to glass-CER
hybrid composite resins result in a light propagation
pattern similar to that of the natural tooth structure
21. NANOFILLED COMPOSITE RESINS
• introduced in 2002
• Clinicians have reported the excellent polishability of these
materials and their inherent high gloss.
• particles up to 100 nm (0.1 μm) in diameter
• Filtek Supreme Ultra
22. UNIVERSAL COMPOSITE RESINS
This is a new generation of composite resins that includes microfilled,
nanofilled and hybrid composite resins.
Four major characteristics make them universal composites:
• They are indicated for all direct restorative procedures class I to class VI
direct restorations and direct veneers.
• Most of them follow the trend of simplification with fewer shades and one
translucency as a result of chameleon effect.
• They have an excellent polish retention.
• costs less than some of the most popular composite resins.
•
23. •Omnichroma , Essentia Universal (GC, one shade), TPH Spectra ST
(Dentsply Sirona, six shades), and Clearfil Majesty ES-2 Premium
(Kuraray Noritake, 10 shades)
•Omnichroma is technically a microfilled composite resin that is
considered truly a universal composite
•75%-80% filler by weight with 100 nm-400 nm (0.1 μm-0.4 μm)
spherical particles reinforced with wide clusters of pre-polymerized
particles ranging from 4 μm to 20 μm
24. DIRECT COMPOSITE RESIN VENEERS
• In 1973, Klaff and Ward115 reported a clinical case of direct
composite veneers to re- shape two peg laterals
• When direct composite veneers are executed following strict
anatomical principles, adequate enamel adhesion, and balanced
occlusal contacts, they can be durable and highly appreciated
• With the introduction of nanofilled composites, one of the clinical
details that clinicians have experienced is the high gloss of the
restorations after polishing.
25. PORCELAIN VENEERS
• Charles Pincus in 1938163 reported the use of ‘Hollywood veneers’
in movie artists as removable snap-on porcelain veneers that
covered just the front of unpleasant teeth
• Alain Rochette –
• The enamel was etched with 40% phosphoric acid for 90 s followed
by bonding a porcelain fragment with Se vitron Cavity Seal
(Amalgamated Dental Company), a self- cured glycerol-phosphoric
acid dimethacrylate
26. • In 1979, it was reported that HF creates porosities on the dental
porcelain surface by dissolving the glass phase. In 1983, the application
of HF on the porcelain restoration intaglio surface prior to bonding to
tooth structure was the milestone that forever transformed the reliabiity
and durability of dental porcelain restorations.
• However, the success of glass-CER veneers depends on diverse factors,
including the operator experience, location of the cervical cavo- surface
angle (enamel or dentin), the reduction depth, the preparation
design,the palatal con tact point position, parafunctional habits, and the
adhesives and composite cements used for the luting procedure
27. • the late 1980s, the most common
preparation technique for porcelain
veneers was the so-called non-prep
veneer
• Lumineers (Den-Mat Holdings LLC;
Lompoc, CA, USA), has been used by
prospective patients as a genericized
trademark for no-preparation veneers
28. LONGEVITY
CERAMIC VENEERS
• with greater longevity
because it undergoes fewer
changes in gloss, texture
and even integrity over time
compared to composite
resin
COMPOSITE VENEERS
• composite resins provide more
conservative restorative
treatments
• result in increased longevity of
the tooth
29. GLOSS AND COLOR STABILITY
CERAMIC VENEERS
• composite resin restorations
become rougher with time
after erosive and abrasive
challenges in the oral
environment
COMPOSITE VENEERS
• Compared to composite
resin, the surface of glass-
CER materials undergoes
little or no deterioration
over time after simulated
toothbrushing and different
loads applied.
30. CHOMATIC STABILITY OF COMPOSITE
• When there is a decrease in the gloss characteristics of a composite
resin restoration, it may be necessary to proceed with periodic
maintenance for the restoration to continue reflecting light similar to
dental enamel
• The time interval or periodicity for re-polishing depends on several
factors, such as type of composite resin (size and shape of filler
particles), patient’s habits, abrasiveness of toothpaste, etc.
• An important factor to consider regarding the loss of gloss in
composite resin restorations is the presence of saliva, since the loss
of gloss is observed only after air drying the surface of the restoration
31. CHROMATIC STABILITY OF CERAMIC
• Glass-CER have excellent esthetics and do not change color over
time
• Natural teeth will undergo physiological discoloration while the color
of the veneered tooth will remain more stable over time resulting in
a lighter restoration
• Composite cement is used as a luting agent for the veneer. The
discoloration of the composite cement is a major issue that may
render the veneer less esthetic
32. DISCUSSION
• With every replacement, additional tooth structure needs to be
sacrificed to reshape the preparation, or to re move residual
restorative materials that are not easily distinguished from enamel or
dentin
• According to the MID philosophy,direct composite veneers are more
likely to preserve the original tissue
• In spite of the novelty of recent CAD/CAM hybrid materials, the ideal
materials for direct and indirect anterior veneers are still composite
resin and glass-CER
33. CONCLUSION
• In spite of the exponential increase in the number of new
dental materials for esthetic clinical procedures in the last few
years, composite resin materials are still an excellent
conservative option providing that patients are informed of the
advantages and disadvantages.
• The use of different materials and techniques for anterior
veneer restorations must be based on sound evidence rather
than on the marketing hype or testimonials
•
34. REFERENCES
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clinical performance: A review. Oper Dent 2018;43: E173-E190
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different computer-aided design/computer-aided manufacturing (CAD/CAM) materials and
thicknesses on the fracture re sistance of occlusal veneers. Oper Dent 2018;43:539–548.
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