Clinical and Esthetical Evaluation of 79 Lithium Disilicate Multilayered Anterior Veneers with a Medium Follow-Up of 3 Years

Bonding Protocols for Lithium Disilicate Veneers: A Narrative Review and Case Study

BACKGROUND

The bonding protocol for lithium disilicate veneers in the esthetic zone plays a crucial role in modern dental restoration techniques, focusing on the replication of natural tooth properties and esthetics. This process involves several meticulous steps on both ceramic and tooth surfaces to optimize material performance and bond strength.

METHODS

The objective of this article is to provide an updated review of the literature on the clinical steps for bonding lithium disilicate veneers in the anterior dentition and to document a clinical case where these advanced restorative techniques were applied to treat a female patient seeking to improve her smile. A preliminary review was conducted on the existing literature regarding the clinical protocols for bonding lithium disilicate veneers in the esthetic zone. The main advantage of careful bonding procedures is that they maximize the full potential of the materials' properties.

RESULTS

A review of the literature reveals some minor differences in cleaning the veneers prior to cementation and in the number of steps involved when combining certain materials in a single application process. However, well-executed bonding procedures, following the manufacturer's recommendations, can maximize the adhesion between the ceramic and the tooth, allowing the restorations to meet the patient's esthetic demands.

CONCLUSIONS

Effective bonding of lithium disilicate veneers in the esthetic zone requires multiple treatments on both the ceramic and tooth surfaces. When procedures are followed carefully, long-term esthetic and functional outcomes can be achieved. It is essential that clinicians are familiar with these steps. Proper patient selection, thoughtful treatment planning, and methodical execution of the case can lead to highly esthetic results that satisfy the patient's demands and ensure long-term success.

Whitening: is Omnichroma universal composite unchanging? Spectrophotometric evaluation

Background

This study aimed to evaluate the color stability of Class V anterior restorations with universal composite after professional bleaching using a spectrophotometer.

Material and Methods

Class V cavities were prepared and restored with universal composite in twenty-eight extracted anterior teeth. One week after restoration, color analysis was performed using the spectrophotometer. In-office bleaching was performed. Color analysis was performed 24 hours, 72 hours and 30 days after bleaching. The parameters evaluated were L* values of each tooth and ΔE values between tooth and restoration at different timepoints. Data were analyzed using a statistical software. A P-value ≤0.05 was used to indicate statistical significance of the results.

Results

There was a non-statistically significant but noticeable difference between the L* values in term of tooth bleaching effect. Non-statistically significant differences were found between the L* values and the ΔE values at different timepoints when evaluating the chromatic difference between the tooth surface and the restoration. The ΔE value one week after the restoration is higher than the ΔE values at the following timepoints, therefore the color difference between the restoration and the adjacent tooth decreases with time after bleaching.

Conclusions

Universal Composite was found to be able to match the color of the surrounding tooth even after the bleaching procedure. Key words:Omnichroma, composite, color, spectrophotometer, whitening.

Survival and Complication Rates of Feldspathic, Leucite-Reinforced, Lithium Disilicate and Zirconia Ceramic Laminate Veneers: A Systematic Review and Meta-Analysis

OBJECTIVES

To analyze survival and complication rates for anterior and premolar laminate-veneers out of different ceramic materials (feldspathic, leucite-reinforced glass-ceramic [LRGC], lithium-disilicate [LDS] and zirconia).

MATERIAL AND METHODS

A systematic literature search was conducted across multiple databases for clinical studies on ceramic laminate-veneers with a minimum-follow-up of ≥ 1 year. The date of last search was on February 19, 2024. Survival, technical, esthetic and biological events were assessed for different laminate-veneer materials at three observation periods (short- [1-3 years], mid- [4-6 years] and long-term [≥ 7 years]).

RESULTS

Twenty-nine studies were included. Meta-analysis revealed a pooled survival-rate of 96.13% for feldspathic, 93.70% for LRGC and 96.81% for LDS at 10.4 years. No difference was found between materials. Complication rates (technical/esthetic/biological) were as follows: Feldspathic: 41.48%/19.64%/6.51%; LRGC: 29.87%/17.89%/4.4%; LDS: 6.1%/1.9%/0.45% at 10.4 years. Zirconia showed a 100% survival-rate with no complications at 2.6 years. No long-term data was available for zirconia.

CONCLUSIONS

Feldspathic, LRGC and LDS laminate-veneers showed high survival-rates at long-term observation. LDS slightly outperforms feldspathic and LRGC laminate-veneers with lower long-term complication rates. More studies providing long-term data on zirconia laminate-veneers are needed.

CLINICAL SIGNIFICANCE

Ceramic laminate-veneers are a reliable treatment option. LDS may be preferred as a restorative material for long-term success.

Printed Digital Wax-up Model as a Blueprint for Layered Pressed-ceramic Laminate Veneers: Technique Description and Case Report

This article presents a clinical technique for transferring Digital Smile Design (DSD) information and a digital wax-up to fabricate highly personalized ceramic laminate veneers. The hybrid workflow of digitally designed wax-up and conventional hand-crafted veneers is showcased in a female adult who sought to improve her smile due to maxillary anterior incisal wear. The ceramic veneers, layered by feldspathic porcelain, followed the contours and shade blueprint planned with the digital wax-up. The DSD improved the harmony of the facial-and-smile relationship, and the ceramic restorations fulfilled the patient's esthetic and functional demands. Guides based on the printed model with the digitally designed wax-up can provide a reference for pressed lithium disilicate veneers layered with feldspathic porcelain.

Marginal Discrepancy of Five Contemporary Dental Ceramics for Anterior Restorations

OBJECTIVES

 This study aimed to compare marginal accuracy of five contemporary all-ceramic crowns indicated for anterior restorations.

MATERIALS AND METHODS

 A master die of maxillary central incisor was prepared for all-ceramic crown and duplicated to produce 50 replicas of epoxy resin material. Five ceramic materials were used to mill the crowns (n = 10). All crowns were manufactured following the same digital workflow; same master die, scanning unit and design software, and the recommended manufacturing protocol. Final seating of crown was secured by a small droplet of temporary cement on its incisal edge. Marginal accuracy was evaluated by scanning electronic microscope with a magnification of 300 × . Vertical marginal gap was measured for each crown at predefined four points.

STATISTICAL ANALYSIS

 One-way analysis of variance was used to test differences between groups and Tukey test was used for multiple comparisons between group combinations. A level of significance at 95% was set for all statistics.

RESULTS

 The highest mean marginal gap and mean maximum gap calculated were for the e.max CAD crowns (49.2 µm, 87.6 µm), while the lowest values were for the Cercon xt crowns (10.2 µm, 21.7 µm). The mean marginal gap and the mean maximum gap of the e.max CAD crowns were statistically significantly greater than those of all other groups (p < 0.05). However, the differences between all other combinations were insignificant (p > 0.05).

CONCLUSION

 Marginal accuracy of lithium disilicate crowns is clinically acceptable. Zirconia and zirconia-reinforced lithium silicate materials can produce a greater level of marginal accuracy compared to lithium disilicate.

A comprehensive technique using digital workflow to improve an unpleasant smile: A clinical report

By utilising open-source digital software, clinicians can create an integrative digital workflow composed of various technological systems. This report presents a clinical case that follows a comprehensive digital workflow to improve the smile of a 42-year-old female patient. The patient presented with minor attrition of maxillary anterior teeth and discoloured, asymmetrical composite restorations on central maxillary incisors. Her smile was rehabilitated by restoring her maxillary anterior teeth with lithium disilicate ceramic veneers. A smile design system was used to create a virtual simulation of the patient's desired treatment outcome. Utilising a 3D tooth library generated by the smile design system, extra-oral photographs, and intra-oral scans of the patient's maxillary and mandibular arches, a 3D model of the proposed smile design was created in an advanced 3D sculpting software. The resin casts that were fabricated with a 3D printer were used to fabricate a mockup and sent to the laboratory as reference for the final restoration. The specific shade recipe for the ceramic veneers was obtained using a special polar eye filter and digital shade matching software. There is no doubt that advancements in digital technology are providing clinicians with limitless treatment modalities. From intra-oral scanners and smile design systems to 3D sculpting software and even digital shade matching systems, continuous technological developments are paving the way for the complete digitalisation of dentistry. This case report presents an example of this digital revolution.

Esthetic Rehabilitation of Anterior Dentition with Different Types of Ceramic Restorations: Two Case Reports

All-ceramic systems represent an excellent restorative alternative for fixed dental prostheses, single crowns, and veneers in the anterior dentition. With respect to improved mechanical properties, lithium disilicate ceramic material provide a broad range of indications, and extended veneers can serve as an alternative to full crowns. Although ceramic veneers represent a more conservative approach compared to crowns, the correct indication is essential to achieving the ideal outcome. The following case reports describe two types of fixed restorations of the anterior dentition: extended lithium disilicate ceramic veneers and lithium disilicate full crowns. Factors influencing treatment selection for each type of restorations are presented.

Microleakage of Direct Restorations-Comparisonbetween Bulk-Fill and Traditional Composite Resins:Systematic Review and Meta-Analysis

Since the bulk-fill composites were produced, there was a progressive diffusion of their use for direct conservative treatment in posterior teeth. Their chemical structure increases the depth of cure and decreases the polymerization contraction; in this manner, bulk-fill composites can be placed in 4 mm single layers and the treatment times are considerably reduced. However, aesthetic and mechanical properties and impact on microleakage of bulk-fill resins are still unclear.

This systematic review and meta-analysis aimed to assess the risk of microleakage of direct posterior restorations made of bulk-fill versus conventional composite resins.

Researches were performed on PubMed and Scopus databases. Eligible in vivo studies, published since 2006, were reviewed. Outcomes of marginal discoloration, marginal adaptation, and recurrent caries were considered to conduct the systematic review and meta-analysis. Secondary data were examined to implement additional analysis and assess the risk of bias.

Eight randomized clinical trials were analyzed, involving 778 direct restorations. The summary of RCTs led to significant but inconsistent results; the marginal discoloration and recurrent caries were found to be improved respectively by 5.1 and 1.4%, whereas the marginal adaptation was reduced of 6.5%. Secondary analyses revealed that follow-up periods, the adhesive system used and the class of carious lesions evaluated are confounding factors, and they result in a risk of bias across studies.

Bulk-fill composites are innovative materials for conservative dentistry and they can be used to reduce treatment steps and duration of operative times. There are insufficient data to explore the relationship between bulk-fill composites and microleakage and further investigations are needed.

Single-Tooth Rehabilitation Combining Root Displacement and Crown Lengthening Two-Year Follow-Up: A Case Report

CLINICAL RELEVANCE

Combined techniques to expose circumferential tooth structure associated with subsequent restoration may represent a valid option in many situations. This case provides an example of the successful management of the anterior tooth rehabilitation combining root displacement and crown lengthening.

SUMMARY

Rehabilitation of an extensively compromised single anterior tooth represents an intriguing challenge for dentists, particularly when the rehabilitation involves esthetic, psychosocial, and functional requirements. The success in rehabilitating a patient with a conservative approach depends on a critical evaluation of the remaining structures, precise treatment plan, systematic treatment strategies, and patient compliance. In this case, the patient's chief complaint was the undesirable appearance of the maxillary right lateral, caused by the displacement of the post and crown. Clinical examination revealed a remaining tooth with coronal fracture, severe loss of tissue due to caries, and absence of ferrule effect. Radiographic examination revealed that the fracture margin was located subgingival. This case report describes a single-tooth rehabilitation involving a combination of root displacement via orthodontic extrusion and crown lengthening. The rehabilitation was followed by post-and-core restoration using a prefabricated glass fiber post associated with a disilicate lithium crown. The clinical decision making and combined effect of both treatment strategies are explained in this report. The treatment required three months, including recovery times after surgery and the placement of the provisional crown. The patient was esthetically and functionally satisfied with the restoration. Patient follow-up examination was performed 24 months after the treatment. This clinical report contributes to the clinical practice and exemplifies the possibility of rehabilitating the natural tooth using combined techniques, which may offer particular advantages regarding prognosis and invested efforts.

Resin Infiltration in Dental Fluorosis Treatment-1-Year Follow-Up

Background and objective: Dental fluorosis is a disease affecting dental hard tissues featured with white or yellowish lesions. Several treatments are proposed in the literature, some even invasive. This clinical study aimed to evaluate the effectiveness of resin infiltration in terms of lesions resolution, trend of sensitive teeth and satisfaction of patients over time. Methods and material: 200 fluorosis lesions were treated using ICON infiltrating resin (DMG, Hamburg, Germany). Parameters related to patients were collected by a questionnaire and analyzed aesthetic dissatisfaction about lesions, Shiff Air Index Sensitive Scale, sensitive teeth after treatment, the satisfaction of duration of treatment. The same operator measured dimensions of lesions Tooth Surface Index of Fluorosis (TSIF) and numbers of etching cycles needed for treating lesions. Statistical analysis was performed. The follow-up was of 1-year a measurement were performed at baseline (t0), immediately after the treatment (t1) and every three months during the observation period. Results: All lesions disappeared after one treatment. Pain or sensitive teeth were reported inside the 72 h and they disappeared after. Statistical analysis showed highly statistically correlation between etching cycles and the dimension of lesions and TSIF at the time-points evaluated as well as for pain during treatment, whereas a statistical significance was not noticed where etching cycles were correlated to sensitive teeth after 72 h. Overall, the treatment was found to be statistically significantly associated with differences in answers of aesthetic dissatisfaction between t0 and t1 and those collected between t1 and t2. Between t2 and t3 and between t3 and t4 no statistical differences were found in answers of patients about dissatisfaction, indicating the stability of the results. Conclusions: The ICON resin infiltration technique was found to be effective in lesions resolution with steady results.

Survival Rates for Porcelain Laminate Veneers: A Systematic Review

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 studies 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 articles 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 synthesis. The remaining 27 publications were retained to discuss the heterogeneity in the current literature and reported longevity of veneer restorations. A conclusive estimation 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 heterogeneity among research study designs. Researchers should aim for homogeneous study designs that can be included in systematic reviews and meta-analyses.

In Vitro Evaluation of Physical and Mechanical Properties of Light-Curing Resin Cement: A Comparative Study

OBJECTIVE

 The aim of study was to evaluate in vitro the surface hardness, sorption, solubility, and color stability of three light-cured resin cements, namely RelyX Veneer (RLX), Variolink Veneer (VLK), and All Cem Veneer (ACV).

MATERIALS AND METHODS

 Cylindrical samples (15 × 1 mm) were made for each group using a metallic mold (n = 10). Vickers microhardness test was performed, and average hardness was calculated from three indentations (300 gf/15s) per sample. The sorption and solubility of the materials were evaluated according to ISO 4049:2009 based on three samples weighing: initial (m ₁), after immersion in distilled water for 7 days (m ₂), and final (after removal of all moisture [m ₃]). The color change was observed using a digital spectrophotometer, at three different time points, baseline, 1 day, and 1 week of immersion in coffee and distilled water (control).

STATISTICAL ANALYSIS

 Shapiro-Wilk test was used to analyze the normality of the data, and groups were compared using Kruskal-Wallis and Mann-Whitney tests. A significance level of 5% was used.

RESULTS

 RLX showed the highest microhardness mean values (36.96 VHN), but higher sorption (23.2 µg/mm³) and solubility (2.40 µg/mm³), with statistically significant differences with the other groups. For color stability, higher ∆E was observed for the samples immersed in coffee (p = 0.009). The VLK resin cement presented statistically significant differences from the other groups, with higher color changes in coffee at 1 day (15.14) and after 1 week (23.65).

CONCLUSION

 RLX resin cement showed better hardness results. All materials tested performed satisfactorily for sorption and solubility according to ISO 4049:2009. All materials showed high-staining values after 1 week of immersion in coffee.