Contemporary Clinical Dentistry
   
  Home | About us | Editorial board | Search
Ahead of print | Current Issue | Archives | Advertise
Instructions | Online submission| Contact us | Subscribe |

 

Login  | Users Online: 182  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 



 
 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 313-316  

Ceramic laminate veneers luted with preheated resin composite: A 10-year clinical report


1 Private Practice, Curitiba, PR; Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
2 Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil

Date of Submission04-Sep-2020
Date of Decision10-Oct-2020
Date of Acceptance25-Oct-2020
Date of Web Publication21-Sep-2021

Correspondence Address:
Prof. Rafael R Moraes
Federal University of Pelotas, Rua Gonçalves Chaves 457, Sala 505, Pelotas, RS 96015-560
Brazil
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccd.ccd_788_20

Rights and Permissions
   Abstract 


Resin cement and preheated restorative resin composite may be used for luting laminate veneers. The main advantage of resin composite is increased wear resistance, which could lead to better marginal performance in long term. This article reports a clinical treatment with feldspar laminate veneers luted to the maxillary teeth with preheated resin composite in a private practice. Case was finalized in May 2009 and followed by 10 years. Excellent clinical service and remarkable long-lasting marginal integrity were observed after 123 months. Scanning electron microscopy analysis showed no wear, gaps, or ditching at the margins. Restorative margins showed a smooth transition between ceramic and tooth with no signs of degradation. Preheated resin composite for luting ceramic laminate veneers may be considered an excellent clinical option.

Keywords: Dental porcelain, dental veneers, longevity, resin composites, scanning electron microscopy


How to cite this article:
Marcondes RL, Lima VP, Isolan CP, Lima GS, Moraes RR. Ceramic laminate veneers luted with preheated resin composite: A 10-year clinical report. Contemp Clin Dent 2021;12:313-6

How to cite this URL:
Marcondes RL, Lima VP, Isolan CP, Lima GS, Moraes RR. Ceramic laminate veneers luted with preheated resin composite: A 10-year clinical report. Contemp Clin Dent [serial online] 2021 [cited 2021 Dec 3];12:313-6. Available from: https://www.contempclindent.org/text.asp?2021/12/3/313/326336




   Introduction Top


Ceramic laminate veneers are widely used for esthetic restorations. Clinical studies report survival rates above 80% in up to 20 years of follow-up.[1],[2],[3] In addition to ceramic cracking, chipping and fractures, the main reported reasons for failures of ceramic laminate veneers are related to marginal adaptation, integrity, and/or discoloration.[1],[2],[3] It is known that patient-specific risks and variables influence the success of laminate veneers. For instance, smoking and the presence of endodontic treatment have been associated with increased marginal discoloration.[1],[4] Marginal failures also could be associated with the resin-based luting agent used. A recent prospective trial of laminate veneers up to 11 years reported low rates of marginal failures.[4] It is speculated that such a finding is explained by the use of preheated resin composite to lute the laminate veneers, but that was not the focus of the study. The report by Friedman[5] is likely the first on the use of restorative resin composite as a luting agent, but no preheating was described by the author. Preheating is necessary to reduce viscosity and film thickness,[6] which are of particular importance for thin restorations. As compared with resin cements, restorative composites have the advantage of increased filler loading, wear resistance, and mechanical strength. Less marginal ditching has also been suggested.[7] These characteristics, in the long term, could reflect in less marginal problems and staining. The objective of this article is to report a clinical treatment in which ceramic laminate veneers were luted to the maxillary anterior teeth with preheated resin composite and showed excellent clinical service and remarkable marginal integrity after 123 months of follow up.


   Clinical Report Top


The CARE guideline was used for this report.[8] A 28-year-old female patient had a complaint about esthetics in her maxillary anterior teeth. The six maxillary anterior teeth had complete or partial resin composite veneers including a diastema closure [Figure 1]a. Restorations had problems of chipping and minor fractures, staining, surface roughness and texture, and loss of surface gloss [Figure 1]b and [Figure 1]c. The anamnesis appointment took place in May 2009. The patient reported that the treatment had been finalized 6 months before and asked for longer-lasting restorations. The use of ceramic laminate veneers was proposed for eight maxillary teeth to widen the buccal corridor and because the first premolars had a gingival recession. Potential risks were discussed with the patient, who agreed with the treatment. A double impression technique with polyvinylsiloxane (PVS) (Panasil Putty and Light, Kettenbach, Eschenburg, Germany) was made for obtaining stone cast models, from which the occlusion was analyzed on articulator and a diagnostic waxing was created. Tooth preparation was carried out with K0082 Magne bur system (Brasseler, Georgetown, GA) over the direct resin composites with little (if any) extension into the underlying enamel. Refining was carried out ultrasonically with diamond tips (T9 and T10; Sonicflex, KaVo, Biberach, Germany). [Figure 1]d shows the definitive teeth preparations. A double impression with PVS (Panasil) was made. Mockup and provisional restorations were created with acrylic resin (New Outline; Anaxdent, Stuttgart, Germany).
Figure 1: (a) Patient had complete or partial resin composite veneers in maxillary anterior teeth including diastema closure. Restorations had problems including chipping, fractures, staining, surface roughness and texture, and loss of surface gloss. (b) The patient smile with lips and cheeks retracted. (c) Maxillary teeth with a black background. (d) Low-invasive teeth preparations

Click here to view


Feldspar laminate veneers (IPS d.SIGN; Ivoclar Vivadent, Schaan, Liechtenstein) with thicknesses between 0.2 and 0.4 mm were created using a layering technique [Figure 2]a and [Figure 2]b. For luting, the intaglio ceramic surfaces were etched with 9.5% hydrofluoric acid for 60 s (Porcelain Etchant; Bisco, Schaumburg, IL, USA), cleaned with phosphoric acid for 15 s (Ultra Etch; Ultradent, South Jordan, UT, USA), silanated (Bis-Silane; Bisco), and filled adhesive from a 3-step system (OptiBond FL; Kerr, Brea, CA, USA) was applied. The operative field was isolated using a modified rubber dam technique. Enamel was etched with phosphoric acid gel for 30 s and the same adhesive used. Compules of resin composite Filtek Z250, shade A1 (3M ESPE, St. Paul, MN, USA) were preheated to 68°C for 10 min (Calset warmer; AdDent, Danbury, CT, USA) and used as luting material. The composite was applied to the veneers with Centrix syringe, restorations were positioned on prepared teeth, and seating hand pressure applied. Excess resin composite was removed and photoactivation was carried out for 60 s with a LED unit (Radii 2; SDI, Bayswater, Australia). Finishing was carried out with scalpel blades and polishing with diamond polishers (D. Fine; Clinician's Choice, New Milford, CT, USA). [Figure 3]a and [Figure 3]b show clinical pictures after luting (same day).
Figure 2: (a) Laminate feldspar ceramic veneers (IPS d.SIGN) with thicknesses between 0.2 and 0.4 mm were created using the layering technique. (b) Translucent, thin aspect of restoration

Click here to view
Figure 3: (a) Clinical aspect of ceramic laminate veneers after luting to prepared teeth with preheated resin composite (same day of luting). (b) Maxillary teeth with black background

Click here to view


After 21 days, occlusion was rechecked and the treatment was finalized. The patient returned for follow-up appointments after every 18–24 months. The last follow-up visit was in June 2019, i.e. 123 months after the treatment was finalized. Pictures and a PVS impression were made (Elite Putty and Regular; Zhermack, Badia Polesine, Italy). The mold was poured with epoxy resin (Fiberglass, Porto Alegre, Brazil) for observation of the restorations using scanning electron microscopy (SEM) (JSM6610; Jeol, Tokyo, Japan). The biological, esthetic, and mechanical success of the treatment was clinically evident [Figure 4]a, [Figure 4]b and [Figure 4]c. [Figure 5] presents an overlapping between clinical and SEM pictures to show that the restorative margins had no gaps nor signs of deterioration, marginal ditching, wear, or staining. SEM images of the laminate veneer bonded to the maxillary right central incisor [Figure 6]a and [Figure 6]b show the integrity of tooth-composite-ceramic interface after 123 months of clinical service. No wear, gaps, or any signs of degradation were observed at the margins, which showed a smooth transition between substrates. A cone-beam computed tomography image of the same tooth [Figure 6]c showed excellent adaptation of the laminate veneer; one can also notice the thickness of resin composite layer at the bonded interface. Both patient and dentist were well satisfied with the excellent, long-lasting results. The patient signed an informed consent term to allow reproduction of images.
Figure 4: (a) Ceramic laminate veneers showed remarkably good clinical performance and aspect after 123 months of clinical service, with no signs of marginal deterioration, marginal ditching, or staining. (b) Maxillary teeth with a black background. (c) Palatal view of maxillary anterior teeth

Click here to view
Figure 5: Overlapping between clinical and scanning electron microscope images (×12). Restorative margins showed no gaps nor signs of deterioration, wear, ditching, or staining during 123 months of clinical service

Click here to view
Figure 6: (a) Scanning electron microscope images of ceramic veneer bonded to maxillary right central incisor after 123 months of clinical service. (b) Tooth-resin composite-ceramic interface had no wear, gaps, or any sign of degradation, with a smooth transition between substrates (a) ×10; (b) ×50. (c) Cone-beam computed tomography image of same tooth showing excellent adaptation of ceramic veneer

Click here to view



   Discussion Top


Reports on the use of preheated resin composite as luting agent for laminate veneers are available, but this is the first with a clinical follow-up time longer than 5 years and with a close analysis on marginal integrity. Exceptional long-term biological, esthetic, and mechanical results were observed, notably regarding the absence of any marginal deterioration and maintenance of a smooth ceramic-tooth transition. The same could happen for other restoration types, provided that the restoration allows adequate light transmission for photopolymerization. Benefits of resin composites over resin cements as luting agents include more shades available, lower polymerization shrinkage/stress, and improved mechanical strength.

The main shortcoming usually reported for preheated resin composites is higher film thickness. A recent study showed that selection of resin composite should consider its response to preheating since viscosity, flowability, and even the reinforcing effect provided to thin ceramic structures are material dependent.[6] Since that information was not available at the time the present treatment was conducted, perhaps the resin composite used was not the best in terms of response to preheating. That did not preclude an excellent marginal and internal adaptation, and a long-lasting clinical service. One should note that an optimal preheating temperature (68°C) and time (10 min) were used, different preheating approaches could lead to distinct results. Maintaining the temperature and gained flowability is a challenge because heat dissipation occurs fast after preheating is ceased. Heating devices also offer the possibility of warming up the ceramic laminate veneers, which could reduce heat dissipation. In addition, up-to-date clinical luting approaches with preheated resin composite include an ultrasonic activation step to further increase flowability and reduce film thickness. Taking all into account and considering the excellent long-term clinical service reported here, preheated resin composite may be considered an excellent clinical option for luting ceramic laminate veneers.


   Conclusion Top


Preheated resin composite for luting ceramic laminate veneers may be considered an excellent clinical option since no signs of marginal degradation or staining was observed after 10-year of clinical service. The smooth marginal transition between ceramic, luting agent, and tooth and the absence of marginal gaps and ditching indicate that the restorative resin composite was able to withstand the abrasive and surface challenges imposed by the oral environment in the long term.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Beier US, Kapferer I, Burtscher D, Dumfahrt H. Clinical performance of porcelain laminate veneers for up to 20 years. Int J Prosthodont 2012;25:79-85.  Back to cited text no. 1
    
2.
Fradeani M, Redemagni M, Corrado M. Porcelain laminate veneers: 6- to 12-year clinical evaluation A retrospective study. Int J Periodontics Restorative Dent 2005;25:9-17.  Back to cited text no. 2
    
3.
Guess PC, Stappert CF. Midterm results of a 5-year prospective clinical investigation of extended ceramic veneers. Dent Mater 2008;24:804-13.  Back to cited text no. 3
    
4.
Gresnigt MM, Cune MS, Schuitemaker J, van der Made SA, Meisberger EW, Magne P, et al. Performance of ceramic laminate veneers with immediate dentine sealing: An 11 year prospective clinical trial. Dent Mater 2019;35:1042-52.  Back to cited text no. 4
    
5.
Friedman M. Multiple potential of etched porcelain laminate veneers. J Am Dent Assoc 1987;Spec No:83E-7.  Back to cited text no. 5
    
6.
Coelho NF, Barbon FJ, Machado RG, Boscato N, Moraes RR. Response of composite resins to preheating and the resulting strengthening of luted feldspar ceramic. Dent Mater 2019;35:1430-8.  Back to cited text no. 6
    
7.
Duarte Jr., S, Sartori N, Sadan A, Phark JH. Adhesive resin cements for bonding esthetic restorations: A review. Quintessence Dent Tech 2011;34:40-66.  Back to cited text no. 7
    
8.
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE Guidelines: Consensus-based clinical case reporting guideline development. Glob Adv Heal Med 2013;2:38-43.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Clinical Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed302    
    Printed10    
    Emailed0    
    PDF Downloaded61    
    Comments [Add]    

Recommend this journal