j m

a

A R T I C L E S

A clinical comparison of two different types o f dental veneers— baked porcelain veneer and heatand-pressure processed urethane resin veneer— was made after 2 years. Although the esthetic ap­ pearance and gingival response were equal fo r both systems, the resin veneers had a greater tendency to chip and fracture. By the end o f 2 years, 20% o f the resin veneers had failed, whereas all of the porcelain veneers remained.

Porcelain and resin veneers clinically evaluated: 2-year results L an ce M . R ucker, DD S; W illiam R ichter, D M D , MSc; M ich ael M acE ntee, LDS (I) FRCD (C ), PhD ; A lan R ichardson, D D S, M Sc o r m o r e th a n a d e c a d e , p r e f a b r i­ c a te d v e n e e r s h a v e b e e n u s e d to im p ro v e th e a p p e a ra n c e o f esth e tically co m p ro m ise d a n te rio r te e th a n d prem olars.'-5 C o m b in in g im p ro v e d m a te ria ls a n d t e c h n i q u e s w ith t h e h ig h p u b li c d e m a n d fo r th ese services, th e v e n e e rin g o f te e th is rap id ly in c re a sin g in p o p u la r­ ity.6-8 In p a rtic u la r, la b o ra to ry -fa b ric a te d v e n e e rs have receiv ed th e m o st a tte n tio n in th e p ast several years.9-" A lo n g i tu d i n a l stu d y w as in i ti a te d in 1986 to evaluate a n d c o m p a re two laboratory-fabricated v e n e e rin g m aterials: b ak ed p o rc e la in v e n e e r (V ita d ur, V ita Z ahnfabrik) a n d h eat-an d -p ressu re p ro cessed u re ­ t h a n e m e t h y lm e th a c r y li c r e s in ( I s o s it Ivoclar-V ivadent).

F

types w ere used. T h e m o st usu al a rra n g e ­ m e n t was to p lace o n e m aterial o n th e c e n ­ t r a l i n c i s o r s , t h e o t h e r o n th e l a t e r a l incisors, a n d o n e o f each o n th e canines. In trin sic stain in g was th e usu al d e n ta l co n ­ c e rn . S ubjects w ith e ith e r m in im al stain in g o r w ith s ig n s o f e x c e ss iv e in c is iv e (o c ­ c lu s a l) f o r c e s w e re e x c lu d e d fr o m th e

study. All p ro c e d u re s w ere p e rf o rm e d by o n e o f th e fo u r investigators, a n d a t least two o f th e fo u r investigators w ere p re s e n t fo r each clinical p ro c e d u re a n d evalu ation in th e study fo r a h ig h level o f consistency. T e e th w ere p re p a r e d a n d all m a te ria ls m ix e d a n d u se d a c c o rd in g to th e re c o m ­ m e n d a tio n s o f th e m a n u fa c tu rers. S hades

Table 1 ■ Initial distribution of treated teeth. T o o th

P o rc e la in

R esin

T o tal

M axillary C e n tra l in ciso rs L a teral in c iso rs

18 10 7

11 11

29

2

21 3

1

2

3

36

36

72

C e n tra l in ciso rs

4

L a teral in ciso rs C a n in e s P re m o la rs

2

2 3

2 0

2 1

5 4 1

8

8

16

44

44

88

C a n in e s P re m o la rs T o tal

Methods and materials M a n d ib u la r

A to ta l o f 44 p o rc e la in a n d 44 re s in ve­ n e e r s w e re p la c e d in 16 s u b je c ts in 3 m o n th s. T h e n u m b e r o f v en eers p e r sub­ je c t ra n g e d from 2 to 14. Sixty-nine o f th e v e n e e rs w ere fo r m ax illary a n te rio r te e th (T ab le 1). In all b u t o n e o f th e su b je c ts w ho received only two v en e e rs b o th v e n e e r 5 9 4 ■ JADA, Vol. 121, N ovem b er 1990

T otal T o tal fo r b o th

6

A R T I C L E S

w ere m a tc h e d w ith V ita-Lum in (Ivoclar-Viv a d e n t) a n d K erasco p (Ivoclar-V ivadent) sh a d e guides. A d ia m o n d b u r was u sed to re d u c e th e labial su rfa c e o f th e te e th by 0.5 m m , a n d a c h a m fe r m a rg in was p ro ­ d u c e d ap p ro x im ately 1 m m above th e g in ­ g iv a l m a r g in a n d j u s t f a c ia l to t h e p ro x im a l co n tacts. M axillary to o th p re p a ­ r a t i o n s in c l u d e d a n in c is a l b e v e l, b u t m a n d ib u la r p re p a ra tio n s d id n o t e x te n d to th e incisal ed g e. M ultiple polysiloxane im p re s s io n s w e re ta k e n , w h ic h a llo w e d se p a ra te im pressions fo r th e sim u ltan eo u s fab ricatio n o f p o rcelain a n d resin v en eers a t t h e s a m e d e n t a l la b o r a to r y . T o o th p r e p a r a t i o n d i d n o t e x p o s e s e n s itiv e d e n tin , so it was n o t n ecessary to p lace a te m p o ra ry re sto ra tio n o n th e te eth d u rin g th e 2 w eeks w hile th e v en ee rs w ere b e in g m ade.

Fig 1 ■ P reoperative view showing intrinsic stain­ ing.

F ig 2 ■ A lte rn a tin g p o rc e la in a n d resin v e n ee r prep aratio n s com pleted.

Table 2 ■ Distribution of treated teeth evaluated at 2 years. T o o th

P o rc e la in

R esin

T o tal

M axillary C e n tra l incisors L a te ra l in c iso rs

14

10

24

C a n in e s

9 7

9 9

18 16

P re m o la rs

1

2

3

31

30

61

C e n tra l in c iso rs L a te ra l in c iso rs

2 2

2

4

1

C a n in e s

2 0

2 1

3 4

T otal

M a n d ib u la r

P re m o la rs T o tal T o tal f o r b o th

1

6

6

12

37

36

73

B o th p o rc e la in a n d resin v e n e e rs w ere p la c e d w ith c o m p atib le resin c e m e n ts (Helio lin k a n d D u al, Iv o clar-V iv ad en t). T h e D ual c e m e n t was u sed fo r v e n e ers in th re e o f th e p a tie n ts (fo u r p o rc e la in a n d fo u r resin v en eers) a n d H e lio lin k fo r all o th e r v e n e e rs . All o f th e m a n u fa c tu re r-re c o m m e n d e d steps fo r th e p re p a ra tio n o f tee th a n d v e n e e rs in b o n d in g w ere strictly fol­ low ed. All v e n e e r m a rg in s w ere fin ish e d w ith d ia m o n d fin ish in g b u rs (U ltra -fin e, P re m ie r), h a n d in stru m e n ts, a n d d ia m o n d p o lish in g p a ste (L u ste r P aste , K e rr) c ar­ rie d o n ro ta ry en d -b ristle b ru s h e s o r cups. A fter th e fin ish in g process, e a c h v e n ee r w as i n d e p e n d e n t l y a s s e s s e d f o r c o lo r , m a rg in a l integrity, d u rability, gingival tol­ e ra n c e , a n d p a tie n t ac c ep tan c e (Fig 1, 2). P h o to g r a p h s a n d s c a n n in g e le c tr o n m i­ c ro sco p y (SEM ) im p re ssio n s o f th e co m ­ p le te d cases w ere also tak en . E a c h y e a r a f t e r p l a c e m e n t o f th e re s to ra tio n s (Fig 3 ), p a tie n ts u n d e r w e n t c lin ic a l e x a m in a tio n s , in t r a o r a l p h o ­ to g r a p h s , a n d im p re s s io n s f o r s c a n n in g e le c tro n m icroscopic evaluations to b e u n ­ d e rta k e n a t th e e n d o f 3 years.

o rig in a l v e n e e rs r e m a in in g in th e stu d y s u b je c ts ’ m o u th s w e re in d is tin g u is h a b ly co m p a ra b le esthetically a n d w ith re g a rd to m a r g in a l in te g rity , b o th to th e s u b je c ts a n d to th e ex am in ers. O f th e fo u r re s in v e n e e rs a tta c h e d to th e te e th w ith D ual c e m e n t, th r e e failed w ith in 2 years. O f th e 40 resin v e n e e rs at­ ta c h e d with H elio lin k , six failed. F a ile d v e n e e rs w e re r e t r e a t e d , b u t re ­ m o v e d fro m th e stu d y . F o r th e s e te e th , w h en a n incisal c h ip o r o th e r m in o r re p a ir p e r m it te d a r e p a ir w ith o u t re m a k e , th e

Fig 4 ■ R esin ven eer frac tu re (m axillary central incisor).

Results

Fig 3 ■ P ostoperative results 1 year later.

A fter 1 year, all o f th e v en e e rs w ere avail­ ab le fo r ev aluation. A fter 2 years, 37 p o rce­ la in a n d 36 re s in v e n e e rs w e re av ailable (T able 2). A t 2 years, n in e o f th e resin v en e e rs h a d c h ip p e d o r fra c tu re d in six d iffe re n t sub­ je c ts (Fig 4, 5 ). Five o f th o se failu re s h a d o c c u rr e d in th e first y e a r (T ab le 3 ), a n d f o u r a d d itio n a l fa ilu re s o c c u r r e d in th e se c o n d y ear (T able 4 ). N o n e o f th e p o rc e­ la in v e n e e rs fa ile d (T a b le 5 ). All o f th e

Fig 5 ■ R esin ven eer fra c tu re (m a n d ib u la r c en ­ tra l incisor.

JADA, Vol. 121, N o v em b er 1990 ■ 595

A R T I C L E S

Tabic 3



Veneer failures at

T o o th

1 year.

P o rc e la in

R esin

M ax illary C e n tra l in c iso rs C a n in e

0 0

3 1

0

1

0

5

M a n d ib u la r C a n in e T o ta l fo r y e a r o n e

Table 4



Veneer failures during second

year. T o o th

P o rc e la in

R esin

M ax illary C e n tr a l in c iso rs

0

3

M a n d ib u la r P r e m o la r T o tal fo r y e a r two

Table 5



0

1

0

4

Total veneer failures. P o rc e la in

D u rin g y e a r o n e D u rin g y e a r tw o

T o tal

R esin

0 0

5 4

0

9

a re a was s m o o th e d o r a c o m p a tib le resin a d d e d d ire c tly a t c h a irsid e . O th e rw ise , a re p la c e m e n t v e n e e r was placed . T h e inves­ tig a to rs c o n tin u e d to o b se rv e th e se sites a fte r th e y w ere re m o v e d fro m th e study, a n d it is especially in te re stin g to n o te th e p ro g r e s s o f w h a t m ay b e h ig h e r-risk ve­ n e e r i n g s itu a tio n s . T w o o f th e re s in ve­ n e e rs re p la c e d b efo re th e e n d o f th e first year fra c tu re d again w ithin 6 m o n th s, a n d they w ere re p la c e d with p o rcelain v en eers w hich re m a in e d in place to th e e n d o f th e s e c o n d year. Two m o re o f th e se year-one resin v e n eers rem ak es h a d to b e sim ilarly re p la c e d in year two. In all cases, re p la c e ­ m e n t p o rc e la in v e n e e rs fu n c tio n e d w ith ­ o u t fail in sites in w hich resin v en eers h a d failed. A fter th e year-one results w ere eval­ u a te d , th e e m e rg in g p a tte rn was con v in c­ in g e n o u g h th a t all s u b s e q u e n t re m a k e s

5 9 6 ■ JADA, Vol. 121, N ovem b er 1990

w ere d o n e im m e d ia te ly in p o rc e la in . All six p o rc e la in re m a k e s a re c o n tin u in g to f u n c tio n w ell. T h e h ig h su c c e s s o f th e p o r c e la in v e n e e r s is s im ila r to t h a t r e ­ p o rte d by C alam ia.12

p ro cessed u re th a n e resin v eneers. Insuffi­ c ie n t resistan ce to c h ip p in g a n d fra c tu re re s u lte d in a less e f f ic ie n t re s in v e n e e r s y s te m c o m p a r e d w ith t h e p o r c e l a i n v e n e e r system.

Discussion

------------------------ J 'A O A ------------------------

T h e in v e stig a to rs h a d fo u n d th a t th e r e ­ silien cy o f th e h e a t-a n d -p re s s u re tr e a te d resin m aterial did n o t p ro v id e a v en e e rin g sy stem m o r e c o m p a tib le w ith in t r a o r a l s t r e s s e s t h a n t h e c o m p a r a ti v e ly r i g id p o r c e l a i n . P a t t e r n s o f v e n e e r f a i lu r e s q u ic k ly e m e r g e d . F ra c tu re s o f re s in v e­ n e e r s t h a t in v o lv e d m o r e th a n a sm a ll (< 3-4 m m ) incisal c h ip w ere vertical an d involved o n e -th ird to o n e -h a lf o f th e total veneer. U sually th e p o rtio n o f th e v en e e r re m a in in g o n th e to o th w as b o n d e d so firm ly th a t a h ig h -sp eed d ia m o n d b u r was re q u ire d to rem ove it fro m th e to o th . Initial c o n c e rn th a t resin v e n e e r failures m ig h t have b e e n re la te d to th e unw ittin g assig n m en t o f th o se v en e e rs to te e th w hich h a p p e n e d to h a v e u n d e te c te d h ig h o c ­ clusal risk was m ollified by th e survival o f a ll r e p l a c e m e n t p o r c e l a i n v e n e e r s o n th o s e sam e te e th . E ven a t 2 years, it was virtually im possible to d istin g u ish th e heatan d -p re ssu re tre a te d resin fro m p o rce la in v en eers o n th e basis o f color, su rface c h a r­ acteristics, a n d o th e r esth etic factors. T h is is c o n s is te n t w ith o th e r o b s e r v a tio n s o f s u c h r e s in s in o t h e r i n t r a o r a l a p p li c a ­ tio n s.13 B ecause id e n tica l a n d c o m p atib le b o n d ­ in g m ate rials w ere u sed fo r b o th types o f v e n e e rs , it se e m s u n lik e ly t h a t fa ilu re s w e re r e l a te d to f a ilu r e w ith in b o n d in g re sin o r a t th e r e s in /t o o th in te rfa c e . Al­ th o u g h th e p e r c e n ta g e f a ilu r e w ith th e r e s in v e n e e r s c e m e n t e d w ith D u a l is h ig h e r th a n w ith th e H elio lin k , th e sm all n u m b e r s o f D u a l-c e m e n te d m a te ria l r e n d e r sta tistic a l c o m p a r is o n s m e a n in g ­ less. In ad d itio n , all D u al-cem en ted p o rc e ­ lain v en eers w ere successful a fte r 2 years.

Summary

T h e a u th o r s ac k n o w le d g e th e c o n tr ib u tio n m a d e to th is p r o je c t by th e W illiam s-Iv o clar-V iv ad en t R esea rc h G ro u p . I n f o r m a tio n a b o u t th e m a n u f a c tu r e r s o r p ro d u c ts m e n tio n e d in th is a rtic le is av a ilab le fro m th e a u th o rs. N e ith e r th e a u th o r s n o r th e A m e ric a n D e n ta l A ssocia­ tio n h a s an y c o m m e rc ia l in te r e s t in th e p ro d u c ts m e n ­ tio n e d . P re lim in a ry d a ta w ere p r e s e n te d a t th e A m e ric a n As­ s o c ia tio n fo r D e n ta l R e se a rc h m e e tin g , S an F ran cisco , 1989. Dr. R u c k e r is assistan t p ro fesso r, Dr. R ic h te r is a r e ­ t i r e d p r o f e s s o r , D r. M a c E n te e is p r o f e s s o r , a n d D r. R ic h a rd s o n is p ro fesso r, d e p a r t m e n t o f c lin ic al d e n ta l scie n ces, F aculty o f D en tistry , T h e U n iv ersity o f B ritish C o l u m b i a , 2 1 9 9 W e s b r o o k M a ll, V a n c o u v e r , B C , C a n a d a V 6T IZ7. A d d ress re q u e s ts f o r r e p r in ts to Dr. R ucker. 1. M o u ra d ia n WF, G r a h a m D, F e rn a ld o L. A n ew ap ­ p r o a c h to t r e a t m e n t o f t e t r a c y c lin e - s t a in e d t e e th : r e p o r t o f a case. J D e n t C h ild 1976;43:103-5. 2. F a u n c e FR, M yers D R . L a m in a te v e n e e r re s to r a ­ tio n o f p e r m a n e n t in ciso rs. JA D A 1976;93:790-2. 3. J o r d a n RE, S u z u k i M , G w in n e tt AJ, H u n t e r JK . R e s to r a tio n o f f r a c t u r e d a n d h y p o p la s tic in c is o rs by t h e a c id - e tc h r e s in t e c h n i q u e : a th r e e - y e a r r e p o r t . JA D A 1977;95:795-803. 4. B ark ley RL, G aw AF, F a u n c e FR. A e s th e tic to o th r e s to ra tio n . D e n t S u rv 1979;55:22-7. 5. A v e rt PR. V o lu m e 7: I m p r o v in g a e s th e tic s w ith la m in a te v e n e e rs. In: G o ld m a n H M , e d . C u r r e n t th e r ­ ap y in d en tistry . S t. L o u is: M osby; 1980:432-7. 6. C h a lk le y Y. C lin ic a l u s e o f a n t e r i o r la m in a te s — c o n s tru c tio n a n d p la c e m e n t. JA D A 1980;101:485-7. 7. P a tte r s o n J R , A n so n RA. L a m in a te s — a p ra c tic a l a p p r o a c h to r e s to rin g te tra c y c lin e -sta in e d te e th . P ed ia t r D e n t (C h ic ag o ) 1980;2:300-3. 8. R o n k SL. D e n t a l la m i n a t e : w h ic h te c h n i q u e ? JA D A 1981;102:186-8. 9. C h e u n g W S, P u ln e r F, S m ith D C . C u s to m -m a d e v e n e e rs fo r p e r m a n e n t a n t e r io r te e th . JA D A 1982;105:1015-29. 10. H o r n H R . A n ew la m in a tio n : p o rc e la in b o n d e d to e n a m e l. N Y S ta te D e n tJ 1983;49:401-3. 11. S ta n g e l I, N a th a n s o n D , H su CS. S h e a r s tre n g th o f c o m p o s ite b o n d to e t c h e d p o r c e la in . J D e n t R es 1987;66:1460-5. 12. C a la m ia JR . E tc h e d p o r c e la in v e n e e rs: th e c u r ­ r e n t state o f th e a rt. Q u in te s s e n c e I n t 1985;1:5-12.

At th e e n d o f 2 years, e sth e tic a p p e a ra n c e a n d tissu e re s p o n se w ere e q u a l fo r b o th th e p o rc e la in a n d th e h e a t-a n d -p re s su re

13. R u c k e r LM . P ro sth e tic tr e a tm e n t f o r th e p a tie n t w ith u n c o n tr o lle d g r a n d m a l e p ile p tic s e iz u re s. S p ec C a re D e n tist 1985;12:206-7.

Porcelain and resin veneers clinically evaluated: 2-year results.

A clinical comparison of two different types of dental veneers--baked porcelain veneer and heat-and-pressure processed urethane resin veneer--was made...
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