Scientific Discussion about the Durability of Porcelain Veneers
The "best" porcelain veneers are bonded well and functionally fully integrated.
Cosmetic dentists have been using porcelain veneers for smile makeovers for over 30 years. While early clinical expectations were uncertain, an abundance of dental literature now supports the long-term reliability of porcelain veneers. Advances in materials and bonding techniques have further enhanced their durability, making them a preferred choice for aesthetic dental restorations.
Porcelain veneers have become the most widely utilized component in cosmetic dentistry practices. Patients often express concerns about the necessity of tooth reduction for veneers. While these concerns are valid, tooth preparation is essential to achieve anatomic accuracy and aesthetic harmony. Alternatives such as no-prep veneers (e.g., Lumineers) frequently result in over-contoured, bulky teeth that lack natural translucency and internal character, making them an inferior aesthetic option compared to traditional porcelain veneers.
Tooth preparation for porcelain veneers is not a one-size-fits-all approach; it must be customized based on each clinical case. A skilled cosmetic dentist assesses factors such as enamel thickness, occlusion, and alignment to determine the most conservative and effective preparation. Although preserving enamel is ideal for superior bonding strength, some cases necessitate dentin exposure, particularly when correcting significant misalignment or replacing old restorations. However, a highly experienced cosmetic dentist possesses the expertise to optimize preparation while minimizing unnecessary tooth structure removal.
The bonding process is another critical aspect that directly impacts the longevity of porcelain veneers. Adhesive technology has evolved over the decades, with modern bonding agents providing superior adhesion between the veneer and the natural tooth structure. An expert cosmetic dentist meticulously applies etching agents, bonding resins, and luting cements in a controlled environment, ensuring optimal adhesion and reducing the risk of debonding or microleakage. The role of an experienced cosmetic dentist is indispensable in this phase, as improper application of bonding agents can lead to veneer failure over time.
Studies have consistently shown that the expertise of the dentist significantly influences the durability and success of porcelain veneers. A study by Giachetti et al. (2008) examined microleakage in bonding systems and found that total-etch adhesives, when applied by skilled practitioners, resulted in lower microleakage and superior bonding integrity. Similarly, Layton and Walton’s 21-year prospective study (2011) confirmed that porcelain veneers bonded to enamel exhibit excellent long-term survival when placed by experienced clinicians.
Another important factor influencing veneer longevity is occlusion and functional dynamics. A well-trained cosmetic dentist evaluates the patient’s bite and occlusal forces to ensure the veneers can withstand daily functional stress. Patients who exhibit parafunctional habits such as bruxism (teeth grinding) require additional considerations, including the possible use of a night guard to protect the veneers from excessive wear. Failure to address occlusal issues may lead to fractures, debonding, or premature veneer failure.
Recent long-term studies further validate the exceptional longevity of porcelain veneers. A systematic review by AlJazairy (2021) reported high success rates for porcelain laminate veneers (PLVs), though it highlighted inconsistencies in study designs that limit conclusive estimations beyond 20 years. Another study by Layton and Walton (2011) demonstrated a 96% survival rate at 10 years and 91% at 20 years for feldspathic porcelain veneers bonded to enamel. Additionally, a 2008 study by Guess et al. confirmed that extended pressed-ceramic veneers remain a reliable restorative solution over a five-year period, with survival rates of 97.5% for overlap veneers and 100% for full veneers.
Moreover, a 16-year study by Dumfahrt and Schaffer (2000) found that porcelain veneers bonded primarily to enamel had a significantly higher success rate compared to those bonded partially to dentin. This finding further reinforces the importance of proper preparation techniques that maximize enamel bonding. When veneers are bonded to enamel, they exhibit enhanced resistance to marginal discoloration, microleakage, and failure.
In addition to clinical factors, patient compliance and maintenance play a crucial role in veneer longevity. Proper oral hygiene, routine dental visits, and avoiding excessive force on the veneers contribute to their long-term success. Patients are advised to avoid using their veneers to bite on hard objects such as ice or pens, as excessive force can lead to fractures. A skilled cosmetic dentist educates patients on best practices for maintaining their veneers and ensures that they understand how to prolong their restoration’s lifespan.
The evolution of porcelain materials has also contributed to enhanced veneer longevity. Modern ceramic systems such as lithium disilicate and zirconia-reinforced ceramics provide superior strength and aesthetics compared to traditional feldspathic porcelain. These advanced materials exhibit improved fracture resistance and translucency, closely mimicking the appearance of natural teeth. When combined with proper bonding techniques and expert application, these materials contribute to veneers that not only look natural but also last for decades.
Furthermore, advances in digital dentistry, including CAD/CAM technology, have improved the precision of veneer fabrication. Digital impressions and computer-assisted design allow for highly accurate veneer fittings, reducing the margin for error and enhancing overall longevity. An experienced cosmetic dentist utilizes these technological advancements to ensure that the veneers fit seamlessly, optimizing both function and aesthetics.
In conclusion, the longevity of porcelain veneers is well-supported by extensive clinical research, with survival rates often exceeding 90% over decades. However, the experience and skill of the cosmetic dentist remain critical determinants of long-term success. An accredited cosmetic dentist, well-versed in preparation techniques, material chemistry, bonding protocols, and occlusal considerations, is best equipped to provide veneers that are both aesthetically and functionally superior. Additionally, advancements in materials and digital technology continue to enhance veneer durability, making them a reliable option for patients seeking a long-lasting smile transformation. By selecting a highly skilled and accredited cosmetic dentist, patients can ensure they receive veneers that not only enhance their appearance but also stand the test of time.
References and Abstracts
Clinical evaluation of 546 tetracycline-stained teeth treated with porcelain laminate veneers.
Chen JH, Shi CX, Wang M, Zhao SJ, Wang H. J Dent. 2005 Jan;33(1):3-8. Department of Prosthodontics, The Fourth Military Medical University, Dental College, 7 Kang Fu Road, Xian 710032, China.
OBJECTIVE: The purpose of this study was to evaluate the clinical result of 546 tetracycline-stained teeth restored with a porcelain laminate veneer system (Cerinate, Den-Mat, USA) for aesthetic reasons. METHODS: Tetracycline-stained teeth (546) were restored with a porcelain veneer system, and bonded with Ultra Bond resin cement. The restorations were recalled after 0.5, 1.5 and 2.5 years, respectively. Modified Ryge criteria were used to evaluate the veneers marginal adaptation, interfacial staining, secondary caries, postoperative sensitivity and the patients' satisfaction of the colour of the restorations. RESULTS: This study found that 99% veneers had excellent marginal adaptations; and less than 1% veneers required rebonding in the first 6 months; the colour of the veneers was stable and no evident staining was found. Almost all patients were satisfied with the colour match of their restorations 1 year after placement. CONCLUSIONS: The research indicated that the porcelain veneer restoration system under investigation provided a reliable and highly satisfactory choice for the aesthetic restoration of tetracycline-stained teeth.
Predictable, precise, and repeatable tooth preparation for porcelain laminate veneers.
Gyrel G. Pract Proced Aesthet Dent. 2003 Jan-Feb;15(1):17-24; Center for Continuing Education, New York University College of Dentistry, New York, New York, USA.
Advances in dental materials and techniques have enabled porcelain laminate veneers to evolve into the treatment of choice for minimally invasive aesthetic dentistry. Treatment planning and tooth preparation are crucial for optimal function and aesthetics. While minimal invasion is important, sufficient space must be provided for the appropriate porcelain buildup. Various preparation guidelines have been advocated for porcelain veneers, yet they vary in accuracy and by indication. This article provides a simple, precise technique for veneer preparation regardless of tooth position and condition.
Midterm results of a 5-year prospective clinical investigation of extended ceramic veneers.
Guess PC, Stappert CF. Dent Mater. 2008 Jun;24(6):804-13. Department of Prosthodontics, School of Dentistry, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg, Germany.
OBJECTIVES: Midterm-evaluation of a prospective 5-year clinical study on long-term performance and success rate of pressed-ceramic veneers with two extended preparation designs. METHODS: Anterior teeth of 25 patients were restored with 66 extended veneers. Forty-two overlap veneers (OV) (incisal-edge-reduction 0.5-1.5mm, butt-joint) and 24 full veneers (FV) were inserted. Both veneer designs were similar in buccal (0.5mm) and proximal (0.5-0.7mm) chamfer preparation, but differed in palatal extension. Ceramic veneers were fabricated with IPS Empress* and adhesively luted with dual-polymerizing composite Variolink II* (*Ivoclar Vivadent). Clinical reevaluations were performed 6, 12, 25, 39, 45, and 62 months after insertion of the veneers according to the modified USPHS-criteria. Absolute failures were recorded as survival-rate, relative failures demonstrated by Kaplan-Meier success-rate. RESULTS: After an observation time up to 5 years, survival-rate of full veneers was 100%, of overlap veneers 97.5% due to one severe fracture. Kaplan-Meier-analysis of relative failures resulted in a success-rate of 85% for FV and 72% for OV. Reasons for relative failures were cracks, ceramic-cohesive-fractures, and loss-of-adhesion. No significant differences were found between the two veneer groups. Secondary caries and endodontic complications did not occur. Increased clinical service time resulted in enhanced marginal discoloration and decrease of marginal adaptation. SIGNIFICANCE: Extended pressed-ceramic veneers (both OV and FV) proved to be reliable procedures to restore larger deficits in anterior teeth. Pronounced palatal extension of full veneers was not linked to a higher failure probability. Reliable adhesive bonding, as well as ceramic fatigue and fracture resistance are considered key factors for long-term success of extended-veneer restorations.
An up to 16-year prospective study of 304 porcelain veneers.
Layton D, Walton T. Int J Prosthodont. 2007 Jul-Aug;20(4):389-96. Faculty of Dentistry, University of Queensland, Australia.
PURPOSE: This study aimed to prospectively analyze the outcomes of 304 feldspathic porcelain veneers prepared by the same operator, in 100 patients, that were in situ for up to 16 years. MATERIALS AND METHODS: A total of 304 porcelain veneers on incisors, canines, and premolars in 100 patients completed by one prosthodontist between 1988 and 2003 were sequentially included. Preparations were designed with chamfer margins, incisal reduction, and palatal overlap. At least 80% of each preparation was in enamel. Feldspathic porcelain veneers from refractory dies were etched (hydrofluoric acid), silanated, and cemented (Vision 2, Mirage Dental Systems). Outcomes were expressed as percentages (success, survival, unknown, dead, repair, failure). The results were statistically analyzed using the chi-square test and Kaplan-Meier survival estimation. Statistical significance was set at P .05. RESULTS: The cumulative survival for veneers was 96% +/- 1% at 5 to 6 years, 93% +/- 2% at 10 to 11 years, 91% +/- 3% at 12 to 13 years, and 73% +/- 16% at 15 to 16 years. The marked drop in survival between 13 and 16 years was the result of the death of 1 patient and the low number of veneers in that period. The cumulative survival was greater when different statistical methods were employed. Sixteen veneers in 14 patients failed. Failed veneers were associated with esthetics (31%), mechanical complications (31%), periodontal support (12.5%), loss of retention >2 (12.5%), caries (6%), and tooth fracture (6%). Statistically significantly fewer veneers survived as the time in situ increased. CONCLUSIONS: Feldspathic porcelain veneers, when bonded to enamel substrate, offer a predictable long-term restoration with a low failure rate. The statistical methods used to calculate the cumulative survival can markedly affect the apparent outcome and thus should be clearly defined in outcome studies.
Porcelain laminate veneers. A retrospective evaluation after 1 to 10 years of service: Part II--Clinical results.
Dumfahrt H, Schaffer H. Int J Prosthodont. 2000 Jan-Feb;13(1):9-18. Clinical Department of Prosthetic Dentistry, University of Innsbruck, School of Medicine, Innsbruck, Austria.
PURPOSE: The objective of this study was to evaluate the clinical quality of 191 porcelain laminate veneers and to explore the gingival response in a long-term survey. MATERIALS AND METHODS: The clinical examination was made by two calibrated examiners following modified California Dental Association/Ryge criteria. In addition, margin index, papillary bleeding index, sulcus probing depth, and increase in gingival recession were recorded. Two age groups were formed to evaluate the influence of wearing time upon the clinical results. The results were statistically evaluated using the Kaplan-Meier survival estimation method, Chi-squared test, and Kruskal-Wallis test. RESULTS: A failure rate of 4% was found. Six of the total of seven failures were seen when veneers were partially bonded to dentin. Marginal integrity was acceptable in 99% and was rated as excellent in 63%. Superficial marginal discoloration was present in 17%. Slight marginal recession was detected in 31%, and bleeding on probing was found in 25%. CONCLUSION: Porcelain laminate veneers offer a predictable and successful treatment modality that preserves a maximum of sound tooth structure. An increased risk of failure is present only when veneers are partially bonded to dentin. The estimated survival probability over a period of 10 years is 91%.
Five-year clinical performance of porcelain laminate veneers.
Aristidis GA, Dimitra B. Quintessence Int. 2002 Mar;33(3):185-9. Department of Fixed Prosthodontics, University of Athens, Athens, Greece.
OBJECTIVE: The clinical performance of porcelain laminate veneers was evaluated at 5 years. METHOD AND MATERIALS: One hundred eighty-six porcelain laminate veneers were placed in 61 patients, aged 18 to 70 years, by a single operator following the same clinical procedure. At the 5-year recall, esthetics, marginal integrity, marginal discoloration, fracture rate, and patient satisfaction were recorded. RESULTS: At recall 98.4% of the veneers were satisfactory without intervention. The retention rate was excellent, the fracture rate was very low, and the maintenance of esthetics was superior. Patient satisfaction was very high. CONCLUSION: Porcelain laminate veneers offer a reliable and effective procedure for the conservative and esthetic treatment of anterior teeth.
Influence of operator skill on microleakege of total-etch and self-etch bonding systems.
Giachetti L, Scaminaci Russo D, Bambi C, Nieri M, Bertini F. J Dent. 2008; Jan;36(1):49-53. Department of Dentistry, Faculty of Medicine and Surgery, University of Florence, Florence, Italy.
OBJECTIVES: To evaluate the influence of operator skill on microleakage in class V restorations using simplified bonding systems. METHODS: Two cavities were carried out on the buccal and lingual surfaces of 50 human bicuspid teeth. The teeth were randomly assigned to two groups according to the operator's skill: student group and expert group. The two cavities of each tooth were randomly treated with Adper Scotchbond 1 XT (total-etch adhesive) and Adper Prompt L-Pop (self-etch adhesive). All cavities were restored with a 0.2mm thick layer of flowable composite (Filtek flow) followed by one bulk increment of resin composite (Filtek Supreme XT). Specimens were thermocycled, immersed in 2% methylene blue and sectioned in a bucco-lingual plane. They were then examined under a stereomicroscope and scored according to microleakage. The data was subjected to a multilevel statistical model. RESULTS: At the dentine margin the microleakage resulting from both the self-etch adhesive and the total-etch one was similar in the student and in the expert groups. The interaction term skill x adhesive was not statistically significant (p=0.4156). At the enamel margin the self-etch adhesive microleakage within the student group resulted lower than that within the expert group. On the other hand, the total-etch adhesive microleakage within the expert group resulted lower than that within the student group. The interaction term skill x adhesive was statistically significant (p=0.0037). CONCLUSIONS: Both the adhesives used were sensitive to operator skill in obtaining a reliable seal with the enamel. On the dentine, both adhesives demonstrated little sensitivity to operator skill.
The Up to 21-Year Clinical Outcome and Survival of Feldspathic Porcelain Veneers: Accounting for Clustering.
Layton D, Walton TR. Int J Prosthodontics 25(6):604-12, Nov 2011.
PURPOSE: This study aimed to investigate the clinical outcome and estimated cumulative survival rate of feldspathic porcelain veneers in situ for up to 21 years while also accounting for clustered outcomes. Materials and methods: Porcelain veneers(n = 499) placed in patients (n = 155) by a single prosthodontist between 1990 and 2010 were sequentially included, with 239 veneers (88 patients) placed before 2001 and 260 veneers (67 patients) placed thereafter. Nonvital teeth, molar teeth, or teeth with an unfavorable periodontal prognosis were excluded. Preparations had chamfer margins, incisal reduction, palatal overlap, and at least 80% enamel. Feldspathic veneers from refractory dies were etched (hydrofluoric acid), silanated, and bonded. Many patients received more than 1 veneer (mean: 5.8 ± 4.3). Clustered outcomes were accounted for by randomly selecting (random table) 1 veneer per patient for analysis. Clinical outcome (success, survival, unknown, dead, repair, failure) and Kaplan-Meier estimated cumulative survival were reported. Differences in survival were analyzed using the log-rank test. RESULTS: For the random sample of veneers (n = 155), the estimated cumulative survival rates were 96% ± 2% (10 years) and 96% ± 2% (20 years). For the entire sample, the survival rates were 96% ± 1% (10 years) and 91% ± 2% (20 years). Survival did not statistically differ between these groups (P = .65). Seventeen veneers in 8 patients failed, 75 veneers in 30 patients were classified as unknown, and 407 veneers in 130 patients survived. Multiple veneers in the same mouth experienced the same outcome, clustering the results. CONCLUSIONS: Multiple dental prostheses in the same mouth are exposed to the same local and systemic factors, resulting in clustered outcomes. Clustered outcomes should be accounted for during analysis. When bonded to prepared enamel substrate, feldspathic porcelain veneers have excellent long-term survival with a low failure rate. The 21-year estimated cumulative survival for feldspathic porcelain veneers bonded to prepared enamel was 96% ± 2%.
A 15-year review of porcelain veneer failure--a clinician's observations.
Friedman MJ. Compend Contin Educ Dent. 1998 Jun;19(6):625-8.
ABSTRACT: The interest in porcelain veneers has followed the trend in restorative dentistry to conserve natural tooth structure. Although these restorations have been widely accepted, certain patterns have begun to emerge relative to their limitations. It is important for dental practitioners to recognize the limitations of porcelain veneers and to communicate this information to their patients before such treatment is initiated. This article presents a clinician's observation of porcelain veneer failure patterns over a 15-year period. These findings are based on a review of approximately 3,500 restorations.
Survival Rates for Porcelain Laminate Veneers: A Systematic Review
AlJazairy YH. J Dent. 2021 May;15(2):360-368.
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.
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