Keywords
porcelain veneers - veneer restoration - satisfaction
Introduction
In the past, teeth with abnormal shape and color were previously often restored with
porcelain crowns that required grinding tooth tissue which resulted in weakened teeth,
changing the feeling of chewing, and stimulating periodontal tissue. Veneers are substituted
for a full crown with outstanding advantages: less tooth grinding saves tooth tissue,
minimally invasive, intact tooth neckline, high aesthetics, good compatibility with
soft tissues, sustainable in the long run.[1]
[2] Porcelain veneers have shown long-term esthetics.[2] and they also show a high survival rate with most failure cases resulting from fracture
and debonding.[3] Ceramic materials also improve the periodontal health of patients.[4]
Currently, ceramic materials and technology are increasingly being improved and widely
used in clinical practice with two types: oxide porcelain and glass porcelain.[5]
[6]
[7] The oxide porcelain is essentially zirconia oxide; this type is poor in light conductivity,
so when indicated for front teeth are often chiseled, affecting aesthetics; moreover,
they are very hard and cannot be worn and glued to tooth tissue, while the glass porcelain
line that overcomes this disadvantage has the optical properties of the teeth. At
present, translucent ceramic biomaterials are being developed increasing the esthetics.[8]
[9]
[10] They are natural and preserved by the chemical adhesive mechanism to increase the
durability of the restoration.[11]
At present, glass porcelain such as Empress, Empress II, and Emax have been widely
used at the Hospital of Odonto-Stomatology. But there has been no research on porcelain
veneer restorations (VRs). Hence, it was important to study the clinical characteristics
and patient satisfaction with the porcelain veneer aesthetic restoration in Vietnam.
Therefore, the aim of this study was to study the clinical characteristics and patient
satisfaction of the porcelain veneer aesthetic restoration at the Central Odonto-Stomatology
Hospital, Vietnam.
Materials and Methods
Study Design
This is a cross-sectional descriptive study done on 94 teeth in 12 patients with indications
for glass-ceramic restorations at the Department of Prosthodontics at the Central
Odonto-Stomatology Hospital during the period from July 2021 to December 2022. Ethical
approval was taken from the Ethics Committee of the Central Odonto-Stomatology Hospital
(Approval number 1298/QD-BVRHMTW). Three researchers asked the questions with patients
and evaluated the results. Patients voluntarily participated in the study and the
patient information is kept confidential.
Study Subjects
Patients who were indicated for porcelain VRs for various causes at the Department
of Prosthetics, Central Hospital of Odonto-Stomatology were included in the study.
Exclusion criteria included teeth with contraindications to porcelain veneers, patients
with bad habits affecting prosthetics, and patients who do not cooperate or cannot
be re-examined.
Study Details
Following the patient examination, pictures were taken and marked. Initial casts were
poured and wax-up was done in the casts. Then, mock-up simulations were done on the
patient's mouth. Grinding and preparing teeth to make veneers were done as needed.
Temporary restorations were made and inserted. Following the preparation of the final
veneers from the dental laboratory, they were inserted in the patients and cemented
using resin cement.
Porcelain veneer aesthetic restorations in patients were evaluated using FDI World
Dental Federation clinical criteria[12] for the evaluation of VRs for the esthetic parameters, functional parameters, biological
parameters, and reliability. Following items were used in terms of aesthetic, biological,
and functional parameters.
Aesthetics
-
- Natural color, similar to real teeth, in harmony with neighboring teeth.
-
- Surface gloss is similar to neighboring tooth enamel.
-
- The shape and size of the teeth are harmonious and commensurate with the neighboring
teeth
Biology
-
- Healthy gum line, rosy, natural color of the tooth neck area.
-
- Pillar teeth are not sensitive when chewing.
Function
Restore chewing function and bite.
+ Bite in static state:
Touch evenly at the central occlusion. Overbite and overbite are within allowable
limits.
+ Bite in dynamic state:
Instructions to bring the lower jaw forward with the participation of the incisors.
When sliding the lower jaw forward until the head touches the head with many touching
teeth, the back teeth disengage. Moving the jaw to the sides is guided by the canine
teeth properly and does not cause trauma.
The occlusal restoration is both static and dynamic.
-
- Evaluate chewing function: The patient chews normally and does not have food pulled
when using the scanner.
-
- The crown fits tightly to the finished line of the tooth base
-
- Good contact point with neighboring teeth.
Patient Satisfaction with Treatment Results
Patient Satisfaction with Treatment Results
Assessed by interviewing the patient immediately after tooth installation, after 3
months of follow-up, with a set of questions according to Sulaya and Guttal.[13]
-
How do you evaluate the chewing ability of your restoration?
-
How do you evaluate the color match of your restoration?
-
How do you evaluate the appearance of your restoration?
-
How would you rate the comfort of your restoration?
Assessment
Evaluation of aesthetics, function, biology, and satisfaction was done ([Fig. 1]) using a scale: Very good—good—average—poor—very poor = 5–4-3–2-1. The evaluation
was done immediately after installation and after 3 months.
Fig. 1 Study parameters of the veneer restorations; esthetic parameters, functional parameters,
biological parameters, and reliability.
Statistical Analysis
Data were analyzed using SPSS 18 software and descriptive statistics were calculated
and compared. The results were compared using an independent t-test at a significant level at p-value = 0.05.
Results
The demographic details of the study are shown in [Table 1]. The results of the assessment of porcelain VR immediately after the insertion were
as follows: very good (83%) and good (17%). The results of color assessment immediately
after the insertion were very good (64; 68.1%), good (28; 29.8), and moderate (2;
2.1%), whereas the results after 3 months were very good (64; 68.1%), good (27; 28.7),
and moderate (3; 3.2%) ([Fig. 2]). The results were no significant differences between immediately after the insertion
and after 3 months (p-value >0.05).
Fig. 2 Results of the color of the porcelain veneer restorations.
Table 1
The demographic detail of the study
|
Age
|
Gender
|
Total
|
|
Male
|
Female
|
Number
|
Percentage
|
|
Number
|
Percentage
|
Number
|
Percentage
|
|
< 30
|
1
|
8.3
|
2
|
16.7
|
3
|
25
|
|
30–50
|
2
|
16.7
|
7
|
58.3
|
9
|
75
|
|
Total
|
3
|
25
|
9
|
75
|
12
|
100
|
The tightness of the finishing line of the VR was very good in both immediate insertion
and after 3 months (87.3%). There was a decrease in the good level from 10 to 5% and
a decrease in the moderate level from 2 to 7% in immediate insertion and after 3 months
([Fig. 3]).
Fig. 3 Results of the finishing line of the porcelain veneer restorations.
At 3 months of insertion, the results of the surface color stability and contour were
very good 53 (56.4%), good 31 (33%), and moderate 10 (10.6%) ([Fig. 4]). In addition, there was no change in physical structure 3 months after the insertion.
Fig. 4 Results of the veneer color stability and restoration contour.
For the lateral contact and food intake results, the very good results were similar
immediately after the insertion and at 3 months after the insertion (70.2%). And there
was a sight difference in the good and moderate results ([Fig. 5]).
Fig. 5 Evaluation of lateral contact and food intake results.
The result of biological evaluation after 3 months of insertion of the VRs showed
significant differences in the sensitivity between very good, good, and moderate/bad
(p-value <0.01; [Fig. 6]). Good conditions showed no differences between good and moderate.
Fig. 6 Evaluation of biological results after 3 months.
[Fig. 7] shows the overall results of the porcelain VRs immediately after the insertion and
3 months after the insertion. The majority of the results show good results 82.2%
immediately after the insertion and 76% 3 months after the insertion. There are no
bad results.
Fig. 7 Overall results according to the two evaluation time points.
Patient satisfaction is shown in [Fig. 8]. It showed that 83.3% of the patients were very satisfied and 16.7% were satisfied
following the porcelain veneer treatment.
Fig. 8 Evaluation of patient satisfaction with treatment results.
Discussion
The porcelain VRs achieve good esthetic results with a more balanced harmony.[3]
[9] At present various newer ceramic biomaterials are being developed with various treatment
modalities to produce esthetic results.[2]
[10] Our aim of this study was to study the clinical characteristics and patient satisfaction
of the porcelain veneer aesthetic restoration at the Central Odonto-Stomatology Hospital,
Vietnam. The overall results were very good, and the patients were satisfied with
the porcelain VRs.
VRs can restore the teeth shape and color. In this study, immediately after insertion,
the abnormal shape of the original teeth was covered with veneer producing esthetic
results with very good assessment accounting for 83%. Porcelain veneers with good
shape create contact between adjacent teeth to achieve horizontal stability for the
dental arch and bring the patient's esthetics. Porcelain veneers can restore teeth
colors, such as in fluorosis, and mild tetracycline contamination. In our study, the
majority of the veneer restored the esthetic tooth color (68.1%) immediately after
the restoration and at 3 months of the restoration. In one patient, there was tetracycline
staining of teeth, and at 3 months of re-examination, there was a phenomenon of discoloration
from the restoration edge, the average result (increased) was 3.2%, and the good results
decreased by 1.1%. Therefore, when choosing the adhesive, it is necessary to adhere
to the step of coating with an antioxidant after attaching and polishing carefully.
The closer the adhesive surface is to the thin layer of cement, the less disintegration
will be reduced of cement.[14] Furthermore, in this study, the surface color adhesion and restoration margins are
mostly good and very good to ensure a good restoration border after attaching the
restoration. It is necessary to completely clean the excess cement and polish carefully
with porcelain polishing tips to minimize gingivitis and color adhesion at the edge
of the restoration.
For the restored teeth, the finishing line is under the gum to cover the stained color
of the teeth, the restorative teeth due to gap or bad shape, and the finishing line
is under the gum when making restorations.[4] During the cementation of the prosthesis, it is ensured a tight fit, and excess
cement is removed to avoid causing gingivitis. Mandibular teeth are often difficult
in finishing and grinding as the lower teeth are often small in size and often have
a very narrow shape in the neck area, so technicians when designing machining often
lack porcelain in this area.
Meijering et al[1] also studied to measure the satisfaction of patients with respect to the aesthetics
of VRs and to identify potential factors influencing their satisfaction with three
different types (direct composite, indirect composite, and porcelain) placed on anterior
teeth. They found that at baseline the overall satisfaction was 76%; after 2 years
this was 78%. At 2-year evaluation patients with porcelain, VRs were more satisfied
than those with direct composite VRs (p-value <0.05).
The evaluation of the durability of the VRs must be done after a long time of follow-up;
however, due to the limited time of the study, we could only evaluate it after 3 months
of treatment. This is one of the limitations of this study because the research was
conducted in the early stages of the coronavirus disease 2019 epidemic, so the number
of patients was not enough. In this study with a total of 94 teeth performed for 12
patients, we did not detect any cases of broken, cracked, or broken porcelain. Therefore,
the durability of the restoration is 100% in both groups of incisors, canines, and
premolars. Over time, the patient's occlusion can change, hence regular follow-up
is necessary.
Conclusion
Porcelain VRs are less invasive esthetic restorations and help to improve the tooth
shape and color. The patients were satisfied with the porcelain VRs.
