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Limited evidence suggests a high 5-year survival rate for non-feldspathic porcelain veneers

Karessa Kuntz DDS .


Overview

Systematic Review Conclusion

The 5-year survival for non-feldspathic porcelain veneers is estimated to be over 90%.

Critical Summary Assessment

A well-conducted systematic review suggests high 5-year and uncertain 10-year success rates for non-feldspathic porcelain veneers.

Evidence Quality Rating

Limited Evidence


Structured Abstract

Clinical Questions:

In patients who receive non-feldspathic porcelain veneers, what are the 5- and 10-year survival (success) rates?

Review Methods:

The authors searched four electronic databases up to June 2011 in all languages, hand searched six journals, and also searched for unpublished literature. Two authors independently selected and extracted data with disagreements resolved by discussion. The inclusion criteria were human subjects, prospective or retrospective cohort studies and controlled trials, greater than 15 patients, and at least a 5-year follow-up. The exclusion criteria were studies reporting duplicate data and unusual veneer design/preparation including excessive or no preparation. The authors defined survival as retreatment, major repair, or failed veneer not occurring within the follow-up time and failure as a disrupted marginal integrity, completely or partially lost, or retention that failed more than twice. Survival outcomes included minor smoothing of chipping that did not affect marginal integrity and follow-ups from the restoring dentist, referring dentists, and patients confirming no retreatment. The authors did not consider patient satisfaction, vitality, sensitivity, marginal staining and defects.

Main Results:

Of 4294 studies, the authors retained 10 studies for qualitative analysis and five studies (ranging between 17-70 subjects and 36-323 veneers) for quantitative analysis. The meta-analysis of four studies showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and a range between 66% to 94% (95% CI: 55% to 99%) for 10-year survival. Only two studies contributed to the 10-year survival. Data regarding other non-feldspathic porcelain materials were lacking with only a single study reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. No studies for eMax or Procera met the inclusion criteria. The sensitivity analysis showed data from one study had a stabilizing effect on the 5-year pooled estimate.

Conclusion:

The 5-year survival rate for non-feldspathic veneers was above 90%. Long term results are uncertain.

Source of Funding:

Source of funding is unknown


Commentary

Importance and Context:

Dentists have been offering porcelain veneers for the esthetic restorations of malpositioned, malformed, and discolored teeth since the early 1980s. The esthetic, functional and user demands have driven an increase in material options. Although there have been previous studies published on survival of non-feldspathic porcelain veneers, a systematic review summarizing the long term survival of non-feldspathic porcelain veneers is needed.

Strengths and Weaknesses of the Systematic Review:

The authors followed accepted methods to identify, screen according to specified inclusion and exclusion criteria, extract, and analyze data. They did not assess risks of bias, and studies were evaluated only by study design. A sensitivity analysis and publication bias was performed.

Strengths and Weaknesses of the Evidence:

The authors could only include five cohort studies in their quantitative analysis. The number of patients ranged between 17 and 70, and the average number of veneers per patient varied between two and 10. The studies also varied with respect to materials, preparation design, population length of follow-up, loss of follow-up, and clinical methodology, all of which created heterogeneity. Few studies reported longer than 10 years results, and beyond five years there was a lack of sufficient follow-up.

Implications for Dental Practice:

This systematic review suggests that non-feldspathic porcelain veneers have a high 5-year success rate over 90%, although e-Max or Procera veneers were not included. Findings are similar to traditional feldspathic veneers, which have been evaluated to have a 5- to 10-year survival rate of 96%.(1) There was insufficient evidence to evaluate the long term (10-year) success of non-feldspathic veneers. Future studies should report outcomes including complications, failures, and loss to follow-up with sufficient detail to facilitate meta-analyses. In addition, since eMax (lithium disilicate) is likely the most commonly used veneer, longer term studies using this material are also needed. 1. Layton DM, Clarke M, Walton TR. A systematic review and meta-analysis of the survival of feldspathic porcelain veneers over 5 and 10 years. Int J Prosthodont 2012;25:590?603.


Critical Summary Publication Date:

12/21/2014

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2018