OBJECTIVE: To evaluate the survival rate of minimally invasive semipermanent occlusal polymethyl methacrylate (PMMA) onlays/veneers in previous temporomandibular disorder (TMD) patients with severe tooth wear and with a loss of vertical dimension after up to 7 years.
METHODS: This case series was designed as a follow-up evaluation with consecutive patient recruitment. All patients bearing the indication for this kind of rehabilitation were treated by the same clinician using the same adhesive methodology. The study included 22 patients (3 men/19 women), with a mean ± SD age of 50.7 ± 11.6 years. Controls followed within the first 4 weeks (and subsequently as required). Failure criteria included damage by fracture, chipping, and retention loss. Survival rates were determined based on the Kaplan-Meier analysis.
RESULTS: 328 semipermanent occlusal/incisal veneers were included (142 maxillary/186 mandibular teeth). Almost 80% of the restorations were in place and in function when starting the follow-up treatment after 180 days; failures predominantly occurred within the first 3 to 6 months but proved reparable. Depending on the patients\' priorities, scheduled replacements followed successively, and more than 65% did not show repair or any renewal needs for more than 360 days.
CONCLUSIONS: Within the limitations of this study the survival rates of occlusal veneers made of PMMA were sufficiently high to allow for consecutive treatment of the respective teeth by means of permanent restorations while preserving the restored vertical dimension. In patients with severe tooth wear and a TMD history, semipermanent restorative therapy with occlusal PMMA onlays/veneers would seem a noteworthy option.

OBJECTIVE: The aim of the study is measuring the magnitude and determining the method of finger pressure exerted by doctors on ceramic veneers during their fixation.
METHODS: A simulation model was designed in order to measure the volume of finger pressure. Veneers were produced for 2 central incisors. Doctors alternately placed veneers on the model and applied pressure on them for 20 seconds simulating the clinical stage of cementing. The operator recorded the maximum readings of the scales and entered the result on the research protocol. In addition, it was recorded which finger the doctor exerts on the veneer during its cementing to ensure a tight fit: thumb or index finger.
RESULTS: The values obtained during cementation of 54% doctors ranged up to 1 kg, 27% of doctors from 1 to 2 kg and only 19% more than 2 kg. 80% of doctors applied the main pressure on the veneer using their thumb, while the pressure force was 1.4 kg. For those doctors who pressed the veneer to the tooth with their index finger, the impact value was 0.8 kg.
CONCLUSIONS: The finger pressure on the veneer during cementation applied by dentists varies, the average pressure on the veneers was about 1.5 kg. The amount of pressure on cement during laboratory tests of cements for fixing veneers differs from clinical values many times. The development of a veneers fixation protocol, taking into account the conducted research, will ensure a reliable and accurate fit of the veneer at the stage of its cementing.
UNASSIGNED: Измерение величины и определение способа пальцевого давления, оказываемого врачами на керамические виниры во время их фиксации.
UNASSIGNED: Для измерения величины пальцевого давления была спроектирована симуляционная модель. На 2 центральных резца были изготовлены виниры. Врачи поочередно устанавливали виниры на модель и в течение 20 с на них оказывали давление, имитируя клинический этап цементирования. Оператор регистрировал максимальные показания весов и заносил полученный результат в протокол исследования. Кроме того, фиксировали, каким именно пальцем врач оказывает воздействие на винир во время его цементирования для обеспечения плотной посадки: большим или указательным.
UNASSIGNED: Установлено, что 54% врачей во время цементирования оказывают давление на винир до 1 кг, 27% врачей — от 1 до 2 кг, и только 19% врачей — более 2 кг; 80% врачей оказывали основное давление на винир, используя большой палец, при этом сила прижимного давления составила 1,4 кг. У врачей, которые прижимали винир к зубу указательным пальцем, величина воздействия была 0,8 кг.
UNASSIGNED: Пальцевое давление на винир во время его цементирования у разных врачей имеет существенные различия, в среднем давление на виниры составило около 1,5 кг. Давление на цемент во время лабораторных испытаний цементов для фиксации виниров отличается от клинических величин многократно. Разработка протокола фиксации виниров с учетом поведенных исследований обеспечит надежную и точную посадку винира на этапе его цементирования.

OBJECTIVE: During the manufacturing of Porcelain Veneered Zirconia (PVZ) dental crowns, the veneer-core system undergoes high-temperature firing cycles and gets fused together which is then, under a controlled setting, cooled down to room temperature. During this cooling process, the mismatch in thermal properties between zirconia and porcelain leads to the development of transient and residual thermal stresses within the crown. These thermal stresses are inherent to the PVZ dental crown systems and render the crown structure weak, acting as a precursor to veneer chipping, fracture, and delamination. In this study, the introduction of an intermediate functionally graded material (FGM) layer at the bi-material interface is investigated as a potentially viable alternative for providing a smoother transition of properties between zirconia and porcelain in a PVZ crown system.
METHODS: Anatomically correct 3D crown models were developed for this study, with and without the FGM layer modeled at the bi-material interface. A viscoelastic finite element model was developed and validated for an anatomically correct bilayer PVZ crown system which was then used for predicting residual and transient stresses in the bilayer PVZ crown. Subsequently, the viscoelastic finite element model was further extended for the analysis of graded sublayers within the FGM layer, and this extended model was used for predicting the residual and transient stresses in the functionally graded PVZ crown, with an FGM layer at the bi-material interface.
RESULTS: The study showed that the introduction of an FGM layer at the bi-material interface has the potential to reduce the effects from transient and residual stresses within the PVZ crown system relative to a bilayer PVZ crown structure. Furthermore, the study revealed that the FGM layer causes stress redistribution to alleviate the stress concentration at the interfacial surface between porcelain and zirconia which can potentially enhance the durability of the PVZ crowns towards interfacial debonding or fracture.
CONCLUSIONS: Thus, the use of an FGM layer at the bi-material interface shows a good prospect for enhancing the longevity of the PVZ dental crown restorations by alleviating the abrupt thermal property difference and relaxing thermal stresses.

OBJECTIVE: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers.
METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate.
RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of \'pain\', \'occlusal discomfort\', \'uncomfortable to eat\', \'diet unsatisfactory\' and \'interrupted meals\' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%.
CONCLUSIONS: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth.
CONCLUSIONS: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

OBJECTIVE: To compare the fracture resistance and failure mode of porcelain laminate veneers with different preparation depths in endodontically treated teeth.
METHODS: Root canal treatment was performed for 40 maxillary central incisors, and then the teeth were divided into four groups (n= 10). The preparation depths were as follows: Group A: 0.9 mm, Group B: 0.6 mm, Group C: 0.3 mm, and in all three groups, 2 mm butt joint incisal reductions were performed; Group D was a control group with no preparation. Then 30 lithium disilicate porcelain veneers were milled by CAD- CAM method and cemented. After that, all specimens were subjected to cyclic loading and thermal cycling and finally were tested by a universal testing machine until failure occurred.
RESULTS: The mean failure loads (N) after exposure to continuous load were as follows: Group A: 625.70 (401.45-1037.77), Group B: 780.32 (222.93-1391.82), Group C: 748.81 (239.68-1241.87) and Group D (control) : 509.88 (84.42-1025.85) and P= 0.216. Analysis of failure mode in four groups showed that P= 0.469. There was no significant difference between the control and the other groups. In this study, 0.3, 0.6 and 0.9 mm depths of preparation for porcelain laminate veneers for endodontically treated teeth had no significant difference in fracture resistance and failure mode with non-prepared teeth.
CONCLUSIONS: Reasonable consideration might be given to porcelain laminate veneer treatment for teeth that have become discolored and resistant to bleaching (such as instances where discoloration is severe following root canal treatment). This approach is considered to be on the conservative side, and has demonstrated that a labial preparation depth reduction of up to 0.9 mm does not have any impact on the failure mode or fracture resistance of endodontically-treated teeth.

OBJECTIVE: The main aim of the present study was to compare and evaluate the effect of repetitive firings on different shades of a pressable all ceramic system layered with veneering porcelain.
METHODS: In-vitro comparative study.
METHODS: An in vitro comparative study was conducted, and a total of 60 disc shaped specimens (15 mm in diameter and 0.8 mm in thickness) were made of heat pressed ceramic of shades A2, A3, and B2 (20 discs of each shade) grouped as Group I, II, and III, respectively, using the lost wax technique. The discs were subsequently layered with veneering porcelain followed by glazing and overglazing and underwent a firing cycle at each step until six times combined. CIE L*a*b* measurements were noted on each sample after the third, fourth, fifth, and sixth firing using VITA Easyshade Advance 4.0 spectrophotometer.
METHODS: Statistical Analysis was done by SPSS 17.0 software. One way analysis of variance, multiple comparisons using the Tukey test, and descriptive statistical analysis were done for all the groups in the study. P <0.05 was statistically significant.
RESULTS: The mean color differences for the repeated firings were imperceptible (ΔE <1.67) to the human eye for all ceramic samples tested except between the fourth and fifth firing of Group II (shade A3).
CONCLUSIONS: The analysis revealed that although repeated firings lead to changes in L*, a*, and b* values, the mean color difference was below the clinically acceptable color change (ΔE <3.7).

BACKGROUND: Self-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass-ceramic veneers made by either pressing (PG) or milling (MG) process.
METHODS: Fifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.
RESULTS: A total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).
CONCLUSIONS: SZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

BACKGROUND: The type of veneer preparation is often chosen according to the patient\'s tooth structure and occlusion. Taking biomechanics into account in this decision-making process provides the clinician with more technical information on how to improve the clinical longevity of restorations. However, biomechanical analyses of veneer preparation designs are sparse.
OBJECTIVE: The purpose of this 3-dimensional (3D) finite element analysis with microcomputed tomography (µCT) data obtained from realistic models was to assess the influence of different preparations for ceramic and composite resin veneers on restoration and resin layer stress distribution.
METHODS: Four replicas of a central incisor were printed and prepared for laminate veneers with 4 different incisal edge designs: shoulder (SH), palatal chamfer (PC), palatal chamfer and oblique fracture involving the distal angle (OF-PC), and palatal chamfer involving horizontal incisal fracture (IF-PC). After fabrication and cementation of the veneers, the restored replicas were assessed with µCT, and 3D finite element models were built. A 100-N load was applied on the palatal surface at 60 and 125 degrees relative to the longitudinal axis. Maximum principal stress and stress distribution on the veneers, cement layer, and tooth structure were calculated and analyzed.
RESULTS: The SH preparation exhibited better stress distribution than the PC preparation, and the cement layer and the veneer were subjected to lower stress. The IF-PC preparation had better stress distribution than the OF-PC. The shoulder and IF-PC showed higher stress on laminate veneers, but lower stress on the cement layer. Ceramic veneers exhibited lower stress than composite resin veneers.
CONCLUSIONS: The different incisal preparations for laminate veneers influenced stress distribution on restorations and on the resin cement layer. The shoulder type preparation showed better stress distribution and the composite resin veneers showed unfavorable results compared with the ceramic veneers.

BACKGROUND: The authors evaluated the prognostic factors associated with pulp status in patients with cracked teeth (CT) treated with occlusal veneer.
METHODS: An analysis of 80 CT (71 patients) with 1 or more crack lines (CLs) and normal pulp vitality or reversible pulpitis was performed. All patients received occlusal veneer and their demographic and clinical data were recorded. Pulp status and clinical features were recorded at 1 week and posttreatment at 1, 2, 3, 6, 12, 18, and 24 months.
RESULTS: Maxillary first molars were commonly involved (30 [38%]). The number of CLs on the finish line ranged from 1 through 7 and most had 3 CLs (24 [30%]). The number of CLs through preparation on the finish line ranged from 0 through 4, and 2 CLs (42 [53%]) were the most prevalent. During follow-up, 5 of 80 CT progressed to pulp disease, resulting in a success rate of 93.8%. Results of the Cox model and Kaplan-Meier analysis showed that probing depth greater than 6 mm, widening periodontal ligament of apical area, more than 4 CLs on finish line, and more than 2 CLs through preparation on the finish line were risk factors associated with pulp status (P < .05).
CONCLUSIONS: Occlusal veneer can protect CT without preventive root canal therapy.
CONCLUSIONS: The success rate and risk factors of pulp disease in CT restored with occlusal veneer are reported.

The present study aims to examine the influence of the build angle on the accuracy (trueness and precision) of 3D printed crowns, table-tops and veneers with a hybrid resin-ceramic material.
One crown, on table-top and one veneer were printed in five different build angles (0°, 30°, 45°, 60°, 90°) (n = 50) with the digital light processing (DLP) system (Varseo XS, Bego) using hybrid resin (Varseo Smile Crownplus A3, Bego). All printed restorations were scanned using the laboratory scanner (D2000, 3Shape) and matched onto the initial reference design in metrology software (Geomagic Control X, 3D Systems). The root mean square error (RMSE) was calculated between the scanned and reference data. The data was statistically analyzed using the Tukey multiple comparison test and Wilcoxon multiple comparison test.
The crown group showed higher trueness at 30° (0.021 ± 0.002) and 45° (0.020 ± 0.002), and table-tops at 0° (0.015 ± 0.001) and 30° (0.014 ± 0.001) (p < 0.0001). Veneers demonstrated higher trueness at 30° (0.016 ± 0.002) (p < 0.0001). All three restoration types demonstrated the lowest trueness at a 90° build angle and portrayed deviations along the z axis. The veneer and table-top groups showed the lowest precision at 90° (veneers: 0.021 ± 0.008; table-tops: 0.013 ± 0.003). The crown group portrayed the lowest precision at 45° (0.017 ± 0.005) (p < 0.0001).
The build angle of DLP-printed hybrid resin-ceramic restorations influences their accuracy.
Considering the build angle is important to achieve a better accuracy of 3D-printed resin-ceramic hybrid restorations. This may help predict or avoid the interference points between a restoration and a die and minimize the clinical adjustments.