Clinical Performance of Minimally Invasive Monolithic Ultratranslucent Zirconia Veneers: A Case Series up to Five Years of Follow-up
There is a lack of reports in the literature on the long-term clinical performance of ultratranslucent zirconia, especially considering its use in manufacturing monolithic veneers. The purpose of this case series is to describe the aesthetic treatment steps of three patients with minimally invasive ultratranslucent zirconia veneers and to report the clinical findings up to five years. Three patients (woman: 2, man: 1; mean age: 30 years) unsatisfied with their dental aesthetics sought dental treatment. The treatment plan involved cementing ultratranslucent zirconia veneers. Air-abrasion was performed on the internal surface of zirconia with alumina particles coated by silica (silicatization), followed by silane and adhesive applications for the adhesive cementation. All veneers were adhesively cemented to enamel with resin cement (Variolink Esthetic, Ivoclar). The patients were clinically evaluated annually considering the Ryge modified/ California Dental Association criteria. After a mean follow-up of 4.33 years (4-5 years), a survival rate of 100% was detected for the 28 minimally invasive ultratranslucent zirconia veneers cemented in the 3 patients. There were no absolute failures such as debonding, veneer fracture, or secondary caries. Superficial marginal discoloration was observed in one element (maxillary left lateral incisor) of one patient. Ultratranslucent zirconia is a viable option for manufacturing veneers due to its excellent clinical performance and longevity. However, further long-term clinical studies are essential to consolidate this material as an option for esthetic restorations.SUMMARY
Frontal view of the initial facial appearance of the patients. (A) Patient #1. (B) Patient #2. (C) Patient #3.
Digital smile design (DSD) for determining tooth proportion, analyzing the gingival contouring, and planning the periodontal surgery.
(A) Waxed cast based on the DSD and index for the mock-up. (B) Front view of the mock-up simulating incisal and gingivoplasty.
(A) Removal of composite resin veneers before preparation. (B) Aspect after tooth preparation with the aid of the silicon index.
Digital design of ultrathin veneers in CAD software after scanning of the stone casts. (A) Front view. (B) Occlusal view.
Color selection of resin cement with try-in paste.
(A) Silicatization (CoJet, 3M ESPE) of ultrathin veneers. (B) Application of silane (Monobond Plus, Ivoclar Vivadent) and adhesive (Tetric N-Bond Universal; Ivoclar Vivadent).
(A) Enamel appearance after etching with phosphoric acid (35%). (B) Application of the adhesive system.
(A) Insertion of resin cement. (B) Light curing after removal of excess resin cement and application of glycerin gel at the margins of the veneers.
Clinical aspect of the initial smile and the ultrathin veneers after 5-years follow-up of patient #1. (A) Front view of the initial smile. (B) Front view and (C) lateral view of the smile with ultrathin veneers after 4-years. (D) Facial appearance (E) Lateral facial appearance with ultrathin veneers after 4 years.
Clinical aspect of the initial smile and the ultrathin veneers after 4-years follow-up of patient #2. (A) Front view of the initial smile. (B) Front view and (C) lateral view of the smile with ultrathin veneers after 4-years. (D) Facial appearance (E) Lateral facial appearance with ultrathin veneers after 4 years.
Clinical aspect of the initial smile and the ultrathin veneers after 4-years follow-up of patient #3. (A) Front view of the initial smile. (B) Front view and (C) lateral view of the smile with ultrathin veneers after 4-years. (D) Facial appearance (E) Lateral facial appearance with ultrathin veneers after 4 years.
Marginal discoloration detected in the left lateral incisor (patient #2).
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