Survival of Hybrid Laminate Veneers using two different tooth preparation techniques: Randomized Clinical Trial

Attia, Yara Sayed; Sherif, Rana Mahmoud; Zaghloul, Hanaa Hassan

doi:10.1590/0103-6440202103907

Yara Sayed Attia

Department of Fixed Prosthodontics, Faculty of Dentistry, Misr International University, Cairo, Egypt

http://orcid.org/0000-0002-1034-4996

Rana Mahmoud Sherif

Department of Fixed Prosthodontics, Faculty of Dentistry, Misr International University, Cairo, Egypt

http://orcid.org/0000-0003-3033-4100

Hanaa Hassan Zaghloul

Department of Fixed Prosthodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt

http://orcid.org/0000-0002-3271-4441

Correspondence: Yara Sayed Attia - Lecturer, Fixed Prosthodontics Department, Faculty of Oral and Dental Medicine, Misr International University, KM 28 Cairo - Ismailia Road Ahmed Orabi District, Postal Code 1, Cairo - Egypt. Email: yara-attia@hotmail.com

Figures (13)
Tables (9)

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Figure 1
(A) Pre-operative frontal smile. (B)Pre-operative frontal retracted view showing multiple spacing. (C)Digital smile design: drawing upper anterior teeth outlines. (D) Final result of the digital smile design.

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Figure 2
Construction of Group A veneers (A) Additive wax-up (B) Reductive Wax up: Tooth areas in extreme labial position that needed to be removed before construction of diagnostic wax-up (C) Spot etching (D) Silicon matrix filled with Bis-acrylic material seated inside patient's mouth (E) Finished Aesthetic Pre-evaluative Temporary (APT) (F) Depth Grooves performed through the APT (G) Finished tooth preparation (H) Cheek retracted view after cementation and finishing (I) Post operative Patient's smile

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Figure 3
Horizontal index sliced into incisal, Middle and cervical layers

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Figure 4
Tooth preparation for Group T veneers (A) Pre-operative photograph showing diastema. (B) Depth cuts performed directly on the tooth structure (C) Final Tooth preparation carried out directly on the tooth structure

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Figure 5
(A) Intra-oral scanning using Cerec Omnicam (B) Marking of prepation finish line(C) Veneers designed according to the scanned APT (D) Designed veneer ready for milling.

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Figure 6
Patients flow diagram including detailed information on the excluded participants.

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Figure 7
Bar chart representing marginal adaptation scores in the two groups.

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Figure 8
Bar chart representing marginal discoloration scores in the two groups

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Figure 9
Bar chart representing color match scores in the two groups

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Figure 10
Bar chart representing fracture scores in the two groups

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Figure 11
Bar chart representing gingival response scores in the two groups

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Figure 12
Bar chart representing post-operative sensitivity scores in the two groups

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Figure 13:
Bar chart representing patient satisfaction scores in the two groups

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Table 1
Modified United States Public Health Service Criteria

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Table 2
Results of USPHS criteria for evaluation of Group T and Group A veneers

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Table 3
Descriptive statistics and results of Fisher’s Exact test for comparison between marginal adaptation in the two groups

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Table 4
Descriptive statistics and results of Fisher’s Exact test for comparison between marginal discoloration in the two groups

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Time Group T (n = 27) Group A (n = 27) P-value Effect size (v) n % n % Base line NC† Alpha 27 100 27 100 3 months NC† Alpha 27 100 27 100 6 months 0.023* 0.354 Alpha 27 100 21 77.8 Bravo 0 0 6 22.2 12 months <0.001 0.5996 Alpha 7 25.9 23 85.2 Bravo 20 74.1 4 14.8 *: Significant at P ≤ 0.05, NC † : Not Computed because the variable is constant

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Table 6
Descriptive statistics and results of Fisher’s Exact test for comparison between fracture in the two groups

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Table 7
Descriptive statistics and results of Fisher’s Exact test for comparison between gingival response in the two groups

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Table 8
Descriptive statistics and results of Fisher’s Exact test for comparison between post-operative sensitivity in the two groups

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Table 9
Descriptive statistics and results of Fisher’s Exact test for comparison between post-operative sensitivity in the two groups

Outcome	Measuring Device	Score	Characteristics
Secondary caries	Visual inspection, explorer	-Alfa	-No evidence of caries at margin of restoration
		-Bravo	-Caries at the margin of restoration
		-Charlie	-N/A
Marginal adaptation	Visual inspection, explorer	-Alfa	-No visible evidence of crevice along margin, no catch or penetration of explorer
		-Bravo	-visible evidence of crevice and/or catch of explorer , no penetration of explorer
		-Charlie	-visible evidence of crevice and explorer penetration
Marginal discoloration	Visual inspection	-Alfa	-No discoloration at the margin
		-Bravo	-Superficial discoloration at the margin, does not penetrate in pulpal direction
		-Charlie	-Discoloration has penetrated along the margin in pulpal direction
Color match	Visual inspection, VITA shade guide, VITA Zahnbabrik	-Alfa	-No mismatch in color, shade, and/ or translucency between restoration and adjacent tooth
		-Bravo	-Mismatch between the restoration and tooth structure within normal range of color, shade and/ or translucency (<1 shade off)
		-Charlie	- Mismatch between the restoration and tooth structure outside normal range of color, shade and/ or translucency (>1 shade off)
Endodontic complications	Cold vitality test	Yes/No	-Vitality Negative
Endodontic complications	Cold vitality test	Yes/No	-Percussion positive
Fracture	Modified USPHS criteria	-Alfa	-None
		-Bravo	-Minimal/acceptable
		-Charlie	-Extensive/unacceptable
Crack	Visual inspection, explorer	-Alfa	-None
		-Bravo	-Minimal/acceptable
		-Charlie	-Extensive/unacceptable
Retention of the veneer	Modified USPHS criteria	-Alfa	-Bonded
		-Bravo	-Rebonded
		-Charlie	-Lost
Gingival Response	Visual inspection, periodontal probe	-Alfa	-Healthy
		-Bravo	-Calculus or gingivitis
		-Charlie	-Pocketing and bleeding present
Postoperative sensitivity	Explorer	-Alfa	-No symptoms
		-Bravo	-Slight sensitivity
		-Charlie	-Moderate pain
Patient satisfaction	Modified USPHS criteria	-Alfa	-High
		-Bravo	-Moderate
		-Charlie	-Not satisfied

Criteria	Score	Baseline				3 months				6 months				12 months
		T		A		T		A		T		A		T		>A
		n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Secondary caries	Alfa	27	100	27	100	27	100	27	100	27	100	27	100	27	100	27	100
	Bravo	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Marginal adaptation	Alfa	27	100	27	100	27	100	27	100	26	96.3	24	88.9	26	96.3	24	88.9
	Bravo	0	0	0	0	0	0	0	0	1	3.7	3	11.1	1	3.7%	3	11.1
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Marginal discoloration	Alfa	27	100	27	100	27	100	27	100	27	100	25	92.6	26	96.3	26	96.3
	Bravo	0	0	0	0	0	0	0	0	0	0	2	7.4	1	3.7	1	3.7
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Color match	Alfa	27	100	27	100	27	100	27	100	27	100	21	77.8	7	25.9	23	85.2
	Bravo	0	0	0	0	0	0	0	0	0	0	6	22.2	20	74.1	4	14.8
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Endodontic complications	Yes/No	No	No	No	No	No	No	No	No	No	No	No	No	No	No	No	No
Fracture	Alfa	27	100	27	100	26	96.3	27	100	26	96.3	26	96.3	26	96.3	26	96.3
	Bravo	0	0	0	0	1	3.7	0	0	1	3.7	1	3.7	1	3.7	1	3.7
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Crack	Alfa	27	100	27	100	27	100	27	100	27	100	27	100	27	100	27	100
	Bravo	0	0	27	100	0	0	0	0	0	0	0	0	0	0	0	0
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Retention of the veneer	Alfa	27	100	27	100	27	100	27	100	27	100	27	100	27	100	27	100
	Bravo	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Gingival Response	Alfa	27	100	27	100	23	85.2	22	81.5	23	85.2	23	85.2	23	85.2	24	88.9
	Bravo	0	0	0	0	4	14.8	5	18.5	4	14.8	4	14.8	4	14.8	3	11.1
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Postoperative sensitivity	Alfa	27	100	27	100	25	92.6	27	100	25	92.6	27	100	27	100	27	100
	Bravo	0	0	0	0	2	7.4	0	0	2	7.4	0	0	0	0	0	0
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Patient satisfaction	Alfa	27	100	27	100	27	100	27	100	25	92.6	24	88.9	27	100	27	100
	Bravo	0	0	0	0	0	0	0	0	2	7.4	3	11.1	0	0	0	0
	Charlie	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	27	100	27	100	NC^†
6 months					0.610	0.141
Alpha	26	96.3	24	88.9
Bravo	1	3.7	3	11.1
12 months					0.610	0.141
Alpha	26	96.3	24	88.9
Bravo	1	3.7	3	11.1

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	27	100	27	100	NC^†
6 months					0.491	0.196
Alpha	27	100	25	92.5
Bravo	0	0	0	7.4
12 months					1.000	0.000
Alpha	26	96.3	26	96.3
Bravo	1	3.7	1	3.7

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	27	100	27	100	NC^†
6 months					0.023*	0.354
Alpha	27	100	21	77.8
Bravo	0	0	6	22.2
12 months					<0.001	0.5996
Alpha	7	25.9	23	85.2
Bravo	20	74.1	4	14.8

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	26	96.3	27	100
Bravo	1	3.7	0	0
6 months					1.000	0.000
Alpha	26	96.3	26	96.3
Bravo	1	3.7	1	3.7
12 months					1.000	0.000
Alpha	26	96.3	26	96.3
Bravo	1	3.7	1	3.7

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	23	85.2	22	81.5
Bravo	4	14.8	5	18.5
6 months					0.491	0.196
Alpha	23	85.2	23	85.2
Bravo	4	14.8	4	14.8
12 months					1.000	0.000
Alpha	23	85.2	24	88.9
Bravo	4	14.8	3	11.1

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	25	92.6	27	100
Bravo	2	7.4	0	0
6 months					0.491	0.196
Alpha	25	92.6	27	100
Bravo	2	7.4	0	0
12 months					1.000	0.000
Alpha	27	100	27	100
Bravo

Time	Group T (n = 27)		Group A (n = 27)		P-value	Effect size (v)
Time	n	%	n	%	P-value	Effect size (v)
Base line					NC^†
Alpha	27	100	27	100	NC^†
3 months					NC^†
Alpha	27	100	27	100	NC^†
6 months					1.000	0.064
Alpha	25	92.6	24	88.9
Bravo	2	7.4	3	11.1
12 months					NC^†
Alpha	27	100	27	100	NC^†

[1] Correspondence: Yara Sayed Attia - Lecturer, Fixed Prosthodontics Department, Faculty of Oral and Dental Medicine, Misr International University, KM 28 Cairo - Ismailia Road Ahmed Orabi District, Postal Code 1, Cairo - Egypt. Email: yara-attia@hotmail.com

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Survival of Hybrid Laminate Veneers using two different tooth preparation techniques: Randomized Clinical Trial

Abstract