1Effect of porcelain and enamel thickness on porcelain veneer failure loads

in vitro.

Ge C1, Green CC2, Sederstrom D3, McLaren EA4, White SN5.

Author information
Abstract
STATEMENT OF PROBLEM:
Bonded porcelain veneers are widely used esthetic restorations. Although high success
and survival rates have been reported, failures occur. Fracture is the most common failure
mode. Fractures range from incomplete cracks to the catastrophic. Minimally invasive or
thin partial veneers have gained popularity.

PURPOSE:
The aim of this study was to measure the influences
of porcelain veneer thickness and enamel substrate thickness on the loads needed to
cause the initial fracture and catastrophic failure of porcelain veneers.

MATERIAL AND METHODS:

Model discoid porcelain veneer specimens of varying thickness were bonded to the
flattened facial surfaces of incisors, artificially aged, and loaded to failure with a small
sphere. Individual fracture events were identified and analyzed statistically and
fractographically.

RESULTS:
Fracture events included initial Hertzian cracks, intermediate radial cracks, and
catastrophic gross failure. Increased porcelain, enamel, and their
combined thickness had like effects in substantially raising resistance to catastrophic
failure but also slightly decreased resistance to initial Hertzian cracking. Fractographic
and numerical data demonstrated that porcelain and tooth enamel behaved in a
remarkably similar manner. As porcelain thickness, enamel thickness, and their
combined thickness increased, the loads needed to produce initial fracture and
catastrophic failure rose substantially. Porcelain veneers withstood considerable damage
before catastrophic failure.

CONCLUSIONS:
Increased enamel thickness, increased porcelain thickness, and increased
combined enamel and porcelain thickness all profoundly raised the failure loads
necessary to cause catastrophic failure. Enamel and feldspathic porcelain behaved in a
like manner. Surface contact damage occurred initially. Final catastrophic failure followed
flexural radial cracking. Bonded porcelain veneers were highly damage tolerant.

Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by
Elsevier Inc. All rights reserved.
2Comparative evaluation of fracture resistance of Ceramic Veneer with three
different incisal design preparations - An In-vitro Study.

Jankar AS1, Kale Y2, Kangane S3, Ambekar A3, Sinha M4, Chaware S5.
Author information
Abstract
BACKGROUND:
Ceramic veneer fracture has occurred mainly at the incisal edge of the veneer because of
greater stress. This study compares and evaluates the fracture resistance ceramic
veneers with three different incisal preparations.

MATERIALS & METHODS:

15 human permanent maxillary central incisor extracted were selected which were divided
into three groups of 5 each having a different Incial design Preparation. Group 1: No
Incisal reduction with facio- incisal bevel, Group 2 : 1 mm incisal reduction with butt joint,
Group 3 : 1 mm incisal reduction with 1 mm height of Palatal chamfer. It was found that
Group III had greater fracture resistance as compared to Group I and Group II. Group I
had least fracture resistance as compared to Group II and III. Group II had greater fracture
resistance as compared to Group I but less than Group III.

RESULTS:
Ceramic veneer with 1mm incisal reduction with 1mm height of palatal chamfer showed
highest fracture resistance as compared to 1mm incisal reduction with butt joint and no
incisal reduction with facial-incisal bevel, in order to achieve better esthetic and functional
results.

CONCLUSION:
The palatal chamfer margin results in preservation of some peripheral enamel layer, which
eliminates the micro leakage at the palatal margin-restoration interface and also
effectively counteracting shear stress. This design provides a definite seat for
cementation. How to cite the article: Jankar AS, Kale Y, Kangane S, Ambekar A, Sinha
M, Chaware S. Comparative evaluation of fracture resistance of Ceramic Veneer with
three different incisal design preparations - An In-vitro Study. J Int Oral Health
2014;6(1):48-54.
KEYWORDS:

Ceramic veneer; esthetics; fracture resistance; incisal design

3Fracture resistance of ceramic veneers with different preparation designs.
Akoğlu B1, Gemalmaz D.
Author information
Abstract
PURPOSE:
The purpose of this study was to examine the fracture load of ceramic veneers with
different preparation designs.
MATERIALS AND METHODS:
Seventy-five extracted, intact, human maxillary central incisors were prepared according
to five preparation designs (P) (n: 15) as follows: (1) P2e: 2-mm incisal reduction,
preparation entirely in enamel; (2) P4e: 4-mm incisal reduction, preparation entirely in
enamel; (3) P2d: 2-mm incisal reduction, preparation entirely in dentin; (4) P4d: 4-mm
incisal reduction, preparation entirely in dentin; and (6) Pc: Unrestored, intact teeth as
control. All preparations had a butt joint incisal finish line, rounded internal line angles,
and cervical finish lines 1 mm above the cementoenamel junction. Ceramic veneers were
fabricated with IPS Empress (Ivoclar Vivadent AG, Schaan, Liechtenstein) and cemented
with Syntac Classic Adhesive system and Variolink II (Ivoclar) resin
cement. Veneers were loaded until fracture at a 90° angle to the lingual surface of the test
tooth following the thermocycling process (5° to 55°, 3500 times). Statistical analyses
were performed using analysis of variance (ANOVA) and Tukey's Multiple Range Test.
RESULTS:
The mean fracture loads (SD) were (in N) as follows: (1) P2e: 262 (63); (2) P4e: 189 (40);
(3) P2d: 239 (53); (4) P4d: 162 (36); and (5) Pc: 277 (66). The amount of incisal reduction
exhibited a significant influence on fracture resistance regardless of the preparation depth
(p < 0.05).
CONCLUSIONS:
Ceramic veneers with preparation designs entirely on dentin with 4-mm incisal reduction
yielded lower fracture loads than those prepared with 2-mm incisal
reduction. Veneers with 2-mm incisal reduction exhibited fracture resistance similar to
that of intact teeth for preparation designs supplied on both enamel and dentin.
4. In vitro evaluation of the fracture resistance and microleakage of porcelain
laminate veneers bonded to teeth with composite fillings after cyclic loading.

Sadighpour L1, Geramipanah F2, Allahyari S1, Fallahi Sichani B3, Kharazi Fard MJ4.
Author information
Abstract
PURPOSE:
There is insufficient data regarding the durability of porcelain laminate veneers bonded to
existing composite fillings. The aim of the present study was to evaluate
the fracture resistance and microleakage of porcelain laminate veneers bonded to teeth
with existing composite fillings.

MATERIALS AND METHODS:

Thirty maxillary central incisors were divided into three groups (for each group, n=10):
intact teeth (NP), teeth with class III composite fillings (C3) and teeth with class IV cavities
(C4). Porcelain laminate veneers were made using IPS-Empress ceramic and bonded
with Panavia F2 resin cement. The microleakage of all of the specimens was tested before
and after cyclic loading (1 × 10(6) cycles, 1.2 Hz). The fracture resistance values (N) were
measured using a universal testing machine, and the mode of failure was also examined.
The statistical analyses were performed using one-way ANOVA and Tukey post hoc tests
(α=.05).

RESULTS:
There was a significant difference in the mean microleakage of group C4 compared with
group NT (P=.013). There was no significant difference in the fracture loads among the
groups.

CONCLUSION:
The microleakage and failure loads of porcelain laminate veneers bonded to intact teeth
and teeth with standard class III composite fillings were not significantly different.

KEYWORDS:

Fracture resistance; Microleakage; Porcelain laminate veneer

PMID:
ORIGINAL ARTICLE

Year : 2017 | Volume : 17 | Issue : 4 | Page : 325-331

5. Evaluation of fracture resistance of ceramic veneers with different preparation

designs and loading conditions: An in vitro study

Aman Arora, Viram Upadhyaya, Sheen J Arora, Prachi Jain, Avneet Yadav
Department of Prosthodontics, J.N. Kapoor D.A.V. (C) Dental College, Yamuna Nagar,
Haryana, India

04-Feb-
Date of Submission
2017
15-Jul-
Date of Acceptance
2017
Date of Web 3-Nov-
Publication 2017

Correspondence Address:
Prachi Jain
Department of Prosthodontics, J.N. Kapoor D.A.V. (C) Dental College, Yamuna Nagar -
135 001, Haryana
India

Abstract

Purpose: The purpose of this study was to evaluate the effect of incisal butt joint and
incisal overlap design on the fracture resistance of ceramic veneers under two different
loading conditions, i.e., 125° and 60° representing protrusive and intercuspal movements,
respectively.
Materials and Methods: Thirty-two maxillary central incisors were divided into two
groups of sixteen specimens each and were prepared with incisal butt joint and incisal
overlap design. Ceramic veneers were fabricated and cemented. Both the groups were
further divided and mechanical testing to evaluate the fracture resistance were done using
the universal testing machine. The values were recorded in Newton along with the
assessment of the failure mode of both veneer and the tooth.
Results: Unpaired t-test showed a significant difference (P < 0.05) with butt joint design
having higher fracture resistance than palatal overlap design with the mean value of
409.50N at 60° angle and 473.37N at 125° angle. Paired t-test depicted a significant
difference for both the designs at 125° than at 60° angle (P < 0.05). Chi-square analysis
showed more number of intact veneers with butt joint design; however, there was no
significant difference (P > 0.05). Failure mode of teeth showed more number of coronal
fracture followed by cervical fracture and root fracture, but there was no significant
difference between the two groups (P > 0.05).
Conclusion: Butt joint design had higher fracture resistance than palatal overlap design.
Under functional loads for both designs, fracture resistance was higher at 125° than at
60° angle.

Keywords: Ceramic veneers, incisal butt joint, incisal overlap

How to cite this article:

Arora A, Upadhyaya V, Arora SJ, Jain P, Yadav A. Evaluation of fracture resistance of
ceramic veneers with different preparation designs and loading conditions: An in
vitro study. J Indian Prosthodont Soc 2017;17:325-31

How to cite this URL:

Arora A, Upadhyaya V, Arora SJ, Jain P, Yadav A. Evaluation of fracture resistance of
ceramic veneers with different preparation designs and loading conditions: An in
vitro study. J Indian Prosthodont Soc [serial online] 2017 [cited 2017 Dec 12];17:325-31.
Available from: http://www.j-ips.org/text.asp?2017/17/4/325/217286
6. Effect of newly Developed Resin Cements and Thermocycling on the Strength of
Porcelain Laminate Veneers.
Alqahtani FI1.

Author information

Abstract

AIM:

The aim of this study was to determine the effect of different luting cements and
accelerated artificial aging (AAA) in the fracture resistance of porcelain
laminate veneers (PLVs).

MATERIALS AND METHODS:

A total of 80 disc-shaped specimens were prepared using computer-aided

design/computer-aided milling technology from lithium disilicate glass-ceramic blocks.
Specimens (0.5 mm thick, 10 mm diameter) were divided into eight groups of 10
specimens per group. The control groups consisted of specimens without cement and not
subjected to AAA (CN group) and specimens prepared without cement but subjected to
AAA (CW group). The experimental groups were subjected to AAA and cemented with
Variolink Veneer, Variolink Esthetic LC, Variolink Esthetic DC, RelyX Unicem, RelyX
Veneer, or RelyX Ultimate. Specimens were individually tested for biaxial flexure on a
universal testing machine. One-way analysis of variance and the Tukey's post hoc test
were used to compare the groups' significance statistically (α = 0.05).

RESULTS:

The loads to fracture (LTF) values in the CN group were higher than those in the CW and
experimental groups. The lowest LTF value was in the CW group (31.5 ± 9.5 N) and the
highest LTF value in the CN group (56.7 ± 10.6 N). Tukey's post hoc test demonstrated a
statistically significant (p < 0.01) difference between the CN group and the other groups.
CONCLUSION:

Artificial aging had a significant effect on the LTF value of the tested specimens compared
with the resin cements used. Cohesive failure within the PLVs was the most common
mode of failure.

CLINICAL SIGNIFICANCE:

Fatigue strength of dental ceramics and moisture was shown to affect the mechanical
properties of all-ceramicrestorations. All-ceramic material is extremely sensitive to
humidity and thermocycling.

KEYWORDS:

Ceramic restoration; Fracture resistance; Laminate veneer; Loads to fracture; Porcelain

veneer Thermocycling.
7. Fracture resistance and marginal discrepancy of porcelain laminate veneers
influenced by preparation design and restorative material in vitro
Author links open overlay panelTai-MinLinaPerng-RuLiubLance C.RampcMilton
E.EssigcDaniel A.GivanbYu-HwaPand
Show more
https://doi.org/10.1016/j.jdent.2011.12.008Get rights and content
Abstract
Objectives
The purpose of this investigation is to evaluate marginal discrepancy and fracture
resistance of two veneering materials using two preparation designs.
Methods
Two veneer preparation designs (full and traditional) were restored with leucite-reinforced
ceramic (ProCAD, Ivoclar Vivadent, Amherst, NY) milled by CAD/CAM (Cerec 3D milling
system, Serona Dental Systems), and conventional sintered feldspathic porcelain
(Noritake Super Porcelain EX3, Noritake Dental Supply Co). Forty-eight specimens were
analysed with a sample size of n = 12 per group. The thickness of each veneer was
measured on four specific surfaces. Marginal discrepancy was evaluated with a replica
technique and cross-sectional view using a digital microscope. The fracture resistance of
veneers cemented on standardised composite resin dies was evaluated using a universal
testing machine. Results were analysed with ANOVA, Tukey–Kramer post hoc testing,
and linear regression.
Results
The results of this investigation revealed no correlation between the thickness and
marginal discrepancy of the veneers. The full preparation design with ProCAD and the
traditional preparation design with feldspathic porcelain manifested smaller gap. Fracture
resistance was decreased for the full preparation design with feldspathic porcelain.
Conclusions
In terms of marginal discrepancy and fracture resistance, the most favourable combination
was a traditional veneer preparation design with conventional sintered feldspathic
porcelain. For the full veneer preparation, a stronger ceramic material such as ProCAD is
suggested.
Keywords
Traditional veneer
Full veneer
Fracture resistance
Marginal discrepancy
Sintered feldspathic porcelain
CAD/CAM
Resin tooth replica
Cross-sectional view
Ratio of elastic modulus
8. Fracture Resistance of Laminate Veneers Made with
Different Cutting and Preparation Techniques
International Journal of Dental Sciences and Research

Vol. 4, No. 3, 2016, pp 42-48. doi: 10.12691/ijdsr-4-3-3 | Research Article

Mustafa Duzyol1, , Esra Duzyol2, Nilgun Seven3

1
Gaziantep University, Faculty of Dentistry, Department of Restorative Dentistry,
Gaziantep, Turkey
2
Ataturk University, Faculty of Dentistry, Department of Pediatric Dentistry, Erzurum,
Turkey
3
Ataturk University, Faculty of Dentistry, Department of Restorative Dentistry, Erzurum,
Turkey
Abstract

Introduction: The purpose of this study was to evaluate the fracture resistance of most used three
preparation techniques applied laminate veneers made with three different restoration methods.
Materials and Methods: 195 same sized maxillary central incisor teeth were grouped 10 different
groups randomly. (testing groups n=20, control group n=15) Three different preparation techniques
used for teeth preparation which were feather-edge, insical overlap and window. Laminate veneers
were produced with three different methods that direct, indirect technique, and CAD/CAM milling.
Control group was chosen from untreated teeth. Universal testing machine was used for fracture
resistance test. Data were analyzed with two-ways ANOVA and Tukey LSD. Results: According to
results, statistically differences were found between all groups.(p<0,05) Combination of insical
overlap preparation and direct technique has higher fracture resistance values than other
groups.(563,9 N). Conclusions: Preparation and restoration techniques are important for fracture
resistance of laminate veneers.
Keywords: CAD/CAM, laminate veneer, fracture resistance, resin composite, resin nano ceramics
Copyright © 2016 Science and Education Publishing. All Rights Reserved.

Introduction

Personal appearance is getting more and more important in society as it is the aesthetic
aspect that is primarily realized in people. A properly formed smile line and teeth that are
aligned and contoured in accordance with this line are considered the most important factors
that affect appearance. Orthodontic, periodontal and restorative operations are performed
together or separately in patients, who make this request.

Treatments administered depend on the age of the patient, the relationship of the teeth to
adjacent tissue and teeth, the skills of the dentist, socioeconomic status of the patient, cause
of the aesthetic problem and the material to be used. Aesthetic restorative treatments are
the most preferred methods.

Dr. Frank Faunce defined acrylic prefabricated laminate veneers in the 70's. In 1975,
Rochette suggested using resin connected ceramics on anterior teeth. In 1983, Horn, in
1987 Hobo and Iwata attempted platinum folio and castable porcelain as a means to produce
porcelain laminate veneers. As better adhesion was achieved with silane application, this
was used more commonly and more materials are used for this application.

Laminate veneers are made using two techniques. Direct laminates are made by placing
resin composite material on tooth in the clinic. Indirect laminate veneers are made by
applying porcelain or resin composite on the models based on the patient and administered
on the patient by using an adhesive agent. [1]

One of these two methods shall be chosen considering the severity of the dental problem,
technical sensitivity and costs. In addition to these considerations, the restoration material
to be used may be subject to change after it is determined if the existing aesthetics problem
is limited to dentine or not.

Laminate veneers should be prepared with special cut drills and within the boundaries of the
dentine. There are four different cutting techniques that can be used in this manner and be
chosen in accordance with the event. These are:

• In-dentine window technique: This is a cutting technique applied by leaving 1 mm openings

at all edges of the teeth and by remaining within the healthy dentine section. These are
generally used in acrylic resin laminate veneers.

• Feather edge incisal cutting technique: This technique is applied with abrasion on the facial
surface without shortening the cutting edge of the tooth. This is terminated at the incisal
edge.

• 30 – 40 ° angled incisal bevel cutting technique: In addition to the abrasion on the facial
surface, the incisal edge of the tooth is shortened by 1.5 mm and added to the preparation.

• Incisal overlap (cutting including the whole incisal edge, terminated at the palatine of the
tooth) technique: The cutting edge of the tooth is shortened by 2 mm and this cutting
technique includes 1.5-2 mm of the palatine of the tooth. [2]
Direct composite veneers have several advantages such as protecting dental tissue, superior
physical characteristics, acceptable edge compatibility and sufficient aesthetic
characteristics. Also, when compared with porcelain restorations, resin composites are less
risky in terms of catastrophic fractures and have a less abrasive effect. It costs less when
compared to the indirect method. One of the most important characteristics of this method
is that it is reversible. [1]

Indirect composite laminate veneers are applied in the laboratory on the model prepared in
accordance with the measurements taken after cavity preparation. They are polymerized in
the furnaces in the laboratory, which use various polymerization techniques. There are
secondary and high polymerization furnaces in form of pressure-heat-light and heat-light.
In systems that provide high polymerization, light is used on the restoration placed inside
the polymerization beads for 4-6 minutes and then heat is applied under 60 psi pressure at
130°C in water for 10-12 minutes. This type is the polymerized composite resin with
composite homogenous micro and hybrid filling and is less porous and has better color
stabilization compared to the polymerized nanofilled composite resin. Also, as this type
reaches high polymerization values, shrinkage and amount of residual monomers are scarce.
Laminate veneers prepared in the laboratory are fixated using dual-cure resin cement. [3]

As resin composites are fixed with adhesive, they are better at transmitting the stress
imposed on the restoration compared to the ceramic types due to their low elasticity
modules. Also marginal discoloration, secondary decays, postoperative complaints and
microleaks causing pulpal problems have been reduced.

CAD/CAM stands for computer aided design/computer aided milling. Dr. Duret, Dr. Anderson
and Dr. Mörmann have created dental CAD/CAM systems with the studies they have
conducted. After these pioneer scientists, dental CAD/CAM systems have progressed rapidly
and their scope of indications has grown.

Today, laminate veneer, inlay, onlay, bridgeworks, structures of partial denture, personal
implants, implant supported dentures and crowns can be made. In this system, prefabricated
blocks are used for drilling. These blocks may be manufactured for various indications with
various content such as ceramics, metal alloys, zirconium oxide and resin.

The purpose of our study is to perform a comparative evaluation of the fracture resistance
data of laminate veneers prepared using the most common cutting types and production
techniques in literature and clinical practice.

In this study, our hypothesis is that different cutting techniques and different preparation
methods can affect the fracture resistance of laminate veneers.

2. Materials and Methods

 The effect of certain cutting techniques and various restoration materials used in laminate
veneers on the fracture resistance was experimented in vitro. 195 same sized, freshly pulled
out, maxillary central incisor teeth, without any decay, defect or cracking, with a crown
length of 12 mm and mesiodistal width of 9 mm were used in this study. After the residues
on the teeth were removed, the healthy ones without restoration were included in the control
group. (n=15) 20 teeth were included in each group randomly. The Power analysis was
performed using the universal software (SPSS 20.0, IBM, Chicago, USA) in order to
determine if the amount of samples in the control group affect the statistical analysis.

60 of the samples prepared using the window type, feather and incisal overlap cutting
techniques were restored using resin nano ceramic based blocks, 60 of the samples were
restored using indirect composite resin and 60 were restored with nanohybrid composites.
A braking resistance test was performed on the samples prepared, in accordance with the
literature. Groups determined for fracture resistance test are provided in Table 1.
Table 1. Cutting techniques and production methods by group numbers

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2.1. Preparation of Samples

For standardization, a drilling set specific for laminate veneer preparation (Laminate Veneer
Set, Axis, Kerr, Texas, USA) was used. Guiding grooves were created on the facial surfaces
of teeth 0.3 mm wide at cervical 1/3, 0.5 mm wide at middle and incisal 1/3, using depth
determination drills numbered M834-016 and M834-021 (Axis, Texas, USA). Diamond burr
numbered H284K-016 (Axis, Texas, USA) was used on the preparation surface. The middle
trio of the preparations was corrected using correction burr numbered SF134-014, and the
cervical and incisal trios were corrected using correction burrs numbered SF132-008 and
SF379-023 (Axis, Texas, USA).

Each group was cut differently. For in-dentine window preparation, 1 mm of the dentine was
left at four edges of the tooth, without including the cutting edge. For feather preparation,
cutting was terminated at incisal, without shortening the cutting edge. For incisal overlap
preparation, the cutting edge was shortened for 2 mm and preparation was also applied at
palatine. Samples of each group of the experiment were prepared concomitantly.

34% phosphoric acid was applied on all groups that have undergone the cutting process
(Scotchbond Universal Etchant, 3M ESPE, St. Paul, USA) and after 15 seconds, it was sprayed
with water for 15 seconds, and dried by spraying air for 30 seconds. The materials used are
provided in Table 2 in detail.
A fine layer of isolating material (Die Separator, Bisco, Schaumburg, USA) was used on the
teeth that will be prepared using indirect composite resin in Group 1, 4 and 7 in order to
prevent the composite from getting stuck and to create a cement space. After the lower
composite layer (Tescera Body, Bisco, Schaumburg, USA) was placed using the composite
layering technique, this piece was placed on a special device (Tescera ATL, Bisco,
Schaumburg, USA) that provides polymerization with heat and light. First, it was placed in
the beads in the light container and was exposed to a pressure and light cycle for 2 minutes.
After this procedure, a grey microfilled composite (Tescera Incisal, Bisco, Schaumburg, USA)
was used as the upper layer and the light cycle was repeated. Following the completion of
the cycle, the light container was moved away from the device. After these processes,
restoration was removed from the cavity and was put in the bin inside the heat container
half filled with distilled water. An oxygen cleaning capsule was placed in the bin and the
restoration was subjected to a pressure, light and heat cycle for 10-13 minutes.

Table 2. Name, content and manufacturers of the materials used

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Teeth in groups 2, 5 and 8 were secured on an artificial maxilla. The purpose of this
procedure was to obtain a more reliable image using the optic measurement cap of the
CAD/CAM device. Appropriate restorations were selected on the models obtained with the
computer system and the cement opening (300 μm) was set. Afterwards, resin nano ceramic
block (Lava Ultimate, 3M ESPE, St. Paul, USA) was placed in the milling device (CEREC MC
XL, Sirona Dental, New York, USA) and veneers were produced.

For groups 3, 6 and 9, acid was applied on teeth (Scotchbond Universal Etchant, 3M ESPE,
St. Paul, USA) and a single stage all-in-one dental adhesive bonding agent (Scotchbond
Universal, 3M ESPE, St. Paul, USA) was used. It was slightly dispensed with air for 15
seconds, in accordance with the instructions provided by the company. Polymerization was
performed in plasma mode, with an LED device with a light density of 1800 mW/cm 2 and
wavelength of 430-480 nm (Valo LED, Ultradent, South Jordan, USA) for 10 seconds. After
acidification and bonding, nanohybrid resin composite (Filtek Ultimate, 3M ESPE, St. Paul,
USA) with a layering technique. Veneers were completed after each layer was polymerized
for 20 seconds in plasma mode using a LED device with a light density of 1800 mW/cm2 and
wavelength of 430-480 nm.
After the completion of the restorations, silane (RelyX Ceramic Primer, 3M ESPE, St. Paul,
USA) was applied on veneers in groups 2, 5 and 8. After the teeth prepared for all indirect
veneers were etched with acid (Scotchbond Universal Etchant, 3M ESPE, St. Paul, USA) and
a single stage all-in-one dental adhesive bonding agent (Scotchbond Universal, 3M ESPE,
St. Paul, USA) was used. It was slightly dispensed with air for 15 seconds, in accordance
with the instructions provided by the company. Polymerization was performed with a Valo
LED device for 10 seconds in plasma mode. After these procedures, restorations were
attached to the teeth with an adhesive resin cement developed for veneers (RelyX Arc, 3M
ESPE, St. Paul, USA) and cementation was completed after polymerization for 40 seconds
with a Valo LED device. After the cementing procedures are completed, aluminum oxide
plated discs (OptiDisc Set, Kerr, Bioggio, Switzerland) were applied in all groups and rubber
pieces (Identoflex Composite Polishing Set, Kerr, Bioggio, Switzerland) were used and the
teeth in all experimental groups were subject to finishing and polishing procedures.

After the samples in the experimental and control groups were held in distilled water at 37°C
for 24 hours, 1200 thermal cycles were applied consisting of maintaining the samples
between temperatures of 5°C-55°C in each water tank for 20 seconds in the thermal cycler
(Atatürk University Faculty of Dentistry Pedodontology Department, Erzurum, Turkey).

2.2. Fracture Resistance Test

After the thermal cycle procedure, teeth were held in distilled water at 37°C for 24 hours.
Before the samples were embedded in acrylic, the nozzle part of 10 cc injectors (Maviset,
İzmir, Turkey) were cut using a scalpel numbered 11. Injectors were secured with a 90°
angle to the ground level. Autopolymerization repair acrylic (SC Soğuk Akrilik, Imicryl,
Konya, Turkey) was placed in the gap formed and teeth were inserted in this gap with an
angle of 135°. After acrylic is hardened, samples were held in distilled water at 37°C for 24
hours.

Mechanisms were installed in the universal test device (Instron 3350, Instron Industrial
Products, Grove City, USA) and a 0.75 mm/min force was applied towards the incisal
direction. Data obtained at first fracture were taken down in Newton units.

In experiments carried out with the feather cutting groups, 2 samples produced with the
indirect technique and 1 sample produced using CAD/CAM system gave wrong results
without providing any data.

Broken samples were examined at a zoom rate of 10x under a light microscope (SOIF
Biocular Light Microscope, Shangai Optical Instruments, Shangai, China) and types of
breaking were determined. The differences between the breakage test data of grou ps were
analyzed with “Two-way ANOVA”, two item comparisons were performed with “TUKEY post-
hoc” and a “Chi square analysis” was performed for the determination of the ratio between
fracture severity. The confidence interval was set as 95%+ and a software (SPSS 20.0, IBM,
Chicago, USA) was used for statistical analysis. Significant difference indicator, p was taken
as >0.05.

3. Results
In this study, the fracture resistance of laminate veneers produced with different types of
preparation and restored using different restoration techniques were analyzed. The
maximum breaking resistance data, which explain the final fracture value, were noted in
Newton (N) unit.

Highest fracture resistance values were obtained at Groups 1, 2 and 3, with feather type
preparation; 326 N, 410.4 N and 510.37 N, respectively, at Groups 4, 5 and 6 with incisal
overlap type preparation; 451 N, 513 N and 563.91 N, respectively and at Groups 7, 8 and
9, with feather type preparation; 322.5 N, 399 N and 456.3 N, respectively. In Group 10 ,
which consists of unprocessed samples, which were only subject to aging, the highest value
was measured as 530.82 N.

The analyses performed at a confidence interval of 95% with “Two-way ANOVA”, and
significant differences were observed at the content of restorative materials used in groups,
preparation types and laminate veneer production techniques used (p<0,05). (Table 3)
Table 3. Variance analysis for the maximum fracture resistance values of various
restoration techniques and cutting types
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The broken samples were analyzed under light microscope and defined as adhesive, cohesive
or mixed in accordance with the type of breaking. Based on the chi square analysis, adhesive
fractures were observed in groups, to which the indirect technique was ap plied, at an
approximate rate of 76%, cohesive fractures were observed in groups, to which the direct
technique was applied, at an approximate rate of 57% and adhesive fractures were observed
in groups, to which CAD/CAM system was applied, at an approximate rate of 63% Also, when
the types of breaking are compared in accordance with their cutting techniques, in groups
where feather type cutting technique was used, adhesive fractures were observed at around
approximately 40%, in groups where incisal overlap type cutting technique was used,
adhesive fractures were observed at around approximately 42% and in groups where window
type cutting technique was used, adhesive fractures were observed at around approximately
57%. Mixed breaking was not observed in groups, where window type cutting technique was
used.

4. Discussion
The results obtained with this study, where the cutting techniques and veneer production
methods used for the restoration of teeth, shows that the cutting and production techniques
used for the preparation of laminate veneers affect the fracture resistance at this type of
restorations.

One of the techniques used on the anterior teeth, which are discolored, broken or has
hyperplasic regions is layering. [4]
In this techniques, several layers of composite resin
(dentine, body) is applied at various thicknesses and restoration is completed by applying a
dentine composite resin. Thus, an aesthetic restoration with characteristics similar to the
dentine tissue is obtained. [5]
With this method, which aims to benefit from the
characteristics of composite resins to the maximum extent, the skills and experience level
of the dentist has high importance. As there were disadvantages with this technique such as
the success of the restoration work performed with this technique being dependent on the
dexterity of the dentist, the color stability being obtained in the long run and being
dependent on the diet of the patient and the physical, mechanical and optical characteristics
of the composite resin material having a significant effect on the life cycle of the restoration,
composite resin laminate veneers were created. [6]
In dentistry, laminate veneers can be produced using special polymerization furnaces with
indirect composite resins, computer supported milling systems with ceramic or composite
resin blocks, in laboratory environment with porcelains and inside the patient's mouth with
special composite resins manufactured for this aesthetic region. Although long term clinical
observations support the view that for laminate veneers, the best results are obtained with
porcelain laminate veneers, these are used less commonly as resin composites are being
improved and ceramics with composite content are obtained. Moreover, Robbins [7]
has also
stated in his study that the length of treatment is a disadvantage.
Fracture resistance test is one of the stress tests recommended by ISO. It is recommended
as a simple, precise and reliable method. [8]
Spheres, bars or bar shaped fracture tips may
be used for fracture resistance tests. [9]
Also, Hara et al. have obtained 91% adhesive
breaking with tests at 0.75 mm/min. In our study, we have used a sphere tip with a diameter
of 1 mm and the tests were performed using the application rate of 0.75 mm/min, in
accordance with the studies in the literature. [9]
In a study conducted by Lin et al. [10]
, it was
proven that the fracture tip being applied from the edge with an angle of 135°, recreates
the force laminate veneers are subjected to in the mouth.
6 main designs were proposed by McLaughlin [11]
for the cutting techniques that may be
used for veneer restorations. Incisal overlap, feather edge, bevel and in-dentine window
type cuttings were the ones that were used most commonly. Incisal overlap cutting
technique is recommended by many scientists, which include a section of the palatinal edge,
which is aesthetically satisfactory as it provides better imitation of teeth and increases the
resistance of the incisal edge to occlusal forces. [12]
Highton et al. have proven that, incisal
overlap preparation decreases the stress concentration in laminate veneers by dispensing
the occlusal force to a wider area in a study, where two dimensional photo elastic stress
analysis was performed. [13]
Berksun et al. [14]
have stated that stress is most commonly
observed at bevel type cuts and in window preparations, where the whole restoration is
inside dentine, window preparation was the most resistant cutting technique in terms of
axial stresses. Meijering et al. [15]
have shown that the preparation type of the incisal edge
is not related to the success of restoration, in a clinical study conducted for a term of 2.5
years. Troedson et al. [16]
have reported that the direction of the chewing force on teeth is
more significant for the success of restoration than the type of preparation. In light of all
these data, feather edge, incisal overlap and in-dentine window preparation types were
used.
With the increased use of computer supported systems and inclusion of software in our daily
lives, computer supported systems have also started being used in dentistry. CAD/CAM
systems have enabled many restorative applications to be performed more rapidly, without
the need of a laboratory. Although CAD/CAM systems are equipped with a system that allows
applications directly on the patient (CEREC system, Sirona Dental, New York, USA), the
number of resin containing blocks are extremely low. [17]
Today, these are Vita Zahnfabrk,
Bad Säckingen, Germany), Lava Ultimate CAD/CAM (3M ESPE, St. Paul, USA) and Cerasmart
(GC America Inc., Illinois, USA) blocks. Lava Ultimate blocks have 80% nanoceramic filling
in UDMA resin and thus they have an elastic structure compared to the porcelain containing
materials. [17]
In this study, it was shown that fracturability is similar to direct composite
resin veneers, considering the amount of cracks and plastic deformations.
The success of the restoration depends on a strong and durable adhesion between the
enamel and dentine, and restorative material and resin cement. The main purpose of using
adhesive bonding cements was to reinforce the weakened dental structure and support the
enamel and dentine tissue underneath. We mainly used dual cure adhesive cement hardened
with light, developed for anterior region laminate veneers. Mahmood et al. [18]
have reported
that a proper cement material would absorb the stress caused by the force of chewing and
be effective in preventing fractures and adhesive type breaking. Our study has revealed that
adhesive breaking was observed in cemented restorations more commonly and cohesive and
mixed breaking is more common in direct restorations.
In direct composite applications, high value results were obtained at crown fractures and
cervical region fractures, in line with previous studies. [19]
Also, Hagge and Lindemuth [20]
,
have reported that adhesive fractures are observed at lower values and cohesive fractures
are observed at higher values. In our study, fractures in highly resistant direct composite
resin restorations were cohesive and on the exterior hard dental tissue and fractures in
indirect composite resin restorations, which are less resistant to fractures, breaking is often
adhesive and at the connection between the cement and teeth or restoration and cement.
When the fracture types in CAD/CAM systems are analyzed, adhesive fractures are more
common, though a significant difference was not observed.
Turkaslan et al. [21]
have proven that fracture resistance can reach 552-790 N, in a study
concerning the fracture resistance of laminate veneers prepared using different restoration
techniques and materials. Hagberg [22]
states that the physiologic biting forces in adults are
between 108 and 230 N. This is why the maximum force level, where the main fracture
occurs is important. In our study, these values were determined to be between 253 N and
563 N, considering all groups. Although techniques used in our groups may be superior to
each other, as the data obtained in all types were higher than the biting force of an adult,
they are proven to be suitable for clinical practice.
Meijering et al. [15]
have defended that the minimal the invasiveness of the preparation, the
higher the resistance of the tooth will be. Calamia [23]
has reported that window type
preparations are more resistant to fractures than the ones terminated at the incisal edge,
however, in clinical practice, the fracture incidence of incisal overlap cuts were lower. De
Andrade et al. [24]
have proven that when feather type cutting is compared to incisal overlap
cuts, incisal overlap cuts are 3 times more resistant to the axial forces than feather type
cuts. Highton et al.have explained this difference with the observation that the forces at the
incisal edge being dispensed better at overlap cuts. [13]
Pascotto and Benetti [25]
have stated
that veneers made using feather type preparations would not break after 3 years and
suggested using feather type preparations as it was difficult to completely mask the enamel
restoration connection at the incisal edge of the in-dentine preparation. In a study
concerning the photo elasticity of porcelain laminate veneers, Highton et al. have reported
that laminate veneers produced using the incisal overlap cutting technique dispense force
more effectively and have higher fracture resistance when compared to natural teeth. [13]
In
light of the findings of our study, we are also able to say that incisal overlap preparation
increases resistance to fractures in laminate veneers.
In this study, considering the indirect composite resin laminate veneer production technique,
there is no significant statistical difference between feather type cuts and window type cuts
and the highest fracture resistance data was observed with incisal overlap cuts. In groups,
where direct composite resin laminate veneer production technique is used, the order of
fracture resistance from the highest to the lowest is; incisal overlap cuts, in-dentine windows
and feather edges. In veneers produced using computer supported nano ceramic blocks, the
highest values were obtained with incisal overlap cuts. In light of these data, we can state
that incisal overlap cuts, which are claimed to distribute the stress most efficiently, have
proven their success in all three groups. [19, 25]

Incisal overlap cut direct composite resin laminate veneer technique, which has provided the
highest fracture resistance values, transmitted the force to hard dental tissue and the
fractures were mainly observed at the cervical region of the teeth; at the crown and root.
Restorations produced using the CAD/CAM system, with the same cutting technique, have
similar fracture resistance, however, they have proven to protect the hard dental tissue and
were broken adhesively. Thus, the force absorbing effect of cement material is also proven
in this study.

In light of all these data, it can be stated that when incisal overlap type cuts are applied, all
Tescera ATL, direct and CAD/CAM systems provide acceptable fracture resistance values.
However, in order to reach a final conclusion, this study should be supported with in vivo
studies.

5. Conclusion
1. A significant statistical difference was observed in groups prepared using different
preparation and production techniques. (p<0.05) The highest value in all groups was 563.9
N, at the incisal overlap cut direct composite resin laminate veneer group. The lowest value
observed was 253 N, at the feather type cut indirect composite resin laminate veneer group.

2. The average value of all groups is higher than the anterior biting force. (108-230 N) Thus,
with this study, it is proven that all of the groups used in the study can be used at the
anterior region on the condition that the patients are selected properly and the techniques
are used for the right indications.

3. Groups prepared using the incisal overlap cutting method have the highest resistance to
fractures as they dispense the forces on the teeth most efficiently on hard tissues.

4. In groups where feather preparations are used, there is no significant statistical difference
between CAD/CAM and direct composite resin techniques and in order to prevent the
fractures at the hard dental tissue, CAD/CAM restorations may be preferred.

5. In groups, where in-dentine preparations are used, the results were not aesthetically
satisfactory and in this study, these preparations have proven to be the weakest group in
terms of fracture resistance.

6. The type of fracture observed in direct composite resin laminate veneers is cohesive and
fractures are observed at high values. In cemented (indirect composite resin and CAD/ CAM
drilling) groups, adhesive cement acts as a force absorbing buffer and prevents cohesive
fractures on hard dental tissues. However, these may facilitate adhesive type fractures at
lower values.

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9Effect of luting agent on
the load to failure and accelerated-fatigue resistance of
lithium disilicate laminate veneers.
Gresnigt MMM1, Özcan M2, Carvalho M3, Lazari P3, Cune MS4, Razavi P4, Magne P5.
Author information
Abstract
OBJECTIVE:
The aim of this study was to investigate the influence of the luting agent on the application of
laminate veneers (LVs) in an accelerated fatigue and load-to-failure test after thermo-cyclic aging.

METHODS:
Sound maxillary central incisors (N=40) were randomly divided into four groups to receive LVs
(Li2Si2O5) that were adhesively bonded: Group CEMF: Adhesive cement (Variolink Esthetic
LC), fatigue test; Group CEMLF: Adhesive cement, load-to-failure test; Group COMF: Resin
composite (Enamel HFO), fatigue test; Group COMLF: Resin composite, load-to-failure test. The
specimens were thermo-mechanically aged (1.2×106 cycles at 1.7Hz/50N, 8000 cycles 5-55°C) and
then subjected to either accelerated fatigue (5Hz, 25N increasing after each 500 cycles)
or load to failure (1mm/min). Failure types were classified and data analyzed using chi-square,
Kaplan Meier survival, Log Rank (Mantel-Cox) and independent-samples t-test.

RESULTS:
After thermo-mechanical aging, fracture resistance (p<0.000) was higher in the composite groups.
Kaplan Meier survival rates showed significant difference (p<0.001) between the composite
(mean load: 1165N; mean cycles: 22.595) and the cement groups (mean load: 762.5N; mean cycles:
14.569). The same differences were observed in the load to failure test (cement M=629.4N,
SD±212.82 and composite M=927.59N, SD±261.06); t (18)=-2.80, p=0.01. Failure types were
observed as fractures and chipping in group CEMF, all other groups were predominantly adhesive
failures between the luting agent and the laminate veneer.

SIGNIFICANCE:
The delivery of laminate veneers using a direct restorative composite rather than a resin cement
resulted in significantly less chipping and fractures, higher fracture strength in
both accelerated fatigue and load-to-failure.

Copyright © 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Adhesion; Bonding; Cementation; Ceramic; Fatigue; Fracture; Laminate; Veneer
 Showing results for EFFECT[Title] AND NEWLY[Title] AND DEVELOPED[Title] AND RESIN[Title]
AND CEMENTS[Title]. Your search for EFFECT OF NEWLY DEVELOPED RESIN CEMENTS AND
THERMOCYCILING ON THE retrieved no results.

J Contemp Dent Pract. 2017 Mar 1;18(3):209-213.

10Effect of newly Developed Resin Cements and Thermocycling on

the Strength of Porcelain Laminate Veneers.
Alqahtani FI1.

Author information
Abstract
AIM:
The aim of this study was to determine the effect of different luting cements and accelerated artificial
aging (AAA) in the fracture resistance of porcelain laminate veneers (PLVs).

MATERIALS AND METHODS:

A total of 80 disc-shaped specimens were prepared using computer-aided design/computer-aided
milling technology from lithium disilicate glass-ceramic blocks. Specimens (0.5 mm thick, 10 mm
diameter) were divided into eight groups of 10 specimens per group. The control groups consisted of
specimens without cement and not subjected to AAA (CN group) and specimens prepared without
cement but subjected to AAA (CW group). The experimental groups were subjected to AAA and
cemented with Variolink Veneer, Variolink Esthetic LC, Variolink Esthetic DC, RelyX Unicem, RelyX
Veneer, or RelyX Ultimate. Specimens were individually tested for biaxial flexure on a universal
testing machine. One-way analysis of variance and the Tukey's post hoc test were used to compare
the groups' significance statistically (α = 0.05).

RESULTS:
The loads to fracture (LTF) values in the CN group were higher than those in the CW and
experimental groups. The lowest LTF value was in the CW group (31.5 ± 9.5 N) and the highest LTF
value in the CN group (56.7 ± 10.6 N). Tukey's post hoc test demonstrated a statistically significant (p
< 0.01) difference between the CN group and the other groups.

CONCLUSION:
Artificial aging had a significant effect on the LTF value of the tested specimens compared with
the resin cements used. Cohesive failure within the PLVs was the most common mode of failure.

CLINICAL SIGNIFICANCE:
Fatigue strength of dental ceramics and moisture was shown to affect the mechanical properties of
all-ceramic restorations. All-ceramic material is extremely sensitive to humidity and thermocycling.
KEYWORDS:
Ceramic restoration; Fracture resistance; Laminate veneer; Loads to fracture; Porcelain veneer Thermocycling.
 Showing results for influence of preparation design AND existing condition of tooth structure on
load to failure. Your search for INFLUENCE OF PREPARATION DESGIN AND EXISTING CONDITION
OF TOOTH STRUCTURE ON LOAD TO FILURE retrieved no results.

J Prosthet Dent. 2011 Jun;105(6):374-82. doi: 10.1016/S0022-3913(11)60077-2.

11Influence of preparation design and existing condition of tooth

structure on load to failure of ceramic laminate veneers.
Schmidt KK1, Chiayabutr Y, Phillips KM, Kois JC.

Author information
Abstract
STATEMENT OF PROBLEM:
Although investigators have evaluated the effect of ceramic veneer preparation design, limited
information is available regarding preparation design in association with
the condition of existing tooth structure.

PURPOSE:
The purpose of this in vitro study was to evaluate the effect of preparation design and the amount
of existing tooth structure on the fracture resistance of pressable ceramic laminate veneers.

MATERIAL AND METHODS:

Thirty-two extracted human maxillary central incisors were allocated into 4 groups (n=8) to test for 2
variables: (1) the preparation design (a 2 mm incisal reduction shoulder finish line with or without
palatal chamfer) and (2) the existing amount of tooth structure (non-worn tooth or worn tooth).
Measurement of the remaining enamel thickness on the inciso-occlusal surface was made after
the tooth was prepared. All prepared teeth were restored with pressable ceramic (IPS Empress)
veneers, and the veneers were luted with resin cement (Rely-X Veneer). These luted specimens
were loaded to failure in a universal testing machine, in the compression mode, with a crosshead
speed of 0.05 mm/min. The data were analyzed using a 2-way ANOVA and Tukey's HSD multiple
comparison test (α=.05)

RESULTS:
Preparation design and the amount of existing tooth structure had a significant effect on
the load to failure value (P<.001); however, the interaction
between preparation design and existing amount of tooth structure was not significant (P=.702).
Mean (SD) load to failure values were as follows: a preparation design with a palatal chamfer margin
with a non-worn tooth (166.67 N (28.89)) revealed a significantly higher failure load than the group
with a shoulder finish line alone (131.84 N (18.88)) (P<.01). The preparation design with a palatal
chamfer margin for worn teeth (119.56 N (23.88)) revealed a significantly higher failure load than a
shoulder finish line design alone (90.56 N (9.32)) (P<.05). The preparation design with a shoulder
finish line for worn teeth had a significantly lower failure load than those on non-worn teeth (P<.003).

CONCLUSIONS:
Preparation design and the amount of existing tooth structure had a significant effect
on load to failure for ceramic veneers. This study revealed that using a palatal chamfer
margin design significantly increased the load to failure compared to a shoulder finish line.

Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights
reserved.

PMID:

21640238

DOI:

10.1016/S0022-3913(11)60077-2