Knowledge, Attitude and Practice on Laminate Veneer Preparations among Dental Practitioners

 

A. Ashwatha Prath¹, Ashish. R. Jain²

¹Second Year, Department of Prosthodontics,  Saveetha Dental College and Hospital, Chennai, India.​

²Reasearch Scholar, Reader, Department of Prosthodontics, Saveetha Dental College and Hospitals,

Saveetha University, Chennai, India.

 

ABSTRACT:

Background: A Laminate veneer is a porcelain dental appliance bonded to the front surface of an anterior tooth to improve appearance, close up existing spaces and improve alignment of the tooth. It is a conservative method for treatment of esthetic and functional problems in anterior region of oral cavity. For fabrication of laminate veneers, wide range of dental ceramics is now available on market. Aim: To create awareness in dental practitioners about the laminate veneer preparation. Materials And Methods: A questionnaire survey was designed for Dental Practitioners. The questionnaire had 10 questions about procedures and materials involved in Laminate veneers preparation. The subjects involved were Dental Practitioners (n=50) who had minimum of one year of clinical experience after their dental education. Questionnaires were distributed to the Dental Practitioners of Chennai city and Data analysis was done using SPSS software. Result: 75% of the dentists were aware about the materials to be used in fabricating laminate veneers. 71% of the dental practitioners had the knowledge about the tooth preparation process in laminate veneer procedure. 84% of the dentists were aware about the alternative treatment for discolouration of teeth due to fluorosis. 49% of the dentists had knowledge on the cementation technique being used. Conclusion: The present study found that the dental practitioners were aware about the laminate veneers but unaware about the recent advances and consequences of laminate veneer failure. Further awareness would enhance the efficacy of usage and overcome the difficulties faced while practicing. Therefore it must be necessary to increase the awareness among dental practitioner about the recent advances and consequences of laminate veneer failure.

 

 

INTRODUCTION:

The laminate veneers are thin pieces of porcelain applied to the the tooth for esthetically restoring, localizedor generalized defects or intrinsic discolourations. This technique was first described by Dr. Charles Pincus in 1940^[1].  The main indications of laminate veneers include correction of unaesthetic surface defects such as hypoplastic enamel or enamel lost by erosion or abrasion, masking of discoloration resulting from trauma, endodontic treatment, tetracycline stains, repair of structural deficiencies such as fractured incisal edge, diastema and peg laterals^[2]. The long term success of porcelain veneers is due to important parameter slikeshade selection, tooth preparation, cementation technique and patient maintenance. The popularity and advantages of this laminate veneers include esthetic quality, conservative preparation, fracture resistance, tissue acceptance, low debonding rate, patient satisfaction, and negligible incidence of caries^[3]. It has been found that the porcelain veneers showed favorable clinical performance and excellent maintainance of aesthetics, high patient satisfaction^[4]. Porcelain veneers are considered more durable than direct composite veneers^[5]. The steps involved in the preparation of laminate veneers include the shade selection, tooth preparation, proximal reduction, incisal reduction,    gingival displacement, provisional restoration, laboratory procedure, try in and bonding procedure^[2]. The evolution of ceramic materials and adhesive systems permits improvement of aesthetics and the self-esteem of the patient. Clinicians should understand the latest ceramic materials in order to be able to recommend them. The maintenance of porcelain veneers in the medium to long term was excellent, patient satisfaction was high and porcelain veneers had no adverse effects on gingival health inpatients with an optimal oral hygiene. Major short comings of the porcelain veneer system were described as a relatively large marginal discrepancy, and an insufficient wear resistance of the luting composite^[5].

 

MATERIALS AND METHODS:

A questionnaire survey was designed forDental Practitioners. The questionnaire had 10 questions about procedures and materials involved in Laminate veneers preparation (Table 1). The subjects involved were Dental Practioners (n=50) who had minimum of one year of clinical experience after their dental education. Questionnaires were distributed to the Dental Practioners of Chennai city and Data analysis was done using SPSS software.

 

RESULT:

The study was conducted on 50 dental practitioners. 84% of the dentists were aware about the alternative treatment for discolouration of teeth due to fluorosis as veneers can be used in case of intrinsic damages to the tooth.75% of the dentists were aware about the materials to be used in fabricating laminate veneers. 71% of the dental practitioners had the knowledge about the tooth preparation process in laminate veneer procedure. Only 43% of the practitioners were aware about the recent advances in materials being used. 55% of the dental practitioners had the knowledge about the classification of veneers. 42% of the dentists were aware about failures in laminate veneers. 49% of the dentists have knowledge on the cementation technique being used. 39% of the dental practitioners were aware about the thickness of porcelain laminate veneers. 67% of the dental practitioners were aware about the biplanar reduction of incisors during preparation. The three methods of veneer construction was known by almost 51% of dental practitioners (Figure 1-5).

 

Figure 1: Awareness About Laminate Veneers

 

Figure 2: Knowledge About Tooth Preparation

 

Figure 3: Knowledge about cementation technique

 

Figure 4: Knowledge About Materials Used

 

Figure 5: Knowledge About The Thickness Of Porcelain Veneers

 

Table1: Sample Questionnaire on Laminate Veneer Preparation

S.No	Questions	Options:
1	Are you aware of the alternative treatment for discolouration of teeth due to fluorosis other than scaling?	Yes	No
2	Are you aware of the types of materials used in laminate veneer preparation?	Yes	No
3	Do you know how to do a tooth preparation for the laminate veneers?	Yes	No
4	Are you aware of the recent advances in materials used?	Yes	No
5	Do you know the types of classification of veneers?	Yes	No
6	Are you aware of the consequences of failure of laminate veneers placement?	Yes	No
7	Are you aware of the cementation technique?	Yes	No
8	Are you aware of biplane type of reduction for incisors?	Yes	No
9	Do you know the thickness of porcelain laminate veneers?	Yes	No
10	Are you aware of the three methods of veneer construction?	Yes	No

 

 

DISCUSSION:

This study examined the knowledge, attitude and practice on laminate veneer preparation among dental practitioners and found that the dental practitioners were aware about the laminate veneers but unaware about the recent advances and consequences of laminate veneer failure as well as about some preparation technique. A study has stated that there are three reasons why tooth preparation is necessary which include strength, seat and color^[6]. The present trend when teeth are prepared for porcelain laminate veneers is to include the incisal edge either by bevelling or by means of overlapping. In the present study 67% of the dental practitioners were aware about the biplanar reduction of incisors during preparation. A silicone index is more helpful than a depth gauge bur when preparing the palatal surface and reducing the incisal edge, a depth gauge bur having limited application in these situations. It could be considered that a disadvantage of making an index of addition silicone is the expense in terms of material and time required to produce such an index. It is suggested however that the benefits to the patient and the operator from using a silicone index far exceed the additional cost of fabricating the index. A further advantage of a silicone index is that it can be sectioned so that the parts can be relocated accurately. The index can then be reconstructed and used to fabricate a temporary restoration. If a depth gauge bur is used in preference to

 

a silicone index minimal smoothing of the labial face to prevent over preparation is recommended^[7]. In the present study 39% of the dental practitioners were aware about the thickness of porcelain laminate veneers. The preparation of porcelain veneer is to be made in the enamel as it has various advantages like to maximize the resin bond strength and decrease the tensile stresses in the porcelain^[8]. Enamel preservation is the most critical because excessive tooth preparation can expose dentin reducing bond strength, which is a factor that can cause a decrease in long-term clinical success^[9]. In the present study 49% of the dentists had knowledge on the cementation technique being used. According to Ayoub Pahlevan, the gingival area requires a knife edge preparation^[10]. In the present study, 71% of the dental practitioners had the knowledge about the tooth preparation process in laminate veneer procedure. Veneers are alternative technique used for treating discolouration^[11]. In the present study 84% of the dentists were aware about the alternative treatment for dis colouration of teeth due to fluorosis as veneers can be used in case of intrinsic damages to the tooth. The various steps involved in fabricating the laminate veneers include treatment planning, digital planning, diagnostic wax up, gingivoplasty, colour choice, minimal invasive preparations, Impression procedure, shade selection and cementation^[12]. Clinical failure of porcelain laminate veneer restorations may occur due to development of flaws on the surface of the restorations, surface imperfections which act as a potential source of crack propagation, or during surface treatment or cementation. Thermal, mechanical and chemical variations may also lead to post-operative failure of the restoration^[13,14]. In the present study 42% of the dentists were aware about failure of laminate veneers. According to NúbiaPavesiPini, two types of materials are used for fabricating laminate veneers indicated for their translucency and potential to be used in small thickness. They are sintered feld spathic porcelain and pressable ceramic. Recent advances include the computer-aided design/computer-aided manufacturing (CAD/CAM), which make production of veneers easier^[15]. In the present study only 43% of the practitioners were aware about the recent advances in materials being used.

 

CONCLUSION:

Within the limitations of the study most of the dental practitioners were aware about the laminate veneers but still lack knowledge on clinical skills which is necessary to prevent the failure. Furthur awareness would enhance the efficacy of usage and overcome the difficulties faced while practicing.

 

REFERENCES:

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3.       Guruprasada, Lt Col, N. Rivankar, Lt Col, (Retd),  R.K. Dhiman, Col,  and M. Viswambaran, Cold,” Evaluation of the effect of surface preparation using phosphoric acid and luting cement on the flexural strength of porcelain laminate veneering material”, Med J Armed Forces India. 2015 Dec; 71(Suppl 2): S299–S305.Published online 2012 Oct 23. doi:  10.1016/j.mjafi.2012.08.026

4.       Núbia Pavesi Pini, Flávio Henrique Baggio Aguiar, Débora Alves Nunes Leite Lima, José Roberto Lovadino, Raquel Sano Suga Terada, and Renata CorrêaPascotto,” Advances in dental veneers: materials, applications, and techniques”, ClinCosmetInvestig Dent. 2012; 4: 9–16.Published online 2012 Feb 10. doi:  10.2147/CCIDEN.S7837

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7.       P A Brunton, A Aminian and N H F Wilson^.,” Restorative dentistry: Tooth preparation techniques for porcelain laminate veneers”, British Dental Journal 189, 260 - 262 (2000) .Published online: 9 September 2000 | doi:10.1038/sj.bdj.4800739

8.       Seymour KG, Cherukara GP, Samarawickrama DY. Stresses within porcelain veneers and the composite lute using different preparation designs. J Prosthodont. 2001 Mar;10 (1):16–21. 

9.       Oswaldo Andrade et.al,”Ultimate ceramic veneer: a laboratory-guided preparation technique for minimally invasive laminate veneers”,Journal of the California Dental Association 40(6):489-94 · June 2012

10.     Ayoub Pahlevan, Mansoreh Mirzaee, Esmaeil Yassine, Ladan Ranjbar Omrany, Masumeh Hasani Tabatabaee, Hamid Kermanshah, Sakineh Arami, and Mehdy Abbasi,” Enamel Thickness After Preparation of Tooth for Porcelain Laminate”, J Dent (Tehran). 2014 Jul; 11(4): 428–432.Published online 2014 Jul 31.

11.     Griffiths CE, Bailey JR, Jarad FD, Youngson CC. An investigation into most effective method of treating stained teeth: an in vitro study. J Dent. 2008;36:54–62. doi: 10.1016/j.jdent.2007.10.009. [PubMed][Cross Ref]

12.     R. K. Morita, M. F. Hayashida,Y. M. Pupo, G. Berger,  R. D. Reggiani,  and E. A. G. Betiol,” Minimally Invasive Laminate Veneers: Clinical Aspects in Treatment Planning and Cementation Procedures”, Case Rep Dent. 2016; 2016: 1839793. Published online 2016 Dec 13. doi:  10.1155/2016/1839793.

13.     Magne P., Kwon K.R., Belser U.C., Hodges J.S., Douglas W.H. Crack propensity of porcelain laminate veneers: a simulated operatory evaluation. J Prosthet Dent. 1999;81:327–334. [PubMed]

14.     Addison O., Fleming G.J., Marquis P.M. The effect of thermocycling on the strength of porcelain laminate veneer (PLV) materials. Dent Mater. 2003 Jun;19 (4):291–297. [PubMed]

15.     Núbia Pavesi Pini, Flávio Henrique Baggio Aguiar, Débora Alves NunesLeite Lima, José Roberto Lovadino, Raquel Sano Suga Terada, and  Renata CorrêaPascotto,” Advances in dental veneers: materials, applications, and techniques”, Clin Cosmet Investig Dent. 2012; 4: 9–16.Published online 2012 Feb 10. doi:  10.2147/CCIDEN.S7837

 

 

 

Accepted on 27.04.2017        © RJPT All right reserved