Anterior Veneer Restorations - An Evidence-based Minimal-Intervention Perspective

Purpose: The goals of this review are (1) to describe the evidence behind the use of ceramics vs composite resin to restore teeth with anterior veneers using a minimally-invasive strategy; and (2) to discuss the choice of materials and techniques for anterior veneer restorations. Overview: In recent years new adhesive restorative materials and techniques have been introduced in dentistry, including nanofilled composite resins for direct restorations, new ceramic materials that combine esthetics and strength, and polymer/ceramic materials for indirect restorations that are fabricated chairside using CAD/CAM technology, allowing the dentist to design, mill, and cement the restoration in one session. In spite of the novelty and new technology behind the introduction of new materials, the available evidence that backs some of these materials does not justify their use over similar materials or techniques that have been used by dentists for some years. Notwithstanding the success of laminate veneers and the popularity of new materials and digital techniques, the classical direct composite resin veneer is still very popular among clinicians and taught in dental schools and continuing education courses. Direct composite resin veneers are usually more affordable than indirect veneers, less invasive of the tooth structure, and easier to repair. Current composite resin materials can be finished to a tooth-like appearance, but they are susceptible to alterations of the surface gloss and potential discoloration of the composite resin. On the other hand, the preparation for indirect veneers is generally more invasive and the respective restorations are more difficult to repair. In addition, the esthetic outcome of bonded ceramic restorations still depends on the clinical behavior of the dentin adhesive and resin luting cement used to bond the restoration to the tooth structure. Conclusions: The ultimate goals of any restorative treatment are to restore function and esthetics, prevent recurrent caries lesions and bacterial leakage into the pulp space, save tooth structure, and promote the well-being of our patients. The armamentarium of new dental materials for esthetic clinical procedures has increased exponentially in the last few years. The use of different materials and techniques for anterior veneer restorations must be based on sound evidence rather than on the marketing hype or testimonials.