A Systematic Review of Anterior Labial Porcelain Veneers

Objectives: To determine the nature and rate of complications and failures at 5- and 10-years of service in adults receiving anterior labial porcelain veneers (PVs), using the available evidence. Methods: MEDLINE, EMBASE, the Cochrane Library, text books, grey literature and conference proceedings were searched in the course of this systematic review. The following inclusion criteria were required: a) Patients aged minimum 18-years. b) PVs on maxillary or mandibular incisors or canines. c) Mean veneer follow-up times of at least 5-years. d) Formal clinical evaluation at the end of the reported study period. e) Case reports, cross sectional and case control studies were excluded. Included studies were assessed for bias and quality. Complication and failure rates per veneer per year (CRs and FRs) were calculated for each study and divided into mechanical, aesthetic and biological causes. Results: Initially 2225 articles were returned, 86 fulfilled primary criteria which were retrieved in full text, and 4 were included into the review. These studies followed 5 patient cohorts. Only one followed patients up to 5- and 10-years. A narrative synthesis was performed due to clinical and methodological heterogeneity. In the first 5-years of clinical service CRs were between 0.97 to 5.16% and FRs between 0.22 to 0.55%. Between 6- and 10-years CRs were 14.32% and FRs were 0.49%. CRs increased from 5.16% to 14.32% after 5-years and were mostly mechanical, including cracks, microleakage and diminished adaptation (p<0.05). Conclusion: FRs are low during the first 10-years of service. Aesthetic, mechanical and biological CRs do not differ statistically in the first 5-years. Mechanical CRs become significant after 5-years, which maintenance regimes should address. However, these results are derived from a limited number of studies, conducted in controlled environments and may not reflect CRs and FRs in every-day dentistry.