Comparison of conventional ceramic laminate veneers, partial laminate veneers and direct composite resin restorations in fracture strength after aging

Objectives: The objectives of this study were to test the fracture strength in vitro of laminate veneers, partial laminate veneers and composite restorations after aging and analyze the failure mode.Methods: Forty extracted, sound human teeth were selected and divided into four groups: 1) Control group (CG); 2) Conventional Laminate Veneer (CLV); 3) Partial Laminate Veneer (PLV); 4) Direct Composite Resin (DCR). Laminate veneer preparations with incisal overlap were made in group CLV whereas only incisal preparations were made with a 1 mm bevel in group PLV and DCR. The indirect restorations were luted with a resin composite and the DCR group was restored with a direct resin composite restoration. The restored teeth were subsequently aged by thermocycling (20.000 cycles, 5-55 degrees C). Subsequently, the fracture strength was tested by a load to failure test at 135. on the incisal edge. A failure analysis was performed using light microscopy. The results were analyzed using Shapiro-Wilk and Kruska-Wallis test.Results: After thermocycling, one sample from group CLV presented a premature adhesive failure and was excluded. Three restorations from groups PLV and DCR presented small cracks but were taken to the fracture test. After aging mean fracture load + SD (N) were: Group DCR (n = 10): 385 +/- 225; Group CG (n = 10): 271 +/- 100; Group PLV (n = 10): 266 +/- 69; Group CLV (n = 9): 264 +/- 66. Fracture strength means from groups CLV and PLV did not differ statistically from each other nor from control (p = 0.05). In the group CLV the root fracture was the most occurring fracture. In groups PLV and DCR, material cohesive failures and a mix (adhesive, tooth and material cohesive) failures were most observed.Significance: This in vitro study showed for the first time that partial laminate veneers can exhibit fracture strength values similar to direct composite restorations or conventional ceramic laminate veneers. All three restorative procedures presented clinically acceptable values of fracture strength. Even though three samples from groups PLV and three from DCR presented small cracks after thermocycling, these cracks do not appear to have a negative effect on the fracture strength.