Bilayered ceramic anterior restorations with reinforcement of the incisal edge by using lithium disilicate:A multicenter retrospective survival analysis with a maximum of 6-year follow-up

STATEMENT OF PROBLEM: The esthetics of anterior lithium disilicate restorations can be enhanced if the buccal aspect is layered with a feldspathic ceramic. However, whether fractures and chipping of this layer are a prevalent complication is unclear.PURPOSE: The purpose of this retrospective study was to evaluate the incidence of incisal fracture of a specially designed lithium disilicate reinforcement of the incisal edge for indirect anterior bilayered restorations on both teeth and implants.MATERIAL AND METHODS: A total of 924 anterior bilayered pressed lithium disilicate restorations in 324 patients and made in one dental laboratory were delivered by 4 restorative dentists. The restorations had the palatal side of the incisal edge in monolithic lithium disilicate and the facial side in feldspathic porcelain. The restorations were evaluated for survival and the occurrence of fracture or chipping. Survival analyses were performed by using the Kaplan-Meier and log rank (Mantel-Cox) tests (α=.05).RESULTS: Of the 924 restorations, 798 (236 complete crowns, 562 partial restorations) were placed on teeth and 126 on implants. The mean observation time was 38 months (3 to 72 months). The survival rate was 96.5%, with 14 failures occurring. The failures were fracture after dental trauma (n=5), ceramic fracture (n=1), debonding (n=6), poor shade match (n=1), and tooth loss (n=2). Restorations in patients with parafunctional habits and endodontically treated teeth showed a significant decrease in survival rate (P=.018). No significant differences were found between the survival of restorations on teeth and implants and between complete crowns and partial restorations (P=.021). No chipping was observed on any restorations in the study.CONCLUSIONS: Modified anterior bilayered ceramic restorations showed good survival rates, and no chipping was observed up to 6 years of follow-up. Parafunctional habits and endodontic treatment had a negative effect on the survival rate of restorations. The support of tooth or implant and the restoration type had no effect on the survival.