Title	Esthetic Perception of Direct Composite Veneers are Preferred over Porcelain Veneers
Clinical Question	Is patient satisfaction enhanced with the esthetic results of porcelain veneers or direct composite veneers?
Clinical Bottom Line	The majority of patients prefer direct composite veneers to porcelain veneers because of enhanced esthetics, preservation of tooth structure, shorter treatment time, and affordable cost.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 14974066 Wakiaga/2004 Previous studies Cochrane Review Key results After a thorough search of six publications, only one trial met the Cochrane review’s criteria; however, issues with data reporting limited the statistical analysis of the selected trial. The conclusion was that there is not enough evidence in the literature about differences between direct composite veneers and porcelain veneers when treating stained and discolored teeth. 7876412 Meijering/1998 180 veneer restorations (maxillary incisors). Prospective cohort study Key results This longitudinal clinical trial compared treatment times of different methods of fabricating veneers. The mean treatment times were 46 minutes for direct composite veneers, 70 minutes for indirect composite veneers (total of two appointments), and 62 minutes for porcelain veneers (two appointments). 19629085 Nalbandian/2009 96 patients Retrospective clinical study Key results This retrospective study evaluated the patients’ satisfaction regarding esthetic perception of their smiles after receiving maxillary anterior treatment with either direct composite veneers or porcelain veneers. The results of this study showed that patients elected direct composite veneers as their choice of treatment for maxillary anterior restorations due to the preservation of tooth structure and cost of repair and placement. 14974066 Yu/2009 10 shades of BelleGlass NG (indirect resin), 12 shades of Estelite Sigma (direct shade), and 4 shades of veneer ceramics In vitro study Key results This in vitro study analyzed the translucency of direct composite veneers, indirect composite veneers, and porcelain veneers. The study’s findings suggested that direct resin-based composite should be the material of choice for esthetic restorations rather than indirect resin-based composite or porcelain due to its similarity in opalescence to natural tooth enamel.
Evidence Search	PubMed: direct composite veneers, indirect porcelain veneers, anterior esthetic restorations, conservative anterior restorations, patient esthetic perception of veneers, and cost of direct composite veneers.
Comments on The Evidence	After searching the literature for the highest evidence on this topic, no meta-analyses were found. The Cochrane review conducted by Wakiaga et al. only found one article that satisfied its rigorous inclusion criteria. The qualified clinical trial by Meijering et al. had an adequate sample size, but there was a high level of variability among providers. The retrospective and in vitro studies were well done and provided adequate data to support the use of direct composite veneers. In conclusion, the level of evidence on this topic was moderate.
Applicability	Dentists and patients have multiple factors to consider when treatment planning anterior restorations. Patient satisfaction is a critical part of any dental practice, thus clinicians must consider cost, tooth conservation, treatment time, and esthetic results in all restorative treatment plans.
Specialty	(General Dentistry) (Restorative Dentistry)
Keywords	Direct composite veneers; indirect porcelain veneers; esthetic perception; anterior restorations; patient satisfaction; tooth conservation; treatment time; conservative treatment.
ID#	2478
Date of submission	05/07/2013
E-mail	daniel.sluyk@ucdenver.edu
Author	Danny Sluyk
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Deise Oliveira, DDS
Faculty mentor e-mail	deise.oliveira@ucdenver.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available