UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4391
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass ceramic
anterior laminate veneers (Randomized Clinical Trial)
Correspondência de cor, adaptação marginal e satisfação do paciente: laminados de cerâmica infiltrada por polímero versus
cerâmica vítrea de dissilicato de lítio (Ensaio Clínico Randomizado)
Nancy SAYED ABDELAZIZ ABDELAAL KHALIL1 , Hesham ALANSARY1 , Eman EZZAT YOUSSEF1
1 - Cairo University, Department of Fixed Prosthodontics. Cairo, Egypt.
How to cite: Khalil NSAA, Alansary H, Ezzat Youssef E. Shade match, marginal adaptation and patient satisfaction: polymer inltrated
ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial). Braz Dent Sci. 2024;27(4):e4391.
https://doi.org/10.4322/bds.2024.e4391
Abstract
Objective: To evaluate the shade match, marginal adaptation and patient satisfaction of VITA ENAMIC multiColor
anterior laminate veneers and compare it to that of IPS e.max CAD. Material and Methods: A total of twenty-two
laminate veneers were fabricated from IPS e.max CAD and VITA ENAMIC multiColor in the anterior zone, eleven
veneers for each group. The patients were randomly divided into two equal groups according to the restorative
material. Group EX (control group) eleven IPS e.max CAD veneers and Group EMC (intervention group) eleven
VITA ENAMIC multiColor veneers. Shade match and marginal adaptation was assessed using modied USPHS
criteria and patient satisfaction was evaluated through visual analogue scale (VAS), immediately after cementation.
Data were analyzed using CHI- square test. P 0.05 was considered statistically signicant. Results: The results
showed that there was no statistically signicant difference between the two groups in terms of shade matching,
marginal adaptation and patient satisfaction. Conclusion: IPS e.max CAD and VITA ENAMIC multiColor veneers
provided a successful clinical performance in terms of shade match, marginal adaptation and patient satisfaction.
KEYWORDS
CAD-CAM; Ceramics; Color perception; Hybrid; Lithium disilicate.
RESUMO
Objetivo: Avaliar a correspondência de cor, adaptação marginal e satisfação de pacientes, de laminados cerâmicos
anteriores VITA ENAMIC multiColor e compará-los com o IPS e.max CAD. Material e Métodos: Um total de vinte e
dois laminados cerâmicos foram fabricados a partir do IPS e.max CAD e VITA ENAMIC multiColor na zona anterior,
onze laminados para cada grupo. Os pacientes foram divididos aleatoriamente em dois grupos iguais de acordo com
o material restaurador. Grupo EX (grupo controle) onze laminados IPS e.max CAD e Grupo EMC (grupo intervenção)
onze laminados VITA ENAMIC multiColor. A correspondência de cor e a adaptação marginal foram avaliadas usando
os critérios modicados do USPHS e a satisfação do paciente foi avaliada através da escala analógica visual (VAS),
imediatamente após a cimentação. Os dados foram analisados usando o teste de qui-quadrado. P < 0,05 foi considerado
estatisticamente signicante. Resultados: Os resultados mostraram que não houve diferença estatisticamente signicante
entre os dois grupos em termos de correspondência de cor, adaptação marginal e satisfação do paciente. Conclusão:
Os laminados cerâmicos IPS e.max CAD e VITA ENAMIC multiColor apresentaram um desempenho clínico bem-
sucedido em termos de correspondência de cor, adaptação marginal e satisfação do paciente.
PALAVRAS-CHAVE
CAD-CAM; Cerâmica; Percepção de cor; Híbrido; Dissilicato de lítio.
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
INTRODUCTION
Laminate veneers are considered one of the
most desirable esthetic restorations owing to their
conservatism, superior esthetics, bond strength,
durability and high survival rate. It preserves the
tooth structure, in which it requires minimal tooth
preparation on the labial surface and/or incisal
edges, that is kept almost entirely in the enamel.
Therefore, laminate veneers offers minimal risk
of pulp vitality changes and superior periodontal
health status [1]. Additionally, local anesthesia
is rarely required, making the dental visit more
comfortable for the patient [2].
Lithium disilicate ceramics offer excellent
esthetics, biocompatibility, color stability, and
translucency, similar to feldspathic ceramics.
However, it offers greater fracture resistance and
clinical longevity [3].
Different fabrication techniques can be
used; either bilayered or monolithic. Bilayered
techniques offer enhanced esthetics due to
multiple layers and ceramic blends, whereas
monolithic approaches provide technical ease
and can be efciently created using CAD/CAM
technology. However, monolithic restorations
are often considered less esthetic compared to
bilayered restorations due to their single-colored
body resulting in a less natural appearance [4].
Nowadays, several manufacturers provide
polychromatic ceramic blocks that closely
resemble the natural dentition in terms of
color, translucency, and even uorescence. This
versatility enables more lifelike, natural and
aesthetically pleasing results, especially in the
esthetic zone, while beneting from the efciency
and precision of digital manufacturing [5].
VITA ENAMIC multiColor, the most recent
hybrid ceramic blocks, introduced by Vita,
provide a progressive color transition over six
separate layers, from the cervical to the incisal
edge to replicate the inherent color progression
observed in teeth [6]. Meanwhile, it shows a
modulus of elasticity similar to dentin, which
allows for more uniform stress distribution under
load and increases resistance to crack formation
and propagation. This material is indicated for
the fabrication of minimally invasive restorations
especially laminate veneers, inlays, onlays for
molars and premolars, crowns for posterior teeth
and implant-supported crowns [7].
Excellent shade match is a challenging
procedure and any mismatch could require a
restoration remake [8]. Moreover, it serves as
an immediate reection of shade determination
and may be evaluated using various visual and
instruments methods. One of the most common
visual methods is the modied USPHS criteria,
which are notably comprehensive [9].
Marginal adaptation is crucial for achieving
superior esthetics, periodontal health and
durability of veneers. Veneers were also clinically
evaluated for marginal adaptation using modied
USPHS criteria [10].
Patient satisfaction is vital for evidence-
based dentistry and effective communication
between dentists and patients [11]. It was
measured using VAS [12].
However, data comparing VITA ENAMIC
multiColor laminate veneers to the highly esthetic
layered lithium disilicate in regards to shade
matching, marginal adaptation and patient
satisfaction clinically is still lacking. Thus, the aim
of this study was to evaluate the shade match,
marginal adaptation and patient satisfaction of
VITA ENAMIC multiColor anterior laminate veneers
and compare it to that of IPS e.max CAD veneers
immediately post cementation. The null hypothesis
of the study stated that there would be no difference
in shade match, marginal adaptation and patient
satisfaction between VITA ENAMIC multiColor and
IPS e.max CAD anterior laminate veneers.
MATERIAL AND METHODS
Study design
The current study was a randomized clinical
trial in which participants were allocated into two
groups at random. In the rst group (intervention;
Group EMC): patients received VITA ENAMIC
multiColor laminate veneers. While in the second
group (control; EX): patients received IPS e.max
CAD laminate veneers.
Sample size
The sample size for this study was determined
based on data obtained from a previous study by
Mert Yuce et al. [13] and calculated by using CHI-
square test, power of 80% and a 5% alpha level
of signicance. The calculated sample size was
11 patients per group with a total of 22 patients
for the full study.
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
Participant’s selection
A total of 22 participants were recruited from
the outpatient clinic of the Department of Fixed
Prosthodontics of Faculty of Dentistry, Cairo
University, Cairo, Egypt.
Eligibility criteria
Inclusion criteria
a. Patients aged 18-55 years who were able
to read and sign the informed consent
document
b. Patients who were physically and
psychologically able to tolerate conventional
restorative procedures
c. Absence of active periodontal or pulpal
diseases
d. Patients with discoloration such as white
spots due to developmental defects as dental
uorosis or acquired discoloration such as
discolored incisal edge, tooth fracture that
does not involve more than 50% enamel
loss, mild tooth malposition, abnormal tooth
shapes, peg-shaped lateral incisor tooth
Exclusion criteria
a. Patients with partially erupted teeth
b. Fractured teeth of more than 50% enamel loss
c. Poor oral hygiene
d. Non-vital teeth
e. Generalized wear or TMJ problems or
parafunctional habits
RANDOMIZATION, ALLOCATION CON-
CEALMENT MECHANISM AND IMPLE-
MENTATION
Patients fullling the inclusion criteria were
numbered 1 to 22. The participants were randomly
assigned into two groups at 1:1 allocation ratio
using computerized software [14]. The sequence
involved distributing numbers 1 to 22 across a
two-column table in a randomized manner.
Each patient within the two groups received
an assigned number, which was also inscribed on
a large white paper. This paper was meticulously
folded eight times before being enclosed within
a securely sealed opaque envelope.
An independent researcher opened the
envelope in the operating room immediately after
secondary impression to determine the veneer
material. The envelope was sent to the lab for
fabrication of the veneer restoration.
Blinding
The trial participants, outcome assessor
and statistician were blinded to the type of the
tested materials. However, the operator was not
blinded due to the difference in surface treatment
protocols for each material prior to cementation
(Flowchart 1).
Treatment phases
A total of twenty-two patients who needed
laminate veneer for shade modification or
fractured incisal edge were selected. Two ceramic
materials (IPS e.max CAD and VITA ENAMIC
multiColor) were selected for veneer fabrication
in this study (Table I). All treatment procedures
were performed by the same clinician (N.K.).
Preparatory phase
Meticulous scaling and polishing were
performed for each patient to remove dental
plaque and external stains, that may negatively
affect the shade selection. Shade determination of
the contralateral tooth was recorded visually using
VITA Tooth guide 3D-Master during daylight.
(Figures 1 and 2) Study casts were mounted on a
semi-adjustable articulator using facebow transfer.
Tooth preparation
Standardized amount of labial reduction of
0.3 mm, 0.5 mm, and 0.7 mm at the cervical,
Table I - The materials investigated in the study
Material name Description Manufacturer Batch number
IPS e.max CAD Lithium disilicate glass ceramic Ivoclar Vivadent, Principality of
Liechtenstein, Germany Z01SBP
VITA ENAMIC multiColor Polymer infiltrated ceramic, dual
ceramic polymer network structure
VITA Zahnfabrik H. Rauter GmbH &
Co.KG Bad Säckingen, Germany 91810
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
Flowchart 1 - Schematic diagram of the procedures adopted in the present study.
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Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
middle, and incisal parts respectively was
performed using a three-wheel depth cutter
stone and sharp pencil for shading the grooves.
A 0.3 mm thick supragingival chamfer nish line
was also created. Butt joint incisal preparation of
1 to 1.5 mm depth was standardized using vertical
depth grooves created by tapered diamond stone.
The amount of tooth prepared was checked using
a graduated periodontal probe, guided by an
index previously made with addition polyvinyl
siloxane rubber base impression material,
putty consistency, which was adapted onto the
diagnostic wax-up without a tray to record the
contours, and then sectioned buccolingually after
complete setting to guide the preparation check.
Subsequently, stump shade was selected using
stump shade guide.
Secondary impression and master cast digi-
tal scan
A two-step impression technique using
PVS rubber base impression material (Panasil,
Kettenbach, USA) was used, and temporary
veneer restoration (Structur 2 SC, VOCO,
Germany) was constructed directly intra-oral.
Secondary impression was poured into dental
stone type IV to obtain the master cast, which was
then scanned using SWING HD Desktop Scanner
(DOF, Korea), an extra-oral scanner featuring
10 μm scanning accuracy, 1.3-megapixel dual
cameras for precise scanning, and a high-
performance USB 3.0 interface for fast data
processing.
Milling of the denitive veneers
CORiTEC 350i PRO, imes-icore, a five-
axis wet milling machine was used to mill the
denitive veneers, designed using the dental CAD
software (ExoCAD galway3.0).
Veneering of IPS e.max veneers
The veneer was airborne-particle abraded
with 50-μm glass beads at 10 mm distance with
2 bar air pressure and then the surface was
cleaned with a steam jet and subsequently dried.
Porcelain buildup of the facial cutback tooth-
colored IPS e.max veneer was done using IPS
e.max Ceram material.
Denitive veneer evaluation
Each veneer was checked for proper seating
and margins were evaluated during the try-in
stage. For shade matching, each veneer was
compared to the contralateral tooth. During
the initial try-in of IPS e.max CAD veneers,
two veneers (18%) showed mismatched body
shades because the abutment’s shade was falling
between two shades. Therefore, a slightly lighter
shade block was selected, with the intention of
adjusting the final color using stains. During
the delivery stage, another two veneers (18%)
required further shade modification through
the application of stains intraorally and were
immediately red [15-17].
For VITA ENAMIC multiColor, during the
initial try-in, eleven (100%) veneers matched
the body shade due to the polychromatic nature
of the material. Nine veneers (81%) exhibited
a translucent incisal third, necessitating the
application of creamy white stains on the incisal
third of the palatal surface to reduce translucency.
During the delivery stage, one veneer (9%)
required further shade characterization with
stains that were light-cured intraorally.
Figure 2 - Assessment of shade match post cementation.
Figure 1 - Visual shade determination using VITA Tooth guide
3D-Master.
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
Cementation
A heavy rubber dam sheet was used to isolate
the anterior teeth, where two universal canine or
premolar winged clamps were placed over canine
teeth bilaterally and a tissue retractor anterior
clamp was placed to isolate the intended tooth.
A veneer holding stick was used for easy handling
and precise placement of the veneer during
cementation. The tting surfaces of all veneers
were treated and silanated according to the
manufacturer’s instructions and abutment teeth
were prepared where total etch protocol was
followed using light-cured resin cement (Choice
2 veneer resin cement, translucent shade).
Outcomes measurement
Shade matching
Two experienced observers who were blinded
to tested materials, evaluated the restorations for
shade matching independently according to the
modied USPHS criteria. The restorations were
visually inspected immediately post cementation
for shade match with the contralateral tooth and
grades were recorded (Figure 2).
Marginal adaptation
The two experienced observers also
evaluated the restorations for marginal adaptation
independently, according to USPHS criteria.
The restorations were assessed by direct visual
and tactile examination with mouth mirror and
explorer of 0.2 mm single-ended working end
under magnication of dental loupes immediately
post cementation.
Patient satisfaction
A questionnaire was formulated according
to the VAS and given to all patients in both
groups. VAS scoring was made between 0 to
10 representing a score between full satisfaction
and complete dissatisfaction. The patients
were left unattended until they completed the
questionnaire.
Statistical analysis
For parametric data, Student’s t-test was used
to compare between the two groups. For non-
parametric data, Mann-Whitney U test was used
to compare the two groups. The significance
level was set at P ≤ 0.05. Statistical analysis was
Table IV - Results of comparing patient satisfaction scores in the two tested groups (Group EX and Group EMC)
Patient satisfaction Group EX (n = 11) Group EMC (n = 11) *p-value Effect size (d)
Median (Range) 10 (10 – 10) 10 (9 – 10) 0.317 0.154
Mean (SD) 10 (0) 9.91 (0.3)
*Significant at p ≤ 0.05. ; SD: standard deviation; SD: standard deviation.
Table II - Results of comparing shade matching scores in the two tested groups (Group EX and Group EMC)
Shade match
Group EX (n = 11) Group EMC (n = 11)
*p-value Effect size (OR)
N % n %
Alpha 9 81.8 8 72.7 1 1.688
Bravo 2 18.2 3 27.3
*Significant at p ≤ 0.05. OR: Odds Ratio; %: percentage; SD: standard deviation.
Table III - Results of comparing marginal adaptation scores in the two tested groups (Group EX and Group EMC)
Marginal adaptation
Group EX (n = 11) Group EMC (n = 11)
*p-value Effect size (v)
n % N %
Alpha 8 72.7 10 90.9
0.586 0.266Bravo 2 18.2 1 9.1
Charlie 1 9.1 0 0
*Significant at p ≤ 0.05.
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
performed with IBM SPSS Statistics for Windows,
Version 23.0. Armonk, NY: IBM Corp.
RESULTS
Regarding shade matching, no statistically
signicant difference between the two groups
(P-value = 1, Effect size = 1.688) was revealed
by Fisher’s Exact test, where group EX was
1.688 folds prone to have (Alpha) scores than
group EMC as shown in Table II.
Regarding the marginal adaptation, no
statistically signicant difference between the two
groups (P-value = 0.586, Effect size = 0.266)
was revealed by Fisher’s Exact test (Table III).
Regarding patient satisfaction, there was no
statistically signicant difference between patient
satisfaction scores in the two groups (p-value =
0.317, Effect size = 0.154) (Table IV).
DISCUSSION
Porcelain laminate veneers are regarded as
one of the most desired restorations owing to their
conservatism, superior esthetics, bond strength,
durability and high survival rate. Laminate
veneers require minimal tooth preparation and
are primarily conned to the enamel [1].
IPS e.max ceramic is considered the gold
standard for laminate veneers as it offers
superior optical characteristics, closely mimicking
the natural teeth in terms of translucency,
opacity, halo incisal effect and chameleon
effect [8]. Additionally, it has superior mechanical
properties, bond strength, biocompatibility and
processing tolerance for fabricating thin veneer
restorations [18]. Meanwhile, milling lithium
disilicate glass ceramic blocks in the blue stage
enhanced the ease of milling and minimized bur
wear [18].
CAD/CAM technology offered highly
accurate milled laminate veneer restorations with
enhanced precision. Meanwhile, it reduced chair
side time, offering a more comfortable experience
for the patient [19].
Construction of IPS e.max CAD veneer using
cutback technique was used to increase the incisal
translucency, add internal characteristics, and
create the illusion of depth, thereby enhancing
the esthetic [20,21].
VITA ENAMIC multiColor blocks possessed
natural chromatic transition integrated in six layers
from the cervical to incisal layer. Moreover, the
polymer component of VITA ENAMIC multiColor
offered resilience, that allowed absorbing
chewing forces more effectively and decreased
the chance of chipping or fracture [5,6,22-25].
Additionally, hybrid ceramics offered single-visit
dentistry since it does not necessitate ring in
a ceramic furnace. In addition, VITA ENAMIC
multiColor provided adequate bonding with resin
cement [22,23].
This study employed a randomized clinical
trial since it reduced confounding variables
and investigator bias [26]. Randomization
guaranteed that the assessments across both
groups are equal and the results are not biased
by confounding factors [27]. A triple blinded
study design minimized potential biases that
could affect the interpretation of the results [28].
Sample size calculation prevented wasting
research time, resources, and money and ensured
that no signicant treatment effects were missed
due to an inadequate sample size [29].
Shade determination was done to obtain
optimum shade match. Visual shade matching
was used because it is simple and economical.
Vitapan 3D-Master shade guide was used since
it has uniform color distribution of shade tabs
and uses a clear, logical structure based on value,
chroma, and hue [30]. Shade mapping was done
to ensure effective communication with the
ceramist and thereby excellent shade match and
high patient satisfaction [8].
The amount of tooth preparation was
standardized in all patients. Thereby, it guaranteed
uniform thickness of the veneer restoration, which
inuences the color outcome [31,32]. Moreover,
it reduced dentin exposure which could result in
compromised bond strength [23].
External surface characterization and
staining was performed to provide seamless
blend of the veneer with the patient’s natural
teeth. Characterization, through the application
of extrinsic staining allowed dental professionals
to mimic the complex color variations and unique
features of natural teeth [33].
Glazing was performed to minimize the
adverse effect of roughness on color and increase
the strength of the material [34].
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
The null hypothesis of the study regarding
shade match, marginal adaptation and patient
satisfaction between VITA ENAMIC multiColor
and IPS e.max CAD anterior laminate veneers
was accepted.
Regarding the results of shade match:
the null hypothesis was accepted as the results
revealed that there was no statistically signicant
difference between the two groups, with the
alpha score being prevalent in both groups.
This might be due to meticulous shade selection
using 3D Master tooth shade guide. Also, the
appropriate construction technique employing
the cutback technique in the fabrication of IPS
e.max CAD veneer helped achieve this result,
where characterization and staining employed in
both groups. Meanwhile, the polychromacity of
VITA ENAMIC multiColor block made it feasible
to replicate the complex appearance of natural
teeth [6].
Although the results showed insignicant
difference, alpha score was higher in IPS
e.max CAD group. This might be attributed
to the difference in the nature of the materials
used [35]. Additionally, some researchers found
that indirect hybrid ceramics have a reduced
matching capacity of the neighboring structures
compared to IPS e.max [6].
Our ndings aligned with those of M ElGendi
M, [36] who evaluated the color match of IPS
e.max CAD and Lava Ultimate veneer restorations
immediately after cementation according to
modied USPHS criteria and concluded that all
restorations showed Alpha scores.
The results of the present study were in
accordance with Fawakhiri et al. [37], who
concluded that a good color match (score 1) was
detected on the IPS e.max veneers according to
Hickel assessment.
Our findings aligned with those of
Mosallam et al. [38] who evaluated the color
match of lithium disilicate glass ceramic crown
restorations immediately after cementation using
VITA Easyshade device and concluded that glazed
restorations showed statistically signicant higher
color match compared to polished restorations.
Our ndings aligned with those of Attia et al.
[39] who evaluated fifty-four vita enamic
laminate veneers following traditional and
aesthetic pre-evaluative temporary techniques
immediately postcementation using modified
USPHS criteria. The study concluded that all
vita enamic veneers achieved 100% color match
(alpha score) at base line results.
The results of the present study were in
accordance with Saeed et al. [40] who assessed
the color change of twenty-four IPS e.max ceramic
laminate veneers using modied USPHS criteria
and found that all IPS e.max ceramic laminate
veneers exhibited 100% perfect color match
(alpha score) immediately post cementation
and at follow up periods, irrespective of the
preparation design.
However, the results of the present study
disagreed with those reported by Lee & Choi [31]
who found high color mismatch of HT and LT
lithium disilicate laminate veneers when cemented
by translucent resin cement. The difference in
their results might be attributed to articial aging
and using different evaluation technique that is
the spectrophotometer.
Regarding the results of marginal
adaptation: the null hypothesis was accepted,
as the results revealed no statistically signicant
difference between the two groups, with the
alpha score being prevalent in both groups. This
might be attributed to the use of CAD/CAM
technology, as well as a highly accurate extra-
oral scanner, namely DOF SWING HD Desktop
Scanner and precise milling with a five-axis
milling machine unit [41]. Another factor could
be bonding using resin cement that tend to exhibit
superior marginal adaptation, specifically in
enamel compared to dentin [42]. Additionally,
using the butt-joint incisal configuration for
tooth preparation facilitated an easy insertion
path for the laminate during cementation, while
preserving a peripheral enamel layer along all
margins [43].
Although the results showed insignicant
difference, alpha score was higher in VITA
ENAMIC multiColor group. This might be
attributed to the dual network structure (polymer
content) of the VITA ENAMIC multiColor that
offers the combination of strength, resilience,
and excellent machinability, achieving superior
marginal adaptation [7]. Additionally, VITA
ENAMIC multiColor blocks do not require
additional crystallization firing after milling,
which typically involves a 0.2% shrinkage
occurring during the densification of lithium
disilicate ceramics that can lead to an increased
marginal gap [44,45].
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
Our ndings aligned with those of Attia et al.
[39] who evaluated vita enamic veneers
using modified USPHS criteria immediately
postcementation. The study concluded that all
vita enamic veneers exhibited 100% alpha score,
interpreted as no visible evidence of crevice, catch
or penetration of explorer along the margin.
Our findings aligned with those of
Osman et al. [43], who evaluated IPS e.max
CAD veneers using modified USPHS criteria.
The study demonstrated 100% alpha score for
marginal adaptation.
Regarding the results of patient satisfaction:
the null hypothesis was accepted as the results
revealed that there was no statistically signicant
difference between patient satisfaction scores
in the two groups, with the alpha score being
prevalent in both groups. These results might
be attributed to the involvement of patients
in shade selection and mock-up modification
according to patient aesthetic and functional
needs [46]. Furthermore, obtaining patients’
consent and verifying the restoration’s shape
before fabricating the nal prosthesis appeared
to enhance patient satisfaction [37].
The findings of the current study were
consistent with those of Fawakhiri et al. [37] who
used Hickel’s 2010 criteria to assess IPS e.max
veneers for patient satisfaction and came to the
conclusion that 98% of participants reported
satisfaction with the restorations.
Our ndings aligned with those of Attia et al.
[39] who evaluated patient satisfaction using
modied USPHS criteria and concluded that all
participants in the group receiving vita enamic
veneers expressed high levels of satisfaction and
were assigned an alpha score at the baseline
assessment.
The results of the present study were in
accordance with Mosallam et al. [38] who
evaluated patient satisfaction of glazed lithium
disilicate glass ceramic restorations using visual
analogue scale and found out that all patients
reported complete satisfaction.
However, the results of the present study aligned
with those reported by Nejatidanesh et al. [47] who
evaluated IPS e.max CAD laminate veneers using
visual analogue scale and reported high patient
satisfaction, with mean score of 95.5 ± 8.4. This
might be attributed to the ability to complete the
treatment in a single visit.
The current study showed some limitations
including long term follow up.
RECOMMENDATIONS
• It is recommended to conduct further
clinical studies to assess the color stability
of VITA ENAMIC multiColor veneers against
monolithic IPS e.max CAD veneers;
• It is recommended to test the effect of
resin cements of different shades on the
color match and stability of VITA ENAMIC
multiColor veneers versus IPS e.max veneers;
• It is recommended to compare VITA ENAMIC
multiColor to other ceramic materials;
• Clinical Implications: It is advisable that
clinicians use IPS e.max CAD veneers
fabricated using cutback technique to
provide restorations with excellent shade
match and high patient satisfaction.
CONCLUSIONS
Within the limitations of this clinical study,
the following could be concluded: IPS e.max CAD
and VITA ENAMIC multiColor veneers provided
a successful clinical performance in terms of
shade match, marginal adaptation and patient
satisfaction.
Acknowledgements
Not applicable.
Author’s Contributions
NSAAK: Conceptualization, Methodology,
Investigation, Writing – Original Draft
Preparation, Writing – Review & Editing. HA:
Conceptualization, Methodology, Validation,
Formal Analysis, Writing – Review & Editing,
Supervision. EEY: Methodology, Validation,
Formal Analysis, Writing – Review & Editing,
Supervision.
Conict of Interest
The authors have no conicts of interest to
declare.
Funding
10
Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
Khalil NSAA et al.
Shade match, marginal adaptation and patient satisfaction: polymer infiltrated ceramic versus lithium disilicate glass ceramic anterior laminate veneers (Randomized Clinical Trial)
Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
ceramic anterior laminate veneers (Randomized Clinical Trial)
This research did not receive any specic
grant from funding agencies in the public,
commercial, or not-for-prot sectors.
Regulatory Statement
This study protocol was reviewed by the
Ethics Committee of Scientic Research - Faculty
of Dentistry - Cairo University and approved in
October 2020 with ID number: 22 10 20. The
clinical study was performed in the outpatient
clinic of the fixed prosthodontic department
clinic at Cairo University. All patients signed an
informed consent which was approved by the
Ethics committee.
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Braz Dent Sci 2024 Oct/Dec;27 (4): e4391
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Khalil NSAA et al. Shade match, marginal adaptation and patient satisfaction:
polymer infiltrated ceramic versus lithium disilicate glass
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Nancy Sayed Abdelaziz Abdelaal Khalil
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