16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.

Available online at http://www.journalijdr.com

ISSN: 2230-9926 International Journal of Development Research

Vol. 07, Issue, 12, pp. 16777-16788, December, 2017

ORIGINAL RESEARCH ARTICLE

ORIGINAL RESEARCH ARTICLE Open Access

Main Considerations About Indirect Lid Facets: A Review

Gabriela De Almeida Alexandre1, Juliana Cavallini Segura1, Lara Maria Bueno Esteves1, Felipe Pereira
Cunha2, Adriana Santos Leme1, Vera Lúcia Bernardes1, Ana Carolina Bernardes Vanzella1, Idiberto José
Zotarelli Filho3 , Taylane Soffener Berlanga de Araújo1,2
1
University Center of the Educational Foundation of Barretos/ SP/Brazil- UNIFEB.
2
University Center North Paulista (Unorp) - Sao José do Rio Preto – SP, Brazil.
3
São Paulo State University (Unesp), Institute of Biosciences, Humanities and Exact Sciences (Ibilce),
Campus São José do Rio Preto/SP.

ARTICLE INFO ABSTRACT

Article History: The eternal search for a harmonious and aesthetic smile elevates the levels of demand and expectation of
Received 19th August 2017 Received patients. The laminated facets stand out as a treatment option for aesthetic rehabilitation in clinical practice for
in revised form 23rd September, 2017 providing more conservative treatments and minimally invasive preparations of dental structures. The
Accepted 6th October, 2017
development of new ceramic systems reinforced by lithium disilicate and self-adhesive resin cements favored
Published online 7th November, 2017
the increase of longevity and a clinical performance of indirect aesthetic restorations. The aim of this paper is
Key Words: to present a case report of an aesthetic smile rehabilitation, describing a confection protocol of minimally
Aesthetics, invasive preparations, molding and cementation of ceramic facets reinforced with Lithium disilicate, intending
Facets, success in treatment and patient satisfaction.
Ceramics.
.
*Corresponding author:

Copyright ©2017, Gabriela De Almeida Alexandre et al. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: Gabriela De Almeida Alexandre, Juliana Cavallini Segura, Lara Maria Bueno Esteves, Felipe Pereira Cunha, Adriana Santos Leme, Vera Lúcia
Bernardes, Ana Carolina Bernardes Vanzella, Taylane Soffener Berlanga de Araújo , Idiberto José Zotarelli Filho. Main Considerations About Indirect Lid
Facets: A Review. International Journal of Development Research, 7, (12), 16777-16788.
this knowledge allows us to have a varied range of restorative
materials that present excellent characteristics related not only
INTRODUCTION with appearance but also with physical aspects such as
biocompatibility and durability [1]. Dentistry has adhered to
Numerous reports in the literature show the search of
this concept throughout its evolution and has put into practice,
man, over time, for materials that can satisfactorily replace the
always with new discoveries, one that has become relevant is
lost dental structure. The evolution in the research of new
the laminated facets which consists of a high level aesthetic
technologies has led to the discovery of innumerable
technique providing patient and professional satisfaction [2].
possibilities for this purpose and today, the improvement of
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
The constant search for a harmonious and aesthetic smile
elevates the level of demand and expectation of patients [3].
This fact favors the development of new materials and
techniques in dentistry, aiming for more conservative
procedures and results that are increasingly aesthetically
predictable. Among the various treatment options for aesthetic
purposes, the laminated facets stand out for the possibility of
providing less wear of dental structures compared to the total
crowns [4].
The facets are characterized by the covering of the
vestibular face of the dental element by a restorative material,
attached to the dental element and can be made by direct or
indirect technique. Indirect facets are indicated when dental
problems arise regarding shape, position, symmetry, surface
texture and color, and are contraindicated in cases of
significant reduction of healthy tooth structure, in cases of
bruxism or dental tightening, with some severe periodontal
disease and severe vestibularization [5].
Ceramic veneered veneers have proven to be a
successful treatment modality for aesthetic rehabilitation in
clinical practice in recent years [5,6]. Ceramics have become
the material of choice as their outstanding properties have been
highlighted, such as biocompatibility, color stability,
longevity, tooth appearance and predictability of outcome. The
fact that minimal wear of healthy structures has made this
restoration technique indicated on a large scale in the last ten
years [6,7].
The progressive improvement of dental ceramics has
enabled the preparation of prosthetic works that reach the
current high esthetic and functional standards in restorative
dentistry [7]. A range of ceramic and technical systems have
been developed in the last decades to satisfy the search for
restorations that are increasingly resistant and optically similar
to dental structures [8].
Currently the most commonly used classification for
dental ceramics is the one that defines them according to their
crystalline phase in feldspathic, reinforced by leucite,
aluminized, with high content of alumina, zirconia and spinel
infiltrated by glass, vitreous ceramics and densely synthesized
alumina. Characterized as glass, conventional dental ceramics
were the pioneers to be made in high melting [9]. They are
called Feldspathic Ceramics because they have a greater
amount of feldspar compared to other elements. They have
very interesting physical properties and excellent aesthetic
quality. "Crystalline nuclei not incorporated into the vitreous
matrix formed, act as reinforcing framework ... forming the
complex structure resulting from the fusion of oxides at high
temperature, giving the ceramic a resistance greater than that
of ordinary glass [10].
This vitreous structure gives ceramics a more
elaborate optical reflection interaction with a high aesthetic
value, being very similar to dental tissues. Very interesting
physico-chemical aspects are mentioned by Kina (2005) in his
literature review, such as: properties of solubility and
corrosion quite adequate, allowing the construction of
restorations with good appearance and tolerance to the buccal
environment; low conductivity and thermal and electrical
diffusivity, constituting excellent insulators; low plastic, with
precarious tensile properties, low malleability and sensibly
friable, and is contraindicated for regions of load bearing or
masticatory stress [11].
The anterior teeth have fundamental importance in the
aesthetics of the face and, therefore, are highly valued by
patients who wish to lighten, increase, improve their anatomy
or position, in search of a more natural and harmonious smile.
The current trend is that the modifications in the smile are
carried out in a way that there is minimal wear of healthy
dental structure [12]. The laminated facets have been able to
combine the conservative requirement of their preparations
with their qualities of resistance, biocompatibility and, above
all, unmatched aesthetics. However, all this aesthetic
excellence can only be achieved if there is knowledge of the
basic principles of dental aesthetics, as well as the excellent
mastery of the technique [13].
The study aimed to transcend the possible problems,
revising current literature in order to influence the dental
surgeon in obtaining adequate knowledge of current ceramics
and preparatory and aesthetic principles.
METHODS
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
Experimental and clinical studies were included (case reports,
retrospective, prospective and randomized trials) with
qualitative and / or quantitative analysis. Initially, the key
words were determined by searching the DeCS tool
(Descriptors in Pubmed, Health Sciences, BIREME base) and
later verified and validated by MeSh system (Medical Subject
Headings, the US National Library of Medicine) in order to
achieve consistent search.
Mesh Terms
The words were included Aesthetics, Facets, Ceramics. For
further specification, the "Indirect facets" description for
refinement was added during searches. The literature search
was conducted through online databases: Pubmed,
Periodicos.com and Google Scholar. It was stipulated deadline,
and the related search covering all available literature on
virtual libraries.
Series of Articles and Eligibility
A total of 105 articles were found involving
temporomandibular dysfunction. Initially, it was held the
exclusion existing title and duplications in accordance with the
interest described this work. After this process, the summaries
were evaluated and a new exclusion was held. A total of 85
articles were evaluated in full, and 71 were included and
discussed in this study.
Literature Review
The indication of the use of ceramic laminates in
aesthetic procedures must be preceded by a careful and careful
analysis of the case [1-3]. One must be convinced of the real
need for this treatment, given the complexity of the procedure
and the possibility of dental wear, even when conservative [4].
Despite being considered the pinnacle of aesthetic
materials, the ceramics went through a period of forgetfulness,
as soon as the composite resin appeared on the market. Due to
its fragility, several stages for its preparation, cost, adequate
cementation, made the choice for other material was greater
[5-7]. However, with studies and results obtained after a long
period of experience and comparison between materials, the
conclusion was reached that when compared to resin with
ceramics, ceramics can re-emerge to the market with greater
credibility due to their results. Ceramics is the material that
most naturally imitates the dental structure. Having not only
aesthetics, but achieving excellence as biocompatibility, longer
duration in relation to color stability, longevity and possesses
mechanical properties that copies the natural process [7-10].
The perfect smile goes far beyond what one imagines,
associating physical, socio-economic and psychological well-
being; and also personal and professional success. The search
for a satisfactory visual became very common, which made
articles of aesthetics highly sought after, even equating plastic
surgery with restorative dentistry [11-14].
The efficacy and scientific proof of the ceramic
rehabilitation with ceramic laminates is sedimented in
dentistry. The science provides parameters to guide us in
relation to a correct diagnosis, safe planning, adequate
technique, material more indicated, however the professional
must be sure to interact with such factors that are determinant
in this modality of treatment [15-18].
There may be failures to achieve a satisfactory result
in the manufacture of laminated facets, considering various
requirements such as biocompatibility, strength and
satisfactory aesthetics to achieve a harmonic result. Flaws can
happen to any surgeon, but they can help the practitioner to
hone his techniques by following his instructions [19].
Telling about the preparation of the laminated facets
are three techniques used, basically they are: the first one that
uses the refractory material, the second is through the
pressurized heat and the third one that was discovered in the
last decade that is through the use of the computer [20-24].
These techniques were compared with their durability. The
ceramic laminates promoted excellent aesthetic results, and the
knowledge of the surgical technique and the restorative
materials and the quality of the prosthetic work are essential
for the planning and execution of aesthetic restorations [25-
28].
Indications
The indication of the use of ceramic laminates in
aesthetic procedures must be preceded by a careful and careful
analysis of the case [1-4]. One must be convinced of the real
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
need for this treatment, given the complexity of the procedure
and the possibility of dental wear, even when conservative [5].
Ceramic laminated veneers are indicated to restore
teeth with diastema; teeth with traumatic markings, endodontic
treatment or medications; conoid teeth; moderately poorly
positioned teeth; dental fractures; teeth with congenital
abnormalities; teeth with enamel hypoplasia; teeth with
imperfect amelogenesis; teeth that did not respond to tooth
whitening with large restorations on the vestibular face;
correction of minor alignment deviations and teeth with
fluorosis. Indirect facets are usually indicated for changes in
the dental shape, cases of color change of the dental element in
which bleaching was not satisfactory, alteration of the position
of the tooth in the dental arcade and cases of smile
rehabilitation [29].
Against Indication
Some of the facet limitations are insufficiency of
dental remnants, top occlusion, bruxism, and parafunctional
habits [30]. This procedure, however, is contraindicated for
excessively vestibularized teeth, crowded teeth, teeth with
insufficient dental remnants, teeth in end-to-end occlusion,
teeth with large and / or multiple restorations, bruxism and
habits parafunctional and patients with poor oral hygiene or
with high caries activity [31-34].
Therefore, it is contraindicated to make indirect
facets, in cases of parafunctional habits, patients with severe
periodontal disease and severe vestibularization [35].
Advantages
There are several advantages presented by the indirect
facets of porcelain such as, excellent aesthetics; adhesion to
the cementing agent and dental substrates; excellent abrasion
resistance; high flexural strength, which makes porcelain more
resistant to deformation; radiopacity; conductivity and
coefficient of thermal expansion similar to dental structures;
biocompatibility; chemical stability; compressive strength;
color stability; to be repaired; systems [36-39].
Ceramic laminates have many advantages, due to the
qualities of the composites, such as the ability to be bonded to
the dental substrate, and ceramics, such as color stability, high
strength, thermal expansion similar to dental enamel and great
aesthetic reproducibility [40-43]. Also, these procedures, in
addition to color and texture stability, present durability and
stiffness similar to dental enamel, without the drawbacks of
polymerization contraction and thermal expansion inherent in
composite resins, which in the case of facets is limited to the
resin cement [44,45].
Because they are vitreous and crystalline, these
materials present a more elaborate optical reflection, very
similar to dental structures and thanks to their chemical inertia.
Characteristic, its properties of solubility and corrosion are
adequate, it allows the construction of restorations with
aesthetic satisfactory and biocompatibility to the buccal
environment [46-48]. Also, it should be considered that the
ceramics are excellent insulators, with low conductivity and
thermal and electrical diffusivity [49].
It is possible to return the color of darkened teeth by
endodontic treatment through the porcelain facet, where one
can recover the aesthetics. Other advantages are the recovery
of guides, anatomical transformations, recovery of the smile
line, lip volume, reinforcement of teeth very restored and in
the small deviations of positioning [49].
However, the indirect facets have several advantages,
we can mention as main the ceramics that perform in a similar
way - and sometimes even better - the mechanical
characteristics of the enamel with respect to the modulus of
elasticity, fracture strength, hardness, thermal expansion,
compression and abrasion, conductivity and coefficient of
thermal expansion [50-54]. In this way, they exhibit good
longevity, excellent aesthetics, color stability, biocompatibility
with the periodontium, resistance to physical and chemical
wear, adhesion to the cementing agent and dental substrates,
radiopacity, minimally invasive preparation, low plate
accumulation and easy hygiene [55-58].
Disadvantages
The main disadvantages pointed out in the literature
are: difficult and demanding preparation of previous training;
adhesive procedures required for critical and time-consuming
fixation; to its cementation. Great care is needed to avoid
cracks and / or fractures; The repair, even if possible, is very
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
difficult and not recommended; performing temporary
restorations is difficult and requires patience and a lot of skill;
possibility of wearing down the opposing teeth; specific
materials for molding and adhesive cementation; specialized
laboratory; porcelain specific; longer time to manufacture and
higher cost [59-62].
The need for good training on the part of the
professional for the previous execution, the difficulty of a good
result for crowded and very dark teeth, fragility of the part
before cementation, difficulty of preparation, provisional that
require much of the dental surgeon for the aesthetic level [63].
The need for preparation that is responsible for the
wear of the dental structure, some difficulties of marginal
adaptation, tooth sensitivity, thorough technique and possible
wear to the antagonist teeth [64-67].
Stages Of Planning
To define an aesthetic smile is to characterize details
and harmony in a subjective way through the perception of
what is beautiful and sublime [68]. Despite the subjectivity of
this concept, the fashion and aesthetic industry together with
the media and the contemporary community establish patterns
of facial and body beauty that are increasingly demanding and
difficult to achieve through the overvaluation of the
phenotype. These media establish as ideal model to obtain a
smile with white teeth, aligned in the arch and free of any wear
and perception of occurrences, such as past tooth trauma; color
changes; form; structural abnormalities; position of anterior
teeth [69].
Anatomical variations are common, established
according to the age and community studied. The prevalence
of young people with diastema is between 15.4 and 27.0 %,
and the presence of conoid teeth can reach 28.9 % of the
population and microdontia has a rate of only 1.0 % [70].
Since the early 1980s, the development of minimally
invasive facets has enjoyed widespread enthusiasm and
success. Some authors have used the term contact lenses to
designate the minimally invasive laminated facets, mainly
because of the reduced thickness of the restoration. However,
it is believed that what will determine whether the restoration
will be minimally invasive or conventional (ie more invasive)
is the protocol of preparation and amount of wear [71].
The most important achievement of the minimally
invasive rehabilitation concept is the conservation of tooth
structure, which will be seen below [2-5]. In recent years, it
has become a widely accepted and popular procedure, as well
as providing the dentist and patient with the opportunity to
enhance the beauty of the smile without the need for heavy
wear. The minimally invasive procedures are supported by two
basic concepts: adhesion and conservation of dental structure
[6-8].
In spite of the great evolution in its composition in the last
60 years, resulting in an improvement of the mechanical and
optical properties, resin restorations present a high failure rate
when indicated for large restorations, besides the high color
instability over time and the failure rate of 2.9 % per year [10-
13].
To minimize protocol and contamination errors, absolute
isolation is indicated for restorative steps, either direct or
indirect. However, ceramic laminates almost always present
the cervical term at the level of the gingival sulcus, making it
not always possible to use the rubber sheet without interfering
negatively in the positioning of the indirect restoration [14].
Thus, the joining of the rubber dam for insulation associated
with relative insulation devices with cotton rollers in the
vestibule bag bottom, gauze on the back of the tongue and
mouth opening should be indicated for the cementation step.
Reverse planning will aid in aesthetic diagnosis,
communication with the dental technician, critical analysis
before / after treatment and in the relationship between the
dentist and patient, increasing motivation, confidence in the
performing team, and being an excellent tool for marketing
[15].
Treatment Of The Internal Surface of
Minimally Invasive Ceramic Facets
Surface conditioning is generated by the chemical reaction
of the hydrofluoric acid with the silica present in the vitreous
ceramics, resulting in a salt as a product, called
hexafluorosilicate [16-18]. Thus, the treatment of the internal
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
surface of the indirect restorations is modulated mainly by the
composition of the material . Therefore, the hydrofluoric acid
application time is directly related to the amount of silica
present in the ceramic composition; ratifying that the
knowledge of the composition of the type of ceramic used and
the treatment protocol is necessary for the success of
rehabilitation [19].
The silane, when applied on a glassy ceramic surface
without previous conditioning with hydrofluoric acid, presents
a less resistant adhesive interface. For this, the chemical
conditioning of the internal surface of vitreous ceramics with
hydrofluoric acid in concentration of 8.0 to 10.0 % is
necessary to promote morphological alteration of the glassy
phase and to create topography with hive aspect, considered
ideal for the micromechanical retention [20].
The feldspathic ceramics, due to their high amount of
glass, must be conditioned for the period of 120 to 150s.
Ceramics reinforced with leucite crystals, because they have
less silica than feldspathic, should be conditioned by 60s.
Following the gradual decrease of the proportion of the glass
phase, the conditioning for 20s is sufficient for the removal of
the second crystalline phase and vitreous matrix of ceramics
reinforced with lithium disilicate, promoting the creation of
micro-retentions and an acceptable union pattern. Due to the
reaction of hydrofluoric acid with silica resulting in the
formation of a hexafluorosilicate precipitate, the cleaning of
the part is indicated, it is possible to apply 37.0 % phosphoric
acid and to rub with microapplicator for 60s, or to insert the
laminates in an ultrasonic vessel by 3min [30-37].
Classification of Odontological Ceramics
The classification of ceramics for dental use can be
made according to several parameters such as: its use,
manufacturing temperature, ceramic system, composition,
microstructure and translucency [37-39].
Kelly (2008) subdivide the ceramics of dental use into
three main categories based on the vitreous composition;
reinforced; polycrystalline. Martínez et al. (2007) classifies
them into three main categories based on the technique of
confectioning condensation under refractory die, injected (lost-
wax technique, computer-aided technology (CAD-CAM) [40].
Glass ceramics
The best dental ceramics, considering the mimicry of
the optical properties of enamel and dentin, are those
containing a high content of glass. The feldspathic ceramics
were the first to be made in high melt, but always in
association with platinum sheets. Despite its excellent aesthetic
quality, its low resistance limited its indication only to
previous unitary crowns, in situations of small occlusal stress
[40-45].
Ceramics and glasses must be considered extremely
friable materials, which means that both have high
compressive strength but low tensile strength, and can fracture
under extremely low force [46-49].
In the beginning, porcelain for dental use had the
same composition as porcelain used in handicrafts. They
contained the 3 basic elements of the pottery: feldspar, quartz
and kaolin. Over time this composition was modified until the
present feldspathic ceramics are composed of a feldspar
matrix, in which are dispersed quartz particles and in smaller
amount the kaolin. The feldspar when decomposing into glass
is responsible for translucency, quartz is the crystalline phase
and kaolin gives the plasticity and facilitates handling when
the pottery is not yet cooked. In addition, to reduce the
sintering temperature of the blend, fluxes, and pigments are
incorporated to give different shades [50].
According to Villarroel et al (2012) feldspar ceramics
is essentially a mixture of potassium feldspar or sodium and
quartz feldspar. When its components are melted at high
temperatures (1200 - 1250 ° C) a liquid glass and leucite
crystals are formed [51-54]. This molten mass is then cooled
abruptly to maintain the vitreous state, which basically consists
of a silica network. After cooling the mass is ground and a
powder is obtained. Thus, feldspathic ceramics has two phases:
a vitreous, basically responsible for the translucency of the
material, and a crystalline, which confers resistance. As the
feldspathic ceramic is basically composed of glass, they have
excellent optical properties that allow us to achieve good
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.

aesthetic results, but at the same time they are fragile, for this
reason, the composition of the ceramics was modified until
new materials were found that presented a suitable for the
production of fully ceramic restorations [55].
Ceramics reinforced
In order to improve mechanical properties and to
control optical effects such as opalescence, color and opacity,
crystalline or high melting glass particles have been
incorporated into the composition of vitreous ceramics [56].
pre-ceramized glass tablet is injected, which will be melted in
a special oven, under controlled temperature and pressure,
mainly directed towards the preparation of ceramic laminates
and previous crowns. IPS Empress Esthetic (Ivoclar Vivadent
AG, Liechtenstein) which is a very similar system to the IPS
Empress, but contains a greater amount of leucite crystals in its
composition. The differential of this system is the possibility
of partial lamination, so that the restoration can be totally
made up, or 50.0 % made up and 50.0 % laminated [63].
Ceramic reinforced by lithium disilicate crystals

Feldspathic Ceramics enhanced by Leucita

Lithium Dissilicate ceramics (60.0 % to 70.0 %) were
Launched in the market in 1991, the incorporation of
developed to increase cohesion, flexural strength from 300 to
leucite ridges (40.0 to 50.0 %) in feldspathic ceramics was
400 MPa, maintaining a favorable aesthetic result, replacing
aimed at reinforcing the material and preventing micro
leucite-reinforced ceramics on the market [5].
fractures. This summation may have a high degree of
Ceramics reinforced with lithium disilicate crystals
translucency, bending of 97 - 180 MPa and a higher
were developed with the aim of increasing the use of adhesive
compressive strength when compared to conventional
restorations for the manufacture of bridges, based on a SiO2-
feldspathic [57].
LiO system (Empress II, Ivoclar-Vivadent, Schaan,
Its limitations are related to low tensile strength,
Liechtenstein). This system is manufactured through a
porosity, thermal expansion difference. Kelly and Benetti
combination of techniques: lost wax and injection by heat and
(2011) verified in their literature review that the leucite is
pressure. The function of the lithium disilicate crystals in this
considered a good option to increase the resistance of the
system is to give the ceramic better mechanical properties,
feldspathic ceramic, because its refraction indices are very
making the system more resistant. However, such resistance
close, causing a moderate increase in resistance without any an
does not interfere in the final optical result of the restoration
increase in the opacity of the material. This composition is also
due to the high translucency that the system presentes [6].
easily conditioned, creating micromechanical properties for
For the purpose of chromatizing and saturating the
resin adhesion [59].
piece there are two techniques: the first is the technique of
Another positive point is that due to the cooling of the
painting or makeup, and the second, the stratification. In the
particles, a volumetric percentage reduction of the leucite
make-up technique the piece is fused to a single color and then
occurs, larger than the surrounding glass and this difference
characterized with special dyes belonging to the same system
generates residual stresses that oppose the propagation of
[7]. A layer of glaze will be applied to the makeup and the
cracks, according to Villaroel (2012), its main advantages are
piece will be returned to the oven to avoid losing
the lack of metallic infrastructure, good translucency and
characterization over the years. In the technique of the
moderate flexural strength [60].
stratification, it is applied on an infrastructure made by
One of the methods is the one used by the lost wax
injection, covering ceramics, making possible a greater
technique to make the ceramic reinforced by leucite crystals,
stratification of the color and characterization of the incisals
where the total waxing of the part is included in a phosphate
[8].
coating, which will be subsequently subjected to injection [62].
The makeup should be performed when the facet
The wax is then burned and melted, and in the created space a
thickness is up to 0.6 mm and the stratification when the
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
thickness is at least 0.8 mm [10]. In 2005 a ceramics based on
injectable lithium disilicate was launched, with characteristics
superior to IPS Empress II, the IPS emax Press (Ivoclar
Vivadent, Liechtenstein). This system of injectable ceramics
presents a difference in the burning process, and its physical
properties and translucency were improved, making this
system feasible as aesthetic ceramics of coverage [10].
The IPS e.max have two forms of presentation, the
monolithic, which is the most common, where the ceramic is
milled or pressed and then stained [12]. Monolithic
restorations tend to have greater strength since only one
material is involved and there is no coating layer. However the
aesthetics acquired with monolithic crowns is not as
satisfactory as that acquired with laminated restorations where
there is a crushed or pressed lithium disilicate core covered by
a cover porcelain with the same coefficient of thermal
expansion / contraction. Stratified restorations have better
esthetics, but resistance is significantly reduced [13].
Ceramics reinforced by alumina, magnesium and
zirconia
In 1965, McLean and Hughes opened a new line of
investigations in the world of metal-free ceramics. They
incorporated the feldspathic ceramic into large amounts of
aluminum oxide, reducing the proportion of quartz [14]. The
result was a mixed microstructure material in which the
alumina, having a high melting temperature, remained in
suspension in the matrix, and these crystals greatly improved
the mechanical properties of the ceramic, but with a sudden
reduction in translucency [16].
Discussion
The esthetic dentistry is in a great development,
demanding an increasing search for conservative treatments
and due to the great propagation of a perfect smile in the
means of communication, the patients are more demanding in
relation to the aesthetic results obtained [22-24]. With the
proposal to mimic the dental structure, the porcelain veneers
present optical and mechanical characteristics that are well
suited to replace the altered dental tissue. It is a great
alternative in aesthetic rehabilitation and allows you to
reproduce a harmonious and natural smile [25].
Clinical studies have confirmed the maintenance of
aesthetics, biocompatibility and longevity of ceramic facets, in
longer periods for 9 years. According to Gurelet al (2012),
several longitudinal studies performed between 5 and 12 years
showed excellent results, with success rates ranging from 85.0
to 98.0%. The longevity and success of the facets represents
the satisfaction of patients undergoing these treatments [26].
According to Peumans et al (2000), 80.0 to 100.0% of patients
are satisfied with the aesthetic results of this type of
restorations. These patterns tend to increase over the years
after the facet placement due to the acceptance and habituation
of patients to their new smile [27].
A high degree of predictability of ceramic
restorations, indicating them for restorations that require
superior aesthetic solutions. Its characteristics, such as high
strength, biocompatibility, color stability, thermal expansion
coefficient close to the enamel and low thermal conductivity
are in contrast with the decline of the resistance,
polymerization contraction, higher wear, loss of brightness,
and initial texture of the resins [28]. In teeth with extensive
deficient restorations involving the vestibular face, obtaining a
harmony of color and shape is easier to achieve through
ceramic laminates than with composite resin restorations [28].
On aesthetic rehabilitation with ceramic facets in
anterior teeth with color alteration, it was observed that they
are considered a treatment approach more conservative than
total crowns, since the preparation of the teeth for facets
requires a less tooth surface wear than full crown preparations,
plus the facets have a greater periodontal biocompatibility and
better esthetics [30].
Ceramic materials have two problems related to their
use: cracking and wear on the antagonist tooth. The problem of
these materials occurs due to the propagation of cracks,
through the body of the restoration. Even though porcelains
exhibit high compressive strength, they have friability because
of their low tensile strength [31].
It was reported that in short- and medium-term
studies, failure rates related to facet decay or ceramic fractures
were between 0 and 5 % [31]. However, other studies on the
16777-16788 Gabriela De Almeida Alexandre et al. Main Considerations About Indirect Lid Facets: A Review.
longitudinal clinical performance of porcelain veneers; clinical
evaluation of porcelain veneers over a period of 18 to 42
months and clinical observation of porcelain veneers over a
period of 5 years ranged from 7 to 14 % over a period of 2 to 5
years [32].
Conclusion
These studies recommend that the risk factors for
failure of facets are their cementation on pre-existing
composite resin restorations; placement by an inexperienced
dentist; and the use of facets to restore worn or fractured teeth
in patients with parafunctions and poor dental structure with
many areas of exposed dentin. Another risk for faults in the
facets is related to thermal changes associated with the stress
generated by the polymerization contraction, in facets with
little thickness of ceramic material and a great thickness of
cement, leading to a possible fracture.
Conflict of interests: There is no conflict of interest
between authors.
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