Retrospective clinical evaluation of a no-prep porcelain veneer protocol

Statement of problem: Porcelain laminate veneers without tooth preparation (no-prep veneers) might represent a convenient and conservative option for the esthetic rehabilitation of anterior teeth. However, controversy exists about their predictability. Purpose: The purpose of this clinical study was to retrospectively evaluate the performance of no-prep porcelain veneers placed as per the recently proposed “CH no-prep” protocol, which claimed to overcome many of the drawbacks of previous no-prep veneer solutions. Material and methods: One hundred eight no-prep porcelain laminate veneers based on the CH no-prep protocol were placed in 21 patients between 2015 and 2017. All participants were contacted, and 15 received a recall examination: a total of 78 veneers were evaluated as per the Clinical-Photographic-Micromorphologic coding. Plaque and gingival indexes and any increase in gingival recession were recorded. Pulp vitality was verified. A survival rate based on the count of absolute failures and a success rate summarizing the effect of both absolute and relative failures were calculated. Results: The mean observation period was 43.1 months, with an observation interval of 36 to 60 months and a survival rate of 97.4%. From the 5 relative failures (3 minimal fractures or chips and 2 limited marginal discolorations) and the 2 absolute failures (unrepairable fractures), an overall success rate of 91.0% was recorded, with 71 restorations that were judged excellent in terms of clinical acceptance after the recall examination. From the Clinical-Photographic-Micromorphologic evaluation, 5 restorations (6.4%) showed minimal issues for marginal integrity, while a limited porcelain overhang was identified on 2 restorations (2.8%). Micromorphologic analyses confirmed the clinical evaluations. No periodontal recession was observed, and plaque and gingival indexes appeared stable. Conclusions: Porcelain laminate veneers placed as per the CH no-prep protocol demonstrated excellent performances after 36 to 60 months of clinical service. The achieved outcomes, in terms of color match and overall esthetic and anatomic integration, confirmed that a prepless approach may be safely adopted provided that strict rules for patient selection and finish line placement are adopted.