Long-term clinical performance of bilaminar veneers combined with the Dahl concept for the management of localized anterior tooth wear: An ambispective cohort study.

OBJECTIVES

To evaluate the long-term clinical performance of bilaminar restorations-functional palatal resin-based composite (RBC) veneers (PVs) combined with labial ceramic veneers (LVs) - used for the rehabilitation of localized anterior tooth wear with the Dahl concept, with emphasis on survival, failure patterns, and material- and patient-related risk factors.

METHODS

Twenty-six patients (156 maxillary anterior teeth) received bilaminar restorations. PVs were fabricated from RBCs (Enamel Plus HRi BioFunction or Estelite Sigma Quick), and LVs from lithium disilicate ceramics (IPS e.max Press or GC Initial LiSi Press). Clinical evaluation was performed at 3-5 and 6-8 years using USPHS criteria. Outcomes were classified as success, survival with deficiencies, or failure requiring replacement. Survival was analyzed using Kaplan-Meier estimates, and risk factors were assessed by multivariable regression analysis (p < 0.05).

RESULTS

Cumulative survival was 92.3% for PVs and 98.1% for LVs. Fifteen restorations (4.8%) required replacement, predominantly PVs due to wear- and fatigue-related deterioration. No survival difference was observed between LVs. PV performance showed significant material-related differences, with Estelite Sigma Quick exhibiting fewer failures and higher success rates than Enamel Plus HRi BioFunction. Unsatisfactory oral hygiene, bruxism, coffee/tea consumption, and increasing restoration age were associated with higher failure risk. Baseline erosion severity significantly affected PVs, but not LVs outcomes.

SIGNIFICANCE: Bilaminar restorations combined with the Dahl concept offer a durable, minimally invasive solution for localized anterior tooth wear over up to eight years. However, while LVs demonstrate excellent long-term stability, the performance of functional PVs remains material-dependent and requires ongoing maintenance.