Composite or ceramic veneers: what is the difference?

What the main differences are

What the studies comparing the two materials say

Let us look at two clinical studies that compared ceramic and composite resin directly, with ten years of follow-up.

In a split-mouth randomised clinical trial, with 48 veneers placed on the upper anterior teeth, cumulative survival at ten years was 100% for the ceramic veneers and in 75% for the indirect composite veneers. Among the veneers that remained in function, colour match, surface roughness, fracture and wear were significantly less favourable in the composite ^[2].

A practice-based study analysed 1,459 veneers in 341 patients over ten years. The annual failure rate was 1.2% for ceramic and in 4.1% for direct composite; the risk of failure was around four times higher in the composite ^[3].

A two-year randomised trial compared 60 direct composite veneers with 60 ceramic veneers in the closure of diastemas. Survival was statistically similar — 93.4% for composite and 95% for ceramic — but surface changes were clearly more frequent in the composite: staining in 11 veneers and roughness in 14 ^[5].

These are different study designs, with specific materials and techniques. Both point in the same direction, but they do not allow generalisation to all composites or to all ceramics.

Do resin veneers become stained?

Composite resin is more prone to staining and to surface changes. How marked those changes are depends on the material, on the finishing, on hygiene and on the patient's habits.

The review of composite veneers identified surface roughness, colour mismatch and the marginal discolouration as the most frequently reported complications ^[1]. That does not mean that every veneer develops visible changes over the same period.

Some surface changes can be corrected by polishing. Others may require repair or replacement.

Do ceramic veneers always keep the same colour?

Ceramic shows high colour stability, owing to the low degree of porosity of the material.

In laboratory studies, ceramic samples immersed in staining solutions — coffee and red wine had the greatest potential — may show a slight variation in colour, in most cases within clinically acceptable values ^[4]. This is, however, prolonged, continuous immersion, a regime that does not correspond to the intermittent contact that occurs in the mouth. Extrapolated to clinical reality, the effect is practically imperceptible.

Compared with composite resin veneers, the colour change of a ceramic veneer can be considered not perceptible over time, which is why it is regarded as a material of high colour stabilityIn a composite resin veneer, that change is visible and calls for maintenance — polishing and, in more extreme cases, replacement of the veneer — because of the greater porosity and water absorption of the material.

Even so, review appointments are necessary with both materials, so that this stability is maintained.

When choosing composite resin makes sense

Composite resin can be a good option for correcting small fractures, modifying the shape of the teeth or closing spaces, when the tooth position and the bite allow.

It can also be useful when an approach is wanted that allows future adjustments and repairs to be made easily, including in young patients, whose teeth and gums are still changing position. The initial cost is another factor to take into account when deciding.

Composite resin cannot, however, be considered a definitive solution. It can remain in function for a number of years, but it needs maintenance and, predictably, replacement in the future. What matters is that the patient knows about that maintenance and that the treatment is the one appropriate for their teeth.

When I prefer ceramic

I tend to prefer ceramic when the colour and the shape of several teeth need to be changed and aesthetic stability carries significant weight in the decision.

That preference always depends on the clinical assessment. I always consider the amount of enamel available, the amount of tooth structure, the forces of the bite and the presence of bruxism.

Among the ceramics themselves the choice is equally individual: the thickness available, the colour of the tooth and the mechanical and aesthetic demands help to decide which material is the most suitable.

If a veneer breaks, can it be repaired?

Resin veneers are generally simpler to repair: it is often possible to add composite and restore the shape directly in the mouth.

With ceramic, minor damage may allow a repair; an extensive fracture may make replacement necessary.

It should be borne in mind, however, that the greater strength of ceramic makes it less likely to fracture than a composite resin veneer. In the ten-year randomised trial cited above, all the failures recorded — debondings and fractures — occurred in the composite group ^[2]. It is that difference which lies behind the good long-term results of ceramic.

Before deciding, it is important to identify the cause of the problem and to assess both the veneer and the tooth that supports it.

Which is the best option in my case?

The decision should take into account the intended result, the preservation of the tooth and the care needed over the years.

It is important that there is an assessment consultation, at which an aesthetic and functional analysis is made, including of the bite, to determine which material is the most suitable and how many teeth the rehabilitation should include — so that the result is as predictable and long-lasting as possible.

At that consultation I explain the reasoning behind my proposal, the alternatives and the maintenance that can be expected. The patient should understand both what each material can achieve and what it may come to require in the future.