Fracture resistance of lithium disilicate occlusal veneers fabricated with CAD/CAM and luted to dentin: a systematic review.

Abstract

Background: Lithium disilicate occlusal veneers offer a conservative solution for restoring posterior tooth wear, especially when bonded to dentin. CAD/CAM technology has enabled precise fabrication of these restorations, but concerns remain regarding their fracture resistance in demanding clinical scenarios. Our objective is to evaluate the fracture resistance of CAD/CAM-fabricated lithium disilicate occlusal veneers luted to dentin through a systematic review of in vitro studies.

Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Embase for in vitro studies published in English, Spanish, or Portuguese over the last 10 years up to 2025. Inclusion criteria focused on experimental studies assessing fracture resistance of lithium disilicate occlusal veneers bonded to dentin. Risk of bias was assessed using the QUIN tool.

Results: Eight studies met the inclusion criteria. All used human teeth and evaluated veneers with thicknesses ranging from 0.5 mm to 2.5 mm. CAD/CAM lithium disilicate veneers consistently demonstrated high fracture resistance values, exceeding typical posterior bite forces. Fracture resistance was positively influenced by increased thickness and the use of immediate dentin sealing. The aging protocols (thermocycling or water storage) showed limited impact on outcomes. All studies were rated as low risk of bias.

Conclusion: Lithium disilicate occlusal veneers fabricated with CAD/CAM and luted to dentin show excellent fracture resistance. A thickness between 0.8 mm and 1.5 mm is recommended for optimal strength, especially when immediate dentin sealing is applied. Further research should explore adhesive protocols to enhance dentin bonding.