Predictors of patient dissatisfaction with ceramic veneers: A matched case–control study

AIM: To assess the association between mock-up technique (chairside bis-acryl vs digitally fabricated 3D-printed) and shade-matching protocol (chairside visual vs laboratory-assisted/digital) with patient-initiated esthetic dissatisfaction resulting in refund or retreatment within 12 months of veneer delivery. SETTINGS AND DESIGN: Single-center, 1:1 matched case-control study (23 pairs; n = 46) in a private prosthodontic practice. MATERIALS AND METHODS: Exposures were chairside bis-acryl versus digitally fabricated 3D-printed mock-ups and chairside visual versus laboratory-assisted/digital shade matching. The primary outcome was patient-initiated esthetic dissatisfaction within 12 months resulting in refund or retreatment; refund-only and retreatment-only outcomes were prespecified as exploratory. STATISTICAL ANALYSIS USED: Primary analysis used exact conditional methods for matched pairs (McNemar) with exact 95% confidence intervals; in the presence of separation, the exact lower confidence bound was reported without continuity corrections. A supportive multivariable unconditional logistic regression adjusted for age, sex, exact number of units, arch, and cost tier, and E-values were calculated to assess robustness to unmeasured confounding. RESULTS: Chairside mock-ups and chairside-only shade selection were more frequent in cases than controls. The matched odds ratio (OR) for chairside versus digitally fabricated mock-ups was ∞ (exact lower 95% confidence interval ≥2.51; P = 0.0010), and for chairside versus laboratory-assisted/digital shade matching was 6.00 (95% confidence interval 1.34-55.20; P = 0.0129). In the supportive adjusted model, the ORs were 5.87 (95% confidence interval 1.59-21.66; P = 0.008) for mock-up technique and 4.41 (1.26-15.42; P = 0.021) for shade protocol; corresponding E-values were 11.48, 11.22, and 8.29, respectively. CONCLUSION: Within the limitations of a retrospective, single-center design and modest sample size, chairside bis-acryl mock-ups and chairside-only shade matching were associated with higher odds of early esthetic dissatisfaction leading to refund or retreatment. Adoption of standardized digital workflows with digitally designed/3D-printed mock-ups and calibrated shade protocols is recommended as a clinical quality-assurance measure to mitigate this risk.