Influence of Various Tooth Preparation Designs on Stress Distribution in Anterior Ceramic Veneers: A Systematic Review of Finite Element Analysis Studies

Abstract

OBJECTIVE: This systematic review compared the stress distribution patterns in anterior ceramic veneers with different tooth preparation designs by evaluating finite element analysis (FEA) studies, aiming to improve understanding of this biomechanical aspect related to clinical outcomes. MATERIALS AND METHODS: A systematic search of PubMed, Scopus, Web of Science, and Embase, along with gray literature sources was performed (January 1990-June 2025) to identify FEA studies comparing at least two preparation designs based on a modified preparation classification. Data were extracted using a customized form, and risk of bias was assessed with the ROBFEAD tool. (PROSPERO: CRD420251127762). RESULTS: Out of 9576 studies, 34 were included. In veneers and cement layers, stress concentration was most observed at both incisal and cervical regions, whereas cervical concentration predominated in tooth structures. Higher loading angles increased stress values. Preparations without incisal reduction often showed stress values comparable to or greater than those with incisal reduction. Designs with palatal chamfer frequently demonstrated additional stress concentration in the palatal region. CONCLUSIONS: Preparation design and loading angle influence stress distribution patterns in veneer restorations; however, no single design consistently demonstrates biomechanically superior performance across all conditions. Further standardized FEA studies with clearly justified modeling assumptions are recommended.