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Original Research (Original Article) 


Ahmed Abdullah Alharbi et al, 2020;4(2):347–351.

International Journal of Medicine in Developing Countries

Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region

Ahmed Abdullah Alharbi1*, Abdullah Turki Alharbi1, Abdulmajeed Abdullah Alharbi2, Mohammed Abdullah Alharbi3, Alnashmi Obaid ALanazi1, Abdulaziz Lafi Alharbi1

Correspondence to: Ahmed Abdullah Alharbi

*Dentist in Ministry of Health, Buraydah, Qassim, Saudi Arabia.

Email: A7beny23 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 03 December 2019 | Accepted: 19 December 2019


ABSTRACT

Background:

The interest in dental ceramics has been increasing due to the recently developed techniques and technologies. Thus, this study aimed to evaluate the awareness, knowledge, and practice of the patients using laminate veneers and their effect on the periodontium, in Al-Qassim region.


Methodology:

A cross-sectional study was conducted using an online survey on the adult Saudi population of 18-year old and above, living in the Al-Qassim region. It was a questionnaire-based study consisting of three major areas, including demographic data, participants’ general knowledge about dental veneers, and participants’ main sources of information regarding attitude toward dental veneers.


Results:

A total of 301 individuals filled the online survey. The mean age of the participants was 31.4 ± 7.3 years. Surprisingly, those who used veneers and laminate lacked enough knowledge regarding all its side effects [e.g., gingival infections (p = 0.7), teeth scratches (p = 0.5), accumulation of food and bacteria (p = 0.6), and change in teeth color (p = 0.1)], on the other hand, the knowledge regarding veneers, laminates care, and cleaning was found to be correlated with age (p = 0.007) and in the current users of veneers (p = 0.0001).


Conclusion:

The knowledge of the Saudi population regarding laminate veneers, its care, its side effects, and its lifespan was insufficient.


Keywords:

Awareness, knowledge, practice, veneer, lumineers, periodontium.


Introduction

Esthetic dentistry has been recently influenced by the growing accessibility of media and online information and had become highly demanded by the patients [1]. The interest in dental ceramics has been increased due to the recently developed techniques and technologies [2]. Popular media and the influence of television programs had affected the esthetic dentistry by increasing the demand for teeth whitening (77.8%) and veneers (54.8%) [1]. In the United States, the demand for teeth whitening has increased by 300% among patients aged 20 to 50 years during the period of 1995 to 2000 [3].

Ceramic veneers had become one of the most esthetic, predictable, and conservative treatments, as enamel preparation is usually approximately 0.3 to 0.5 mm, which allowed a minimum thickness of porcelain. Ceramic lumineers might be placed without removing the sound tooth structure in some instances [47].

Veneers are indicated in multiple situations, such as discolored teeth, diastema closure, chipped or cracked teeth, minor misalignments and rotations of the anterior teeth, teeth reshaping, teeth with large cervical lesions or caries in the labial surface, and amelogenesis imperfect disorder. The veneers provided excellent esthetics, less plaque accumulation, resistance to any permanent stains, and more prolonged clinical longevity compared to resin composites. Furthermore, they had a high level of acceptance by patients and were considered a safe option [6,8,9].

A possibility of dentinal sensitivity and difficulty of repairing fractured veneers might be a disadvantage for ceramic laminates and periodontal problems might occur due to over contouring of the veneers [6]. Reid et al. [10] assessed the gingival health of unprepared teeth after ceramic veneer placement and suggested that there was no increase in gingivitis risk. The esthetic results were variable; some of these restorations appeared too bulky and over contoured [11].

The success of laminate veneers relied mainly on proper tooth reduction to providing sufficient space for the fabrication of properly contoured laminate veneers without over modification of the tooth structure [12]. The veneers gave a beautiful appearance to the teeth; they became highly recommended by many individuals of different ages because they had been more knowing that the attractive smile could have a positive impact on self-confidence and could give a good impression to others about the patient himself [13].

The ceramic laminate veneer technique involves bonding of a thin ceramic laminate to the tooth surface using adhesive luting composite to change the color, form, or position of anterior teeth. Laminate veneers were steadily increasing in popularity among today’s dental practitioners due to excellent biocompatibility, stable aesthetic, and minimum destructive technique. Laminates veneers could be used to mask tooth discolorations, alter contours of malformed teeth and teeth with improper positions. Additionally, it could close interproximal spaces and diastema [14].

The long-term success of laminates veneers was due to essential parameters, such as shade selection, tooth preparation, cementation technique, and patient maintenance. The popularity and advantages of dental veneers involved aesthetic quality, fracture resistance, conservative preparation, low deboning rate, tissue acceptance, patient satisfaction, and negligible incidence of caries. The ceramic veneers showed excellent maintenance of aesthetics, favorable clinical performance, and high patient satisfaction [15]. The continued development of dental ceramics offered clinicians many options for creating highly aesthetic and functional laminate veneers. The silica-based glass-ceramics recently are commonly used for the fabrication of laminate veneers due to their excellent cosmetic properties. The inclusion of lithium-disilicate found (IPS empress II) e-max has led to significant improvement in the fracture resistance of glass-ceramics. This evolution of ceramic materials and adhesive systems permitted the development of the aesthetics of the smile and self-esteem of the patient [16]. The maintenance of ceramic veneers in the long term was excellent, patient’s satisfaction was high as laminate veneers had no adverse effects on gingival health in patients with optimal oral hygiene. Failures related to ceramic laminate veneers were related to microleakage, debonding, and fractures [17,18]. This study aimed to evaluate the awareness, knowledge, and practice of the patients using laminate veneers and their effect on the periodontium, in Al-Qassim region.


Subjects and Methods

A cross-sectional study was conducted using an online survey on adult Saudi population aged 18 years and above residing in Al-Qassim region. The questionnaire was in Arabic and asked questions in three major areas. The first section gathered demographic data, including gender, age, nationality, educational level, and occupation. The second section measured the participants’ general knowledge about dental veneers, such as the indication for veneers and their pros and cons. The third section aimed to determine the participants’ main sources of information regarding attitude toward dental veneers. The most desired color for the participants was determined by displaying multiple photos of different teeth shades on the same smile adjusted using Adobe Photoshop (CS6 version 13.0, CA) to mimic the shades BL1, BL2, BL3, BL4, A1, and A2 (Ivoclar Vivadent shade guide, Schaan, Liechtenstein). A pilot study was performed with 10 people, and appropriate modifications were made before the implementation of the study.

Statistical analysis was conducted using STATA 12 software. Continuous variables were presented as mean and SD and inter-group differences were compared using the t-test. Skewed numerical data was presented as median and average rank and between-group differences were compared using the Mann–Whitney U-test. Paired numerical data was compared using the paired t-test. Categorical variables were presented as number and percentage and differences between groups were compared using the Pearson chi-squared test or Fisher’s exact test. Ordinal data was compared using the chi-squared test for trend. Paired binary data was compared using the McNemar test. The p-values <0.05 were considered as statistically significant.


Results

A total of 301 individuals filled the online survey that assesses the knowledge, attitude, and practices for laminate veneers regarding its care, life span, and usage. The mean age of the participants was 31.4 ± 7.3 years. Approximately, 214 individuals were using dental veneers (70.4%), 89 individuals (29.3%) didn’t use it at the time of filling this survey, while only one contributor was of unknown status (Table 1).

Stratifying age into two age groups ≤40 years and > 40 years showed a significant difference in using laminates veneers as the older age group was significantly lower than the younger age group (p-value = 0.004). Females were significantly higher in using veneers and laminates than males (p-value = 0.008), those who had lower educational level used dental veneers and laminates significantly higher than those who had bachelor or postgraduate degrees (p-value = 0.014). Regarding marital status, individuals who were divorced had significantly higher usage of dental veneers and laminates followed by being married and finally who was single (p-value = 0.0001). Females had higher knowledge regarding gingival infections caused by veneers, while males had higher knowledge regarding food accumulation between veneers and tooth leading to bacterial infections with p-value 0.003, 0.014, respectively.

College graduates and postgraduate degree holders had more knowledge regarding veneers causing scratches to natural teeth (p-value = 0.045). Marital status was significantly correlated to knowledge regarding gingival infections and change of natural teeth color which accompany the usage of veneers and laminates, p-values 0.023 and 0.009, respectively. Surprisingly, those who used veneers and laminate lack enough knowledge regarding all its side effects [e.g., gingival infections (p = 0.7), teeth scratches (p = 0.5), accumulation of food and bacteria (p = 0.6), and changing in teeth color (p = 0.1)], on other hand, knowledge regarding veneers and laminates care and cleaning was found to be correlated to age (p = 0.007) and being a current user for veneers (p = 0.0001) (Table 2).

Table 1. Demographic characteristics of the participants.

Demographic characteristics N Percentage (%)
Gender
Male 197 64.8
Female 104 34.2
Unknown 3 1
Education
Primary 7 2.3
Secondary 116 38.2
Institutional 29 9.5
College and postgraduate studies 152 50
Marital status
Single 117 38.5
Divorced 28 9.2
Married 159 52.3
Current user of veneers
Yes 214 70.4
No 89 29.3
Unknown 1 0.3

Table 2. Participant’s knowledge regarding dental veneers.

Question Yes No I don’t know Unknown
Veneers may cause gingival infections 107
(35.2%)
77
(25.3%)
111
(36.5%)
9
(3%)
Veneers may cause dental scratches 68
(22.3%)
123
(40.5%)
104
(34.2%)
9
(3%)
Veneers may cause accumulation of food and bacteria 71
(23.3%)
123
(40.5%)
100
(32.9%)
10
(3.2%)
Veneers may cause dental color changes 75
(24.7%)
113
(37.2%)
101
(33.2%)
15
(4.9%)
Veneers should be cleaned in a different way than natural teeth 155
(51%)
76
(25%)
73
(24%)
0
(0%)

Multivariate analysis showed that the education level significantly affects knowledge and attitude toward veneers and laminates regarding healthy use of veneers, amount of care needed for veneers, avoidance of rough manipulations with veneers, regular checkup, and dentist assessment for veneers with p-value 0.0001, 0.0001, 0.0001, 0.0001, and 0.0001, respectively, while all other factors, including age, gender, marital status, and being a current user of veneers didn’t correlate to attitude toward veneers and laminates (Table 3).

Furthermore, when the total knowledge score was calculated it was found that the knowledge of the Saudi population regarding laminate veneers, its care, its side effects, and its lifespan was insufficient (Figure 1).


Discussion

Laminate veneers are the commonest aesthetic restoration dental procedure done nowadays. Magazines, internet, and newly emerging social media platforms had increased demand for such procedures in the last decades [19]. Saudis had relied on media and TV shows for their source of information regarding laminate veneers, it had been estimated that demand for esthetic dental procedures had tripled in the developed countries as USA [3].

Tin-Oo et al. [20] stated that the dissatisfaction was the leading cause for having laminates veneers, as most of the individuals recruited were not satisfied with color and shades of their teeth as well as how their smile looks. Besides, Samorodnitzky-Naveh et al. [21] had discovered that people tend to insight their teeth shades darker than what it was, which explained the psychological aspect for desiring laminate veneers.

Table 3. Participant’s attitude toward dental veneers.

Question Strongly agree agree neutral disagree Strongly disagree Unknown
The lifespan of veneers depends on the material used. 82
27%
109
35.8%
66
21.7%
30
9.9%
10
3.3%
7
2.3%
The lifespan of veneers depends on personal care and cleanliness 73
24%
115
37.8%
72
23.7%
26
8.5%
11
3.6%
7
2.3%
The lifespan of veneers depends on the health usage of teeth. 98
32.2%
94
31%
67
22%
20
6.6%
16
5.2%
9
3%
The lifespan of veneers depends on avoiding rough usage of teeth (e.g., break a nut). 79
26%
97
32%
58
19%
38
12.5%
23
7.5%
9
3%
The lifespan of veneers depends on a regular cleaning 89
29.3%
86
28.3%
63
20.7%
29
9.5%
21
6.9%
16
5.3%
The lifespan of veneers depends on regular checkups by the dentist 88
29%
100
32.9%
45
14.8%
24
7.9%
32
10.5%
15
4.9%

Figure 1. Total knowledge score of the study population.

Using laminate veneers had proven to be a conservative approach for a perfect smile as it impacts person’s image and self-steam which encouraged individuals to undergo such dental modifications, as Lazar and Deneuve [22], had detailed that only reason for Dutch population to use dental veneers was to have beautiful smiles [22].

In Saudi Arabia knowledge of population regarding laminates veneers, its uses, its care, its side effects, and its real indications seemed to be insufficient, as shown in the current study, individuals who were current users of laminates veneers do not significantly differ in their knowledge of veneers regarding side effects, lifespan, and proper care and cleaning of veneers significantly.

Males represent the majority (65%) of the sample population, however, females were significantly higher in using laminates veneers (p = 0.008), in contrast of Asaad et al. [18], and Vallittu et al. [23], who had a majority of females (72%), and who were also significantly higher in using veneers. Both genders had lack of knowledge regarding side effects of laminates veneers as 62% didn’t know that it may cause gingival infections, 75% didn’t know that it may cause dental scratches, while 73% didn’t know that it cause food and bacterial accumulation, 70.5% didn’t know that it may cause change in color of original teeth, and 49% didn’t know that veneers should be cleaned differently than natural teeth, This was consistent with Alfouzan et al. [19], Farsi et al. [24] who conducted studies assessing knowledge, attitudes, and practice of Saudis and other Arabic countries, it was found that these populations mainly depend on magazines, social media, friends, and relatives as a source of knowledge to dental health and esthetic dental procedures which reflected on marked ignorance of side effects, preparations, lifespan, and regular checkup.

The current study resulted in older age group >40-year old use laminate veneers significantly less frequent than younger age groups which came alongside with Marino et al. and Al-Sadhan et al. [25], who found out that patients in older age groups had lower knowledge regarding oral health than younger age groups.

In the current study, people who had higher educational level seemed to be more aware of side effects and proper attitude toward laminate veneers which was found consistent with Koivusilta et al. [26] and Al fouzan et al. [19], who stated that individuals with higher educational level had profound knowledge of laminate veneers when compared with those who had less educational level.

Nalbandian et al. [27] stated that full knowledge of side effects and care for laminate veneers had been associated with significantly higher rates of satisfaction post-treatment, which emphasized the role of patient education before insertion of dental veneers.


Conclusion

Consequently, it was concluded that the knowledge of the Saudi population regarding laminate veneers, its care, its side effects, and its lifespan were insufficient. Even, there was no significant difference in knowledge score between users and non-users of veneers which ultimately directs the light to the importance of raising awareness of the Saudi population about dental veneers.


Conflict of interest

The authors declared that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent of publication

Informed consent was obtained from all participants.


Ethical approval

Ethical approval was obtained from Institutional research and ethics board.


Author details

Ahmed Abdullah Alharbi1, Abdullah Turki Alharbi1, Abdulmajeed Abdullah Alharbi2, Mohammed Abdullah Alharbi3, Alnashmi Obaid ALanazi1, Abdulaziz Lafi Alharbi1

  1. Dentist in Ministry of Health, Buraydah, Qassim, Saudi Arabia
  2. Intern Dentist, Buraydah College, Buraydah, Saudi Arabia
  3. Dental student, Buraydah College, Buraydah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alharbi AA, Alharbi AT, Alharbi AA, Alharbi MA, ALanazi AO, Alharbi AL. Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. IJMDC. 2020; 4(2): 347-351. doi:10.24911/IJMDC.51-1575413664


Web Style

Alharbi AA, Alharbi AT, Alharbi AA, Alharbi MA, ALanazi AO, Alharbi AL. Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. https://www.ijmdc.com/?mno=76487 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575413664


AMA (American Medical Association) Style

Alharbi AA, Alharbi AT, Alharbi AA, Alharbi MA, ALanazi AO, Alharbi AL. Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. IJMDC. 2020; 4(2): 347-351. doi:10.24911/IJMDC.51-1575413664



Vancouver/ICMJE Style

Alharbi AA, Alharbi AT, Alharbi AA, Alharbi MA, ALanazi AO, Alharbi AL. Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. IJMDC. (2020), [cited October 15, 2021]; 4(2): 347-351. doi:10.24911/IJMDC.51-1575413664



Harvard Style

Alharbi, A. A., Alharbi, . A. T., Alharbi, . A. A., Alharbi, . M. A., ALanazi, . A. O. & Alharbi, . A. L. (2020) Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. IJMDC, 4 (2), 347-351. doi:10.24911/IJMDC.51-1575413664



Turabian Style

Alharbi, Ahmed Abdullah, Abdullah Turki Alharbi, Abdulmajeed Abdullah Alharbi, Mohammed Abdullah Alharbi, Alnashmi Obaid ALanazi, and Abdulaziz Lafi Alharbi. 2020. Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. International Journal of Medicine in Developing Countries, 4 (2), 347-351. doi:10.24911/IJMDC.51-1575413664



Chicago Style

Alharbi, Ahmed Abdullah, Abdullah Turki Alharbi, Abdulmajeed Abdullah Alharbi, Mohammed Abdullah Alharbi, Alnashmi Obaid ALanazi, and Abdulaziz Lafi Alharbi. "Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region." International Journal of Medicine in Developing Countries 4 (2020), 347-351. doi:10.24911/IJMDC.51-1575413664



MLA (The Modern Language Association) Style

Alharbi, Ahmed Abdullah, Abdullah Turki Alharbi, Abdulmajeed Abdullah Alharbi, Mohammed Abdullah Alharbi, Alnashmi Obaid ALanazi, and Abdulaziz Lafi Alharbi. "Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region." International Journal of Medicine in Developing Countries 4.2 (2020), 347-351. Print. doi:10.24911/IJMDC.51-1575413664



APA (American Psychological Association) Style

Alharbi, A. A., Alharbi, . A. T., Alharbi, . A. A., Alharbi, . M. A., ALanazi, . A. O. & Alharbi, . A. L. (2020) Measuring the awareness, knowledge, and practice of the patients using veneer and lumineers and its effect on periodontium: a cross sectional study in Al-Qassim region. International Journal of Medicine in Developing Countries, 4 (2), 347-351. doi:10.24911/IJMDC.51-1575413664