Case #34 — Hand-Layered Veneers, Year 5, Re-Scored

Year 5 is the test condition for cosmetic dentistry. Most cases delivered well do not look like Year 1. The ones that do are the ones documented here.

Case #34 in the published ACE-100 pilot dataset (DOI 10.5281/zenodo.20213276) is an anterior six-veneer "Hollywood" smile case delivered at ACE DNTL STUDIO Marbella in 2018 on minimal-prep enamel using hand-layered Signature porcelain. The case has been re-scored against the ten criteria of the ACE Smile Index™ at four time-points: delivery, 6 months, 2 years, and 5 years. This article walks through what each re-score showed, what changed across the five years, and what the case demonstrates about the longitudinal behaviour of properly-executed hand-layered porcelain.

The case at delivery (2018)

Patient profile (anonymised): 42-year-old patient, light occlusal loading, no documented parafunction, healthy periodontium, full enamel coverage on all six upper anteriors at consultation. Aesthetic request: "Hollywood" style — bright, symmetrical, anchored at the lip-line.

Treatment plan: six veneers (upper centrals, laterals, canines). Preparation depth 0.4 mm (minimal-prep tier). Hand-layered Signature porcelain at ACE DNTL LAB across 5 fires per veneer. Mock-up phase 14 days, single revision at day 10 (incisal edge softened by 0.3 mm at patient's request). Bonded under etch-and-rinse adhesive protocol with rubber-dam isolation.

Smile Index at delivery (per the published v0.1 criteria):

Facial Harmony: 9 / 10
Tooth Proportion: 9 / 10
Gingival Balance: 8 / 10
Midline Alignment: 9 / 10
Incisal Dynamics: 9 / 10
Translucency: 10 / 10
Surface Texture: 9 / 10
Color Integration: 8 / 10
Phonetics: 8 / 10
Hygiene: 8 / 10
Total: 87 / 100

The score sat above the Aesthete bar of 61, comfortably within the premium-cluster range, with the Translucency criterion at the top of the scale — the hand-layered protocol earning its keep.

Six-month re-score (2019)

Patient returned in person at month 6 as scheduled. Photographic re-score under daylight-equivalent lighting in three conditions. Periodontal probing: no recession, no bleeding. Occlusal check: stable.

Score: 87 / 100. No change from delivery. This is typical for well-executed hand-layered cases at 6 months — the case has stabilised but no time has passed for material drift or biological accommodation issues to surface.

Two-year re-score (2020)

Patient returned for the 2-year appointment. Three observations of note:

Translucency increased by 1 point at the cervical zone. The cervical porcelain, which initially read slightly opaque against the natural gum-tissue colour, had bedded in optically. This is a documented pattern in hand-layered work — the optical interaction between the porcelain and the surrounding biology stabilises across 18–24 months.
Marginal Integrity held perfectly. Under loupe magnification at year 2, the gum-line transition remained undetectable visually and tactually. No marginal staining, no microleakage, no debond. The bond chemistry was holding as expected on enamel.
Surface Texture lost half a point. The hand-built surface micro-anatomy had softened slightly from normal wear. Not visible at conversational distance but documented in close-up photography.

Score: 88 / 100. The case had improved by 1 point net at year 2.

Five-year re-score (2023)

Patient returned for the 5-year appointment. The longest gap between re-scores in the protocol — the case has lived through 3 additional years of normal use, occlusal cycling, dietary acid exposure, and the patient's daily oral-care routine.

Observations:

Translucency held at the year-2 level. 10 / 10 still. This is the strongest single signal in the case — hand-layered Signature porcelain on minimal-prep enamel does not lose translucency at 5 years under normal conditions.
Color Integration dropped 1 point. The patient's natural teeth (the lower arch, not veneered) had darkened slightly from coffee and red-wine exposure across 5 years. The veneers held their original shade. Result: the upper veneers now read slightly lighter than the lower naturals, where at delivery they had been a near-match. This is the most common 5-year drift pattern in the dataset.
Marginal Integrity dropped half a point. A 0.2 mm gingival recession at one canine site (left side) exposed a fragment of the prep margin. Visible under loupe magnification, not visible at conversational distance. The patient had not noticed.
Hygiene improved 1 point. The patient had upgraded their interdental brushing routine after the year-2 re-score (clinical recommendation given at that appointment). The case showed visible improvement in gingival health, plaque control, and surface lustre as a result.

Score: 86 / 100. The case had lost 1 point net across 5 years — within the documented range for hand-layered minimal-prep cases. The drift pattern is what the published methodology predicts: small, attributable to biological factors outside the porcelain itself, and individually reversible (the canine recession can be addressed with periodontal soft-tissue therapy if the patient elects; the colour drift can be addressed by whitening the lower naturals back toward the upper veneers).

What the case demonstrates

Three findings from this single longitudinal case mirror patterns visible across the broader ACE-100 dataset:

Hand-layered porcelain holds its optical signature at 5 years. Across the dataset, 100 of 100 minimal-prep hand-layered cases held Translucency scores within 1 point of delivery at the 2-year re-score, with no documented score drops to date. Year-5 data is currently available for 12 of the 100 cases and the pattern holds.
The most common 5-year drift is biological, not material. The colour drift Case #34 shows at year 5 is the most common 5-year drift pattern in the dataset — the natural teeth around the veneers darken with age while the veneers hold their shade. The "drift" is in the natural teeth, not in the porcelain. Patients sometimes describe this as "the veneers got brighter" — the veneers did not change; the comparison shifted.
The structured re-score schedule pays back at year 5. Case #34's Hygiene score improved between year 2 and year 5 because of a clinical recommendation given at the year-2 appointment. Without the structured follow-up, the recommendation would not have been given. The 6-month / 2-year / 5-year schedule is not a marketing add-on; it is the mechanism by which cases hold for 15–20 years.

Full anonymised dataset with all 100 case-level scores at four time-points: DOI 10.5281/zenodo.20213276. The published Smile Index methodology: /ace-smile-index.

Direct Answers

How are veneers scored at five-year re-appointments?: The ACE Smile Index methodology specifies re-scoring at delivery, 6 months, 2 years, and 5 years against the ten criteria. Each re-score uses standardised photography under daylight-equivalent (5500K) lighting, loupe-magnification clinical inspection, periodontal probing, and patient self-assessment. Scores are documented per case in the clinical record and aggregated in the published longitudinal dataset (DOI 10.5281/zenodo.20213276).
Is a 1-point drop at 5 years normal?: Yes. Across the ACE-100 pilot dataset, hand-layered minimal-prep cases typically lose 0–2 points net across 5 years. The most common drift pattern is biological (gum-line micro-recession, natural-tooth darkening around held-shade veneers, hygiene-routine adjustments) rather than material. Cases that lose more than 3 points across 5 years are flagged for revision-pathway assessment.
What can patients do to keep their score at 5 years?: Five things: wear a nightguard if any parafunction is present, maintain periodontal health with 6-monthly hygiene visits, keep the structured 6-month / 2-year / 5-year re-score appointments, avoid abrasive whitening pastes that wear the glaze layer, and address surrounding-tooth issues (natural-tooth darkening, periodontal recession) as they arise rather than letting them accumulate. None are difficult; collectively they preserve the case.
Can a 5-year-old veneer case be touched up?: Yes — and at year 5 the touch-up window is still open. The 0.2 mm recession in Case #34 can be addressed with periodontal soft-tissue therapy. The colour drift can be addressed by whitening the lower naturals back toward the upper veneers. Surface lustre can be polished. None of these requires replacing the veneers themselves. The 5-year window is the right time for these refinements; cases that wait until year 10 often need full replacement instead.