Investigating the impact of surface treatments on tensile bond strength between pediatric prefabricated zirconia crowns and primary maxillary incisors with various types of luting cement: an in vitro study.

PURPOSE: This study aimed to evaluate the effects of two surface treatments on the tensile bond strength of prefabricated zirconia crowns (PZCs) using bioactive and resin cements. METHODS: Forty extracted human primary maxillary incisors were prepared and divided into four groups based on surface treatment and cement type: (1) sandblast with bioactive cement, (2) sandblast with resin cement, (3) 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) with bioactive cement, and (4) 10-MDP with resin cement. After 24 h of cementation, specimens underwent 5000 thermocycling cycles between 5 °C and 55 °C. Tensile bond strengths were measured using a universal testing machine. The data were analyzed using two-way ANOVA and Tukey's post hoc test, with significance set at p < 0.05. RESULTS: The mean tensile bond strengths observed were 2.25 ± 1.27 MPa for sandblast with bioactive cement, 1.39 ± 0.95 MPa for sandblast with resin cement, 2.45 ± 1.15 MPa for 10-MDP with bioactive cement, and 1.68 ± 1.03 MPa for 10-MDP with resin cement. Significant improvements in bond strength were observed in the bioactive cement group treated with 10-MDP compared to those treated with sandblasting (p < 0.05). The 10-MDP treatment did not enhance bond strength for the resin cement compared to sandblasting. CONCLUSIONS: Bioactive cement generally provides a higher tensile bond strength than resin cement. While 10-MDP treatment enhances bond strength when used with bioactive cement, it does not show a similar enhancement when used with resin cement compared to sandblasting, indicating its effectiveness is selective based on the type of cement used.

Trueness and precision of digital light processing fabricated 3D printed monolithic zirconia crowns.

OBJECTIVES: The present study aimed to evaluate the trueness and precision of monolithic zirconia crowns (MZCs) fabricated by 3D printing and milling techniques. METHODS: A premolar crown was designed after scanning a prepared typodont. Twenty MZCs were fabricated using milling and 3D-printing techniques (n = 10). All the specimens were scanned with an industrial scanner, and the scanned data were analyzed using 3D measurement software to evaluate the trueness and precision of each group. Root mean square (RMS) deviations were measured and statistically analyzed (One-way ANOVA, Tukey's, p ≤ 0.05). RESULTS: The trueness of the printed MZC group (140 ± 14 µm) showed a significantly higher RMS value compared to the milled MZCs (96 ± 27 µm,p < 0.001). At the same time, the precision of the milled MZCs (61 ± 17 µm) showed a significantly higher RMS value compared to that of the printed MZCs (31 ± 5 µm,p < 0.001). CONCLUSIONS: The Fabrication techniques had a significant impact on the accuracy of the MZCs. Milled MZCs showed the highest trueness, while printed MZCs showed the highest precision. All the results were within the clinically acceptable error values. CLINICAL SIGNIFICANCE: Although the trueness of the milled MZCs is higher, the manufacturing accuracy of the 3D-printed MZCs showed clinically acceptable results in terms of trueness and precision. However, additional clinical studies are recommended. Furthermore, the volumetric changes of the material should be considered.

Accuracy, adaptation and margin quality of monolithic zirconia crowns fabricated by 3D printing versus subtractive manufacturing technique: A systematic review and meta-analysis of in vitro studies.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the accuracy (trueness and precision), marginal and internal adaptation, and margin quality of zirconia crowns made by additive manufacturing compared to subtractive manufacturing technology. METHODS: The investigation adhered to the PRISMA-ScR guidelines for systematic reviews and was registered at the Prospero database (n°CRD42023452927). Four electronic databases, including PubMed, Scopus, Embase, and Web of Science and manual search was conducted to find relevant studies published until September 2023. In vitro studies that assessed the trueness and precision, marginal and internal adaptation, and margin quality of printed crowns compared to milled ones were included. Studies on crowns over implants, pontics, temporary restorations, laminates, or exclusively experimental materials were excluded. RESULTS: A total of 9 studies were included in the descriptive reporting and 7 for meta-analysis. The global meta-analysis of the trueness (P<0.74,I2=90 %) and the margin quality (P<0.61,I2=0 %) indicated no significant difference between the root mean square of printed and milled zirconia crowns. The subgroup analysis for the printing system showed a significant effect (P<0.01). The meta-analysis of the crown areas indicated no significant difference in most of the areas, except for the marginal (favoring milled crowns) and axial (favoring printed crowns) areas. For precision and adaptation, both methods showed a clinically acceptable level. CONCLUSIONS: Additive manufacturing technology produces crowns with trueness and margin quality comparable to subtractive manufacturing. Both techniques have demonstrated the ability to produce crowns with precision levels, internal discrepancy, and marginal fit within clinically acceptable limits. CLINICAL SIGNIFICANCE: 3D printing emerges as a promising and potentially applicable alternative method for manufacturing zirconia crowns, as it shows trueness and margin quality comparable to restorations produced by the subtractive method.

Influence of attaching mechanical retentive devices onto frameworks on fracture resistance of implant-supported zirconia crowns.

This study investigated the fracture load of implant-supported zirconia crowns (IZCs), in which indirect composite resin or feldspathic porcelain was layered onto zirconia frameworks with mechanical retentive devices. Three different zirconia frameworks were assessed: attaching mechanical retentive devices on glaze and opaque porcelain materials (GL and OP groups, respectively), and no attaching mechanical retentive devices (ND group). The frameworks were layered using feldspathic porcelain (FP veneer) and indirect composite resin (IC veneer). Fracture load of the specimens was measured. In FP veneer, the GL group recorded the highest fracture load. In the IC veneer, the GL and OP groups had significantly higher fracture load than the ND group. The fracture resistance of IZCs can be enhanced by applying glaze material before attaching mechanical retentive devices for porcelain layering. The mechanical retentive devices effectively yielded mechanical interlocking between the zirconia frameworks and the IC veneer in GL and OP groups.

Tensile bond strength between paediatric prefabricated zirconia crowns and primary maxillary incisors when using various types of luting cements: an in vitro study.

PURPOSE: There is limited evidence regarding the most appropriate type of luting cement for paediatric prefabricated zirconia crowns (PZCs) in primary maxillary incisors. The retention of PZCs is dependent on the bond strength of luting cement between PZCs and primary maxillary incisors. The aim of this study was to evaluate the tensile bond strengths between PZCs and primary maxillary incisors with different types of luting cements. METHODS: Thirty freshly extracted human primary maxillary incisors were prepared and randomly divided into three groups corresponding to three luting cements: bioactive cement, resin cement, and resin-modified glass ionomer cement (RMGIC), and then restored with PZCs. Tensile bond strengths were evaluated by a universal testing machine. The results were analysed using one-way ANOVA with Tukey's post-hoc test (p < 0.05). RESULTS: The means of the tensile bond strengths were 1.43 ± 0.85 MPa, 0.91 ± 0.63 MPa, and 0.56 ± 0.39 MPa for the bioactive cement, resin cement, and RMGIC groups, respectively. A significant difference in tensile bond strength was observed between the bioactive cement and the RMGIC group (p < 0.05) but there was no significant difference in tensile bond strength between the resin cement group and the others. CONCLUSION: Types of luting cement influenced the tensile bond strength between PZCs and primary maxillary incisors. The bioactive cement showed higher tensile bond strength than the resin cement and RMGIC.

Shaping Smiles: A Narrative Review of Crown Advancements in Pediatric Dentistry.

This review examines the evolution of dental crowns in pediatric dentistry, highlighting the transition from traditional materials such as stainless steel to aesthetic and biocompatible alternatives like zirconia, resin-based composites, and Bioflex crowns. It focuses on their importance in repairing decayed or damaged teeth and improving children's oral health and psychological well-being. The methodology involved a comprehensive literature search over the past two decades, utilizing databases including PubMed, Google Scholar, and Chat.Consensus.App, with keywords related to pediatric dental crowns. The findings indicate that stainless steel crowns (SSCs) are valued for durability and cost-effectiveness, but they may cause hypersensitivity. Zirconia crowns are favored for biocompatibility, resistance, and aesthetics, although they are costlier and require more tooth reduction. Resin-based composite strip crowns offer a balance of aesthetics and function but have challenges in long-term stability. The review also touches on Bioflex crowns, noting their flexibility, but the limited research on their effectiveness. In summary, the review underscores the vital role of various dental crown materials in pediatric dentistry, stressing the importance of ongoing research to enhance clinical outcomes and pediatric patient quality of life. The selection of crown materials should consider efficacy, aesthetics, and the psychosocial effects on young patients.

Evaluation of Streptococcus mutans Colonization and Oral Hygiene Status in Primary Molars Restored with Two Different Crowns: A Randomized Clinical Trial.

Background: Full-coverage restorations are commonly employed choice of treatment in treating multisurface carious lesions in primary teeth. Aim: To assess the amount of Streptococcus mutans (S. mutans) colonization and oral hygiene status in deciduous molars restored with preformed zirconia and stainless steel crowns (SSC). Materials and methods: A total of 21 children aged between 4 and 7 years with bilateral carious primary molars were randomly divided into two groups of zirconia and SSC. Plaque collection was done using sterile swabs at baseline and 1-month intervals. S. mutans was cultured on mitis salivarius-bacitracin agar (MSBA). The microorganisms were then counted and expressed as colony-forming units. The plaque and gingival indices were recorded during the follow-up visits. All data were tabulated and subjected to statistical analysis, with the level of significance set at 5%. Results: A total of 21 children with 42 teeth were randomized into group I-SSC and group II-zirconia crowns using the split-mouth technique, respectively. The zirconia group showed a statistically significant reduction in the adhesion of S. mutans (p < 0.001). On comparing the plaque and gingival indices between the groups, plaque index (PI) and gingival index (GI) scores were significantly low in the zirconia group as compared with the SSC, with a mean difference of 0.08 at 3 months in group II (p < 0.001). Conclusion: Streptococcus mutans (S. mutans) adhesion to zirconia crowns was significantly less when compared with SSC, with better gingival health and oral hygiene. How to cite this article: Elizabeth JAA, Ramkumar H, Paulindraraj S, et al. Evaluation of Streptococcus mutans Colonization and Oral Hygiene Status in Primary Molars Restored with Two Different Crowns: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-2):S183-S189.

Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial.

BACKGROUND: The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs). METHODS: Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA. RESULTS: A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively. CONCLUSIONS: Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation. CLINICAL TRIAL REGISTRATION NUMBER: NCT05049694.

Assessment of Parental Satisfaction with Various Aesthetic Crowns Among Children of Various Age Groups: An Original Research.

Introduction: Over the past ten years, parents have become more involved in choosing the aesthetic restorations for their ward. The strip crown and the prefabricated zirconia crown are some of the common anterior aesthetic complete crowns. The purpose of this study is to examine parental satisfaction over a one-year period in children aged three to five with "Strip Crowns" versus "Preformed Primary Anterior Zirconia Crowns". Materials and Procedures: Current study included 20 children. Among them their both central incisors were restored using the two varieties of crowns. The distribution of participants was done using the permuted block randomization approach. Twenty parents who participated were called back over a year to complete the questionnaire. The data was collected and compared while the statistics are deemed significant at P < 0.05. Results: Both restoration options received positive feedback from parents. With strip crowns, there was a statistically significant correlation between overall happiness and longevity of the restoration (P = 0.003) and color (P = 0.033) in zirconium crowns. The parents who expressed less pleasure with the strip crowns' longevity and the color of zirconia crowns did so overall, though. Conclusion: In conclusion, prefabricated primary anterior zirconia crowns were more popular with parents than strip crowns. All other criteria were about equally well-liked by parents, with the exception of longevity, which was more common for zirconia crowns.

Clinical Effectiveness of 3D-Milled and 3D-Printed Zirconia Prosthesis-A Systematic Review and Meta-Analysis.

BACKGROUND: Additive manufacturing (three-dimensional (3D) printing) has become a leading manufacturing technique in dentistry due to its various advantages. However, its potential applications for dental ceramics are still being explored. Zirconia, among ceramics, has increasing popularity and applications in dentistry mostly due to its excellent properties. Although subtractive manufacturing (3D milling) is considered the most advanced technology for the fabrication of zirconia restorations, certain disadvantages are associated with it. METHODS: A systematic review was piloted to compare the clinical performance of zirconium crowns that were fabricated using three-dimensional (3D) milling and 3D printing. A meta-analysis was performed, and studies published up to November 2022 were identified. The terms searched were "Zirconium crowns", "3D printing", "CAD/CAM" (Computer-Aided Design and Computer-Aided Manufacturing), "Milling", "dental crowns", and "3D milling". The characteristics that were compared were the year in which the study was published, study design, age of the patient, country, the number of crowns, the type of crown fabrication, marginal integrity, caries status, and outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure this systematic review. Out of eleven hundred and fifty titles identified after a primary search, nine articles were included in the quantitative analysis. The research question based on PICO/PECO (Participant, Intervention/exposure, Comparison, and Outcome) was "Do 3D-printed and milled (P) zirconia crowns and FDPs (I) have a better survival rate (O) when conventional prosthesis is also an option (C)"? The data collected were tabulated and compared, and the risk of bias and meta-analysis were later performed. Only nine articles (clinical research) were selected for the study. Since there were no clinical studies on the 3D printing of zirconium crowns, six in vitro studies were considered for the comparison. Zirconium crowns in the milling group had an average minimum follow-up of 6 months. RESULTS: A moderate risk of bias was found, and survival was significant. A high heterogeneity level was noted among the studies. Marginal integrity, periodontal status, and survival rate were high. Linear regression depicted no statistical correlation between the type of cement used and the survival rate. CONCLUSIONS: It can be concluded that the milled crowns had a higher performance and satisfactory clinical survival.

Fracture resistance of zirconia surveyed crowns with four different occlusal rest seat designs.

PURPOSE: To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. MATERIALS AND METHODS: Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1 Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. RESULTS: The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). CONCLUSIONS: Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.

The use of aesthetic paediatric full coverage restorations among paediatric dental practitioners: an international survey.

Despite the recent growing evidence in support of prefabricated zirconia crown use as a successful option in managing grossly carious anterior and posterior primary teeth, the use of such crowns remains controversial within the paediatric dental profession. This study aims to assess the use of aesthetic full coverage paediatric restorations among paediatric dentists worldwide, with emphasis on aesthetic prefabricated zirconia crowns. This was an online cross-sectional survey questionnaire study comprising of 38 multiple-choice questions disseminated worldwide through the contact lists of national, regional and international paediatric dental organisations and social media platforms. The survey was completed by 556 respondents thus achieving power, with 391 (70.3%) females and 165 (29.7%) males. The respondents were from 55 different countries spread across six continents. The use of aesthetic full coverage restorations was reported by 80% (n = 444) of the respondents. For restoring anterior teeth, participants mainly used either composite strip crowns (94.4%, n = 419) or zirconia crowns (73.6%, n = 327), while those who used aesthetic crowns for restoring posterior teeth mainly used zirconia crowns (68.2%, n = 303). Within the limitations of this study, the results have shown a wide use of full coverage aesthetic restorations, including the use of zirconia crowns, of primary teeth within this international sample of practicing dentists.

Marginal gap and internal fit of 3D printed versus milled monolithic zirconia crowns.

BACKGROUND: This study aimed to evaluate and compare the marginal gap using two different methods and the internal fit of 3D printed and zirconia crowns. METHODS: 3Y-TZP zirconia crowns (n = 20) were manufactured using subtractive milling (group M) and 3D printed (group P). The marginal gap was measured at 60 points using vertical marginal gap technique (VMGT). On the other hand, the silicone replica technique (SRT) was used to evaluate the internal fit and was divided into 4 groups: marginal gap, cervical gap, axial gap, and occlusal gap where the thickness of light impression was measured at 16 references. The numerical data was tested for normality using Shapiro-Wilk's test. They were found to be normally distributed and were analyzed using an independent t-test. RESULTS: Using VMGT, group P had significantly higher mean marginal gap values of 80 ± 30 µm compared to group M = 60 ± 20 µm (p < 0.001). Also, with the SRT, the marginal gap of group P (100 ± 10 µm) had significantly higher values compared to group M (60 ± 10 µm). The internal fit showed significant difference between the tested groups except for Axial Gap. CONCLUSIONS: Although milled crowns showed better results. The 3D printed zirconia crowns offer clinically acceptable results in terms of marginal adaptation and internal fit. Both VMGT and SRT are reliable methods for the assessment of the marginal gap.

Clinical evaluation of cemented and adhesively resin-bonded monolithic and partially layered zirconia and lithium disilicate crowns.

Purpose: Zirconia and lithium disilicate crowns are very popular dental restorations. The cement type and layering technique used can profoundly affect the clinical performance of these crowns.This retrospective study is designed to investigate the success rate of cemented and adhesively bonded monolithic and partially layered zirconia and lithium disilicate crowns placed in faculty practice settings. Materials and Methods: Patients who had received zirconia or lithium disilicate crowns at the faculty practice were invited for clinical examination. The examiner used the modified United States Public Health Service (MUSPHS) evaluation criteria to evaluate the crowns. The crowns were either glass ionomer cemented zirconia (GIC-Zr), resin-bonded zirconia (Adh-Zr), or resin-bonded lithium disilicate (Adh-LD). The crowns were also divided into monolithic and layered groups. Inferential analysis was used to examine the differences through bivariate analysis using t-testing and one-way ANOVA. Results: Thirty-five patients, with a combined total of 218 single crowns, agreed to participate in the study. No statistically significant differences in the quality outcome variables considered were found between the groups, except for marginal adaptation, where Adh-Zr achieved significantly higher scores compared to GIC-Zr and Adh-LD. Layered zirconia and lithium disilicate crowns have significantly higher quality outcomes in terms of anatomic form, marginal adaptation, and color match compared to monolithic zirconia and lithium disilicate crowns. Conclusions: Conventionally cemented zirconia and adhesively bonded zirconia and lithium disilicate crowns are reliable treatment options with high short-term success rates. Clinical studies with longer follow-up times are needed to investigate their long-term success rates.

Shear bond strength of orthodontic brackets bonded to a new version of zirconium all ceramic restoration: An in vitro comparative study.

Objectives: Esthetic restorations such as monolithic zirconia crowns are highly requested for adults nowadays. Bonding orthodontic braces on this type of material became a challenge for orthodontists, because of the special surface treatment needed. This study aims to assess the shear bond strength (SBS) of metal, and ceramic brackets bonded on two types of zirconia ceramics, surface roughness (SR) after different surface treatments for their surfaces, and adhesive remnant index (ARI). Materials and methods: Brackets' base surface area (BSA) was scanned by an extra-oral scanner, then measured. The doubled labial surface of monolithic zirconia crowns (n = 30) and monolithic high translucent zirconia crowns (n = 30) were prepared and each was divided into three groups (n = 10) depending on surface treatment (hydrofluoric acid etching, no treatment, and rocatec airborne abrasion). Extracted lower central incisors (n = 20) were prepared. Each of them was divided into two subgroups depending on the type of bracket bonded on their surfaces (metal and ceramic). The SR, SBS, and ARI were assessed. Statistical analysis used: Tests used are independent-samples t-test, Fisher's exact test, One-Way ANOVA, and Kruskal-Wallis test. Results: The highest SBS and SR were observed in Enamel/Metal and Zirconia/Metal/Rocatec subgroups, respectively. Conclusion: Adequate bond strength could be obtained with the high translucent zirconia group if bonded with ceramic or metal brackets even if no treatment was used. Clinical significance: A proportion of simulation was done like practicing inside the dental clinic to reach the best results regarding the adhesion strength of orthodontic brackets.

Effect of pre-fabricated strip, zirconia and stainless steel crowns in primary molars.

The effect of gingival, clinical and radiographic outcomes while using prefabricated stainless steel crowns (SSC), resin strip crowns and zirconia crowns in primary molars is of interest to dentists. Clinical periodontal and radiographic evaluation was conducted for three groups at baseline 3, 6, 9 and 12 months intervals utilizing scoring system. According to the current study's findings, gingival health was better in the zirconia crown group compared to the resin strip crown and SSC groups. In addition, zirconia group demonstrated respectable clinical and radiographic outcomes when compared to resin strip crowns and stainless steel crowns, with the added benefit of better aesthetics.

Clinical Evaluation of Pediatric Posterior Zirconia and Stainless Steel Crowns: A Comparative Study.

Objective: To clinically evaluate and compare the performance of posterior pediatric zirconia crowns with stainless steel crowns. Materials and methods: Twenty nine children [3-9 years] were selected and given 70 preformed crowns [35: preformed zirconia crowns, Kinderkrown; 35: stainless steel crowns, KIDZ CROWN]. Crowns were evaluated for retention, marginal integrity, opposing tooth wear, plaque accumulation, gingival inflammation, and proximal contact at 3, 6, 9, and 12th month. Results: At the end of follow-up period overall success rate with zirconia crown was 93.5% and that of stainless steel crown was 96.7%. Statistical analysis showed no difference between the groups. Conclusion: Posterior preformed zirconia and stainless steel crowns showed good clinical performance. Preformed zirconia crowns can be an option for posterior full coronal restoration when esthetics is of prime concern for the parent and child. How to cite this article: Murali G, Mungara J, Vijayakumar P, et al. Clinical Evaluation of Pediatric Posterior Zirconia and Stainless Steel Crowns: A Comparative Study. Int J Clin Pediatr Dent 2022;15(1):9-14.

A clinical and radiographic comparative evaluation of custom-made zirconia crowns using CAD-CAM and stainless steel crowns in primary molars.

Background and Aim of Study: Early childhood caries is a multifactorial disease process affecting children below 71 months of age and continues to be a global health problem. Stainless steel crowns (SSCs) are widely used and are very popular in pediatric dentistry due to its superiority and durability when compared with multisurface amalgam restorations. However, one of the major disadvantages with these crowns is the poor esthetics. Parents often request for a more esthetic alternative to the SSC. Zirconia crowns are one of the tooth-colored full crown restorations currently available for use in primary teeth. These are available as both preformed and custom-made crowns and show excellent esthetics. However, these require extensive tooth preparation with a subgingival finish lines, which would cause gingival trauma and bleeding during the preparation. The present study uses intraoral scanners for making the custom-made zirconia crowns, which will avoid the conventional impressions. Currently, there are no studies available in pediatric dentistry regarding CAD-CAM crowns. Hence, there is a need for the study. Aim: The aim of this study is to clinically evaluate the performance of preformed SSCs and custom-made zirconia crowns in primary molars. To elicit parental and patient satisfaction with respect to preformed SSCs and custom made zirconia crowns and to radiographically compare the interproximal bone height for 1 year. Methods: The patients were selected with purposive sampling. The tooth of interest was prepared according to the crown it would receive. The upper and the lower arch of the tooth receiving custom-made zirconia crown was scanned using an intraoral scanner. The crowns were cemented using Type 1 glass ionomer cement (GIC) (SSC) and resin modified GIC (custom-made zirconia crown). After the crown placement, the patient and the parent's satisfaction was scaled regarding the time taken, comfort, cost of crown, appearance of crown, etc., using a 5-point Likert scale. A baseline radiograph was taken after crown placement. The patient was recalled every 3 months till 1 year for evaluation (loss of retention, loss of proximal contact, gingival inflammation, opposing tooth wear, and marginal integrity). At the end of 1 year, radiographs were taken to check the interproximal bone. Results: After 1 year evaluation of custom-made zirconia crowns and preformed SSCs in primary molars, it was shown that both SSC and zirconia crowns showed good gingival scores but zirconia crown was better than SSC in improving the gingival health. SSCs showed better results with respect to the opposing tooth wear and marginal adaptability. Parents as well as patients preferred a tooth-colored crown as a treatment option. Conclusion: Custom-made zirconia crowns are comparable to the preformed SSCs and they show better gingival scores and excellent color match.

Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses.

OBJECTIVE: The aim of this systematic review was to summarize the literature regarding the clinical performance of zirconia crowns for primary teeth. MATERIALS AND METHODS: Four electronic databases, Ovid, PubMed, Scopus, and Web of Science were searched. Clinical, observational, and laboratory studies were included. Studies that assessed the performance of zirconia crowns for primary teeth using outcomes such as gingival and periodontal health, parental satisfaction, color stability, crown retention, contour, fracture resistance, marginal integrity, surface roughness, and recurrent caries were included. Risk of bias was assessed using different assessment tools depending on the type of the assessed study. RESULTS: Out of the 2400 retrieved records, 73 full-text records were assessed for eligibility. Thirty-six studies were included for qualitative analysis. The included studies reported that zirconia crowns for primary teeth were associated with better gingival and periodontal health, good retention, high fracture resistance, color stability, high parental acceptance, good marginal adaptation, smooth cosmetic surface, and no recurrent caries. CONCLUSION: Zirconia crowns are promising alternative to other restorative materials and crowns in the field of pediatric dentistry. They showed higher properties and performance in different clinical aspects and great parental satisfaction.