ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Prefabricated Zirconia Crowns Are More Retentive When Compared to Stainless Steel Crowns in the Anterior Primary Dentition
Clinical Question In the primary dentition of pediatric patients, are prefabricated zirconia crowns as retentive as stainless steel crowns on anterior teeth?
Clinical Bottom Line Prefabricated zirconia crowns are more retentive when compared to stainless steel crowns in the anterior primary dentition. This is supported by a comparison of a cross-sectional study of 44 zirconia crowns with a retrospective study of 637 stainless steel and pre-veneered stainless steel crowns.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27306242Holsinger/201618 children with 57 crownsCross-Sectional Study
Key resultsThis cross-sectional study showed a 96% success rate in anterior zirconia crowns in pediatric patients. Of the 57 crowns evaluated, 8 of the teeth were lost to exfoliation and 3 were extracted due to pathology, leaving 46 crowns that could be evaluated for retention. Two of the 46 debonded, which is a 4% failure rate. These crowns were evaluated at a 6-month recall appointment.
#2) 26883611Lopez-Loverich/ 2015637 crowns in childrenRetrospective Study
Key resultsThis retrospective study showed 91% and 93% success rates both pre-veneered stainless steel crowns and conventional stainless steel crowns, respectively, in pediatric patients. A total of 637 stainless steel crowns were evaluated; with 483 being pre-veneered stainless steel crowns and 154 conventional stainless steel crowns. Failure rates were 9% and 7%, respectively. All the patients were retrospectively evaluated and were required to have had at least one 6-month recall appointment.
Evidence Search ("zirconium oxide"[Supplementary Concept] OR "zirconium oxide"[All Fields] OR "zirconia"[All Fields]) AND ("crowns"[MeSH Terms] OR "crowns"[All Fields]) AND primary[All Fields] ("stainless steel"[MeSH Terms] OR ("stainless"[All Fields] AND "steel"[All Fields]) OR "stainless steel"[All Fields]) AND ("crowns"[MeSH Terms] OR "crowns"[All Fields] OR "crown"[All Fields]) AND ("retention (psychology)"[MeSH Terms] OR ("retention"[All Fields] AND "(psychology)"[All Fields]) OR "retention (psychology)"[All Fields] OR "retention"[All Fields])
Comments on
The Evidence
Validity: Holsinger: This cross-sectional study included children who were assembled and treated equally. All of the children were experiencing early childhood caries and received anterior zirconia crowns from either a first- or second-year pediatric dental resident. This study was small in size. Initially the study included 57 patients, however, only 18 of the patients’ families could be contacted and/or presented for their appointments. The reason the patients could not be contacted was due to invalid phone numbers or the family moving. One examiner completed clinical evaluations of the children. For consistency of clinical assessment, the examiner was calibrated with a single faculty member during the first three examinations, and they were in complete agreement for all three. There were no competing interests. Lopez-Loverich: This retrospective study looked at patient charts of children that had at least one 6-month recall appointment after placement of the stainless steel crowns by pediatric dental faculty, pediatric dental residents, or pre-doc dental students. One examiner did the chart reviews. The patients selected had primary maxillary anterior teeth with caries lesions that were treated with full crown restorations. A large sample size of 637 crowns were considered, broken down into 483 pre-veenered stainless steel crowns and 143 conventional stainless steel crowns. There were no competing interests. Perspective: Holsinger: Although the patient sample size was very limited, the study showed the retention of the prefabricated zirconia crowns is clinically acceptable. More studies on this topic need to be performed so strong evidence can be available. Lopez-Loverich: This retrospective study had believable results due to the large sample size, which showed that pre-veneered and conventional stainless steel crowns are clinically acceptable in regard to retention.
Applicability Pediatric and general dentists have to choose what type of crown to use for acceptable esthetic outcomes on the anterior teeth of children with early childhood caries. Stainless steel crowns have proven to be successful for retention, whereas prefabricated zirconia crowns are newer and not completely proven yet. The Holsinger study when compared to Lopez-Loverich study shows that these newer prefabricated zirconia crowns are an equally acceptable choice for patients or parents with high esthetic demands.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Stainless steel crown, primary teeth, prefabricated zirconia crown, retention
ID# 3158
Date of submission: 03/21/2017spacer
E-mail ardoinj@livemail.uthscsa.edu
Author Jordan Ardoin
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kevin Donly, DDS, MS
Faculty mentor/Co-author e-mail DONLY@uthscsa.edu
Basic Science Rationale
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