Prospective, Randomized, Clinical Evaluation of Preformed Zirconia Crowns and Stainless Steel Crowns on Permanent First Molars: 12-Month Results.

PURPOSE: The purpose of this prospective, randomized, parallel-group clinical study was to evaluate and compare the clinical outcome of preformed zirconia crowns and preformed stainless steel crowns when used to restore permanent first molars. METHODS: Patients with severely decayed, badly broken down hypomineralized or hypoplastic permanent first molars that required a full-coverage restoration were invited to parti- cipate in the study. Sixty-nine healthy, cooperative children, ages six to 12 years, were recruited for the study. Following informed consent, 36 preformed zirconia crowns and 36 stainless steel crowns were placed and assessed at one week, three months, nine months, and 12 months accord- ing to the modified United States Public Health Service Ryge criteria. The parameters evaluated were: the time required for preparation and ce- mentation; plaque accumulation; marginal integrity; fracture of the crown; retention of cement; interference with the eruption of the permanent second molar; and parental acceptance. RESULTS: The clinical evaluation revealed statistically comparable performance in crown retention, fracture, marginal integrity, and plaque retention at 12 months between crown types. Preformed zirconia crowns were preferred by the parents primarily because of esthetics. However, a significant difference was seen in the clinical time required for the preparation and placement of preformed zirconia crowns, which was nearly twice that for stainless steel crowns. CONCLUSIONS: After 12 months of clinical evaluation, preformed zirconia crowns performed comparably to stainless steel crowns in their ability to restore decayed or hypomineralized permanent first molars. However, zirconia crowns took nearly twice as long to prepare, fit, and cement.

An 18-Month Prospective Randomized Clinical Trial Comparing Zirconia Crowns with Glass-reinforced Fiber Composite Crowns in Primary Molar Teeth.

Purpose: The purpose of this clinical trial was to assess the clinical performance of primary molar zirconia crowns with a glass fiber-reinforced composite crown (GFRC) in primary molar teeth. Methods: This trial was designed as a prospective, randomized, bilateral split-mouth study. A total of 66 crowns were placed in 30 children, ages four to nine years, from October 2018 until January 2019. Assessment of the clinical performance was done at one week and at three, six, 12, and 18 months. Several criteria, such as color match, time taken for the clinical procedure, resistance to dislodgement prior to cementation, crown retention, occlusal wear, staining, gingival health, plaque retention, and parental satisfaction, were evaluated. Result: At 18 months, 58 crowns were analyzed: 30 ZR crowns and 28 GFRC crowns. There was a statistically significant difference (P<0.05) between staining, occlusal wear, gingival health, plaque retention, and parental satisfaction between groups at 18 months, with the zirconia crowns outperforming the GFRC crowns in all those categories. The only areas where GFRC crowns performed better than ZR crowns were the time required to place them and the resistance to dislodgement before cementation. Conclusion: This study demonstrated that primary molar zirconia crowns had highly acceptable and significantly better clinical performance than glass fiber-reinforced composite crowns after 18 months.

Prefabricated Zirconia Crowns - A Solution to Treat Hypomineralized Permanent Molars: Report of a Case.

The presence of carious lesions in children associated with developmental defects of enamel is frequently observed. Restoring these affected teeth can be a challenge for the clinician. Teeth with enamel defects may have poor or limited resin adhesion and some may require repeated restoration. Prefabricated zirconia permanent molar crowns were recently introduced as an option for restoring severely decayed and broken down young permanent molars. These new restorations offer an efficient, esthetic, and economic option to restore severely broken down carious permanent molars that may be associated with enamel defects in partially or fully erupted molars. A clinical case of a 13-year-old female patient is presented. She had a mandibular second permanent molar that demonstrated significant caries and loss of much of the clinical crown, which was treated with a vital pulpotomy and restored with a prefabricated zirconia crown.

Restoring primary anterior teeth: updated for 2014.

The purpose of this paper was to review the current literature associated with the techniques and materials for the restoration of primary anterior teeth and make clinical recommendations based upon the available literature. A variety of esthetic restorative materials are available to utilize for restoring primary incisors. Awareness of the specific strengths, weakness, and properties of each material can enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and crowns that are luted onto the tooth and are either some type of stainless steel or zirconia crown. There is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. Operator preferences, esthetic demands by parents, the child's behavior, the amount of tooth structure remaining, and moisture and hemorrhage control are all variables that affect the decision and ultimate outcome of whatever restorative solution is chosen.

Cross sectional: use of coolant for high-speed tooth preparation: a survey of pediatric dentist members of the American Academy of Pediatric Dentistry.

PURPOSE: To report the findings of a survey to determine the educational experiences, opinions and clinical practices relative to the use of coolant during cavity preparation of pediatric dentist members of the American Academy of Pediatric Dentistry (AAPD) and to determine whether teaching policies influenced the type of coolant used in private practice. METHODS: Four thousand fifty surveys were emailed to AAPD members and included questions regarding demographics and predoctoral, graduate, and current practice policies for the use of dry cutting. RESULTS: Returned survey numbered 1730 for a response rate of 43%. Fifteen percent were taught the concept of dry cutting in their predoctoral programs and 34% in their specialty, programs. Sixty percent never or rarely prepare teeth without water coolant. Slightly more than 40% prepared teeth with air coolant alone. Patient behavior (25%) and sedation (21%) were reported as determining factors for cutting dry. Thirty-one percent of private practice clinicians and 34% of part time academics use dry cutting, while only 15% of full time academicians use the technique (P<0.0001). CONCLUSIONS: Respondents tend to use the technique they were taught during their residency. Use of dry cutting was more likely to be utilized during sedations or general anesthesia to avoid airway compromise.

Use of coolant for high-speed tooth preparation: a survey of pediatric dentistry residency program directors in the United States.

PURPOSE: To determine current teaching policies regarding the use of coolant type during tooth preparation with high-speed hand-pieces in pediatric dental residency programs in the US. METHODS: A 17-question survey was electronically mailed to 63 program directors with one follow-up. Multiple-choice questions asked about school and program teaching of cavity preparation with or without water coolant, including hypothetical clinical situations. RESULTS: Fifty-two (83%) program directors returned the survey. Fifty-two percent taught both dry and water coolant methods, 6% taught dry cutting exclusively, and 42% did not teach the dry method and always used water coolant. Dry techniques were used primarily for special needs patients with poor swallow reflexes (50%) and for young children undergoing sedation (41%). Air coolant was taught more frequently in programs in the Midwest (77%) and South (85%) vs. the Northeast (32%) and West (50%) (P<.01). Forty-four percent of combined programs and 60% of hospital programs taught water spray use exclusively, while all university programs taught the dry cutting technique (P<.01). CONCLUSIONS: A majority of program directors teach the use of air coolant alone for high-speed preparation of teeth. University and combined programs were more likely to teach the method compared with hospital based ones.

Clinical outcomes for primary anterior teeth treated with preveneered stainless steel crowns.

PURPOSE: The purpose of this retrospective study was to explore clinical outcomes for NuSmile anterior preveneered stainless steel crowns. METHODS: A convenience sample of healthy children treated with anterior crowns was selected from a teaching clinic and private office. Crowns were placed by either a private practice dentist or pediatric dental resident. Clearly defined clinical outcomes were assessed by 3 calibrated examiners at recall, including: (1) presence; (2) chipping; (3) wear; (4) crazing; and (5) marginal location by clinical and radiographic examination. Factors affecting placement--such as operator experience and behavior--were also assessed. RESULTS: In 46 subjects (21 females, 25 males; mean age at placement=4 years, 2 months), 226 crowns with a mean post-placement time of 12.9 months were evaluated. Only 2 crowns matched natural teeth, with NuSmile crowns lighter in 83% of subjects. Most crowns (86%) were normal in size. Eighty-eight percent resisted fracture for 6 months. All but 3 crowns resisted color change for 6 months. Canine crowns were the least successful, but overall 91% of crowns retained good to excellent clinical appearance. CONCLUSIONS: NuSmile anterior preveneered crowns are a clinically successful restoration for primary incisors with early childhood caries.

Parental satisfaction with bonded resin composite strip crowns for primary incisors.

PURPOSE: The purpose of this study was to evaluate the parental satisfaction of bonded resin composite strip crowns for the treatment of maxillary anterior primary incisors and compare their satisfaction with the clinical evaluation and success of the crowns. METHODS: This was a retrospective, clinical study of patients who had strip crowns (SC) placed on maxillary primary incisors, returned for at least 1 recall examination, and whose parents gave consent for them to participate in the study. Color photographs were used for evaluation by 2 independent pediatric dentists. Parental satisfaction regarding the esthetics of the crowns was evaluated by a questionnaire. RESULTS: One hundred and twelve restorations placed in 40 children were evaluated. The evaluations were performed after the crowns had been in place for an average of 18 months (range=6-25 months). Overall parental satisfaction with the treatment was excellent; however, satisfaction with regard to color received the lowest rating. No significant differences were found between dentist and parent evaluations of color, size, and overall appearance (Fisher exact test; P=.194,.776,.291, respectively). Parents rated their overall satisfaction as being positive regardless of their poor ratings of color, size, or overall appearance. However, a significant relationship was found between durability and overall satisfaction (P=.046). Parents who gave poor ratings to durability also rated their overall satisfaction as being poor. CONCLUSIONS: Parental satisfaction with bonded resin composite SCs for the treatment of primary incisors with large or multi-surface caries was excellent. Parents' dissatisfaction was most often related to color of the restorations. However, this did not affect their overall satisfaction with the crowns. The durability of restorations negatively affected the rating of overall satisfaction with the crown. Durability seems to be of more concern than excellent color match to this group of parents.

The clinical and radiographic success of bonded resin composite strip crowns for primary incisors.

PURPOSE: The aim of this study was to examine the clinical and radiographic success of the treatment of maxillary anterior primary incisors with composite resin strip crowns placed in a private practice setting. METHODS: This was a retrospective, clinical study of patients who had strip crowns (SC) placed on maxillary primary incisors, returned for at least 1, 6-month recall examination, and whose parents consented to participate in the study. Radiographic and photographic examinations were used for evaluation. Two evaluators rated the images independently. When ratings were not in agreement, the 2 examiners reviewed the photograph or radiograph together and reached a consensus rating. RESULTS: One hundred twelve restorations placed in 40 children were evaluated. The evaluations were performed after the crowns had been in place for an average of 18 months. None of the restorations were totally lost, and only 12% were rated as having lost some resin material, resulting in an 88% overall retention rate. There was no difference in restoration success if the crowns were placed 4 at a time, or if fewer crowns were placed in a single sitting; the failure rates were comparable. Teeth that had pulpal treatment were judged to have far more significant color match discrepancies than those teeth without pulpal treatment. Ninety-one percent of the teeth demonstrated healthy pulps. Eight percent had some pulpal changes but did not require immediate attention. Only 1 tooth showed radiographic evidence of pulpal necrosis. Only 11 teeth had pulpal treatment, but of these, 10 demonstrated clinical success. CONCLUSIONS: Composite resin strip crowns for restoring primary incisors with large or multisurface caries performed well. Color match of these crowns with adjacent teeth may be significantly reduced when placed upon teeth that have undergone pulpectomy treatment and have been obturated with an iodoform paste. However, based upon the results of this study, the strip crown may provide an esthetic and durable restoration for carious primary incisors.

Restoring primary anterior teeth.

A variety of esthetic restorative materials are available for restoring primary incisors. Knowledge of the specific strengths, weakness, and properties of each material will enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Each has distinct advantages and disadvantages and the clinical conditions of placement may be a strong determining factor as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and those crowns that are luted onto the tooth and are some type of stainless steel crown. However, due to lack of supporting clinical data, none of the crowns can be said to be superior to the others under all circumstances. Though caries in the mandibular region is rare, restorative solutions for mandibular incisors are needed. Neither stainless steel crowns nor celluloid crown forms are made specifically for mandibular incisors. Many options exist to repair carious primary incisors, but there is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. This does not discount the fact that dentists have been using many of these crowns for years with much success. Operator preferences, esthetic demands by parents, the child's behavior, and moisture and hemorrhage control are all variables which affect the decision and ultimate outcome of whatever restorative treatment is chosen.