08 July 2023

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Zirconia crowns as an alternative to stainless steel for primary teeth

By Lorenzo Breschi and Annamaria Forte

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Despite the efforts devoted to the prevention of dental caries, this disease is still affecting a significant percentage of primary and permanent dentition of children worldwide. If left untreated, caries can lead to severe tooth structure compromission, thus requiring restorative procedures. 

Primary teeth are crucial for preserving space in the dental arch and serving important functions in speech and mastication. In the presence of extensive carious lesion of primary teeth, or those that have undergone pulp therapy, full coverage restorations or crowns can be proposed as treatment options.

These procedures would help the preservation of the primary dental element until the permanent tooth erupts in the oral cavity. Several materials have been proposed for the fabrication of crowns in primary dentition, such as stainless-steel crowns and zirconia. Despite numerous advantages, zirconia crowns are associated with certain potential limitations. These include difficulties in making adjustments for mechanical retention, a limited range of available shades in clinical settings and longer procedure times. Additionally, achieving optimal adaptation may require more extensive reduction of the tooth structure.

Concerns have also been raised regarding pulpal exposure and postoperative complications during the preparation of zirconia crowns. Furthermore, despite the availability of various brands and meeting esthetic demands, zirconia crowns are often considered expensive when compared to alternative treatment options.

A systematic review published in February 2022 provides comprehensive knowledge regarding the clinical effectiveness and outcomes of zirconia crowns specifically designed for primary teeth.

Materials and methods

Four electronic databases (Ovid, PubMed, Scopus, and Web of Science) were searched by the research team. 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

The studies included in this article found 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 when compared to stainless steel zirconia crowns. 

Conclusion

Zirconia crowns exhibit considerable promise as an alternative to traditional restorative materials and crowns within the realm of pediatric dentistry. These crowns have demonstrated superior properties and performance across various clinical aspects, leading to high levels of parental satisfaction. It is crucial to consider certain factors when contemplating zirconia crowns as a substitute for alternative materials and crowns for primary teeth, including the duration of the procedure, cost implications, and the expertise of the dentist. These considerations become particularly relevant when dealing with primary teeth.

Alzanbaqi SD, Alogaiel RM, Alasmari MA, Al Essa AM, Khogeer LN, Alanazi BS, Hawsah ES, Shaikh AM, Ibrahim MS. "Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses." Int J Environ Res Public Health. 2022 Feb 28;19(5):2838. doi: 10.3390/ijerph19052838.