Comparative Clinical Evaluation of Pre-formed Pediatric Zirconia Crowns versus Stainless Steel Crowns (SSC) in Restoring Root Canal-Treated Primary Molars

Abstract

Background: Restoring endodontically treated primary molars is critical for maintaining the integrity of the dental arch, masticatory function, and aesthetics until the natural exfoliation of primary teeth. Historically, stainless steel crowns (SSCs) have been the “gold standard” in the complete restoration of primary molars. However, the demand for aesthetic restorations has led to the increased use of pre-formed pediatric zirconia crowns. Objective: To assess and compare the clinical performance, gingival health, parental satisfaction, and overall success of restorations using pre-formed pediatric zirconia crowns versus stainless steel crowns in the restoration of root canal-treated primary molars. Methodology: The sample consisted of a total 100 children (4-9 years old) who had undergone pulpectomy and required full coronal restoration. The sample was evenly divided in two groups. Group A received pre-formed pediatric zirconia crowns (n=50), while Group B received stainless steel crowns (n=50). Clinical assessments were done at baseline, 3 and 6 months after the restoration. Following the restoration, crown retention, margin integrity, gingival health, plaque accumulation, restoration failure, and parental satisfaction were evaluated. Data obtained were analyzed using SPSS version 26. Chi-square and independent t-tests were performed at a level of significance of p<0.05. Results: Both crown types were associated with similar levels of clinical success after 6 months. Zirconia crowns had a retention rate of 96.0% and SSCs of 94.0% (p = 0.642). SSCs had poorer gingival health and higher plaque accumulation compared to zirconia crowns (p < 0.05). Marginal integrity and the survival of the restorations did not significantly differ between the groups (p > 0.05). Zirconia crowns had significantly higher parental satisfaction for appearance compared to SSCs (p < 0.001). Parental satisfaction for zirconia crowns was 92.0% and for SSCs was 64.0%. Conclusion: Both preformed pediatric zirconia and SSCs are clinically successful restorations for root canal treated primary molars. SSCs are durable, cost-effective restorations, while zirconia crowns have improved gingival health and greater parental satisfaction. Zirconia crowns may be the restorations of choice for SSCs when greater satisfaction is needed for appearance.