Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trial

Preformed Stainless-Steel Crowns: Their Effects on Oral Hygiene Maintenance and Gingival Health - A Prospective Original Research

The stainless-steel crown (SSC) is a durable restoration and has several indications for use in primary teeth such as following a pulpotomy/pulpectomy, fractured teeth, teeth with developmental defects, or large multi-surface caries lesions where amalgam is likely to fail. Due to its durability and a lifespan like the primary tooth, it could well be the gold standard in restorative care. SSCs protect the crown from fracture, reduce the possibility for leakage, and ensure a biological seal. However, the placement of the SSC should follow a meticulous technique. There are some clinical situations where the SSC may fail, leading to plaque accumulation and gingivitis. This could be secondary to improper crimping of crown margins, which lead to poorly adapted SSC. In some clinical situations, ledge formation under the crown or failure to clean excess cement can contact the gingiva and cause gingival inflammation. This study was carried out on 41 children between the ages of 4 and 10 in Al Qassim region to study the effects of SSCs on gingiva and oral hygiene. The study also aims to establish the correlation between SSC adaptation and post-insertion inflammation. The plaque and gingival index were recorded at 3 months' post SSC insertion. Clinical examination was undertaken, and gingival index (Loe and Silness 1967) and plaque index (Silness and Loe 1967) were used to record gingival health and plaque accumulation, respectively. The result for post-inflammation and SSC adaptation showed that there was no statistically significant difference in post-insertion inflammation and crown adaptation (P value = 0.216). The result for pre-operative inflammation and post-operative inflammation shows that there is no significant difference in post-inflammation and adaptation (P value = 0.47). We found that oral hygiene care had a heightening effect and oral hygiene maintenance plays a key role in preventing gingival inflammation irrespective of the SSC adaptation over short periods of time (3 months).

Comparison of periodontal health of primary teeth restored with zirconia and stainless steel crowns: A systemic review and meta-analysis

BACKGROUND/PURPOSE

In children, the use of stainless steel crowns to treat caries has a high success rate. However, due to the unnatural color of stainless steel crowns, it still needs to modify crown types. The present meta-analysis study aims to explore the previous articles on the comparison of stainless steel crowns and zirconia crowns.

METHODS

The systematic search of studies on the comparison of zirconia crowns and stainless steel crowns for primary teeth was mainly in PubMed and Cochrane database. The standardized mean differences (SMDs) of gingival health between zirconia crowns and stainless steel crowns comprised the primary outcome, and the SMDs of plaque index compared two crown treatments was treated as the secondary outcome.

RESULTS

The meta-analysis extracted 187 papers from various databases and collected five randomized controlled trials, four comparisons on deciduous molars and one comparison on deciduous incisors. 160 children were included, ranging in age from 3-9 years old. The quantitative analysis showed a significantly lower gingival index of zirconia crowns in the primary molar group and the primary incisor group. The plaque index between two crown treatments groups was -4.51, indicating less accumulation of plaque on zirconia crown. However, the heterogeneity of included trials still need to be considered.

CONCLUSION

Zirconia crowns for deciduous teeth had its advantages for gingival health. Although stainless steel crowns were more likely to have plaque deposition and gingival inflammation, zirconia crowns relatively caused the opposite tooth wearing and chipping. Therefore, the comprehensive consideration is important to choose deciduous tooth crown.

Comparison between Restorative Materials for Pulpotomised Deciduous Molars: A Randomized Clinical Study

AIM

To evaluate and compare the clinical outcomes of Cention-N (CN) and stainless steel crowns (SSCs) as restorations for pulpotomised primary molars, and to study clinical and radiographic outcomes of pulpotomies restored with these materials.

METHODS

The study was conducted on 60 pulpotomised molars with occlusoproximal caries. These were randomly divided into two groups and restored with either stainless steel crowns or Cention-N. Clinical performance of restorations and clinical and radiographic success of pulpotomy was examined at 6, 9 and 12 months.

RESULTS

The mean scores for marginal integrity deteriorated significantly at 6, 9 and 12 months in both groups but in comparison were insignificant. The mean for proximal contact deteriorated significantly for the Cention-N group, whereas the mean for gingival health deteriorated remarkably for the stainless steel crown group at successive evaluations. No tooth in either group showed secondary caries or discomfort on biting, except for one tooth in Cention-N group which presented with secondary caries. The clinical success rate for pulpotomised molars was 100% for both groups until nine months, although this had reduced by the end of 12 months. Radiographically, the success rate was 79.3% for Cention-N, while it was 86.6% for stainless steel crowns at 12 months. There was no significant difference in clinical and radiographic success between either group.

CONCLUSION

Cention-N and stainless steel crowns are comparable for marginal integrity. However, crowns maintain significantly better proximal contacts while Cention-N was notably better for gingival health of the restored tooth. Both materials do not show secondary caries and discomfort on biting and are comparable in clinical and radiographic success of pulpotomy at the end of one year.

Clinical Evaluation of Zirconia and Stainless-Steel crowns in Primary Molars - A Randomized Control Trial

Background and Aim: Aesthetic alternatives to stainless steel crown for restoring primary molars attain a growing interest. The aim of the study was clinical evaluation and comparison of zirconia and stainless steel crown in primary molars (clinical and radiograph) Methods: A randomized controlled study was conducted on children of age group of 5 to 8 years of age visiting, KVG Dental College and Hospital, Sullia and who were meet the inclusion criteria of the study. The study population was randomly divided into two groups of 24 each. Group I: stainless steel crown, Group II: zirconia crown. Post endodontic tooth preparation was done and selected stainless steel and zirconia crowns followed by cemented using type 1 glass ionomer cement. The subjects was be recalled after 3, 6 and 9 months to check gingival index, oral hygiene index and bone health of the tooth using intraoral periapical radiograph. Results: There was significant increase in score of gingival index and OHI score for both SSC and zirconia crowns after 3 month followed by reduction in score at 6 and 9 months. There was no statistically significant difference in alveolar bone height in both groups (zirconia and SSCs) for 6 months. Conclusion: Zirconia crowns presented to be an excellent choice for primary posterior teeth full coverage restorations. Zirconia crowns performed better than SSCs in the aspect of gingival response and prevention of plaque adhesion. Keywords: zirconia crowns, stainless steel crown, primary molars, esthetics, dental caries.

Clinical effectiveness of restorative materials for the restoration of carious lesions in pulp treated primary teeth: a systematic review

Purpose

To systematically review the clinical performance of restorative materials after pulp therapy of carious primary teeth. It is part 2 of a systematic review on the clinical effectiveness of restorative materials for the management of carious primary teeth supporting the European Academy of Paediatric Dentistry (EAPD) guideline development.

Methods

Four electronic databases were systematically searched up to December 28th, 2020. Randomised controlled clinical trials (RCTs) on restorative materials for the restoration of carious primary teeth after pulp therapy were included. Failure rate, annual failure rate (AFR) and reasons for failure were recorded. Studies were sorted by restorative materials. The Cochrane Risk of bias tool for randomised trials (RoB 2.0) was used for quality assessment.

Results

After identification of 1685 articles and screening of 41 papers from EAPD review group 1, 5 RCTs were included. Restored primary molars with pulpotomy presented the following AFRs: composite resin (CR) 0%, preformed metal crowns (PMCs) 2.4–2.5%, resin-modified glass-ionomer cement combined with CR 3.8%, compomer 8.9%, and amalgam 14.3%. Maxillary primary incisors receiving pulpectomy exhibited AFRs of 0–2.3% for composite strip crowns (CSCs) depending on the post chosen. Reasons for failure were secondary caries, poor marginal adaptation, loss of retention and fracture of restoration. All studies were classified as high risk of bias. Meta-analyses were not feasible given the clinical/methodological heterogeneity amongst studies.

Conclusion

Considering any limitations of this review, CR and PMCs can be recommended for primary molars after pulpotomy, and CSCs for primary incisors receiving pulpectomy. However, a need for further well-designed RCTs was observed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00744-4.

Expert consensus on early childhood caries management

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Evaluation of the bond strengths of restorative materials to primary tooth dentin treated with different pulpotomy techniques

The aim of this study was to investigate the changes of different pulpotomy techniques on the primary tooth dentin and to evaluate the effects of these pulpotomy methods on the shear bond strength of restorative materials to primary tooth dentin. Two hundred and forty dentin specimens were distributed randomly to the study groups as; control, ferric sulphate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma (APCP). After the application of pulpotomy methods, samples were again randomly divided to two restorative materials (glass hybrid and composite resin) (n = 20) and shear bond strength (SBS) test was performed. Then, 12 new dentin specimens were prepared for all groups for surface analysis. Surface examination (n = 12) and fracture analyses (n = 240) were carried out with scanning electron microscope (SEM). Statistical significance range was accepted as α <.05 for all data. A statistically significant difference was obtained among all study groups for glass hybrid material as well as composite material (p <.05). While the highest mean SBS value was obtained with Nd:YAG laser (7.58 ± 0.60 MPa), the lowest value was observed with Biodentine® (6.70 ± 0.91 MPa; p = .001) for glass hybrid material. For composite material, the highest mean SBS value was calculated for Nd:YAG laser (13.79 ± 1.24 MPa), while the lowest value was obtained with ferric sulphate (10.17 ± 1.45 MPa; p = .001). Fracture modes were mainly adhesive and mixed type according to SEM analysis. Moreover, morphological changes were observed with SEM on the dentin surfaces of ferric sulphate, Biodentine® and Nd:YAG laser. Within the limitations of this study, Nd:YAG laser increased the shear bond strength values in groups of composite resin. RESEARCH HIGHLIGHTS: In this article, we report the results of the shear bonding strength test of two restorative materials (glass-hybrid vs. composite resin) to primary tooth dentin following the application of five different pulpotomy techniques (ferric sulfate, Biodentine® , Nd:YAG laser, photobiomodulation, and atmospheric pressure cold plasma) were reported. This article will contribute to the literature that there are considerably limited researches concerning the bond strength of glass hybrid to primary dentin and also atmospheric pressure cold plasma in pulpotomies. The SEM examination was performed in two stages in this study; the morphological changes in both treated dentin surfaces and the surfaces of the samples subjected to the shear bond strength test.

Clinical Performance of Two Types of Primary Molar Indirect Crowns Fabricated by 3D Printer and CAD/CAM for Rehabilitation of Large Carious Primary Molars

Objectives  This randomized clinical trial aimed to evaluate clinical outcomes of two types of esthetic crowns fabricated using a three-dimensional (3D) dental printer and computer-aided design and manufacturing (CAD/CAM) system as an alternative full-coronal restoration for extensively carious pulp-treated primary molars.

Materials and Methods  Randomization was done for 50 lower primary molars in 50 child patients, split into two groups based on the fabrication method used: Group A: CAD/CAM crowns using polymethyl methacrylate (PMMA) blocks and Group B: 3D dental printed crowns using GC photopolymer resin. All crowns were evaluated at baseline and at 3rd, 6th, and 12th months using the U.S. Public Health Service criteria for gingival health, retention, and marginal integrity for both groups.

Statistical Analysis  The survival rate of 3D-printable crowns was 84% compared with 80% survival rate using CAD/CAM fabricated crowns at the end of the 12th-month follow-up. No statistically significant differences were noted in restoration failure. In the evaluation of gingival health between the two groups’ follow-up times, no statistically significant differences were noted at the 3rd- and 6th-month follow-ups, yet at the 12th month, statistically significant differences were noted ( p = 0.022) when comparing gingival health. No statistically significant differences were noted between the two groups when comparing marginal integrity scores in all the follow-up periods.

Conclusion  Resin crowns fabricated via 3D dental printer and PMMA crowns fabricated using CAD/CAM are acceptable esthetic choices in restoring pulp-treated primary molars with great marginal integrity and crowns retention. 3D-printed resin crowns showed less cementing failure and performed better regarding gingival response compared with PMMA crowns.

Non-invasive treatment approach for hypomineralised second primary molars using preformed metal crowns: results after 1-year follow-up

PURPOSE

To evaluate the clinical and radiological outcome of Hypomineralised Second Primary Molars (HSPM) treated with Preformed Metal Crowns (PMC) using the Hall Technique (HT).

METHODS

This prospective cohort study included healthy children presenting at the pediatric dental clinic of the University Hospitals Leuven (Belgium) with at least one primary molar affected by HSPM. The clinical and radiological situation at baseline and after a follow-up of 1 year was registered in detail using standardized criteria. After plaque removal and gentle drying, PMCs (3 M™ ESPE™ Stainless Steel Crowns) were fitted without administration of local anaesthesia nor tooth preparation. Strict outcome criteria, including gingival health condition, were applied. Informed consent was obtained for all individual participants. The study was approved by the institutional Ethics Committee.

RESULTS

A total of 39 PMCs with a follow-up of 12 months, placed in 15 patients (7 boys and 8 girls), were included. The mean age of the patients at the time of fitting the PMC was 4.6 ± 1.1 years (range: 3-7). None of the PMCs was lost nor failed. Clinical outcome was considered fully successful in 64.1%, radiological outcome in 93.3% of the cases; all other cases were rated as acceptable. The main reason for not being categorized as fully successful was deterioration of the gingival condition. Overall, the treatment was well tolerated and accepted by the patients.

CONCLUSION

PMCs fitted using the HT represent an acceptable and well-tolerated treatment option for the management of HSPM. Gingival condition should be incorporated in outcome assessment.

One-year clinical evaluation of two high-viscosity glass-ionomer cements in class II restorations of primary molars

BACKGROUND

Little information exists on the clinical performance of restorative materials on primary teeth of preschool children. This study aimed to evaluate clinical performance of compomer, glass-hybrid-added high-viscosity glass-ionomer cement and zinc-added high-viscosity glass-ionomer cement materials in class ΙΙ restorations of primary molars.

METHODS

The study included 251 teeth of 57 patients aged 4-7 years with proximal caries in primary molars. The teeth were divided into three groups, and each restorative material was randomly distributed. Dyract XP, Equia Forte and ChemFil Rock materials were placed after cavity preparation and clinically evaluated at 3, 6, 9 and 12 months using modified United States Public Health Service criteria. Statistical analyses were performed using chi-square and z tests.

RESULTS

At the end of 12 months, a total of three restorations in Dyract XP group, 22 in Equia Forte group and 11 in ChemFil Rock group failed in retention criteria. No statistically significant difference existed between retention, colour match and surface texture criteria of all groups at 3 and 6 months, but a statistically significant difference was found at 12 months (P < 0.05).

CONCLUSION

For class ΙΙ restorations of primary molars, the success of compomer material was superior to high-viscosity glass-ionomer materials.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Knowledge, attitude, and practice regarding standardized treatment protocol for pulp therapy in deciduous dentition among general dental practitioners of Vadodara, Gujarat, India

INTRODUCTION

Dental caries is the most prevailing disease not only affecting permanent dentition, but also involving deciduous dentition. Deciduous teeth are considered a best space maintainer and preserve arch integrity for eruption of succedaneous permanent teeth. General dental practitioners (GDPs) seem to be less interventionist in their investigation and treatment planning and many times, the treatment done remains incomplete either due to the lack of knowledge of the dentist or due to noncooperation of the child and/or parents.

PURPOSE

The aim of this study was to assess the knowledge, attitude, and practice among GDPs of Vadodara city regarding standardized treatment protocol (STP) for pulp therapy in deciduous dentition.

MATERIALS AND METHODS

This questionnaire-based, cross-sectional study was conducted to assess the knowledge, attitude, and practice regarding standardized treatment options available for pulp therapy in deciduous dentition. The distribution of the self-made questionnaire pro forma was done in person to all the GDPs after obtaining their prior appointments. The GDPs were grouped on the basis of qualification and total clinical experience in years. The questionnaire consisted of 11 questions. The data were collected, and descriptive statistical analysis was performed. The Chi-square test was used to assess the knowledge, attitude, and practice among different groups of GDPs.

RESULTS

A statistically significant difference was observed in knowledge regarding STP for pulp therapy in deciduous dentition among both the groups, which is based on the qualification and on the year of clinical experience.

CONCLUSION

Qualification and years of clinical practice among GDPs affect the knowledge and treatment regarding pulp therapy in deciduous dentition. Most of the GDPs lack knowledge about the STP for pulp therapy in deciduous dentition.

A randomized clinical trial comparing Hall vs conventional technique in placing preformed metal crowns from Sudan

Despite the high success rates of preformed metal crowns (PMCs) in children no randomized clinical trials compare methods of placement and none describe its use in Africa. Our aim was to compare survival and cost-effectiveness of PMCs placed by conventional techniques (CT) and biological Hall techniques (HT) using a prospective randomized control trial in a general dental practice from Khartoum. One hundred and nine and 103 PMCs were placed in randomly selected children (5-8years) with 1–2 carious primary molars using HT and CT respectively and followed for 2 years. Socioeconomic status, periodontal health, occlusion, anxiety, and procedure time were compared using student t-test. Kaplan–Meier survival rates and incremental cost effectiveness ratio (ICER) were compared between CT and HT. CT and HT groups were similar for age, gender, socio-economic status. Survival rates were high (over 90%) for both study arms and not statistically different (p>0.05). Anxiety scores were significantly higher in CT arm after 12 months compared to HT (p<0.001). Clinically, gingival and plaque indices were similar between groups (p>0.05) but occlusions were raised in nearly all subjects in the HT arm (p<0.05). Periodontal health improved, and occlusions adjusted over time in both arms. There were 3 (2.7%) and 6 (5.8%) minor failures, 7 (6.4%) and 6 (5.8%) major failures in HT and CT arms respectively. Mean procedure time was lower in HT (9.1 min) than CT (33.9 min); p<0.001. Mean PMC cost was US$2.45 and US$7.81 for HT and CT respectively. The ICER was US$136.56 more for each PMC placed by CT per life year. We show that PMCs have high survival outcomes in disadvantaged populations similar to results from developed countries. As HT can be carried out by less experienced dental operators and therapists, this biological approach provides a promising cost-effective option to manage caries in developing countries with limited resources.

Trial registration: The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT03640013

Chairside CAD/CAM Composite Onlays for the Restoration Of Primary Molars

After pulp therapy or with multi-surface caries in primary molars, pre-formed stainless steel crowns are usually placed to ensure tooth longevity. Esthetic alternatives, such as zirconia crowns, have been proposed, but they are invasive. Here we describe two cases of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) technology used to treat extended and/or deep caries on primary molars. A powder-free chairside CAD/CAM system, a milling unit and machinable high-performance composite blocks were used. The tooth preparation consisted of preparing the cavity without undercut, to have supra-gingival margins whenever possible, occlusal reduction of thin walls, and proximal box finishing by ultrasonic tips. After the optical impression, the virtual onlay was designed and adapted (from the morphology of a first permanent molar), then chairside-manufactured out of a composite block and bonded by using a self-adhesive resin cement. This technique combines minimally invasive treatment; high strength, biocompatible and aesthetic material; no gingival trauma; easy execution; and patient and parent satisfaction. However, the equipment is quite expensive and the software still does not include the morphology of primary teeth.

Changes in occlusal bite force following placement of preformed metal crowns on primary molars in 4-6 years old children: a 6 months' follow-up pilot study

AIM

To evaluate the occlusal bite force (OBF) changes 6 months after placement of preformed metal crowns PMCs on primary molars in children.

METHOD

Twenty-two subjects (aged 5.08 ± 0.92 years) participated and completed OBF records. Each patient received eight PMCs on their primary molars. OBF was recorded using a battery-operated portable type of OBF gauge at different time intervals: before placement, 1 week-, 1 month-, 2 months-, 3 months-, and 6 months after PMCs placement (T0-T5). A second group consisted of 22 caries-free children matched for age and gender were selected as a control sample and received no dental treatment. OBF was recorded in these subjects at T0 and T5 (6 months after).

RESULTS

OBF was reduced the first week after placement of PMCs. However, the OBF was restored and reached its original value at T4. At the 6-month recall visit (T5), maximum occlusal bite force (MOBF) was 148% and 136% of pre-treatment value on right and left sides, respectively. The mean MOBF difference between T5 and T0 was statistically significant (70.83N and 54.67N on the right and left sides respectively, p < 0.000).

CONCLUSION

OBF decreased 1 week after placement of PMC restoration and started to increase after 1 month reaching 136-140% of its original value after 6 months.

In vitro analysis of the marginal adaptation and discrepancy of stainless steel crowns

Aim: The purpose of the study was to assess the marginal adaptation and discrepancy of SSC's. Differences in adaptation and discrepancy between the four surfaces (mesial, lingual, distal, and buccal) were evaluated. Methods: The placement of stainless steel crowns were completed on a phantom head in accordance with the clinical technique. The ideal tooth preparation was made and this 'master tooth' duplicated to achieve a sample size of 15. The stainless steel crowns were placed, trimmed, and cemented as per the clinical technique. The cemented stainless crowns were analyzed under 100× stereomicroscope magnification. The marginal adaptation and discrepancy of each specimen was measured every 2 µm. Results: All the specimens showed marginal adaptation and discrepancy. The lingual margin had a significantly better adaptation (p < .0001) over the other surfaces. The buccal surface was the only surface that had an appropriate supra-CEJ level with a significance of p < .0001. Conclusion: The marginal discrepancies occur during the trimming procedure and assessment of the gingival approximation of the SSC margin. The inspection of stainless steel crown adaptation and discrepancy is an essential clinical step.

Knowledge and practice of, and attitudes toward, pulp therapy in deciduous teeth among pediatric dentists in India

AIM

The aim of the present study was to assess the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition among pediatric dentists.

METHODS

A cross-sectional, observational survey was conducted using a closed-ended, multiple-choice questionnaire evaluating the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition, which was formulated and sent to 360 pediatric dentists across India. Descriptive statistics were done, followed by χ² -test to test the association between years of experience and the questionnaire items.

RESULTS

A total of 3.5% of pediatric dentists performed their treatment using a rubber dam in all cases; 30% preferred to use local anesthesia prior to indirect pulp therapy (IPT). Traditional indirect pulp capping was preferred to IPT, and only 48% of them believed in not removing it completely. Pulpotomy was preferred over IPT (70%) when there was a probability of pulp exposure following complete caries excavation. Calcium hydroxide, along with iodoform, was the material of choice for the obturation of primary teeth (73.5%). A stainless steel crown was placed after pulp therapy in the primary tooth (86.3%). Most dentists believed requested immediate and 3-month follow up.

CONCLUSION

The survey helps in assessing whether our views or approaches are in line with recent trends.

Investigation of adult stainless steel crown longevity as an interim restoration in pediatric patients

BACKGROUND

Preformed metal crowns, also known as stainless steel crowns (SSC), are utilized for providing full coverage to young permanent teeth and have been used extensively as restorations of primary teeth for approximately 65 years.

AIM

Evaluate permanent tooth SSC longevity as an interim restoration for teeth requiring full coverage restoration in pediatric patients.

DESIGN

Retrospective chart review from 2006 through 2014 in a hospital-based dental clinic for permanent tooth pre-fabricated crown longevity. One hundred and fifty-five SSCs were evaluated with regard to: age of patient at restoration placement, diagnoses, and duration of crown service. Duration service was further categorized as successful or failed.

RESULTS

Of 155 SSCs, 137 were considered successfully functioning. Total failures were 18. The overall combined success rate for the study group was observed to be 88% with an average service period of 45.18 months. Significant success was noted in patients less than 9 years of age, and significant failure was observed in patients 12 years and older.

CONCLUSIONS

Stainless steel crowns are a viable option for interim restoration needs, with an 88% overall success rate during an average service period of 45.18 months.

Can onlay's be an alternative restoration for severely damaged primary teeth

Objective:

The aim of this study was to evaluate indirect compomer and composite resin onlay restorations of severely damaged primary molars in vivo.

Materials and Methods:

At the study, 48 restorations, in seven girls and ten boys totally 17 patients aged 4–8, was evaluated clinically with using USPHS criteria for 15 months.

Results:

The study results revealed that the clinical success rate of compomer and composite onlay restorations was 79% and 96%, respectively. No significant differences were found statistically between the materials.

Conclusions:

In the children severely damaged primary molars, onlays are usually worked with an indirect technique in clinics. One of the advantages of indirect technique is being most similar to its original form morphologically.

Effects of Two Different Anesthetic Solutions on Injection Pain, Efficacy, and Duration of Soft-Tissue Anesthesia with Inferior Alveolar Nerve Block for Primary Molars

OBJECTIVES

The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS).

STUDY DESIGN

The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests.

RESULTS

Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively.

CONCLUSIONS

Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.

Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results

Objective:

The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth.

Materials and Methods:

This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public Health Service criteria were used to evaluate marginal integrity, marginal discoloration, and secondary caries in FRC crowns at intervals of 3, 6, and 12 months. Retention rate and gingival health were also compared between the two groups. The data were analyzed using Friedman, Cochran, and McNemar's tests at a significance level of 0.05.

Results:

Intact marginal integrity in FRC crowns at 3, 6, and 12 months were 93.2%, 94.8%, and 94.2%, respectively. Marginal discoloration and secondary caries were not found at any of the FRC crowns. The retention rates of the FRC crowns were 100%, 98.3%, and 89.7% at 3, 6 and 12 months, respectively, whereas all the SSCs were found to be present and intact after 12 months (P = 0.016). There was no statistically significant difference between the two groups in gingival health.

Conclusion:

According to the results of this study, it seems that when esthetics is a concern, in cooperative patients with good oral hygiene, FRC crowns can be considered as a valuable procedure.

Attitudes of Parents and Children toward Primary Molars Restoration with Stainless Steel Crown

Context:

Today, attention has increasingly been focused on the studies which include patient-centered consequences.

Aims:

The study aims to investigate the attitude of parents and children toward the application of stainless steel crown (SSC) on primary molars.

Settings and Design:

This cross-sectional descriptive study included eighty 4–6-year-old children having treated with SSC over the past 3–6 months.

Subjects and Methods:

Eventually, a validated child- and parent-centered self-report questionnaire was filled, having 14 questions about demographic information, six questions about childrens' attitude, and eight questions about parents' attitude.

Statistical Analysis Used:

Data analysis was conducted using t-test and one-way ANOVA at significant level P < 0.05.

Results:

In general, the score of children's attitude was positive, and the mean of attitude scores was obtained to be 9.9 ± 2.6; attitudes of 82.43% of children were good. Parents had neutral attitude; the mean of their attitude was obtained to be 20.2 ± 4.8. Only 53% of the parents scored good attitudes.

Conclusions:

The attitude score of children toward SSC was good and independent of age, gender, career, and education of the parents. Although the parents were not satisfied with how it appeared, the majority of them reported that their child had well accepted the crown.

Effect of endodontic sealers on bond strength of restorative systems to primary tooth pulp chamber

Background/purpose

Although current literature suggests that root canal sealers affect the bonding ability of restorative systems to pulp chamber dentin of permanent teeth, primary teeth have not been investigated. This study intended to evaluate the microtensile bond strength (μTBS) of three restorative systems to pulp chamber dentin in primary teeth and to determine the effect of two different root canal sealers on the μTBS.

Materials and methods

Ninety primary molars were used in this study. The teeth were randomly divided into three main groups according to canal sealers: (1) control (without sealer); (2) Metapex; and (3) zinc-oxide eugenol. The main groups were further divided into three subgroups depending on the coronal restorative system: (1) compomer (Prime Bond NT + Dyract EXTRA); (2) composite (Clearfil Tri-S Bond + Clearfil Photo Posterior); and (3) resin-modified glass ionomer (Fuji II LC). After restoration, the buccal wall of the pulp chamber was sectioned to obtain sticks (1 mm × 1 mm). The μTBS was then measured. Data were analyzed with two-way analysis of variance, followed by a posthoc test. The interfacial morphology of the bonded space was evaluated using scanning electron microscopy.

Results

In the control group, a significant difference was observed only for the μTBS of the composite (P < 0.05). Compared with the control groups, Metapex and zinc-oxide eugenol significantly reduced the μTBS of restorative systems (P < 0.05).

Conclusion

Composite materials seemed to bond to pulp chamber dentin in primary teeth with a higher strength than compomer and resin-modified glass ionomer. Metapex and zinc-oxide eugenol canal filling materials reduced the bond strength of all three restorative systems.

Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial

Background

In many parts of the world, school-age children have high dental treatment needs; however, there is often low, or no, dental care provision. Although Atraumatic Restorative Treatment (ART) was developed to address this, its survival rate in occluso-proximal lesions is low. An alternative, the Hall Technique (HT) has shown better relative outcomes for occluso-proximal lesions, but has not been directly compared to ART or tested in field settings. This trial will compare ART and the HT for the most clinically- and cost-effective strategy for managing occluso-proximal lesions in primary molars, in a school setting, using low-technology and child-friendly dental techniques.

Methods/Design

This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (n = 124, age 6–8) with at least one occluso-proximal carious primary molar lesion will have random allocation to treatment with ART or HT. Baseline measures and outcome data will be assessed through participant report, clinical examination and parent report/questionnaires. The primary outcome is survival rate, a composite measure of absence of Minor Failures (a defect in the restoration/crown, but not interfering with tooth health) and Major Failures (signs or symptoms of irreversible pulp damage, such as dental fistula/abscess, tooth fracture or failures that cannot be repaired). Secondary outcomes are: (1) child-reported discomfort, (2) childrens’ and (3) parents’ concerns around dental appearance and (4) acceptability of treatments, (5) occlusal-vertical dimensions (OVD) changes, (6) plaque index, (7) gingival health, (8) decayed, missing, filled teeth in permanent teeth (DMFT)/decayed, missing, filled teeth in primary teeth (dmft), (9) oral health-related-quality of life, reported by children and parents/caregivers, (10) the incremental cost-effectiveness, and (11) operator effect. A trained and calibrated examiner will evaluate the treated teeth after 1 week, then 1, 6, 12, 24 and 36 months post treatment. Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome. The Mann-Whitney or t test, Friedman test, paired t test or Wilcoxon test and Ordinal Logistic Regression Analysis will be used to analyze the secondary outcomes.

Discussion

The results of this trial will support decision-making by clinicians and policy-makers for managing occluso-proximal lesions in settings with constrained resources and limited dental access.

Trial registration

www.clinicaltrials.gov, NCT02569047, registered 5 October 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1270-z) contains supplementary material, which is available to authorized users.

Materials for Paediatric Dentistry. Part 1: Background to the Treatment of Carious Primary Teeth

Dental caries is a disease that affects many people, including children, and presents numerous challenges to healthcare providers. As clinicians it is important that we consider the advantages and disadvantages of treating carious primary teeth, and make an informed decision about when it is appropriate or not. This paper describes the background to the treatment of carious primary teeth, looking at the differences between primary and permanent teeth, and the relevance of this. It also suggests points to consider when looking at restoration survival studies, as the ability to appraise the literature critically is important for us all in this 'evidence-based' age. CPD/Clinical Relevance: Our early life experiences have the ability to shape our future attitudes and behaviour. Children with carious teeth require careful management so that pain and suffering is minimized, and positive attitudes towards dentistry are fostered.

Preformed crowns for decayed primary molar teeth

BACKGROUND

Crowns for primary molars are preformed and come in a variety of sizes and materials to be placed over decayed or developmentally defective teeth. They can be made completely of stainless steel (know as 'preformed metal crowns' or PMCs), or to give better aesthetics, may be made of stainless steel with a white veneer cover or made wholly of a white ceramic material. In most cases, teeth are trimmed for the crowns to be fitted conventionally using a local anaesthetic. However, in the case of the Hall Technique, PMCs are pushed over the tooth with no local anaesthetic, carious tissue removal or tooth preparation. Crowns are recommended for restoring primary molar teeth that have had a pulp treatment, are very decayed or are badly broken down. However, few dental practitioners use them in clinical practice. This review updates the original review published in 2007.

OBJECTIVES

Primary objectiveTo evaluate the clinical effectiveness and safety of all types of preformed crowns for restoring primary teeth compared with conventional filling materials (such as amalgam, composite, glass ionomer, resin modified glass ionomer and compomers), other types of crowns or methods of crown placement, non-restorative caries treatment or no treatment. Secondary objectiveTo explore whether the extent of decay has an effect on the clinical outcome of primary teeth restored with all types of preformed crowns compared with those restored with conventional filling materials.

SEARCH METHODS

We searched the following electronic databases: Cochrane Oral Health Group Trials Register (to 21 January 2015), Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2014, Issue 12), MEDLINE via Ovid (1946 to 21 January 2015) and EMBASE via Ovid (1980 to 21 January 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials and Open Grey for grey literature (to 21 January 2015). No restrictions were placed on the language or date of publication when searching the databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) that assessed the effectiveness of crowns compared with fillings, other types of crowns, non-restorative approaches or no treatment in children with untreated tooth decay in one or more primary molar teeth. We would also have included trials comparing different methods of fitting crowns.For trials to be considered for this review, the success or failure of the interventions and other clinical outcomes had to be reported at least six months after intervention (with the exception of 'pain/discomfort during treatment and immediately postoperatively').

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the title and abstracts for each article from the search results. and independently assessed the full text for each potentially relevant study. At least two authors assessed risk of bias and extracted data using a piloted data extraction form.

MAIN RESULTS

We included five studies that evaluated three comparisons. Four studies compared crowns with fillings; two of them compared conventional PMCs with open sandwich restorations, and two compared PMCs fitted using the Hall Technique with fillings. One of these studies included a third arm, which allowed the comparison of PMCs (fitted using the Hall Technique) versus non-restorative caries treatment. In the two studies using crowns fitted using the conventional method, all teeth had undergone pulpotomy prior to the crown being placed. The final study compared two different types of crowns: PMCs versus aesthetic stainless steel crowns with white veneers. No RCT evidence was found that compared different methods of fitting preformed metal crowns (i.e. Hall Technique versus conventional technique).We considered outcomes reported at the dental appointment or within 24 hours of it, and in the short term (less than 12 months) or long term (12 months or more). Some of our outcomes of interest were not measured in the studies: time to restoration failure or retreatment, patient satisfaction and costs. Crowns versus fillingsAll studies in this comparison used PMCs. One study reported outcomes in the short term and found no reports of major failure or pain in either group. There was moderate quality evidence that the risk of major failure was lower in the crowns group in the long term (risk ratio (RR) 0.18, 95% confidence interval (CI) 0.06 to 0.56; 346 teeth in three studies, one conventional and two using Hall Technique). Similarly, there was moderate quality evidence that the risk of pain was lower in the long term for the crown group (RR 0.15, 95% CI 0.04 to 0.67; 312 teeth in two studies).Discomfort associated with the procedure was lower for crowns fitted using the Hall Technique than for fillings (RR 0.56, 95% CI 0.36 to 0.87; 381 teeth) (moderate quality evidence).It is uncertain whether there is a clinically important difference in the risk of gingival bleeding when using crowns rather than fillings, either in the short term (RR 1.69, 95% CI 0.61 to 4.66; 226 teeth) or long term (RR 1.74, 95% CI 0.99 to 3.06; 195 teeth, two studies using PMCs with conventional technique at 12 months) (low quality evidence). Crowns versus non-restorative caries treatmentOnly one study compared PMCs (fitted with the Hall Technique) with non-restorative caries treatment; the evidence quality was very low and we are therefore we are uncertain about the estimates. Metal crowns versus aesthetic crownsOne split-mouth study (11 participants) compared PMCs versus aesthetic crowns (stainless steel with white veneers). It provided very low quality evidence so no conclusions could be drawn.

AUTHORS' CONCLUSIONS

Crowns placed on primary molar teeth with carious lesions, or following pulp treatment, are likely to reduce the risk of major failure or pain in the long term compared to fillings. Crowns fitted using the Hall Technique may reduce discomfort at the time of treatment compared to fillings. The amount and quality of evidence for crowns compared to non-restorative caries, and for metal compared with aesthetic crowns, is very low. There are no RCTs comparing crowns fitted conventionally versus using the Hall Technique.

Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars

AIM

The successful performance of resin modified glass ionomer cement (RMGIC) as an indirect pulp therapy (IPT) dressing material and, independently, as a class II restoration material for primary molars has been adequately documented. This study investigates if an RMGIC can be successfully used in a dual capacity.

METHODS

A total of 61, 3.5-8.5 year old children with deep proximal carious lesions in one or more primary molars, radiographically suspected of pulp exposure, were included. Teeth exclusion criteria were: continuous unprovoked pain and an exposed or a non-vital pulp. Following adequate caries removal, RMGIC restorations were placed. The teeth were followed up for signs/symptoms and for restoration survival according to modified United States Public Health Service (USPHS) criteria. Descriptive statistics and a Fisher's exact test were applied.

RESULTS

The prospective study was completed with 86 restorations in 41 first and 45 second primary molars. Three of the 86 teeth showed pulp necrosis and the remaining 83 (96.5%) were a) asymptomatic for a mean clinical observation time of 31.9 months (SD 10.8) and b) with no radiographic signs of pathology for 25.7 months (SD 10.3). Seventy six of these 83 (91.6%) class II-'extended' restorations were acceptable, exhibiting varying levels of occlusal wear.

CONCLUSIONS

A single application of RMGIC was used successfully for over 2 ½ years as an IPT and restoration material in proximal caries of primary molars.

Child and parental acceptance of preformed metal crowns

AIM

To assess child and parent acceptance of preformed metal crowns (PMCs).

STUDY DESIGN

This was a service evaluation using a child- and parent-centred self-report questionnaire in a convenience sample of hospital patients.

METHODS

Questionnaires were developed with serviceusers and issued to 98 children who had received a PMC on a primary molar within the paediatric dentistry clinic, Sheffield Dental Hospital, UK. Children used a pictorial Likert scale to rate their treatment experience and views on PMCs. Parents were also asked to complete a 5-item questionnaire, to explore their attitudes towards the PMC and how they felt their child had coped with treatment. Both children and parents were invited to comment in a free-text box on any other issues relating to PMCs. Clinical data were extrapolated from the child's dental records as follows: child's age and gender; status of clinician who had placed the PMC (staff or student), and technique for PMC placement (Hall technique or conventional).

RESULTS

62 questionnaires were completed (63% response rate). The mean age of the child participants was 6.6 years (SD±1.51; range=3.8-10.3), and 65% (n=40) were male. Most children found the clinical procedure acceptable with 54.8% (n=34) reporting it was 'really easy', with no significant differences according to placement technique, or the experience level of the operator (P<0.05, chi-squared test). Only 4.8% (n=3) of parents expressed strong objections to the appearance. Both children and parents felt the clinical rationale had been fully explained to them (88.7%, n=55 and 100%, n=62 respectively). Themes commonly identified from the children's accounts related to specialness, function and recollections of the treatment, with the perception that PMCs were valued for being different.

CONCLUSIONS

This study revealed that PMCs were mainly viewed favourably by children and their parents. Clinicians who have been reluctant to use this restorative approach may be encouraged by these findings. However, communication and clinical expertise are paramount in ensuring children and parents have positive treatment experiences and attitudes towards PMCs.

The teaching of management of the pulp in primary molars in Europe: a preliminary investigation in Ireland and the UK

AIM

This was to determine which methods of primary pulp therapy are currently being taught in European dental schools starting with a preliminary study in the UK and Ireland.

METHODS

A questionnaire, based on that used in a USA study, was sent to paediatric dentistry staff at each of 18 dental schools in Ireland and the UK.

RESULTS

There was a response rate of 87%. All respondents taught the vital pulpotomy technique in primary molars but no uniformity was found regarding pulpectomy, indirect and direct pulp capping techniques. Most respondents, 92.9%, taught the use of ferric sulphate for vital pulpotomy. Formocresol, mineral trioxide aggregate and calcium hydroxide accounted for the remainder, with some respondents electing to teach different medicaments depending on whether the students were at undergraduate or postgraduate level.

CONCLUSIONS

Formocresol is no longer the most commonly taught pulp medicament in dental schools in Ireland and the UK.