Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents

Parental perceptions and acceptance of silver diamine fluoride staining in Italy

BACKGROUND

Parental perceptions of staining due to silver diamine fluoride (SDF) could affect its utilization in paediatric dentistry. This study represents the second part of a wider project focused on SDF esthetic acceptability among Italian parents.

AIM

To evaluate parental acceptance of SDF staining in Italy and to assess whether the parent's level of acceptance depends on location, child's behavior, or demographic background.

DESIGN

A cross-sectional study was conducted among Italian parents of children attending two university dental clinics. We used a validated Italian version of the questionnaire "Parental Perceptions of Silver Diamine Fluoride Dental Color Changes."

RESULTS

Two hundred and thirty-four parents took part in the survey. Of parents, 65.4% considered the staining on posterior teeth esthetically "acceptable" or "somewhat acceptable," and 19.3% on anterior teeth (p = .001). In a scenario of positive cooperation, 48.5% of parents were "somewhat likely" or "very likely" to choose SDF to treat posterior teeth, and 17.6% on anterior teeth (p = .001). Level of acceptance increased as the difficulty the child would experience to receive conventional treatment increased.

CONCLUSION

Staining on posterior teeth is more acceptable to parents than staining on anterior teeth. Level of acceptance on anterior teeth increases when sedation or general anesthesia is the alternative for the child.

Matrix metalloproteinase inhibitors in restorative dentistry

Matrix metalloproteinases (MMPs) have been identified as agents that disintegrate the collagen structures of dental hybrid layers, resulting in reduced restorative bond strength. Multiple MMP inhibitors (MMPIs) are known to counteract this degenerative mechanism, thereby preserving bond strength and promoting the longevity of resin-based restorations. Additionally, literature suggests that certain MMPI materials possess antimicrobial/anticariogenic properties, potentially reducing the risk of secondary caries development. Therefore, this review article aims to narrate on the integration of matrix metalloproteinase inhibitors into adhesive systems and their impact on bond strength.

Esthetics in Pediatric Dentistry-BioFlx Crowns: Case Series

Background

The crown is considered the most effective restoration for the management of dental caries. It reproduces the morphology and contour of the damaged coronal portion of the tooth while maintaining its function. The esthetic needs of children and the demands of parents bring advancement in dentistry toward a new era of esthetic crowns. In this era of esthetic crowns, the newly introduced preformed BioFlx crown seems to be an effective esthetic treatment option.

Case description

In the present case series, full coverage restoration for the management of carious and pulp therapy-treated primary molars was done by esthetic and flexible BioFlx crown (Kids-e-Dental, LLP, Mumbai, India). Over a 6 months period, the crowns have demonstrated good retention and esthetic results.

Conclusion

Dealing with the esthetic needs of children and managing primary molars using BioFlx crowns would be practical and successful.

Clinical significance

The treatment described in the case series is a new advancement in pediatric dentistry with promising esthetic alternatives.

How to cite this article

Goswami M, Jangra B, Chauhan N, et al. Esthetics in Pediatric Dentistry-BioFlx Crowns: Case Series. Int J Clin Pediatr Dent 2024;17(3):357-361.

Observation and Assessment of the Parameters of Facial Esthetics in 6-year-old Children with Healthy Dentition

Aim

This study was conducted to observe and assess the dental and facial parameters of esthetics in children with healthy dentition and evaluate whether they are comparable to those of adults.

Materials and methods

An observational study included 70 children with ages ranging from 5 to 6 years who had come to the Department of Pediatric & Preventive Dentistry, Institute of Dental Studies & Technologies, Ghaziabad, Uttar Pradesh, India, with intact primary dentition. Standardized photographs of the children were taken and evaluated. Their facial and dental parameters were recorded and compared to that of those of adults.

Result

The relation of tooth and facial components was established, and it was found that they were not in the same proportion as those of adults.

Conclusion

The proportions of facial and dental parameters of esthetics of children at 6 years of age are different from those of adults.

Clinical significance

Since esthetic rehabilitation of primary teeth is becoming an important requisite of successful dental treatment, it is important to establish a standard guideline of dental and facial parameters for children for prosthetic rehabilitation.

How to cite this article

Potsangbam D, Agarwal N, Jabin Z, et al. Observation and Assessment of the Parameters of Facial Esthetics in 6-year-old Children with Healthy Dentition. Int J Clin Pediatr Dent 2023;16(4):608-611.

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.

Is the Metallic Color of Stainless Steel Crown Satisfying for Cooperative Children and their Parents? a Preliminary Study

STATEMENT OF THE PROBLEM

Currently, the demand for tooth-colored restorations in children and young adults is increasing. Stainless steel crown (SSC) is the most common restoration for decayed primary molars. Given the dark metallic color of SSC, the esthetic appearance of this restoration is poor and subsequently their acceptance is still a matter of debate.

PURPOSE

This study was conducted to evaluate the effect of restoration's color on children's daily living conditions and compare the clinical and radiographic success rates of composite resins with SSC in primary molars.

MATERIALS AND METHOD

This clinical trial study was performed on 70 primary molars in 44 healthy 4- to 7-year-old children. The children were randomly divided into two groups restored with SSC and restored with composite resin. Two researcher-made questionnaires were used to assess the children's satisfaction concerning the appearance and color of restoration. The data were analyzed with SPSS 20 using chi-squared, Fisher's, and Mann-Whitney U tests. The significance level was set at p< 0.05.

RESULTS

Children's satisfaction with restoration color in the treatment session was 75% in the SSC group and 85% in the composite resin group. However, the difference was not statistically significant (p= 0.246). After one year of follow-up, the satisfaction rate decreased to 69% in the SSC group and increased to 90.6% in the composite resin group, with a significant difference (p< 0.001). Moreover, the frequency of clinical success was 95% in the SSC group and 96.7% in the composite resin group, with no statistically significant difference (p= 0.749). The frequency of radiographic success was 87.5% in the SSC group and 100% in the composite resin group; this difference was not significant (p= 0.061).

CONCLUSION

The results verified that restoration color was not important for cooperative children in the treatment session. However, after one year, children who received composite resin restorations were pointedly more satisfied than those who were treated with SSC restorations.

Novel 3D Printed Resin Crowns for Primary Molars: In Vitro Study of Fracture Resistance, Biaxial Flexural Strength, and Dynamic Mechanical Analysis

This study evaluated the fracture resistance, biaxial flexural strength (BFS), and dynamic mechanical analysis (DMA) of three-dimensional (3D) printing resins for the esthetic restoration of primary molars. Two 3D printing resins, Graphy (GP) and NextDent (NXT), and a prefabricated zirconia crown, NuSmile (NS), were tested. GP and NXT samples were 3D printed using the workflow recommended by each manufacturer. Data were collected and statistically analyzed. As a result of the fracture resistance test of 0.7-mm-thick 3D printed resin crowns with a thickness similar to that of the NS crown, there was no statistically significant difference among GP (1491.6 ± 394.6 N), NXT (1634.4 ± 289.3 N), and NS (1622.8 ± 323.9 N). The BFS of GP was higher for all thicknesses than that of NXT. Both resins showed high survival probabilities (more than 90%) when subjected to 50 and 150 MPa. Through DMA, the glass transition temperatures of GP and NXT were above 120 °C and the rheological behavior of GP and NXT according to temperature and frequency were analyzed. In conclusion, GP and NXT showed optimum strength to withstand bite forces in children, and 3D printed resin crowns could be an acceptable option for fixed prostheses of primary teeth.

Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses

Objective: The aim of this systematic review was to summarize the literature regarding the clinical performance of zirconia crowns for primary teeth. Materials and Methods: Four electronic databases, Ovid, PubMed, Scopus, and Web of Science were searched. 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: Out of the 2400 retrieved records, 73 full-text records were assessed for eligibility. Thirty-six studies were included for qualitative analysis. The included studies reported 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. Conclusion: Zirconia crowns are promising alternative to other restorative materials and crowns in the field of pediatric dentistry. They showed higher properties and performance in different clinical aspects and great parental satisfaction.

Clinical Evaluation of Pediatric Posterior Zirconia and Stainless Steel Crowns: A Comparative Study

Objective

To clinically evaluate and compare the performance of posterior pediatric zirconia crowns with stainless steel crowns.

Materials and methods

Twenty nine children [3-9 years] were selected and given 70 preformed crowns [35: preformed zirconia crowns, Kinderkrown; 35: stainless steel crowns, KIDZ CROWN]. Crowns were evaluated for retention, marginal integrity, opposing tooth wear, plaque accumulation, gingival inflammation, and proximal contact at 3, 6, 9, and 12th month.

Results

At the end of follow-up period overall success rate with zirconia crown was 93.5% and that of stainless steel crown was 96.7%. Statistical analysis showed no difference between the groups.

Conclusion

Posterior preformed zirconia and stainless steel crowns showed good clinical performance. Preformed zirconia crowns can be an option for posterior full coronal restoration when esthetics is of prime concern for the parent and child.

How to cite this article

Murali G, Mungara J, Vijayakumar P, et al. Clinical Evaluation of Pediatric Posterior Zirconia and Stainless Steel Crowns: A Comparative Study. Int J Clin Pediatr Dent 2022;15(1):9-14.

"I guess it looks worse to me, it doesn't look like there's been a problem solved but obviously there is": a qualitative exploration of children's and their parents' views of silver diamine fluoride for the management of carious lesions in children

Background

Despite growing evidence to support the use of silver diamine fluoride (SDF) for managing carious lesions, and the increased interest in SDF worldwide, uptake in the UK remains limited. This study explored parents’ and children’s views and acceptability of SDF for the management of carious lesions in children.

Methods

Eleven semi-structured face-to-face interviews were conducted with 11 parent–child dyads recruited from patients attending Dundee Dental Hospital and School. Interviews were transcribed verbatim, coded and thematically analysed.

Results

Previous dental experience varied across all child participants. Of the 11 children, five had undergone general anaesthesia (GA) for multiple primary tooth extractions. Two had received SDF treatment. Child participants expressed concerns about being picked on by their peers, if they had discoloured anterior teeth. Younger children appeared less concerned about the discolouration and child’s gender did not appear to influence parents’ decision-making, nor the child’s preferences regarding the use of SDF. Parents considered SDF to be particularly useful for anxious or uncooperative children but raised concerns about potential bullying at schools due to the unacceptable dental aesthetics when SDF is applied to anterior teeth. They believed they may be judged by others as neglecting their child’s oral health due to the black staining. Both parents and children were more accepting of the SDF when applied to less-visible posterior teeth. Parents accepted the use of SDF if such treatment avoided extractions under GA.

Conclusion

Despite the unfavourable aesthetics of SDF (black staining), parents appreciated SDF treatment, especially for uncooperative or younger children. However, both parents and children shared concerns about bullying at schools as a consequence of the black staining. Raising awareness about SDF was identified as one approach to encourage the uptake of SDF.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01730-w.

Use of Restorative Full Crowns Made with Zirconia in Children: A Systematic Review

Aim and objective

The purpose of this systematic review is to analyze the suitability of the zirconia crowns for restoration of damaged primary teeth in children.

Background

This systematic review has been conducted in line with the preferred reporting items for systematic reviews (which is also called as PRISMA) guidelines. A search for the relevant articles of zirconia crowns in deciduous teeth has been made in electronic database of PubMed and a study design (meta-analysis), i.e., PICOS framework. The words used in the search are “zirconia crowns” and “primary molars,” “zirconia crowns” and “primary incisors,” “zirconia crowns” and “children,” “zirconia crowns” and “primary teeth.”

Review results

The database search showed 44 studies of which 20 articles were excluded as they were irrelevant, duplicates, and data were not available. In the present systematic review, the remaining 24 articles were included.

Conclusion

Zirconia crowns have been proved with better results than other crowns in terms of gingival and periodontal health, esthetics, and crown fractures. However, the quantity of tooth preparation and the wear of antagonist tooth are reported to be more in case of zirconia crowns. Future randomized control studies should be carried out in primary teeth due to less number of randomized studies on this topic.

Clinical significance

Zirconia crowns are now widely used in dentistry and there is an increase in the number of studies, so a systematic review evaluating and comparing results is warranted.

How to cite this article

Ajayakumar LP, Chowdhary N, Reddy VR, et al. Use of Restorative Full Crowns Made with Zirconia in Children: A Systematic Review. Int J Clin Pediatr Dent 2020;13(5):551–558.

In Vitro Comparative Analysis of Fracture Resistance of Lithium Disilicate Endocrown and Prefabricated Zirconium Crown in Pulpotomized Primary Molars

AIM

This study aimed to evaluate the effect of lithium disilicate endocrowns compared to prefabricated zirconia crown used for restoring pulpotomized primary molars, on their Fracture Resistance and to compare the loads to failure these different ceramic restorations with previously reported posterior occlusal forces.

METHODS

Twenty mandibular left second primary molars were randomly distributed into two groups (n = 10 in each group) the zirconia Crown (Nusmile zr.) Group (G1) and the lithium disilicate (IPS e.max Press) Endocrown Group (G2). In all groups pulpotomy procedure was done before preparation then each sample was prepared based on their allocated restoration, both zirconia crown (Nusmile zr.) and endocrown (IPS e.max Press) were cemented by dual-cure resin cement. All samples were loaded to failure using a universal testing machine (Instron, USA), and the compressive force was applied. The data were analysed using one-way (ANOVA) and Tukey's post hoc significance difference tests. Differences were considered significant at (p< 0.05).

RESULTS

Group zirconia crown (G1) showed significantly higher fracture strength than Group (G2) lithium disilicate endocrown (p < 0.05).

CONCLUSION

The zirconia crown showed higher fracture resistance than lithium disilicate endocrown. However, both tested zirconia crown and lithium disilicate endocrown withstood the application of axial occlusal forces greater than the reference values for posterior occlusal loads.

Aesthetic perception, acceptability and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review

BACKGROUND

Silver diamine fluoride (SDF) causes dental black staining after its application.

AIM

Evaluate the aesthetic perception, acceptability, and/or satisfaction of patients, parents, and professionals to the treatment of caries lesions with SDF through a scoping review.

DESIGN

A search was performed in seven databases and two key journals with no language or date restrictions. Studies that evaluated the aesthetic perception, satisfaction, and/or acceptability of patients, parents, and professionals to the treatment of carious lesions with SDF were considered eligible.

RESULTS

From a total of 1177 articles, 10 studies were full text assessed for eligibility, with nine included in this scoping review. In general, the studies varied by population, study design, and methodologic evaluation. The type of tooth (anterior or posterior), family income, parental schooling, ethnicity, and need for advanced behaviour control methods were factors that influenced the results. The acceptability level increased as the child required more advanced methods of behaviour guidance. In general, the pigmentation caused by SDF did not interfere with the parents' acceptability of the treatment; however, professionals believe that this could have influence. Regarding satisfaction, pigmentation did not influence parental satisfaction.

CONCLUSION

Parents were satisfied with and found SDF acceptable, whereas professionals did not.

Parental perceptions and acceptance of silver diamine fluoride staining

BACKGROUND

The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.

METHODS

The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents' demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.

RESULTS

Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child's posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child's anterior teeth. As the number of children's behavioral barriers increased, so did the parents' level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents' acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents' acceptance of the treatment also varied according to their socioeconomic status.

CONCLUSIONS

Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.

PRACTICAL IMPLICATIONS

Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients.