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

Performance of restorations in primary molars over a seven-year period

OBJECTIVE

The aim of this study was to evaluate the use and reintervention rate of fillings compared to preformed metal crowns in the everyday clinical practice of German dentists.

METHODS

In this retrospective, longitudinal analysis, fee codes from the Kassenzahnärztliche Vereinigung Westfalen-Lippe for restorations placed in primary molars between 2012 and 2015 in children until 7 years of age followed for a 7-year period (latest until December 2022) were filtered and analyzed with the Fine and Gray competing risk regression and Cox proportional hazards regression to calculate the risk of reintervention divided into the main outcomes "Successful", "Minor Failure/Repair" and "Major Failure/Endodontic Treatment/Extraction". 367,139 primary molars (one-surface fillings: n = 117,721; two-surface fillings n = 198,815; three-surface fillings n = 36,695; more than three-surface fillings n = 8,267 and preformed metal crowns n = 5,641 were included in this study.

RESULTS

Teeth treated with preformed crowns needed significantly less re-interventions. Subdistribution hazard ratio for minor events was 0.117 (95 %-CI: 0.097 to 0.141) and hazard ratio of major events (HR=0.786; 95 %-CI: 0.695 to 0.890) when compared to one-surface fillings in multivariable adjusted analysis. Within 7-year follow-up preformed crowns required less repairs (80.6 % success rate, minor failure 4.4 %, major failure 16.3 %) than the teeth treated with composite fillings (46.2 %-52.6 % success rate, minor failure 27.0 %-39.5 %, major failure 15.5 %-28.4 %, p < 0.001).

CONCLUSION

Within the German healthcare system fillings are the first choice for treating primary molars despite considerably higher reintervention rates. This encourages a discussion on the indication of fillings and the more durable preformed metal crowns to reduce unnecessary reintervention in young children.

CLINICAL SIGNIFICANCE

This study gives an unprecedented insight into the German healthcare system regarding the reintervention rates of the most relevant treatment techniques for caries in primary molars.

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.

Clinical, individual and environmental factors related to children's health-related quality of life following treatment under general anaesthetic for dental caries: a path analysis

Objective

To examine the impact of clinical, individual, and environmental factors on children’s oral health-related quality of life (OHRQoL) and overall health-related quality of life (HRQoL) following dental caries management under general anaesthetic (GA).

Methods

Participants comprised 5- to 16-year-old children who were referred to a British Dental Hospital, for the management of their dental caries under GA. The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) and the Child Health Utility 9D (CHU9D) were used to assess child-reported OHRQoL and HRQoL, respectively, at baseline and 3-months follow up. A theoretical conceptual model, based on the Wilson and Cleary model of HRQOL, was evaluated using path analysis to explore indirect and direct relationships of the clinical, individual, and environmental variables on the quality of life outcomes following treatment.

Results

85 children completed the study. Path analyses revealed that 47% of the variance in OHRQoL scores was accounted for by the variables in the model. There were significant relationships between change in OHRQoL score and treatment type [extraction only vs. combination care (β = 1.41, p = 0.07)] and number of extractions (β = 0.46, p < 0.001). A higher number of tooth extractions was associated with poorer OHRQoL and HRQoL following treatment.

Conclusions

Treatment type, via number of extractions, may significantly impact on child OHRQoL and HRQoL following treatment under GA. However, to identify any other factors, that might affect these key outcomes, further enquiry is warranted with a bigger sample.

Stainless steel crown vs bulk fill composites for the restoration of primary molars post-pulpectomy: 1-year survival and acceptance results of a randomized clinical trial

BACKGROUND

A key factor for the success and longevity of the endodontic treatment is sealing of the cavity after restorative treatment.

AIM

The aim of this randomised clinical trial was to evaluate the 1-year survival of endodontic treatment in primary molars restored with stainless steel crowns (SSCs) and bulk fill composite resin (BF). As a secondary outcome, the acceptance of both children and parents was evaluated.

DESIGN

Ninety-one 3- to 8-year-old children with at least one primary molar requiring endodontic treatment were selected. Participants were randomized to SSC or BF and evaluated after 1, 3, 6, and 12 months. An acceptance questionnaire was completed immediately after the treatment. The primary outcome was the endodontic treatment success, evaluated in the intention-to-treat (ITT) population using the Kaplan-Meier and non-inferiority Cox regression analyses, with a non-inferiority limit of 15%. Sensitivity analysis between the success rates after 1 year was performed using Miettinen-Nurminen's method. The Mann-Whitney test was used to compare the treatment acceptance (α = 5%).

RESULTS

The survival rate after 1 year was BF = 75% and SSC = 88% (HR = 1.41; 90% CI 0.57-3.43). ITT analysis showed a success rate of BF = 86.7% and SSC = 82.6% (RR = 0.95; 0.78-1.16). The non-inferiority hypothesis between the survival of endodontic treatment could not be proved in both analyses (P > .05). The overall acceptance scores did not differ between the restorative groups (P > .05).

CONCLUSION

This study failed to show non-inferiority of BF compared with the SSC. The materials were well accepted by both children and their parents.