Survival Analysis of Prefabricated Zirconia Crowns with and Without Pulpotomy in Primary Teeth: A Retrospective Cohort Study

Overview

Journal Children (Basel)

Specialty Health Services

Date 2024 Nov 27

PMID 39594977

Authors

Murad Alrashdi

Affiliations

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Abstract

Background: Prefabricated Zirconia Crowns (PZCs) are increasingly preferred for restoring primary teeth due to their esthetic appeal and retention. However, their rigid, unmodifiable design requires precise tooth preparation, often leading to aggressive reduction and potential pulp exposure. Pulpotomy, a standard treatment for reversible pulpitis and mechanical pulp exposure, is sometimes employed before PZCs. While pulpotomy is not routinely performed, its use raises important considerations about the interplay between restorative procedures and pulp therapy in pediatric dentistry, particularly regarding the long-term restoration outcomes of PZCs.

Purpose: This study aimed to investigate the impact of pulpotomy on the success rate of PZCs.

Methods: We examined 81 anterior upper primary teeth treated with PZCs in children aged 2-5 years over a two-year period. Cases were divided into groups with and without pulpotomy. Follow-ups occurred at 6-month intervals, assessing clinical and radiographic outcomes. Analyses were performed using SPSS 25.0 software. The statistical significance was < 0.05.

Results: A total of 81 anterior primary teeth were included. Chi-square analysis showed no association between pulp therapy and PZC success (χ = 0.051, = 0.822). The Kaplan-Meier survival analysis revealed comparable survival curves and the log-rank test showed no statistically significant difference in survival time between pulpotomy-treated and untreated groups (χ = 0.051, = 0.821).

Conclusions: Pulpotomy did not significantly affect the success rate of PZCs within 2 years.

References

Alrashdi M, Ardoin J, Liu J . Zirconia crowns for children: A systematic review. Int J Paediatr Dent. 2021; 32(1):66-81. DOI: 10.1111/ipd.12793. View

Gadallah L, Hamdy M, Bardissy A, Abou El Yazeed M . Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis. F1000Res. 2019; 7:1560. PMC: 6584970. DOI: 10.12688/f1000research.16142.3. View

Alzanbaqi S, Alogaiel R, Alasmari M, Al Essa A, Khogeer L, Alanazi B . Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses. Int J Environ Res Public Health. 2022; 19(5). PMC: 8910015. DOI: 10.3390/ijerph19052838. View

Splieth C, Banerjee A, Bottenberg P, Breschi L, Campus G, Ekstrand K . How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res. 2020; 54(4):297-305. DOI: 10.1159/000507692. View

Zhang Y, Lawn B . Novel Zirconia Materials in Dentistry. J Dent Res. 2017; 97(2):140-147. PMC: 5784474. DOI: 10.1177/0022034517737483. View

Hamrah M, Mokhtari S, Hosseini Z, Khosrozadeh M, Hosseini S, Ghafary E . Evaluation of the Clinical, Child, and Parental Satisfaction with Zirconia Crowns in Maxillary Primary Incisors: A Systematic Review. Int J Dent. 2021; 2021:7877728. PMC: 8275371. DOI: 10.1155/2021/7877728. View

Waggoner W . Restoring primary anterior teeth: updated for 2014. Pediatr Dent. 2015; 37(2):163-70. View

Alhissan A, Chandra Pani S . Factors Influencing the Survival of Preformed Zirconia Crowns in Children Treated under General Anesthesia. Int J Dent. 2021; 2021:5515383. PMC: 8012123. DOI: 10.1155/2021/5515383. View

Lawson N, Jurado C, Huang C, Morris G, Burgess J, Liu P . Effect of Surface Treatment and Cement on Fracture Load of Traditional Zirconia (3Y), Translucent Zirconia (5Y), and Lithium Disilicate Crowns. J Prosthodont. 2019; 28(6):659-665. PMC: 6642729. DOI: 10.1111/jopr.13088. View

10.

Clark L, Wells M, Harris E, Lou J . Comparison of Amount of Primary Tooth Reduction Required for Anterior and Posterior Zirconia and Stainless Steel Crowns. Pediatr Dent. 2016; 38(1):42-6. View

11.

Dhar V, Hsu K, Coll J, Ginsberg E, Ball B, Chhibber S . Evidence-based Update of Pediatric Dental Restorative Procedures: Dental Materials. J Clin Pediatr Dent. 2015; 39(4):303-10. DOI: 10.17796/1053-4628-39.4.303. View

12.

Afrashtehfar K, Jurado C, Al-Hadi D, Shetty K . Pulpotomy versus root canal treatment in permanent teeth with spontaneous pain: comparable clinical and patient outcomes, but insufficient evidence. Evid Based Dent. 2023; 24(2):54-56. PMC: 10289894. DOI: 10.1038/s41432-023-00878-4. View

13.

Yanover L, Tickotsky N, Waggoner W, Kupietzky A, Moskovitz M . Zirconia crown performance in primary maxillary anterior teeth: a retrospective photographic and radiographic cohort study. Eur Arch Paediatr Dent. 2020; 22(3):417-423. DOI: 10.1007/s40368-020-00571-5. View

14.

Zhang F, Inokoshi M, Batuk M, Hadermann J, Naert I, Van Meerbeek B . Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations. Dent Mater. 2016; 32(12):e327-e337. DOI: 10.1016/j.dental.2016.09.025. View

15.

Lin P, Chen H, Wang Y, Tu Y . Primary molar pulpotomy: a systematic review and network meta-analysis. J Dent. 2014; 42(9):1060-77. DOI: 10.1016/j.jdent.2014.02.001. View

16.

Aziz A, El-Mowafy O . Clinical evaluation of zirconia crowns cemented with two different resin cements: A retrospective study. J Oral Rehabil. 2023; 50(12):1481-1486. DOI: 10.1111/joor.13580. View

17.

Yee K, Bhagavatula P, Stover S, Eichmiller F, Hashimoto L, MacDonald S . Survival Rates of Teeth with Primary Endodontic Treatment after Core/Post and Crown Placement. J Endod. 2017; 44(2):220-225. DOI: 10.1016/j.joen.2017.08.034. View

18.

Khodadadi E, Mohammadpour M, Motamedian S, Kouhestani F . Failure Rate of Pediatric Dental Treatment under General Anesthesia. Dent J (Basel). 2018; 6(3). PMC: 6162701. DOI: 10.3390/dj6030025. View

19.

Patnana A, Chugh V, Chugh A, Vanga N, Kumar P . Effectiveness of zirconia crowns compared with stainless steel crowns in primary posterior teeth rehabilitation: A systematic review and meta-analysis. J Am Dent Assoc. 2022; 153(2):158-166.e5. DOI: 10.1016/j.adaj.2021.08.005. View

20.

Bucher K, Tautz A, Hickel R, Kuhnisch J . Longevity of composite restorations in patients with early childhood caries (ECC). Clin Oral Investig. 2013; 18(3):775-82. DOI: 10.1007/s00784-013-1043-y. View