JIDAM

ORIGINAL ARTICLE

“An Official Journal of IDA - Madras

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PARENTAL SATISFACTION WITH PEDIATRIC

POSTERIOR PREFORMED ZIRCONIA AND

STAINLESS STEEL CROWNS- A COMPARATIVE

STUDY

Dr. Gayathri Murali^*, Dr. Jayanthi Mungara, Dr. Nilaya Reddy Venumbaka,

Dr.Sai Sarath kumar Kothimbakkam, Dr.Santhosh Priya. A.K.R

Department of Pedodontics and Preventive Dentistry,

^*SRM Kattankulathur Dental College and Hospital, Tamilnadu, India.

Ragas Dental College and Hospital, Chennai, Tamilnadu, India.

To access & cite this article

ABSTRACT

Website: jidam.idamadras.com

AIM: To elicit parental acceptance and satisfaction with pediatric

preformed Stainless Steel Crown(SSC﴿ and zirconia crowns in

posterior primary teeth.

METHODOLOGY: Parental satisfaction was elicited from

25 parents with a 5-point likert type questionnaire. Problems

experienced by the child and future treatment recommendations

were also elicited with close ended questions during the follow-

up visit after 12 months from the time of treatment.

RESULTS: Overall parental satisfaction was 78% with stainless

steel crowns and 96% with zirconia crowns. 8% of the parents

reported bleeding around the gums in zirconia group. 60% of

Address for correspondence:

the parents in stainless steel crown group and 100% of zirconia

crown group reported that they would opt for these crowns in

future.

Dr.Gayathri Murali, MDS,

3e,Saravana Apartment,

CONCLUSION: Preformed zirconia crowns can be an option

240,St.Marys Road, Mandaveli,

for posterior full coronal restoration when esthetics is of prime

Chennai-600028

concern for the parent and child.

Email id: drgayathrimurali1992@gmail.com

KEY WORDS: Zirconia crowns, Stainless steel crowns,

Parental satisfaction.

Received

: 18.05.2020

Accepted

: 05.06.2020

Published

: 27.06.2020

JIDAM/Chennai/Volume:7/Issue:2/Pages 44 - 49/April-Jun 2020

Gayathri et al: Pediatric Zirconia Crowns

INTRODUCTION:

potential disadvantages include, need for more tooth

reduction¹⁰, inability to crimp or contour the crown

Early childhood caries is a complex disease

and they are also expensive.

affecting the primary teeth for which parents often

seek treatment. The management often includes

It has been observed that impact of esthetics

alleviation of infection and reestablishment of

plays an important role even in posterior primary

form and function using full coronal restorations.

teeth. Zirconia crowns are by far the strongest dental

Stainless steel crowns(SSC) were the choice of full

ceramic restoration available as preformed posterior

coronal restoration, as they were easily available as

esthetic crowns for primary dentition and very limited

pre-formed, pre-trimmed and pre-contoured crowns

literature is available with regards to its efficiency

with wide range of sizes and with proven clinical

and parental acceptance. Thus this study was carried

efficiency.^.The only disadvantage of SSC was its

out to assess and elicit parental satisfaction for

unaesthetic appearance.^1,2,3

preformed posterior zirconia crowns and stainless

steel crowns.

A survey of pediatric dentists reported that

87% of the parents are concerned about the esthetics

METHODOLOGY:

of even posterior restorations. In addition, studies

suggest that even children are more concerned about

Parental satisfaction was elicited after

esthetics as it influences their psychological well

placement of the crown in primary molars of 25

being and physical appearance.^4,5

children post pulp therapy

(Fig

1,2,3). Parental

satisfaction was elicited with regards to the size,

The need to meet the demand for esthetic

shape, colour, durability and overall satisfaction,

restorations led to the introduction of open faced

impact on oral health and appearance. It was assessed

stainless steel crowns, preveneered crowns,

with 5-point likert type questionnaire where ‘1-Very

polycarboxylate crowns and strip crowns. Each

dissatisfied,

2-Dissatisfied,

3-Neutral,

4-Satisfied

of these full coronal restorations has their own

and

5-Very satisfied’. The problems encountered

advantage and disadvantage. Initially preveneered

by the children such as bleeding around crown,

stainless steel crowns showed short term success

sensitivity and food lodgement and future treatment

rate, but long term follow-up studies have reported

options were evaluated with ‘Yes/No’ dichotomous

frequent fracture of these crowns as a whole or a part

questions.^8,13,14

of it.^6,7,8

The technological advances in techniques

and material science led to the evolution of

preformed zirconia crowns for primary teeth, so

as to fulfill the esthetic demands, at the same time

promise good durability. Zirconia crowns are known

as “Ceramic Steel” as it provides strength close to

available metal crowns as well as colour similar to

that of natural teeth. Pediatric zirconia crowns were

introduced by EZ-pedo and became commercially

Fig 1: Post Operative Photograph of Maxilla

available in 2008. Later preformed zirconia crowns

were popularized by companies like Nusmile,

Kinderkrowns, Cheng crowns, Signature crowns

and many more. These preformed crowns differed

with respect to size, shape, shade and pattern of

retention component.⁹ Advantages of preformed

zirconia crowns are its esthetics, full coverage of the

treated tooth, no component of the crown that might

debond and potentially less technique sensitive

Fig 2: Post Operative Photograph of Mandible

when compared to other esthetic alternatives. The

JIDAM/Chennai/Volume:7/Issue:2/Pages 44 - 49/April-Jun 2020

Gayathri et al: Pediatric Zirconia Crowns

steel crowns and only 13% were satisfied with the

colour of it. 100% satisfaction with shape and colour

of zirconia crown was noted while only 87% were

satisfied with the size of the crown.(Graph 1 & 2 ).

Majority of the parents in both the groups

(78% SSCs and 96% zirconia crowns) were satisfied

with the crowns. Mild bleeding (8%) was reported

Fig 3:In Occlusion

in zirconia group whereas no such complaints were

reported with stainless steel crowns. Parents were

RESULT:

ready to recommend both the crowns with preference

for zirconia crowns (100% for zirconia crown and

Parental satisfaction with durability was

60% for stainless steel) because of its colour being

similar in both the groups (100%). 60% of them

similar to that of natural teeth (Graph - 3).

were satisfied with the size and shape of stainless

Graph 1: Parental Satisfaction With Preformed

Graph 2: Parental Satisfaction With Stainless

Zirconia Crowns

Steel Crowns

Graph 3: Future Treatment Option

JIDAM/Chennai/Volume:7/Issue:2/Pages 44 - 49/April-Jun 2020

Gayathri et al: Pediatric Zirconia Crowns

PARENTAL SATISFACTION:

With the concept of esthetics gaining interest

among parents and children, preformed zirconia

Category

steel (2.9) with a mean score of 5. Both zirconia and

crown -

YES / NO

stainless steel crowns performed similar with respect

YES / NO

to parents’ perception of durability with a mean score

of 4.8 which was slightly higher than the values

obtained by Walia et al (4.7).¹⁶Overall satisfaction

DISCUSSION:

with zirconia crown (4.8) was better than the stainless

steel crowns (4.2). Impact of both the crowns on

Full coronal restorations have become the

oral health and appearance (4.8) were slightly higher

prevalent part of rehabilitation of the children affected

than the results of Holsinger et al (4.7).^11.Problems

with early childhood caries. Multiple options

experienced by children after the crowns were

have been tried with each one showing varied

none, except for 8% of the zirconia crowns who

clinical performance. Change in lifestyle, more

reported bleeding around the crowns. Overall plaque

opportunities to socialize and role of media plays

accumulation could be attributed as the reason for

a role in exposing the children to a concept of ideal

poor gingival health as an improvement was noted

beauty at very young age. This has showed impact

with oral prophylaxis and oral health education.

on their concerns about esthetics which is similar to

that of adults.⁴The same principle applies in terms of

All the parents were ready to opt for zirconia

restorations to be placed on their teeth.⁵

crowns (100%), whereas only 60% accepted to opt

for stainless steel crowns. Most of the parents were

JIDAM/Chennai/Volume:7/Issue:2/Pages 44 - 49/April-Jun 2020

Gayathri et al: Pediatric Zirconia Crowns

satisfied with stainless steel crowns only in maxillary

Fishman R, Guelmann M, Bimstein E.

dentition, but with respect to mandibular molars they

Children’s selection of posterior restorative

preferred esthetic zirconia crowns.

materials. Journal of Clinical Pediatric

Dentistry 2007 Sep;31(1):1-4.

Further studies are recommended following

Fuks AB, Ram D, Eidelman E. Clinical

a split-mouth design, testing different brands of

performance of esthetic posterior crowns

commercially available zirconia crowns with varied

in primary molars: a pilot study. Pediatric

level of polish, gloss and morphological variations

dentistry 1999;21(7):445-8.

for a longer duration to get more valuable information

Ram D, Fuks AB, Eidelman E. Long-term

on the clinical performance of preformed zirconia

crowns.

clinical performance of esthetic primary

molar crowns. Pediatric Dentistry 2003 Nov

CONCLUSION:

1;25(6 ).

Roberts C, Lee JY, Wright JT. Clinical

Both stainless steel crowns and zirconia crowns

evaluation of and parental satisfaction with

are an excellent option for restoration of posterior

resin-faced stainless steel crowns. Pediatric

primary teeth. But zirconia crowns can be the choice

Dentistry 2001 Jan;23(1):28-31.

of post-endodontic restoration when esthetics is of

Tote J, Gadhane A, Das G, Soni S, Jaiswal

prime concern for the parents.

K, Vidhale G. Posterior esthetic crowns in

Peadiatric Dentistry. Int J Dent Med Res

FINANCIAL SUPPORT AND

2015;1(6):197-201.

SPONSORSHIP:

10.

Clark L, Wells MH, Harris EF, Lou J.

Nil

Comparison of amount of primary tooth

reduction required for anterior and posterior

CONFLICTS OF INTEREST:

zirconia and stainless steel crowns. Pediatric

dentistry 2016 Feb 15;38(1):42-6.

There are no conflicts of interest.

11.

Holsinger DM, Wells MH, Scarbecz M,

Donaldson M. Clinical evaluation and

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