Background
The authors’ aim was to evaluate the clinical and radiographic effectiveness of zirconia
crowns (ZCs) compared with stainless steel crowns (SSCs) in the rehabilitation of
primary posterior teeth.
Types of Studies Reviewed
Using predefined combinations of different search terms, the authors searched the
standard electronic bibliographic databases—MEDLINE, Embase, Google Scholar, The Cochrane
Library, The Cochrane Central Register of Controlled Trials, and Latin American and
Caribbean Health Sciences Literature—and the Trip medical database for randomized
controlled trials in which the investigators evaluated the clinical and radiographic
effectiveness of ZCs and SSCs. Version 2 of the Cochrane risk of bias tool for randomized
trials was used for quality appraisal of the included clinical trials. Random-effects
model and Mantel-Haenszel test were used for the statistical analysis of estimated
effect sizes. The overall quality of evidence was assessed using GRADEpro GDT software
(McMaster University and Evidence Prime).
Results
A total of 6 studies were included from the initial 641 results. The overall risk
of bias had “low” concerns in 3 studies and “some” concerns in the remaining 3 studies.
From the pooled data of the meta-analysis, the authors observed 63 clinical failure
events in 497 primary teeth rehabilitated with ZCs or SSCs. Rehabilitation of primary
teeth with ZCs may result in fewer clinical failures (risk ratio, 0.48; 95% CI, 0.15
to 1.52; P = .21; I2 = 62%) and probably better gingival health (mean difference, –0.32; 95% CI, –0.42
to –0.23; P < .001; I2 = 0%) than SSCs.
Conclusions and Practical Implications
Primary posterior teeth rehabilitated with ZCs may have less risk of experiencing
clinical failure and probably better gingival health after 12 months than SSCs. Considering
the quality of available literature, no recommendations could be made regarding the
effectiveness of ZCs compared with that of SSCs in the rehabilitation of primary posterior
teeth. Pediatric dentists should select ZCs or SSCs according to the clinical situation
for successful primary teeth rehabilitation.
A protocol was registered with the International Prospective Register of Systematic
Reviews (CRD42020194363).
