Comparison of the clinical success of pediatric zirconia crowns applied with different luting cements: a clinical trial

Background: The effect of luting cement type on the clinical success of pediatric zirconia crowns (PZCs) is still not proven. This study aims to assess and compare the clinical effectiveness and effect on gingival health, of PZCs (NuSmile, ZR Zirconia Primary, TX, USA) cemented with different luting cements. Methods: A total of 60 PZCs were applied to the primary molars of 53 children. Four groups were formed based on the type of luting cement. (Group BC (n = 15): Resin modified glass-ionomer cement (RMGIC) with calcium and phosphate release (BioCem™, Nusmile, TX, USA), Group GC (n = 15): Dual-cure adhesive resin cement (G-CEM LinkForce™, GC, USA), Group F1 (n = 15): Glass-ionomer cement (GIC) (Fuji 1™, GC, USA), Group F2 (n = 15): RMGIC (FujiCEM™ 2, GC, USA). Groups were compared for retention durability, plaque index (PI), gingival index (GI), probing depth (PD), and periapical pathology. Assessments were conducted at 1st, 3rd, 6th and 12th months. Results: Retention loss was observed in seven PZCs, and there was no significant difference among the groups. Eight of the teeth showed periapical pathology. Group F2 showed the highest success in terms of pulpal survival. Across all groups, an observed increase in patients’ PI, GI and PD scores was noted (p > 0.05). PI values obtained from the teeth treated with PZCs were significantly lower than the patients’ total oral PI values (p = 0.001). Conclusions: The absence of a difference among the groups indicates that an ideal cement for luting the zirconia crowns cannot be conclusively recommended. The luting cement can be preferred according to the patient, considering the technical sensitivity of application steps and cooperation. Clinical Trial Registration: (Identifier: NCT06558747).

Luting cements; Periodontal health; Primary molars; Preformed zirconia crowns

[1] Dhar V, Hsu KL, Coll JA, Ginsberg E, Ball BM, Chhibber S, et al. Evidence-based update of pediatric dental restorative procedures: dental materials. Journal of Clinical Pediatric Dentistry. 2015; 39: 303–310.

[2] Humphrey WP. Uses of chrome-steel crown in children dentistry. Dental Surveys. 1950; 26: 945–949.

[3] Innes NP, Ricketts D, Chong LY, Keightley AJ, Lamont T, Santamaria RM. Preformed crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews. 2015; 2015: CD005512.

[4] Mathew M, Roopa K, Soni A, Khan MM, Kauser A. Evaluation of clinical success, parental and child satisfaction of stainless steel crowns and zirconia crowns in primary molars. Journal of Family Medicine and Primary Care. 2020; 9: 1418–1423.

[5] Patnana AK, Chugh VK, Chugh A, Vanga NRV, Kumar P. Effectiveness of zirconia crowns compared with stainless steel crowns in primary posterior teeth rehabilitation. The Journal of the American Dental Association. 2022; 153: 158–166.e5.

[6] Jeffrey A. Dean, David R. Avery, McDonald. RE. McDonald and Avery’s dentistry for the child and adolescent. 10th edn. Elseiver: St. Louis. 2016.

[7] Alzanbaqi SD, Alogaiel RM, Alasmari MA, Al Essa AM, Khogeer LN, Alanazi BS, et al. Zirconia crowns for primary teeth: a systematic review and meta-analyses. International Journal of Environmental Research and Public Health. 2022; 19: 2838.

[8] Sahin I, Karayilmaz H, Çiftçi ZZ, Kirzioglu Z. Fracture resistance of prefabricated primary zirconium crowns cemented with different luting cements. Pediatric Dentistry. 2018; 40: 443–448.

[9] Ashima G, Sarabjot KB, Gauba K, Mittal H. Zirconia crowns for rehabilitation of decayed primary incisors: an esthetic alternative. Journal of Clinical Pediatric Dentistry. 2014; 39: 18–22.

[10] Atsu SS, Kilicarslan MA, Kucukesmen HC, Aka PS. Effect of zirconium-oxide ceramic surface treatments on the bond strength to adhesive resin. Journal of Prosthetic Dentistry. 2006; 95: 430–436.

[11] Otani AC, Pattussi MP, Spohr AM, Grossi ML. Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques. Clinical Oral Investigations. 2024; 28: 136.

[12] Mansour YF, Pintado MR, Mitchell CA. Optimizing resin cement removal around esthetic crown margins. Acta Odontologica Scandinavica. 2006; 64: 231–236.

[13] Pereira S, Anami L, Pereira C, Souza R, Kantorski K, Bottino M, et al. Bacterial colonization in the marginal region of ceramic restorations: effects of different cement removal methods and polishing. Operative Dentistry. 2016; 41: 642–654.

[14] El Shahawy OI, O’Connell AC. Successful restoration of severely mutilated primary incisors using a novel method to retain zirconia crowns—two year results. Journal of Clinical Pediatric Dentistry. 2016; 40: 425–430.

[15] Azab MM, Moheb DM, El Shahawy OI, Rashed MA. Influence of luting cement on the clinical outcomes of Zirconia pediatric crowns: a 3-year split-mouth randomized controlled trial. International Journal of Paediatric Dentistry. 2020; 30: 314–322.

[16] Srinivasan SR, Mathew MG, Jayaraman J. Comparison of three luting cements for prefabricated zirconia crowns in primary molar teeth: a 36-month randomized clinical trial. Pediatric Dentistry. 2023; 45: 117–124.

[17] Korsch M, Walther W. Peri-implantitis associated with type of cement: a retrospective analysis of different types of cement and their clinical correlation to the peri-implant tissue. Clinical Implant Dentistry and Related Research. 2015; 17: e434–e443.

[18] Gehrke P, Bleuel K, Fischer C, Sader R. Influence of margin location and luting material on the amount of undetected cement excess on CAD/CAM implant abutments and cement-retained zirconia crowns: an in-vitro study. BMC Oral Health. 2019; 19: 111.

[19] Augusti D, Augusti G, Re D. Undetected excess cement at marginal areas of zirconia crown copings: in vitro analysis of two luting agents and their influence on retention. The International Journal of Prosthodontics. 2020; 33: 202–211.

[20] Guilardi LF, Pereira GKR, Giordani JC, Kleverlaan CJ, Valandro LF, Rippe MP. Cement choice and the fatigue performance of monolithic zirconia restorations. Operative Dentistry. 2022; 47: 461–472.

[21] Malkondu O, Tinastepe N, Kazazoglu E. Influence of type of cement on the color and translucency of monolithic zirconia. Journal of Prosthetic Dentistry. 2016; 116: 902–908.

[22] Walia T, Salami AA, Bashiri R, Hamoodi OM, Rashid F. A randomised controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth. European Journal of Paediatric Dentistry. 2014; 15: 113–118.

[23] Lee J, Park H, Lee J, Seo H. Shear bonding strength of three cements luted on pediatric zirconia crowns and dentin of primary teeth. Journal of the Korean Academy of Pediatric Dentistry. 2018; 45: 314–323.

[24] Al-Haj Ali SN. In vitro comparison of marginal and internal fit between stainless steel crowns and esthetic crowns of primary molars using different luting cements. Dental Research Journal. 2019; 16: 366–371.

[25] Çiftçi ZZ, Şahin İ, Karayılmaz H. Comparative evaluation of the fracture resistance of newly developed prefabricated fibreglass crowns and zirconium crowns. International Journal of Paediatric Dentistry. 2022; 32: 756–763.

[26] Alrashdi M, Alhunti A. Clinical outcome of prefabricated zirconia crowns cemented with self-adhesive resin and pure glass ionomer on primary teeth: a retrospective cohort study. Children. 2024; 11: 991.

[27] Technologies SOH. EZ-pedo esthetic, metal-free zirconia dental crowns for children now available worldwide as a non-toxic, biocompatible solution. 2018. Available at: https://sprigusa.com/ez-pedo-esthetic-metal-free-zirconia-dental-crowns-for-children-now-available-worldwide-as-a-non-toxic-biocompatible-solution/ (Accessed: 05 May 2024).

[28] Holsinger DM, Wells MH, Scarbecz M, Donaldson M. Clinical evaluation and parental satisfaction with pediatric zirconia anterior crowns. Pediatric Dentistry. 2016; 38: 192–197.

[29] Geduk N, Ozdemir M, Erbas Unverdi G, Ballikaya E, Cehreli ZC. Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial. BMC Oral Health. 2023; 23: 828.

[30] Alrashdi M, Ardoin J, Liu JA. Zirconia crowns for children: a systematic review. International Journal of Paediatric Dentistry. 2022; 32: 66–81.

[31] Thompson JY, Stoner BR, Piascik JR, Smith R. Adhesion/cementation to zirconia and other non-silicate ceramics: where are we now? Dental Materials. 2011; 27: 71–82.

[32] Stepp P, Morrow BR, Wells M, Tipton DA, Garcia-Godoy F. Microleakage of cements in prefabricated zirconia crowns. Pediatric Dentistry. 2018; 40: 136–139.

[33] Selimović-Dragaš M, Huseinbegović A, Kobašlija S, Hatibović-Kofman Š. A comparison of the in vitro cytotoxicity of conventional and resin modified glass ionomer cements. Bosnian Journal of Basic Medical Sciences. 2012; 12: 273–278.

[34] de Souza Costa CA, Hebling J, Garcia-Godoy F, Hanks CT. In vitro cytotoxicity of five glass-ionomer cements. Biomaterials. 2003; 24: 3853–3858.

[35] Mantellini MG, Botero TM, Yaman P, Dennison JB, Hanks CT, Nör JE. Adhesive resin induces apoptosis and cell-cycle arrest of pulp cells. Journal of Dental Research. 2003; 82: 592–596.

[36] Caviedes-Bucheli J, Ariza-Garcia G, Camelo P, Mejia M, Ojeda K, Azuero-Holguin MM, et al. The effect of glass ionomer and adhesive cements on substance P expression in human dental pulp. Medicina Oral, Patologia Oral, Cirugia Bucal. 2013; 18: e896–e901.

[37] Ozdemir M, Unverdi GE, Geduk N, Ballikaya E, Cehreli ZC. Clinical comparison of preformed zirconia and composite strip crowns in primary maxillary incisors: 18-month results of a prospective, randomized trial. Pediatric Dentistry. 2022; 44: 416–422.

[38] Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clinical Oral Investigations. 2020; 24: 3275–3280.