Evaluation of clinical and radiographic success and parental satisfaction of zirconia crowns compared to stainless steel crowns in primary mandibular molars requiring full-crown restoration: a systematic review

Background: This systematic review aimed to evaluate the clinical and radiographic success, along with parental satisfaction, associated with zirconia and stainless steel crowns (SSCs) in primary mandibular molars. Methods: A comprehensive search was conducted across multiple electronic databases, including the Cochrane Library, PubMed, the System for Information on Grey Literature in Europe (SIGLE), the Latin American and Caribbean Health Sciences Literature (LILACS), and Web of Science, to identify randomized clinical trials comparing zirconia and SSCs in primary mandibular molars. Studies meeting the predefined inclusion criteria were selected. Two independent reviewers selected the studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias (RoB 2) tool. Results: A total of 245 studies were screened following the deletion of duplicate entries, with 239 having been excluded based on screening of titles and abstracts. Six studies were identified for full text analysis and all six had their eligibility analyzed. Five studies were identified as being eligible after one study did not meet the inclusion criteria. Zirconia crowns demonstrated clinical and radiographic outcomes comparable to those of SSCs, with potential advantages in gingival health and parental satisfaction. Conclusions: According to the current literature, zirconia crowns represent an acceptable choice to stainless steel crowns for the treatment of primary mandibular molars. The two types of crowns proved themselves to have similar performance; however, there were some benefits associated with zirconia crowns in terms of periodontal status and parents’ satisfaction. Nonetheless, it should be remembered that the results need to be considered carefully because of the small number of available researches. The PROSPERO Registration: CRD42023458332.

Zirconia; Systematic review; Parental satisfaction; Mandibular molars; Crowns; Stainless steel

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