Loading...
Please wait, while we are loading the content...
Similar Documents
Clinical and Radiographic Evaluation of Stainless Steel versus Zirconia Crowns on Primary Molars: Randomized Controlled Trial
| Content Provider | Semantic Scholar |
|---|---|
| Author | Abuelniel, Gihan Mohamed Eltawil, Sherif |
| Copyright Year | 2018 |
| Abstract | Aim or purpose: To evaluate clinical and radiographic success of Stainless steel crowns versus zirconia crowns on primary molars. Materials and methods: Two hundred and forty vital mandibular primary molars in sixty medically free patients were pulpotomized under general anaesthesia. The patients with an age range 4-6 years. After pulp therapy, molars were restored and divided into two equal groups, group (1) stainless steel crowns(control) and group (2) Zirconia crowns. Clinical and radiographic evaluation were conducted at baseline,3,6,9 and 12 months intervals utilizing Scoring system. Data were collected and analysed statistically. Results: There was no statistically significant difference between GI and OHI scores in the two groups at base line, 3 ,6 months. Stainless Steel crown group showed statistically significantly higher mean GI and OHI scores than Zirconia crown group at 9 and 12 months. After 12 months, 75.8% of the Stainless-Steel crowns showed acceptable clinical and radiographic criteria compared to 80.8% of the Zirconia crowns. The drop out were 5 cases in Stainless Steel crown group comprising 20 molars and 4 cases in Zirconia group comprising 16 molars. However, there was no statistically significant difference between the two groups. After 12 months, 9.2% of the SSC group showed inter-proximal bone resorption compared to 7.5% of the Zirconia crowns. However, there was no statistically significant difference between the two groups. Conclusions: Regarding to the results of the current study, Zirconia crowns proved acceptable clinical and radiographic success compared to stainless steel crowns with an advantage of better esthetics. (978) Gihan Abuelniel and Sherif Eltawil E.D.J. Vol. 64, No. 2 restoration. It is also indicated in deep unilateral or bilateral proximal cavities, circumferential caries and history of pulp therapy [2]. In 1950 Stainless Steel Crowns were introduced by Dr William Humphrey. These were the most reliable restoration in terms of full coverage. After pulpectomy or pulpotomy SSC were the treatment of choice due to less microleakage when compared to amalgam restoration[3]. SSCs do not require complete isolation for bonding like crowns made of composite resin and they do not require a preparation incorporating mechanical retention into the design, as do amalgam restorations. After two years of clinical use, the rate of perforations of SSCs was only 12% [4]. However, the parents need for lifelike restorations that looks like natural teeth leads to development of metal free coverage. This is represented through the use of zirconia crowns which are considered cosmetic treatment compared to other alternative crowns [5]. By increasing the translucency of zirconia ceramics which were made of one single material by aid of computer assistant design (CAD) and computer assistant machining (CAM) it showed excellent mechanical properties and perfect aesthetics crowns [6,7]. Numerous studies have focused on the gingival health of primary molars restored with SSC. Goodto moderate-fitting crowns and well-contoured margins led to healthy gingivae, and less plaque accumulation [8]. Another study reported that interproximal bone resorption after placement of an SSC was not adversely affected by (a) an extension or adaptation of the crown’s margin, (b) a tight proximal contact, (c) the level of oral hygiene, or (d)the duration of crown’s presence [9]. Discrepancies of the subgingival margins of the SSC, however, have been implicated by some investigators as one of the causes of gingival inflammation after restoring a primary molar with a SSC [8]. The Debates about SSCs and Zirconia crowns necessitated the investigation of their clinical and radiographic performance as a final restoration of pulpotomized primary molars. SUBJECTS AND METHODS Study design and ethical approval The study was a randomized, non-blinded prospective controlled clinical trial. The children and their parents were informed about the purpose of the study, and an informed consent document prior to participation was also signed. The study was performed according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee, Faculty of Dentistry, Cairo University. Sample size calculation: Sample size determination was based upon the results of Kara NB and Yilmaz Y (2014). Using alpha level of 0.05 (5%) and β level of 0.20 (20%) i.e. power = 80%; the estimated minimum required sample size (n) was 56 crowns per group giving a total of 112 crowns. To compensate for 20% dropout rate, the minimum required sample size could be increased to a minimum of 134 Sample size determination was based upon the results of Kara NB and Yilmaz Y (2014). Using alpha level of 0.05 (5%) and β level of 0.20 (20%) i.e. power = 80%; the estimated minimum required sample size (n) was 56 crowns per group giving a total of 112 crowns. To compensate for 20% drop-out rate, the minimum required sample size could be increased to a minimum of 134 crowns. Sample size determination was based upon the results of Kara NB and Yilmaz Y (2014). Using alpha level of 0.05 (5%) and β level of 0.20 (20%) i.e. power = 80%; the estimated minimum required sample size (n) was 56 crowns per group giving a CLINICAL AND RADIOGRAPHIC EVALUATION OF STAINLESS STEEL VERSUS (979) total of 112 crowns. To compensate for 20% dropout rate, the minimum required sample size could be increased to a minimum of 134. Study Subjects Two hundred and forty vital mandibular primary molars in sixty medically free children (34 boys and 26 girls), with an age range between 4–6 years presented to the Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University for general anaesthesia. Inclusion criteria For inclusion in the study, mandibular molars that required restoration on both sides met one of the following criteria: · patients presented with deep carious lesions including the first and second primary molars bilaterally · No evidence of any clinical pathology · No mobility and had no tenderness to percussion · A normal or non-resorbed interproximal bone level, in which the distance between the crest of interdental bone and cement–enamel junction was not greater than 2 mm on radiographic evaluation · No more than one-third root resorption detected. Exclusion criteria Children who had one of the following were excluded from the study: · Systemic disease · An allergy to any drug, such as a local anaesthetic agent · Extremely poor oral hygiene · Periodontal disease, · Malocclusion. Pateints were treated under general anaesthesia. After local anaesthesia administrated, all caries was removed and coronal access was gained using a sterile No. 330 high speed bur with water spray to expose the pulp chamber. A sterile spoon excavator was used for coronal pulp amputation. Sterile cotton pellet moistened with distilled water was placed over the pulp stumps, and light pressure was applied for 5 minutes for obtaining haemostasis. If bleeding did not stop after 5 minutes, the molar was excluded from the study. Formocresol was applied (formocresol, Dentsply, Surrey, UK) using a sterile cotton pellet for 3–5 mins. After removal of the cotton pellet, a reinforced zinc oxide eugenol base covered the pulp stumps. After the completion of pulp therapy, molars were restored and divided into two equal groups: Group (1) Stainless steel crowns (control): one hundred and twenty mandibular primary molars (first and second molars) in thirty patients (18 boys and 12 girls) bilaterally restored with stainless steel crowns (3M, ESPE, USA). Reduction of the occlusal surface by about 1.5 mm using a flame shapeddiamond bur to produce uniform occlusal reduction. Using long, and tapered diamond bur, adhered marginally convergent to cut interproximal slices mesially and distally. The reduction should allow the probe to pass through the contact area. An appropriate size was chosen according to mesiodistal width of the prepared tooth and trail fit carried out before cementation. The crown should remain no more than 1 mm subgingivally. Contoured and trimmed SSCs were cemented. Group (2) NuSmile Zirconia crowns: one hundred and twenty mandibular primary molars (first and second molars) in thirty patients (16 boys and 14 girls ) bilaterally restored by Zirconia crowns (NuSmile ZR, Houston, TX, USA). Suitable crown size cauld be identified using NuSmile Try-In Crowns and should always be selected before startingmolar reduction.Reduction of the occlusal surface next to the natural occlusal (980) Gihan Abuelniel and Sherif Eltawil E.D.J. Vol. 64, No. 2 profile by 1-1.5 mm. Interproximal contacts were opened. The proximal space should be enough to permit the chosen crown to fit passively. The molar should be trimmed down circumferentially 0.5-1.25 mm as needed with the use of tapered diamond burs. For reduction of the occlusal area, coarse football shaped diamond bur cauld be utilized. Sub gingival reduction: The anticipated edge should be polished to a feather-edge so that no undercuts or subgingival ridges stay roughly 1-2 mm subgingivally on every area. A slim, narrowed diamond bur should be utilized to prevent the breaking up of tissue during subgingival tooth modifications. Finally, elimination of line and point angles to allowall areasof the prepartion to be marginally rounded was done. Clinical and radiographic evaluation were conducted for both groups at baseline, 3,6,9 and 12 months intervals utilizing Scoring system. Evaluation of the gingival health by: 1. Gingival index (GI) (Machen et al,1980) [10]: The GI was measured by passing an explorer tip gently within the sulcus mesial, distal, buccal, and lingual surface of each crowned molarit was scored on a scale of 0 to 3 0= no bleeding 1= only one bleeding point appearing some seconds after probing 2=bleeding points appearing immediately after probing 3=profuse bleeding appearing immediately after probing spreading towards the marginal g |
| Starting Page | 977 |
| Ending Page | 989 |
| Page Count | 13 |
| File Format | PDF HTM / HTML |
| DOI | 10.21608/edj.2018.76940 |
| Volume Number | 64 |
| Alternate Webpage(s) | https://edj.journals.ekb.eg/article_76940_d41d8cd98f00b204e9800998ecf8427e.pdf |
| Alternate Webpage(s) | https://doi.org/10.21608/edj.2018.76940 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
