Reasons for Crown Failures in Primary Teeth: A Systematic Review and Meta-Analysis (Preprint)

Abstract

BACKGROUND There is a tendency nowadays to restore large defects in primary dentition with pediatric crowns instead of conventional restorations. Thus, understanding the factors contributing to the survival or failure of dental crowns in pediatric dentistry is essential for optimizing treatment outcomes. OBJECTIVE This systematic review aims to descriptively analyze the crown-retention rates, complications of crown retention along with the biological and technical complications of pediatric crowns for primary teeth. The meta-analysis reported herein was performed to estimate long-term (3-year and 5-year) retention rates of these pediatric crowns fabricated using various materials. METHODS Using the PICOS paradigm, a systematic search was carried out in the PubMed and Cochrane databases to identify randomized controlled trials (RCTs) and clinical (prospective and retrospective) studies reporting retention rates, complications of crown retention, biological and technical complications. After selecting studies with a predefined set of selection criteria, data from included studies were used for a systematic review aimed at a descriptive analysis of factors associated with failure of crowns for primary tooth. Data from the included RCTs were used for meta-analysis, wherein 3-year and 5-year crown retention rates were estimated using Poisson regression models. RESULTS The systematic review analyzed data from 13 RCTs and 5 clinical studies, with a median follow-up of 12 months (IQR: 9 months) and 20.8 months (IQR: 5 months). In total, 454 children (1172 crowns) and 810 children (2667 crowns) were included. Retention rates of crowns fabricated using compomer, composite resins, and stainless steel ranged from 77.8% to 100%, 80.6% to 100%, and 92.31% to 100%, respectively. Retention rates of strip crowns and zirconia ranged from 78% to 100% and 86.36% to 100%. Estimated 3-year and 5-year retention rates, according to Poisson regression, revealed clinically acceptable rates for compomer (71.65% to 100% and 57.38% to 100%), composite resin (82.40% to 100% and 72.43% to 100%), stainless steel (75.65% to 100% and 62.81% to 100%), strip crowns (28.48% to 100% and 12.33% to 100%), and zirconia (44.12% to 100% and 25.57% to 100%). Common biological complications were secondary caries and gingival inflammation, while frequent technical complications included issues with marginal adaptation, shade mismatch, and wear on the opposing tooth. CONCLUSIONS While retentive complications such as chipping, material loss and fractures do occur across materials, crowns fabricated with compomer, composite resin, stainless steel, strip crowns and zirconia all have clinically acceptable retention rates. However, differences noted between materials for biological and technical complications may offer insights for selecting materials for pediatric crowns based on clinical considerations. CLINICALTRIAL PROSPERO CRD42023442266; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=442266 INTERNATIONAL REGISTERED REPORT RR2-10.2196/51505