Prefabricated zirconia crowns versus alternative full-coverage restorations for primary anterior teeth: a systematic review of clinical outcomes

Abstract

Abstract Background Prefabricated zirconia crowns have gained popularity as an alternative to traditional options such as composite strip crowns and pre-veneered stainless steel crowns. However, their comparative clinical effectiveness remains uncertain. This systematic review aimed to evaluate the clinical outcomes of prefabricated zirconia crowns (ZCs) for restoring primary anterior teeth compared to alternative full-coverage restorations. Methods This systematic review was conducted in alignment with PRISMA guidelines. A comprehensive search of five databases, PubMed, Cochrane Library, Embase, Scopus, and Web of Science, was performed to identify eligible randomised controlled trials (RCTs) addressing the PICO question: “How does the clinical performance of prefabricated ZCs compare to alternative full-coverage restorations in primary anterior teeth?” The Cochrane Risk of Bias 2 (RoB 2) tool was used to assess the methodological quality of the included studies. Due to the heterogeneity of studies, a narrative synthesis of the findings was carried out. Results Out of 993 records identified, seven RCTs involving 326 participants were included. ZC exhibited superior retention, with survival rates of 95–100% at 12–18 months, compared with 46–79% for composite strip crowns (CSC) and 100% for pre-veneered stainless steel crowns. Gingival health was significantly better with ZC. Bleeding scores ranged from 0 to 40% in ZC vs. 20–67% in CSC, and plaque-free surfaces were reported in 80–100% of ZC vs. 40–80% of CSC. Aesthetic outcomes favoured ZC, with colour match 98–100% vs. 44–70% for CSC. Parental satisfaction was highest for ZC, whilst secondary caries was absent in all ZC groups. RoB 2 assessment judged six studies as having “some concerns” and one as “high risk.” Conclusion Current evidence suggests that prefabricated zirconia crowns show promising clinical performance for restoring primary anterior teeth, with advantages in retention, gingival health, and aesthetics. Nonetheless, concerns regarding enamel wear and limited long-term data highlight the need for further high-quality trials.

Affiliated Institutions

• Alexandria University EG
• Arab Academy for Science, Technology, and Maritime Transport EG

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