Effectiveness of zirconia crowns compared with stainless steel crowns in primary posterior teeth rehabilitation: A systematic review and meta-analysis

Background. The authors' aim was to evaluate the clinical and radiographic effectiveness of zirconia crowns (ZCs) compared with stainless steel crowns (SSCs) in the rehabilitation of primary posterior teeth. Types of Studies Reviewed. Using predefined combinations of different search terms, the authors searched the standard electronic bibliographic databases-MEDLINE, Embase, Google Scholar, The Cochrane Library, The Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature-and the Trip medical database for randomized controlled trials in which the investigators evaluated the clinical and radiographic effectiveness of ZCs and SSCs. Version 2 of the Cochrane risk of bias tool for randomized trials was used for quality appraisal of the included clinical trials. Random-effects model and Mantel-Haenszel test were used for the statistical analysis of estimated effect sizes. The overall quality of evidence was assessed using GRADEpro GDT software (McMaster University and Evidence Prime). Results. A total of 6 studies were included from the initial 641 results. The overall risk of bias had "low" concerns in 3 studies and "some" concerns in the remaining 3 studies. From the pooled data of the meta-analysis, the authors observed 63 clinical failure events in 497 primary teeth rehabilitated with ZCs or SSCs. Rehabilitation of primary teeth with ZCs may result in fewer clinical failures (risk ratio, 0.48; 95% CI, 0.15 to 1.52; P = .21; I-2 = 62%) and probably better gingival health (mean difference, -0.32; 95% CI, -0.42 to -0.23; P < .001; I-2 = 0%) than SSCs. Conclusions and Practical Implications. Primary posterior teeth rehabilitated with ZCs may have less risk of experiencing clinical failure and probably better gingival health after 12 months than SSCs. Considering the quality of available literature, no recommendations could be made regarding the effectiveness of ZCs compared with that of SSCs in the rehabilitation of primary posterior teeth. Pediatric dentists should select ZCs or SSCs according to the clinical situation for successful primary teeth rehabilitation.