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REVIEW ARTICLE
Year : 2023 | Volume
: 50
| Issue : 1 | Page : 28-38
Longevity of stainless steel crowns on primary molars - A systematic review and meta-analysis
Riddhi S Joshi1, Niraj S Gokhale1, Shivayogi M Hugar1, Sanjana Soneta2, Chandrashekhar Maruti Badakar2, Nivedita Saxena1
1 Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
2 Department of Pediatric and Preventive Dentistry, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
Correspondence Address:
Niraj S Gokhale
Department of Pediatric and Preventive Dentistry, Kaher's KLE VK Institute of Dental Sciences, Belagavi, Karnataka
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jss.jss_164_22
Background: Restoration of caries having multisurface involvement in primary teeth is a challenge to dentists. The success of the restoration often depends on its longevity. Hence, it is important to systematically review the longevity of stainless steel crowns (SSCs) on primary molars. Objectives: To determine the longevity of SSC and to determine the reasons of failure for the same. Data Sources: A systematic search was conducted in three databases: PubMed, Embase, and Google Scholar for the studies published from January 1, 2009 to September 25, 2019. Cross references of the selected articles were also searched and hand searching was done for the studies whose full texts were not available through the electronic search. Gray literature was also searched for the studies according to the relevance of this review. Study Eligibility: Studies were included if they were published between January 1, 2009 and September 25, 2019, which included comparative assessment of SSCs and other multisurface restorations in primary teeth. The study setting should be clinical based. The study designs included in the review were prospective, retrospective, and randomized control clinical trials. Studies written in the English language and studies written in any other language but are possible to get translated into English were included. Reviews, letters to the editor, and short communications were not included in the review. Studies conducted in permanent dentition were not included. For meta-analysis, randomized control trials and retrospective studies were included. Results: 1398 records were identified through data search using search strategy in PubMed, Google Scholar, and through Gray literature. After further exclusion, the total number of articles came out to be 41. Finally, six articles were included in the systematic review. These articles were also subjected to meta-analysis. The pooled success rate for SSC over 12 months was shown to be 96.096%. This was seen to be significantly higher. Conclusion: SSCs showed good longevity than the other restorative materials on primary molars.
Keywords: Longetivity, primary teeth, stainless steel crowns
The global burden of dental caries has increased substantially.[1] In developing and underdeveloped countries, dental treatment is neglected based on the expense of the treatment. Dental caries not only causes reduced oral health-related quality of life in children but also causes systemic complications if not timely treated.[2] The percentage of untreated dental caries in India is 32% of the total population.[3] The most commonly affected teeth in children are primary molar teeth. Untreated dental caries have an adverse effect on the growth and development of children.[4] Teeth undergo a continual process of demineralization due to acids and enzymes produced by cariogenic bacteria and remineralization due to fluoride components and saliva. Dental caries occurs when the rate of demineralization is greater than that of remineralization.[5] If a carious lesion is located, restoration is typically considered necessary. Hence, Pediatric Restorative Dentistry is gaining importance due to increased worldwide prevalence of dental caries in children. Factors taken into consideration by the clinicians for restoring carious teeth include caries risk assessment, durability, ease of placement, developmental status of the dentition, cost-effectiveness, and extent of co-operation.[6]
Multi-surface restorations have however presents a challenge to the dental community. In treating multi-surface caries, the incidence of failures in restorations is seen to be large. Many materials have been used including amalgam, composites, glass ionomer cements, compomers, resin modified glass ionomers, and stainless steel crowns (SSCs).[7] Clinical decision to use or not to use a material has a close relation to durability of the restoration in case of multisurface involvement.[8],[9],[10],[11],[12]
Re-establishing the form of primary molar teeth with a filling material can be challenging, especially with multi-surface cavities.[13],[14] The enhanced occlusal loading that multi-surface fillings experience, often leads to early restoration failure. As there is a persistent flow of novel adhesive materials in the market, it is essential to test the comparative durability of conventional SSCs for the betterment of the pediatric dental patients in longer run.[15] The most advantageous restoration in child would be the one which would be less painful, less time consuming and most importantly durable until the exfoliation.[16],[17],[18]
Hence, the aim of this systematic review to compare the durability of conventional SSCs to other materials used in multi-surface restorations in primary molars. There is the lack of scientific evidence regarding the best method of restoring primary teeth. This review will help the clinicians gain perspective regarding the use of SSCs in primary molars of pediatric patients. This review sheds a light on the longevity of other restorative materials when compared to SSCs in multi-surface restorations.
Focused question
Are SSCs reliable in terms of longevity in multi-surface restorations of primary molar teeth in children?
Objectives
To determine the comparative longevity of SSCs as multisurface restoration modalityTo determine the reasons of failure for SSCs as multisurface restoration modality. MethodsProtocol and registration
The review has been registered in Prospero; International prospective register of systematic reviews funded by National Institute of Health Research and produced by centre for reviews and dissemination (CRD) an academic department of the University of York. It is an international database for registration of systematic review containing detailed protocol of the review that can be accessed by all and helps to avoid duplication of the review. The registration number of this review is CRD189213 and can be accessed on the website http://www.crd.york.ac.uk/prospero/index.php.
Eligibility criteria
Inclusion and exclusion criteria were fixed and the studies were screened based on the criteria mentioned below.
Inclusion criteria
Study setting should be clinical basedStudy design maybe prospective, retrospective, and randomized control clinical trialsStudy population should be childrenStudies involving deciduous teethStudy published between January 1, 2009 and September 25, 2019Studies written in the English language and studies written in any other language but are possible to get translated into English.Exclusion criteria
Review articles and other systematic reviews were excludedLetter to editor and short communication were excludedStudies involving permanent teethStudies involving single surface restorations were excludedStudies recording comparison between materials other than SSC were excludedSurveys conducted before the year 2009 and after September 25, 2019 were excludedStudies done in adults were excludedStudies in language other than English were excluded.PICO guidelines
Wherein POS from PICO can be referred as:
P (Population) – Children; Deciduous teeth(Outcome) – Longevity of the restorationS (Study design) – Experimental studies, prospective, and retrospectiveP (Population) – Children; Deciduous teethI (Intervention) – SSCC (Comparison) – Multi-surface restorations(Outcome) – Longevity of the restorationInformation sources
Literature search strategy was developed using the keywords related to SSCs and multi-surface restorative materials such as composite, glass ionomer cement, and amalgam. Data were searched through the database, PubMed, Embase, and Google Scholar from January 1, 2009 to September 25, 2019. Cross references were checked for relevant articles, gray literature was also searched. Hand searching of articles was done when the full texts of the relevant studies were not available through electronic database.
Search
The comprehensive data search was performed in PubMed, Embase, and Google Scholar. While carrying out the search through PubMed the filters were put for the dates of publication as January 1, 2009–September 25, 2019. No language restrictions were put though studies included were in English language but studies reported in other language were also selected and then subjected to Google translation to obtain the data in the English language. Studies were excluded through the language only if the data cannot be translated in English. Filters for the study design were clinical-based studies which maybe prospective or retrospective. The keywords for search were decided by reviewing the literature. The search strategy used in PubMed for searching articles was:
Pediatric dentistry and SSCs and restorative material (name of the restorative material for multi-surface restorations)Example: Pediatric dentistry AND SSCs AND RMGIC.Google search was carried out using the MeSH terms including various materials used for multi-surface restorations. Pubmed, Embase, and Google Scholar yielded a total of 1,398 articles which were found to be relevant according to the eligibility criteria. Further review found 41 articles relevant. After further exclusion, a total of 6 articles were found to be relevant for the systematic review.
Study selection
One review reviewer (RJ) independently screened the titles and abstracts obtained by search strategy and included them if they met the inclusion criteria. Later full texts of all the included studies were obtained. After obtaining the full texts of the articles, they were screened by reading the whole article and then decided if they met the inclusion criteria. Whenever there was uncertainty regarding any study to be eligible for inclusion, the problem was resolved by discussing it with the second reviewer (NG). For inclusion of articles for meta-analysis, the quality assessment of each article was done by one reviewer (RJ) independently and later it was crosschecked by other reviewer (NG). Finally, the search yielded 6 studies to be included in both systematic review and meta-analysis. All the excluded studies were recorded with reason for exclusion for each study. None of the reviewers were blinded to the journal titles, study authors or the institutions where the studies were conducted.
Data collection process
A standardized data extraction form was prepared in Microsoft Excel with the help of an expert. Initially 3–4 entries were made in the Excel and it was reviewed by an expert. Any disagreement between the reviewers was resolved by discussion. The following criteria were predetermined for extracting the data:
The major interest was to obtain the success rates of SSCs multi-surface restoration for the pediatric population.Data synthesis
To decide whether to use random effect model of fixed effect model, heterogeneity of the studies was analyzed. Statistical heterogeneity was tested using I2 statistics (0%–40% not important, 30%–60%: representing moderate heterogeneity, 50%–90%: representing substantial heterogeneity, 75%–100% as considerable heterogeneity) as described by the PRISMA protocol for writing the systematic review. If the heterogeneity was above 50%, then random effect model was used for conducting meta-analysis. The weight for each study, and estimates prevalence with upper and lower confidence intervals was obtained. Statistical software STATA was used to do meta-analysis.
Results1398 records were identified through data search using the search strategy in PubMed, Google Scholar, and through gray literature. The second step was screening through the titles. After screening through titles, 1,357 articles were excluded because they were not related to the objectives of the systematic review. Some articles mentioned study done on adult patients, some mentioned inclusion of other variables, some included other types of crowns, in some studies, single surface restorations were compared whereas some were related to the luting cements used. After this, the total number of articles came out to be 41 (19 from Google Scholar and 22 from PubMed). The shortlisted 41 articles which remained where screened for duplicates through Endnote Software Version X7 (Windows, USA). Out of 41, 11 articles were found to be duplicates and thus remaining 30 articles were screened through abstracts as the next step. Through abstract screening, 15 articles were excluded as they did not meet the eligibility criteria. Finally, 15 articles were screened for full text. Out of 15 articles, nine were excluded reason being; two of them were review, age group was not appropriate in one article, two articles were in Chinese language and could not be translated, two articles were in vitro analysis, two of them were not comparing SSC with multi-surface restorations and one study was an in vitro study comparing hall technique versus conventional technique [Figure 1].
After qualitative synthesis, all 6 articles were included for meta-analysis.
Risk of bias within individual studies
Risk of bias within each study is mentioned in the form of a [Table 1] and the studies are categorized into high, medium and low quality studies. Most trials were at low risk of bias in the five domains that we assessed. A summary of the judgments of the risk of bias for each domain in each of the included trials [Figure 2]a and [Figure 2]b. In this, only randomized clinical trials were included.
Figure 2: (a) Individual Risk Bias among Individual selected studies. (b) Funnel plot showing overall Risk Bias among selected studiesRandom sequence generation
This describes the method used to generate the allocation sequence in sufficient detail to allow an assessment of whether it should produce comparable groups. It mainly questions if appropriate randomization techniques have been followed. In the study conducted by Santamaria et al., children were randomized using a computer random number-list generator with allocation concealment to one of 3 arms. Thus, a low risk of selection bias is seen. In the study conducted by Cantekin and Gumus, the primary molars were randomized into three groups. Hence, in this study too, a low risk of selection bias is seen. The material to be used as chosen by tossing a coin in the study conducted by Sonmez and Duruturk as well as in the study conducted by Hutcheson et al. This gave both the studies a low risk of selection bias.
Allocation concealment
The method used to conceal the allocation sequence in detail to determine whether intervention allocations could have been foreseen in advance of, or during, enrolment is assessed. In the study conducted by Santamaria et al., it has been mentioned that allocation concealment was done. Low risk of allocation bias is indicated in this study. In the studies by Cantekin and Gumus and Sonmez and Duruturk, allocation concealment has not been mentioned and thus has been categorized as unclear. The article by Hutcheson et al. has not done allocation concealment and hence is at a high risk of allocation bias.
Blinding of participants, personnel, and outcome assessors
This describes all measures used, if any, to blind study participants and personnel from knowledge of which intervention a participant received. Dentists did not assess their own patients (blinded) in the study conducted by Santamaria et al., giving it a low risk of performance bias. In the article by Cantekin and Gumus, it has been mentioned that all pre and postoperative digital radiographs were taken by two examiners who were blind to the group being studied. Thus, this gives the study a low risk of bias. Two examiners were blinded in the study conducted by Hutcheson et al. and in the study conducted by Sonmez and Duruturk. Hence, there is the low chance of performance bias in these researches
Outcome assessments
This describes the completeness of outcome data for each main outcome, including attrition and exclusions from the analysis. In the study conducted by Santamaria et al. mentions that after 11 months, 148 out of 169 (87.6%) of participants returned for a follow-up. The outcome assessment has been systematically exhibited in the article. In the study conducted by Sonmez and Duruturk, it has been mentioned that at the end of 12 months, 70.7% primary first molars and 70.9% primary second molars were judged successfully. In the study conducted by Cantekin and Gumus, 2 participants did not turn up for a follow-up. Out of 40 patients, 37 were available for 6 month recall in the study conducted by Hutcheson et al. Hence, in all the studies assessed for risk bias, a low attrition bias is found.
Selective outcome reporting
This domain assesses whether authors have conducted suggestion of only selective outcome reporting. In all the studies analyzed for reporting bias, the authors have reported all the findings in an appropriate manner. This makes all the studies assessed the low risk of selection bias.
Risk of bias for nonrandomized studies
The risk of bias for nonrandomized studies has been done using modified Newcastle Ottawa Quality assessment form [Table 2].
Good quality: 3 or 4 stars in selection domain AND 1 or 2 stars in comparability domain AND 2 or 3 stars in outcome/exposure domainFair quality: 2 stars in selection domain AND 1 or 2 stars in comparability domain AND 2 or 3 stars in outcome/exposure domainPoor quality: 0 or 1 star in selection domain OR 0 stars in comparability domain OR 0 or 1 stars in outcome/exposure domain. Results of MetaanalysisMeta-analysis showed a pooled success rate of SSCs with 95% confidence interval was seen to be 96.096%. (I2 = 89.9%; P = 0.000) [Figure 3].
Summary of evidence
There have been numerous studies conducted throughout the world to determine the success rates of individual restorative material for multi-surface restorations.[3],[19],[20],[21],[22] Although evidence is not scanty as to the effectiveness of SSCs in multi-surface restorations, there is a need for an updated comparative evaluation with respect to other commonly used restorative materials. This systematic review was commenced with the aim of obtaining evidence from the year 2009 to 2019 for the best choice of restoration for multiple surface restorative procedures in terms of longevity. A total of 6 studies were chosen for analysis of the longevity of SSC against other multi-surface restorative materials. The results of which have been discussed below.
The most commonly conducted procedure in pediatric dental practice is restorations. These procedures include a variety of materials ranging from glass ionomer cements to composites and SSCs. Multi-surface restorations present somewhat of a challenge to the dental community. The success rate in terms of longevity is important for making evidence-based clinical decision as to which restorative technique to use in multi-surface restorations. From six studies included in this systematic review, evaluating 1378 children, and 1418 restorations, a mean success rate of 96% was found for primary teeth restored with SSCs.
Meta-analysis showed a pooled success rate of SSCs with 95% confidence interval was seen to be 96.096% (I2 = 89.9%; P = 0.000) [Figure 4].
Rubber dam isolation
It is important that rubber dam be used in any restoration. A Cochrane review has found out that the use of rubber dam can result in decrease in restoration failure as compared to cotton roll isolation.[23] In the studies included, in two of the study, cotton roll isolation along with high speed suction was done.[24],[25] One retrospective study which included patients who were treated under general anesthesia mentioned having used rubber dam isolation for the patients whose records were checked.[8] In the study conducted by Cantekin and Gumus and Hutcheson et al., rubber dam isolation was used, whereas one retrospective study did not mention regarding isolation.[26],[27],[28]
Clinical evaluation criteria
In most of the randomized clinical studies, clinical as well as radiographic criteria were used to assess the success rates. In the study conducted by Cantekin and Gumus, the clinical criteria involved assessing the tooth for history of pain, tenderness to percussion, gingival abscess, sinus/fistula and pathological mobility.[26] In another study conducted by Hutcheson et al., teeth were clinically evaluated for appearance of gingival tissue, presence or absence of parulis, quality of contact condition of the margins, colour of the experimental tooth, condition of tooth, and clinical symptoms or pain.[27]
In the study by Santamaria et al. comparing nonrestorative caries treatment, Hall technique, and conventional composite restoration, the authors proposed their own outcome criteria. The outcome assessment of SSC was done on the basis of primary and secondary outcomes. Primary outcome where the treatment was deemed successful, was where crown appeared satisfactory, there were no clinical signs or symptoms of pulpal pathology or tooth exfoliated without minor or major failure. Minor failure was when new carious lesion, crown perforation, minor loss of restoration, and/or signs of reversible pulpitis was appreciated. The major failures included irreversible pulpitis, dental abscess, crown loss where tooth was grossly decayed. The secondary outcome also measured the plaque index and gingival index.[25],[29]
In the retrospective study conducted to review the outcomes of dental treatment in special health care need patients, the criteria for the evaluation of failures in different restorations included assessment of dislodgement, secondary caries, poorly adapted, complete loss, apical radiolucency, pain, loosening, and tooth extracted/mobility due to pathology.[8] In the other retrospective study included in the review, the authors have judged the success rate based on the longevity of the restoration.[28]
Radiographic criteria
In the study conducted by Cantekin and Gumus and Hutcheson et al., the authors used the Zurn and Seale criteria evaluating the radiographic success.[26],[30] The teeth were considered successful when there was no abnormal root resorption, furcation involvement or periapical bone destruction.
Follow-up and success rates
In our systematic review, the primary objective was to assess the comparative longevity of the SSCs with other multi-surface restorative materials.
Follow-up <6 months
Out of the 6 studies identified, one study conducted a follow-up at 6 months, wherein 54 out of 60 teeth treated were available for assessment. Through this, they concluded that at 6 months posttreatment, bulk-fill flowable resin-based composite restoration and SSC restoration achieved the same success rate of 94.4%. On the other hand, resin-based composite restoration achieved a success rate of 88.8% after 6 months. Hence, at 6-month follow-up of the multi-surface restoration, the authors concluded that bulk-fill flowable resin-based composite and SSC were more effective as compared to resin-based composite restoration.[26]
Another study which conducted a comparative analysis of multi-surface restoration with SSC and composite restoration corroborated with these findings.[27] At 6-month follow-up, out of 40 patients treated, 37 patients could be assessed for restoration. The mean age of the patients was 5.1 years. This analysis found a higher success rate of SSC (97%) as compared to composite restoration (81%). Hence, according to these studies, comparing resin-based composite restoration and SSCs, SSCs have more success at 6 months posttreatment as compared to composite restoration. Although the success rate of bulk fill resin-based composite seems to be at par with SSC at 6 months posttreatment.[26]
Follow up >6 months
Longevity of the multi-surface restoration is a very important aspect from the point of view of clinical pediatric dentistry.[31],[32] The right choice of materials may also depend largely on this factor. In one of the studies included in this systematic review, 11 months posttreatment follow-up wherein 87.6% of the participants could be assessed, teeth restored with SSCs were seen to give a higher success rate. The mean age of the participants was 6.5 years. The teeth restored with SSC showed 98% success rate as opposed to conventional composite restoration which showed only 71% success rate after 11 months.[24] A study was also conducted by Sonmez et al. comparing amalgam with SSC multi-surface restorations.[25] At the end of 12 months posttreatment, 109 teeth out of 154 teeth treated with pulpotomy followed by either amalgam or SSC restorations were available for the analysis. In the SSC group, 67 (79.9%) SSC were successful, which was higher than the success rate of amalgam restorations after 12 months (60%). This study concluded that SSC restorations had better longevity as compared to amalgam restorations.
Out of the 6 studies comparing the multi-surface restorations, a study by Catekin et al. found a higher percentage of success rate 12 months posttreatment for teeth treated with SSC (83.3%) as compared to teeth restored with bulk fill resin-based composites (72.2%) and resin-based composites (50%).[26] In the same study, 6 month posttreatment follow-up rate showed equal success rate for teeth treated with SSC as compared to teeth restored with bulk fill resin-based composites. Hence, it may be seen that SSC restorations achieved higher success rates followed by bulk fill resin-based composites and the least successful being resin-based composite restoration. This finding, incidentally also corroborated with a study conducted by Hutcheson et al. in which 31 patients out of 40 turned up for a follow-up and were evaluated for multi-surface composite and SSC restorations.[27] The success rate of SSC was found to be significantly higher (81%) as compared to multi-surface composite restorations (77%). The conclusion of this aspect of analysis is of greater success of SSCs as compared to other multi-surface restorations.
Under general anesthesia
In pediatric dentistry, treatment under general anesthesia is an important part and parcel of clinical practice. Hence, it is important to evaluate the success rates of multi-surface restorations even for patients treated under general anesthesia. In our systematic review, we have included two retrospective studies focusing on this aspect. In one of the multicenter retrospective cohort study conducted by Amin et al., participants aged <72 months undergoing various treatment procedures under general anesthesia were evaluated.[28] Follow-up of 3 years was done. Among the restorative treatments conducted using amalgam, composite resin and SSC on posterior teeth, the success rate of multi-surface amalgam restorations was found to be 100%, multi-surface composite 89.7% and SSC 97.2%. The study concluded that multi-surface amalgam restorations were more effective as compared to multi-surface composite and SSC restorations.
A similar study conducted by Mallineni et al. in special health needs patients treated under general anesthesia found the failure rate of amalgam restorations to be nil, composite restorations 19% (P < 0.001%), glass ionomer cements-20% (P < 0.05) and SSCs-3.9%.[8] This study too concluded that under general anesthesia amalgam restorations gave least failure rates followed by SSC and the least favorable being glass ionomer cement and composite restorations.
Evidence in pulpotomy cases
The success of pulpotomy is dependent on the seal achieved posttreatment.[33] Comparative evaluation of the restoration after pulpotomy treatment is necessary to make a decision regarding the choice of restoration. In this systematic review, two studies have assessed the comparative longevity of SSCs and other restorations.
In the study conducted by Cantekin and Gumus, the success rate achieved by teeth restored with SSC postpulpotomy, 94.4% were found to be successful at 6-month follow-up and 83.3% in 12-month follow-up.[26] Hutcheson et al. found that composite restorations following MTA Pulpotomy were not as durable as SSC restorations.[27] The success rate of SSC was found to be significantly higher (81%) as compared to multi-surface composite restorations (77%). The author also mentioned the change in color of the composite restorations following MTA pulpotomy.
Causes of failures
In the study conducted by Hutcheson, 2% and 6% of the teeth treated with SSC showed gingival inflammation at 6 months follow-up. Almost 100% showed intact crown margins at 6 and 12 months follow-up. Radiographically, 1% of the teeth showed internal resorption at 6 months and 12 months.[27] In another study, 5.5% failure rate was observed due to slight furcal radiolucency at 6 months follow-up. Inspite of this the authors mention overall success rate to be 100. In the same study, at a 12 month recall one tooth in the SSC group was observed to have apparent furcal radiolucency. There was no pain or infection observed in the successful teeth.[26]
In the study conducted by Santamaria et al., failure was perceived due to new caries around the crown margins after 12 months in 1 case.[24] At the end of 24 months' follow-up, 11 out of 289 SSC had failed when the patient was treated under general anesthesia. The percentage of failures was 3.8%.[8] In another retrospective study, failure was due to loss of SSC and pathological tooth mobility.[28]
In all, the reasons of failures for SSC are as follows:
Loss of SSCPathological tooth mobilityNew caries were detected around the crown marginsGingival inflammationShowed internal resorptionFurcal radiolucency.Individual comparison
Resin-based composite restoration versus stainless steel crown
Resin-based composites are now widely used in the field of dentistry. They were introduced almost 50 years ago to the field of dentistry. Composites have obvious esthetic advantages. The Bisphenol A (BPA) and its derivatives in composite produce estrogenecity which may have potential cytotoxic effects. BPA derivatives are released from dental resins through salivary enzymatic hydrolysis and may be detected in saliva up to 3 h after resin placement.[34] To avoid this problem, complete isolation is essential. Numerous factors influence the longevity of resin composites, including operator experience, restoration size, and tooth position.[35] There is strong evidence that composite restorations are successful in class 1 cavities.[36] The effect of composite in multi-surface restorations has not shown equal success rate. Although attaining complete isolation is important, which may not be necessarily attainable in pediatric patients, it has been widely used in multi-surface restorations.
In our review, 5 studies have assessed composite restorations postoperatively. In the study conducted by Cantekin and Gumus, bulk fill resin composite achieved almost comparable success rate with SSC.[26] The success rate at 6-month follow-up was found to be 94.4%.The success rate reduced at 12-month follow-up (83.3%) as compared to SSC. The reasons of failure at 12-month follow-up were evident furcal radiolucency and pathological resorption. On comparing with resin-based composite fillings, a 6-month follow-up success rate of 88.8% was achieved as compared to 94.4% with bulk fill composite restoration and SSC. The failure of the composite restoration was reported to be due to furcal radiolucency and pathological resorption. At 12 months, the success rate was seen to be 83.3%.the failure was seen mainly due to radiolucency in the furcation area.
In the study by Hutcheson, the success rate of SSC was found to be significantly higher (81%) as compared to multi-surface composite restorations (77%). The main reasons for failure for composite restoration in this experimental study were due to internal resorption and calcific metamorphosis.[27] Another study conducted by Santamaria et al. evaluated the success rate of SSC placed using Hall's technique, composite restorations, and nonrestorative caries treatment. One-year follow-up of this study showed percentage of successful SSC inserted using Hall's technique as 98%. The success rate of only 71% was achieved by composite restoration wherein minor failure in composite restoration was due to secondary caries, restoration fracture, and loss of tooth. The causes of major failures were reported to be teeth having dental abcess or reversible pulpitis requiring pulpotomy. This study concluded that when full coverage restoration with Hall's technique is compared to conventional restoration with resin-based composite, SSC has a greater durability.[24]
In the retrospective study to evaluate children whose treatment was done under GA, the failure rates of composite restorations in primary teeth were significant. (P < 0.001). Out of the composite restorations placed in molars, 19% showed failures after 24 months. They also concluded that the longevity of SSC was higher than composite restorations when treated under general anesthesia.[8] In another study, the posterior composite restoration success rate was 89.7% SSC were successful 97.2% SSC had more success.[28]
Amalgam versus stainless steel crown
Success of amalgam restorations have been compared with SSCs often. Although in the recent times preference is given to other adhesive restorative materials. The major disadvantages of amalgam restorations as given by Randall et al.(2000) were fractures, ditching and secondary caries in amalgam restorations. The systematic review also concluded the superiority of SSCs over amalgam.[7]
In our systematic review, one randomized control study aimed at comparing success of calcium hydroxide pulpotomy in primary molars restored with amalgam and SSC found that the percentage of restoration failure was 14.3% in amalgam restorations and 2.4% in SSC restoration.[25] The study thus concluded that success rate of SSC had more success as compared to multi-surface amalgam restoration.
In contrast to this finding, in a retrospective study in patients treated under general anesthesia, the success rate of amalgam restorations in these patients during follow-up was found to be 100% as opposed to 97.2% success rate of SSC. In this study, they concluded that under GA, amalgam restorations have a higher durability.[28]
Glass ionomer cement versus stainless steel crown
Fluoride released from GIC materials may prevent caries, as GIC can reduce the demineralization of adjacent surfaces.[37],[38] Although this is true, there is no strong clinical evidence showing that fluoride-releasing materials prevent the occurrence of secondary caries.[39] Secondary caries seem to be the main reason for failures for glass ionomer materials, suggesting that the release of fluoride by GIC did not influence the longevity of restorations.[40] One of the retrospective studies included in the review assessed the durability of GIC restorations. The study found out that GIC restoration in primary molar teeth treated under general anesthesia had 20% failure rate as compared to SSC which had only 3.9% failure rate. Hence, the study concluded that SSC had better durability over multi-surface GIC restoration.
ConclusionThis systematic review done to assess the durability of SSCs shows that SSC is superior to other multi-surface restorations in primary molars. Meta-analysis of the data too shows significant success of SSC over other multi-surface restorations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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