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Introduction Zirconia is a widely used restorative material in dentistry due to its superior aesthetic and mechanical properties. The oral cavity is a complex ecosystem with various components, which affect the teeth, as well as artificial restorative materials. Various personal and professional interventions carried out can severely affect the properties of restorative materials, thus altering the longevity of the prosthesis; 1.23% acidulated phosphate fluoride (APF) gel is one such professionally applied topical fluoride agent used to prevent caries. The interaction of this APF gel with highly aesthetic restorative material such as zirconia crowns is unknown. Objective The objective of this study is the evaluation of the surface deterioration of prefabricated zirconia crowns on exposure to deionised water and 1.23% acidulated phosphate fluoride (APF) gel with field emission scanning electron microscope (FE-SEM) and mass loss analysis. Material and method Sixty prefabricated paediatric zirconia crowns were taken, 10 samples were immersed in deionised water, 40 samples were immersed in 1.23% APF gel and 10 samples were used as control. Surface morphology and mass loss analysis were carried out at time intervals of four minutes, 24 hours, 48 hours and 72 hours using FE-SEM and digital weighing machine. Results No visual change was observed in the samples immersed in deionised water at the time interval of 72 hours. There was a marked visual change in samples immersed in 1.23% APF gel at the time interval of four minutes to 72 hours; this change involved a loss of gloss to the appearance of chalkiness. FE-SEM analysis for the control group and samples immersed in deionised water showed a smooth, continuous, undisrupted top layer, while samples immersed in 1.23% APF gel showed changes ranging from surface etching, to pinhole porosities, to crack formation and disruption of the surface depending upon the exposure time. Conclusions On the immersion of zirconia crowns in an aqueous acidic medium of 1.23% APF gel, the crowns showed flaws, imperfections and uneven superficial layers. It has been observed that surface grains are disrupted and micropores have been formed. This degraded superficial surface when undergoes cyclic mechanical loading can accelerate the ageing phenomenon of zirconia. Mechanical forces along with a dynamic electrochemical environment can degrade the material properties of zirconia.

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Retentive strength data are critical to predicting the long-term clinical performance of zirconia crowns for primary teeth. Objectives: This research assessed the clinical outcome of prefabricated zirconia crowns (PZCs) cemented with either self-adhesive resin cement or pure glass ionomer cement in the primary teeth of children. Method: In the present research, a sample of 162 prefabricated zirconia crowns were collected through convenience sampling. A follow-up examination was conducted at 12 and 24 months to assess the clinical outcomes of PZCs post cementation. Results: Zirconia crowns cemented with self-adhesive resin showed high clinical outcomes at both 12 and 24 months, with 95.1% of crowns retained. In contrast, crowns cemented with glass ionomer cement had slightly lower clinical outcomes, with 91.4% retained at 12 months and 84.0% retained at 24 months, indicating a significant difference (p-value). Long-term follow-up is crucial for the optimal maintenance of crown stability. Conclusions: Self-adhesive resin cement is a viable option for cementing PZCs in pediatric dentistry, demonstrating satisfactory clinical performance over both 12 and 24 months. Future studies comparing different types of cement are recommended for further validation of these results.

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PURPOSE: This study aimed to evaluate the effects of two surface treatments on the tensile bond strength of prefabricated zirconia crowns (PZCs) using bioactive and resin cements. METHODS: Forty extracted human primary maxillary incisors were prepared and divided into four groups based on surface treatment and cement type: (1) sandblast with bioactive cement, (2) sandblast with resin cement, (3) 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) with bioactive cement, and (4) 10-MDP with resin cement. After 24 h of cementation, specimens underwent 5000 thermocycling cycles between 5 °C and 55 °C. Tensile bond strengths were measured using a universal testing machine. The data were analyzed using two-way ANOVA and Tukey's post hoc test, with significance set at p < 0.05. RESULTS: The mean tensile bond strengths observed were 2.25 ± 1.27 MPa for sandblast with bioactive cement, 1.39 ± 0.95 MPa for sandblast with resin cement, 2.45 ± 1.15 MPa for 10-MDP with bioactive cement, and 1.68 ± 1.03 MPa for 10-MDP with resin cement. Significant improvements in bond strength were observed in the bioactive cement group treated with 10-MDP compared to those treated with sandblasting (p < 0.05). The 10-MDP treatment did not enhance bond strength for the resin cement compared to sandblasting. CONCLUSIONS: Bioactive cement generally provides a higher tensile bond strength than resin cement. While 10-MDP treatment enhances bond strength when used with bioactive cement, it does not show a similar enhancement when used with resin cement compared to sandblasting, indicating its effectiveness is selective based on the type of cement used.

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PURPOSE: There is limited evidence regarding the most appropriate type of luting cement for paediatric prefabricated zirconia crowns (PZCs) in primary maxillary incisors. The retention of PZCs is dependent on the bond strength of luting cement between PZCs and primary maxillary incisors. The aim of this study was to evaluate the tensile bond strengths between PZCs and primary maxillary incisors with different types of luting cements. METHODS: Thirty freshly extracted human primary maxillary incisors were prepared and randomly divided into three groups corresponding to three luting cements: bioactive cement, resin cement, and resin-modified glass ionomer cement (RMGIC), and then restored with PZCs. Tensile bond strengths were evaluated by a universal testing machine. The results were analysed using one-way ANOVA with Tukey's post-hoc test (p < 0.05). RESULTS: The means of the tensile bond strengths were 1.43 ± 0.85 MPa, 0.91 ± 0.63 MPa, and 0.56 ± 0.39 MPa for the bioactive cement, resin cement, and RMGIC groups, respectively. A significant difference in tensile bond strength was observed between the bioactive cement and the RMGIC group (p < 0.05) but there was no significant difference in tensile bond strength between the resin cement group and the others. CONCLUSION: Types of luting cement influenced the tensile bond strength between PZCs and primary maxillary incisors. The bioactive cement showed higher tensile bond strength than the resin cement and RMGIC.

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Despite the recent growing evidence in support of prefabricated zirconia crown use as a successful option in managing grossly carious anterior and posterior primary teeth, the use of such crowns remains controversial within the paediatric dental profession. This study aims to assess the use of aesthetic full coverage paediatric restorations among paediatric dentists worldwide, with emphasis on aesthetic prefabricated zirconia crowns. This was an online cross-sectional survey questionnaire study comprising of 38 multiple-choice questions disseminated worldwide through the contact lists of national, regional and international paediatric dental organisations and social media platforms. The survey was completed by 556 respondents thus achieving power, with 391 (70.3%) females and 165 (29.7%) males. The respondents were from 55 different countries spread across six continents. The use of aesthetic full coverage restorations was reported by 80% (n = 444) of the respondents. For restoring anterior teeth, participants mainly used either composite strip crowns (94.4%, n = 419) or zirconia crowns (73.6%, n = 327), while those who used aesthetic crowns for restoring posterior teeth mainly used zirconia crowns (68.2%, n = 303). Within the limitations of this study, the results have shown a wide use of full coverage aesthetic restorations, including the use of zirconia crowns, of primary teeth within this international sample of practicing dentists.

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BACKGROUND: Preformed metal crowns (PMCs) have been the restoration of choice for paediatric dentistry; however, PMCs have a non-aesthetic appearance, which has become a point of concern. Recently, prefabricated zirconia crowns (PZCs) have been increasingly used as an aesthetic restorative material for primary teeth, as they have pleasing properties. AIM: This systematic review summarises the clinical results for PZCs in the primary dentition, including wear on the opposing dentition, retention, fracture resistance, parental satisfaction, gingival health, and cementation materials. MATERIALS AND METHODS: Electronic database searches were conducted using PubMed, Google Scholar, Web of Science, and the Cochrane Library. Clinical trials, observational studies, and case reports/series were included. The quality of the studies was analysed using the Cochrane tool and the domain-based evaluation for non-randomised studies of interventions. RESULTS: The search retrieved 166 references, of which 14 studies were included for qualitative analyses. The risk of bias varied from low to unclear. The included studies indicated that prefabricated zirconia crowns are retentive and are not associated with accelerated wear on the opposing dentition. They also exhibit a high fracture resistance, satisfy the parents and are compatible with gingival health. There is, however, inconclusive evidence with regard to cementation materials. CONCLUSION: Prefabricated Zirconia Crowns appear to be a good alternative to preformed metal crowns in term of esthetics, retention, resistance to fracture, parent satisfaction, and gingival health.

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