Restorative strategies for deciduous anterior teeth: A systematic review and meta-analysis

Abstract

Aim: Common causes of destruction in primary anterior teeth include dental caries and trauma. This systematic review evaluated the success rate of restorative techniques for these cases.

Methods: Systematic searches were conducted in Medline (PubMed), Scopus, Web of Science, Cochrane, Embase, and ProQuest until February 2024. Randomized controlled trials and non-randomized studies of interventions with ≥12 months of follow-up were included. Exclusion criteria were: studies with >30% loss to follow-up, unclear evaluation criteria, management under general anesthesia, unhealthy patients, or lacking individual success data. A meta-analysis assessed success rates, with subgroup analyses. Risk of bias was evaluated using RoB 2 and ROBINS-I, and evidence certainty was assessed using the GRADE system.

Results: Eight studies involving 852 teeth from 271 children aged 2-9 years, with follow-ups of 3-36 months, were included. The meta-analysis revealed a 71% success rate at 12 months for all techniques. Strip crowns (79%) and zirconia crowns (70%) had the highest success rates for teeth without endodontic treatment. Intracanal posts (resin or glass fiber) achieved an 83% success rate for teeth requiring endodontic treatment. Evidence certainty was low.

Discussion: Strip crowns and zirconia crowns performed well for teeth without endodontic treatment, with strip crowns offering a simpler and less technique-sensitive option. Biological restorations had poorer outcomes due to their complexity, sensitivity, and the need for a tooth biobank, raising legal and logistical challenges. Although zirconia crowns require extensive subgingival preparation, they align less with minimally invasive principles compared to strip crowns. Intracanal posts showed high success rates for teeth needing endodontic treatment, regardless of the material used.

Conclusions: Strip crowns appear to be a suitable option for restoring primary anterior teeth that do not require endodontic treatment. For teeth requiring endodontic treatment, the use of intracanal posts combined with strip crowns seems to yield satisfactory results.