Evaluation of zirconia crowns restoring endodontically treated posterior teeth with 2 finish line designs and 2 occlusal reduction schemes: A randomized clinical trial

Alaa El-Ashkar; Omnia Nabil; Maha Taymour; Adel El-Tannir

doi:10.1016/j.prosdent.2022.10.004

Evaluation of zirconia crowns restoring endodontically treated posterior teeth with 2 finish line designs and 2 occlusal reduction schemes: A randomized clinical trial

J Prosthet Dent. 2022 Nov 14:S0022-3913(22)00634-5. doi: 10.1016/j.prosdent.2022.10.004. Online ahead of print.

Authors

Alaa El-Ashkar¹, Omnia Nabil², Maha Taymour³, Adel El-Tannir⁴

Affiliations

¹ Lecturer, Fixed Prosthodontics Department, Faculty of Dentistry, Galala University, Suez, Egypt. Electronic address: alaas.elashkar@dentistry.cu.edu.eg.
² Lecturer, Fixed Prosthodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
³ Professor, Fixed Prosthodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt; Professor, Fixed Prosthodontics Department, School of Dentistry, New Giza University, Giza, Egypt.
⁴ Professor, Fixed Prosthodontics Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.

PMID: 36396490
DOI: 10.1016/j.prosdent.2022.10.004

Abstract

Statement of problem: Preparation design has been linked to restoration survival, and the finish line geometry, such as a deep chamfer or shoulder, has been linked to marginal integrity. However, limited data are available for restoration success with the feather-edge finish line when used with monolithic zirconia crowns with different occlusal reduction schemes.

Purpose: The purpose of this randomized clinical trial was to evaluate the clinical performance of 2 finish line designs (feather-edge and rounded shoulder) in relation to 2 occlusal designs (flat and planar) in endodontically treated teeth restored with monolithic zirconia crowns.

Material and methods: Sixty-six complete-coverage monolithic zirconia crowns were provided for posterior endodontically treated teeth. The participants were divided into 3 groups based on the preparation design: the control group (PS) had a planar occlusal scheme with a rounded shoulder finish line; the first intervention group (FF) had a flat occlusal scheme with a feather-edge finish line; and the second intervention group (FS) had a flat occlusal scheme with a rounded shoulder finish line. The crowns were designed with the exocad software program and milled with a 5-axis machine. After cementation, clinical performance in terms of marginal adaptation, marginal discoloration, fracture, and secondary caries was evaluated by using the modified United States Public Health Service (USPHS) criteria. The gingival index score system was used to evaluate the gingival response. The scores were recorded immediately after cementation and at 3 subsequent follow-up visits every 3 months for 1 year. The chi-square test was used in all comparisons of outcomes and follow-up durations (α=.05).

Results: In terms of marginal adaptations, the control group (PS) demonstrated the best marginal adaptation scores during follow-up visits, followed by intervention 2 (FS), and lastly, intervention 1 (FF), which was scored mostly with Bravo. At the third follow-up visit, the intervention 1 (FF) group reported the most gingival responses of all groups. No significant difference among the groups was found in terms of marginal discoloration, fracture, or secondary caries at any of the follow-up visits. Each group received a perfect Alfa score of 100% on all 3 follow-up assessments.

Conclusions: In this 1-year randomized clinical trial, all evaluated preparation schemes and corresponding crowns were clinically successful. The clinical performance of monolithic zirconia crowns of the novel preparation design (FF) was successful in terms of marginal adaption, fracture, secondary caries, and marginal discoloration.