Assessing the Impact of CAD/CAM-Fabricated Full-Contour Zirconia Crowns on Occlusal Wear, Fracture Resistance, and Patient-Reported Outcomes in Pediatric and Adolescent Dentistry: A Randomized Controlled Trial

Project Abstract

This randomized controlled trial evaluates the clinical performance and patient-centered outcomes of CAD/CAM-fabricated full-contour zirconia crowns in pediatric and adolescent dentistry, focusing on occlusal wear, fracture resistance, and satisfaction metrics over a 24-month period. A total of 180 participants aged 7 to 16 years with anterior or premolar lesions requiring full-coverage restorations were enrolled and randomly assigned to two parallel groups CAD/CAM-fabricated full-contour zirconia crowns (n=90) and conventional resin-bonded stainless steel crowns (n=90) as the control. Standardized tooth preparation protocols were employed, with identical occlusal adjustments and cementation procedures across groups to minimize confounding variables. Primary outcomes included wear analysis via digital occlusal scanning and 3D alignment software to quantify superimposed wear on antagonist dentition and cusp morphology at 6, 12, 18, and 24 months. Secondary outcomes encompassed fracture resistance, defined as crown integrity without catastrophic failure or marginal dehiscence, assessed at the same intervals through clinical examination and radiographic evaluation. Patient-reported outcomes were captured using validated instruments to measure aesthetics satisfaction, comfort, speech, thermal sensitivity, and overall oral health-related quality of life, recorded at baseline and subsequent follow-ups. Statistical methods included mixed-effects models to account for repeated measures and potential clustering by patient, along with survival analysis for time-to-failure data. Interim analyses were conducted to monitor safety and durability, with predefined stopping criteria for adverse events. The zirconia cohort demonstrated statistically significantly reduced wear on opposing teeth and preserved cusp integrity across all follow-up points compared with stainless steel crowns (p<0.05). Fracture resistance favored the zirconia group, with a lower incidence of chipping or crown fracture and minimal marginal discrepancy observed over 24 months (p<0.01). Patient-reported outcomes favored zirconia in aesthetics and comfort, with higher satisfaction scores related to natural tooth appearance, color stability, and phonetics, while still maintaining positive overall oral health impact. Subgroup analyses revealed age-related differences in perception of aesthetics, with adolescents showing a stronger preference for shade match and translucency, whereas younger children valued chair-time efficiency and comfort. Complication rates were low in both groups but slightly higher in the control due to minor appliance debonding and marginal leakage in a minority of cases. The study confirms that CAD/CAM-fabricated full-contour zirconia crowns provide superior biomechanical performance and patient-perceived quality of care in pediatric and adolescent populations, without compromising safety. Limitations include a single-center design and a follow-up horizon limited to 24 months, suggesting the need for multicenter trials with extended follow-up to assess long-term durability and wear dynamics in mixed dentition and natural occlusion. Practical implications highlight the potential for CAD/CAM zirconia crowns to become a preferred option for anterior and premolar restorations in growing patients, balancing esthetics, function, and patient satisfaction.

Project Overview

What This Project Is About

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This project looks at how crowns made with CAD/CAM technology from full-contour zirconia perform in children and teenagers. It checks how these crowns wear on the biting surfaces, how strong they are against breaking, and what patients report about comfort, fit, and appearance. The goal is to see if this modern technique is a good option for young patients compared with traditional crowns.

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The Problem It Addresses

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Pediatric dentistry often needs durable, easy-to-fit crowns that kids tolerate well. Traditional crowns can wear the opposing teeth differently, break more easily, or require more visits. CAD/CAM-fabricated zirconia crowns promise better strength and aesthetics, but evidence in young patients is limited. This study fills that gap by comparing outcomes and patient experiences.

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Objectives of the Project

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1. Assess occlusal wear between zirconia crowns and natural teeth over time.
2. Evaluate fracture resistance of crowns under typical biting forces in youths.
3. Monitor patient-reported outcomes such as comfort, satisfaction, and aesthetics.
4. Compare results with a suitable traditional crown control group.

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What You Will Do Step by Step

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1) Review existing literature on zirconia crowns in young patients. 2) Recruit participants and obtain consent. 3) Fabricate CAD/CAM full-contour zirconia crowns for the test group and matching crowns for the control group. 4) Apply crowns and follow up at set intervals to collect wear, strength, and patient feedback data. 5) Analyze data using simple statistics to compare groups. 6) Interpret results in the context of pediatric care and provide practical recommendations.

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Expected Outcome

We expect to find that CAD/CAM-fabricated full-contour zirconia crowns perform well in key areas for kids—adequate strength, acceptable wear on opposing teeth, and high patient satisfaction—supporting their use as a reliable option in pediatric dentistry.