Radicular Pathology in Zirconia and Stainless-Steel Crowns in Primary Posterior Teeth: A Retrospective Comparative Longitudinal Study

Background: Zirconia crowns (ZCs) are increasingly used in pediatric dentistry for their esthetic advantages, but evidence regarding their long-term outcomes compared with stainless steel crowns (SSCs) is limited. Methods: This retrospective cohort study evaluated 138 primary molars in 89 children (mean age: 5.1 ± 1.6 years) restored with ZCs (n = 69) or SSCs (n = 69). Radiographic and clinical follow-up averaged 27.7 months. Outcomes included radicular pathology, crown retention, and survival. Statistical analyses examined associations with patient age, tooth type, and pulp therapy. Results: Both groups demonstrated high overall success (87%). However, pathology developed more frequently in ZCs compared with SSCs (18% vs. 9%, p = 0.0025). Loss of retention was also higher in ZCs (16% vs. 3%, p = 0.009). No significant associations were found between pathology and patient age, tooth type, or pulp therapy. SSCs demonstrated longer survival (29.1 vs. 25.1 months, p = 0.034) and later onset of pathology (29.1 vs. 12.5 months, p = 0.003). Crowns offer an esthetic alternative for restoring primary molars but are associated with higher rates of radicular pathology and retention loss. Careful case selection, optimal isolation, and appropriate cementation are essential for clinical success. Stainless steel crowns remain the more durable option, particularly in complex clinical cases.