Clinical efficiency of prefabricated zirconia crowns in primary dentition: A systematic review and meta-analysis

Research Question: This systematic review evaluated the clinical efficiency of prefabricated zirconia crowns (PZCs) compared with stainless steel crowns (SSCs) in primary molars, focusing on crown retention, gingival health, plaque accumulation, antagonist wear, and parental satisfaction. Research Protocol: The review followed PRISMA 2020 guidelines and was registered in PROSPERO 2025 CRD420251016795. Literature Search: Electronic searches were conducted in PubMed, Cochrane Library, ProQuest, Google Scholar, and K-Hub for randomized controlled trials (RCTs) published between 2018 and 2024, with additional manual reference screening. Data Extraction: Two reviewers independently screened and extracted study data on participants, interventions, comparators, outcomes, and follow-up. Discrepancies were resolved by consensus. Quality Appraisal: Risk of bias in RCTs was assessed using the Cochrane RoB 2 tool. Data Analysis and Results: Seven RCTs ( n = 700 crowns) were included; three contributed to the meta-analysis. Both crown types showed high retention with no significant difference (odds ratio = 0.96; 95% confidence interval: 0.40–2.32; P = 0.93). PZCs exhibited better gingival health and reduced plaque accumulation. Some evidence suggested increased antagonist wear with PZCs due to greater material hardness. Parental satisfaction strongly favoured PZCs, reflecting superior esthetics despite higher cost and technique sensitivity. Interpretations of Results: PZCs demonstrate comparable retention and durability to SSCs while offering esthetic and gingival advantages. They represent a reliable alternative for restoring primary molars when esthetics and caregiver preference are prioritized, though cost and antagonist wear should inform treatment decisions.