Anterior crowns for primary anterior teeth: an evidence based assessment of the literature

To review the literature concerning the restoration of primary anterior teeth with pre-formed crowns or with the use of crown forms.

A search of the dental literature was made electronically using key words: crowns, primary teeth, anterior teeth, strip crowns, stainless steel crowns, veneered crowns, (a)esthetic, restorative. All papers were reviewed and assessed for their relevance to paediatric dentistry and then graded according to a set or predetermined criteria. These criteria were used to identify those reports that met 100% of the criteria, graded A; 75% grade B1; more than 50% graded B2 and all others graded C.

There were 90 papers in all using the key words. Of these none were rated grade A; B1 or B2 and all remaining valid papers (not single restoration case reports), 50 were graded C. Failure rates varied between 0% and 50% for strip crowns; 32-39% for veneered metal crowns. The review indicated there is some evidence as to the efficacy and value of using anterior primary teeth crowns because of the improved aesthetics that they achieve. There was an obvious lack of prospective well controlled studies and more studies are needed.

No clinical studies concerning anterior crowns on primary teeth were identified that met all or even a majority of criteria, indicating that there was little, good scientific support for any of the techniques which clinicians have utilized for many years to restore primary anterior teeth. While a lack of strong clinical data does not preclude the use of these techniques it points out the strong need for well designed, prospective clinical studies to validate the use of these techniques.