Eur J Oral Sci 2019; 127: 369–375 © 2019 Eur J Oral Sci

DOI: 10.1111/eos.12645 European Journal of

Printed in Singapore. All rights reserved
Oral Sciences

Stefan Kist1, Bogna Stawarczyk2,

Fracture load and chewing simulation Maximilian Kollmuss1, Reinhard
Hickel1, Karin C. Huth1
of zirconia and stainless-steel crowns 1
Department of Conservative Dentistry and
Periodontology, University Hospital,LMU
Munich, Munich; 2Department of Prosthetic
for primary molars Dentistry, University Hospital, LMU Munich,
Munich, Germany

Kist S, Stawarczyk B, Kollmuss M, Hickel R, Huth KC. Fracture load and chewing
simulation of zirconia and stainless-steel crowns for primary molars.
Eur J Oral Sci 2019; 127: 369–375. © 2019 Eur J Oral Sci
Aesthetic alternatives to stainless-steel crowns for restoring primary molars attain
growing interest. We studied the mechanical properties of prefabricated zirconia
crowns and conventional crowns. Three brands of prefabricated zirconia crowns
were compared with computer-aided design/computer-aided manufacturing (CAD/
CAM) zirconia crowns, preveneered stainless-steel crowns, and conventional stain-
less-steel crowns regarding: (i) fracture load under each of three conditions [no pre-
treatment, artificial aging in saliva for 12 wk, and after chewing simulation/
thermocycling (1.68 9 106 cycles/5–55°C)]; and (ii) survival rate during chewing
simulation, considering decementation, fracture, chipping, fatigue cracks, and occlu-
sal holes. Without pretreatment, the prefabricated zirconia crowns showed mean
fracture load values between 893 N and 1,582 N, while the corresponding values Karin C. Huth, Department of Conservative
Dentistry and Periodontology, University
for CAD/CAM zirconia crowns and preveneered stainless-steel crowns were
Hospital, LMU Munich, Goethestrasse 70,
2,444 N and 6,251 N. Preveneered stainless-steel crowns showed significantly lower 80336 Munich, Germany
fracture loads after artificial aging (5,348 N after saliva aging; 3,778 N after chew-
ing simulation) than without artificial aging, whereas the fracture load of zirconia E-mail: khuth@dent.med.uni-muenchen.de
crowns was not influenced negatively. The survival rate of the different groups of
zirconia crowns and preveneered stainless-steel crowns during chewing simulation Key words: aesthetic restoration; ceramic
was 100%, but only 41.7% for the stainless-steel crowns. These in-vitro data suggest crowns; primary dentition; prosthetic
that prefabricated zirconia crowns are aesthetically and durable alternatives to stain- restoration
less-steel crowns for primary molars. Accepted for publication May 2019

The preservation of primary teeth until physiological
exfoliation is of high importance because of their space
maintenance and chewing function. Dental restorations
of primary teeth should be time and cost efficient, and
also easy to carry out, as young patients usually have
only a limited period of cooperation during treatment.
Prefabricated stainless-steel crowns are often used in
cases of extensive decay after pulpotomy treatments.
However, parents and patients prefer tooth-coloured
restorations because of the increasing importance of
aesthetics (1).
In previous studies, composite strip crowns, preve-
neered stainless-steel crowns, and zirconia crowns
proved to be highly satisfactory regarding colour, size,
and shape (2–5). As far as durability is concerned, there
are differences between these materials. In the case of
strip crowns, 10% of the restorations showed small
areas of material loss and 2% showed large areas of
loss, after an average period of 18 months (2). The
overall parental satisfaction was 78%.
Reports on veneer fractures of preveneered stainless-
steel crowns are associated with a considerable decrease
in parental satisfaction (3). After 1 yr, 9% of the
posterior crowns fractured on the buccal surface and
23% fractured on the occlusal surface. However, after
3 yr the occurrence of fractures on the buccal and
occlusal surfaces increased to 24% and 42%, respec-
tively.
In clinical studies, prefabricated zirconia crowns
seem to demonstrate the highest durability (5, 6).
WALIA and coworkers reported that 100% of zirconia
crowns, 95% of preveneered stainless-steel crowns, and
78% of resin composite strip crowns were intact after
6 months (6). Loss of material was observed in 5% of
the restorations in the preveneered stainless-steel crown
group as well as in the strip crown group. Additionally,
17% of the strip crowns showed total loss of the
restoration. In another clinical study, two of 44 zirco-
nia crowns debonded after 21 months on average; how-
ever, no chipping or fracture was observed (5).
So far, mean values have been reported for the frac-
ture load of prefabricated zirconia crowns for posterior
use; these range from 576 N (Kinder Krowns, St Louis
Park, MN, USA) to 1,091 N [Sprig Oral Health Tech-
nologies (formerly Ez-Pedo), Loomis, CA, USA] (7).
Preveneered stainless-steel crowns showed much higher

370 Kist et al.
fracture loads, with values ranging from 1,671 N (NuS-
mile, Houston, TX, USA) to 1,937 N (NuSmile) (7, 8).
To the best of our knowledge, no literature is avail-
able regarding the influence of aging on the fracture
load and maximal survival period of aesthetic paedi-
atric crowns. In clinical studies, the maximum reported
observation time was 3 yr for resin composite strip
crowns and preveneered stainless-steel crowns and
20.8 months for zirconia crowns (3, 5, 9).
The present in-vitro study compared the fracture load
and survival rate of three different brands of prefabri-
cated zirconia crowns for posterior primary teeth with
individually fabricated computer-aided design/com-
puter-aided manufacturing (CAD/CAM) zirconia
crowns, resin preveneered stainless-steel crowns, and
conventional stainless-steel crowns. Furthermore, the
impact of aging was also investigated.
Material and methods
This in-vitro study was approved by the Ethics Committee
of the University of Munich (no. 371-16). An overview of
the experiments performed is given in Fig. 1.
Model preparation
In a dental training model (AK-6/2; Frasaco, Tettnang,
Germany) tooth 85 (FDI notation) was prepared in
a phantom head, according to the manufacturer’s
Fig. 1. Overview of the experiments. Fracture load tests were
performed on crowns for primary teeth, without or with aging
(storage in saliva or chewing simulation), and the survival
rates during chewing simulation were assessed. *For stainless-
steel crowns, only chewing simulation was performed (no frac-
ture load testing).
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instructions, using the recommended bur kits. Specifically,
in the CAD/CAM group, 1–1.5 mm of anatomical sub-
stance was removed occlusally and 0.8–1.2 mm circumfer-
entially using a convergence angle of 3°, creating a
gingival chamfer. Tooth reduction was checked using a
guide made of silicone (inlay impression tray size M;
SPEIKO, M€ unster, Germany; and Optosil Comfort Putty
und Activator Universal Plus Paste; Heraeus Kulzer,
Hanau, Germany).
The preparations were duplicated with CAD/CAM tech-
nology, resulting in cobalt-chromium (CoCr) abutments.
Briefly, the preparations were scanned (ceramill map400 with
ceramill database software version 1.0; Amann Girrbach,
Koblach, Austria) and milled out of CoCr blanks (Ceramill
Sintron 71L 20 mm; Amann Girrbach) using a five-axis
milling unit (ceramill motion 2; Amann Girrbach). After
milling, the abutments were sintered under an inert gas
(Argon 4.6; Linde, Pullach, Germany) in a sinter furnace
(Ceramill Argotherm 2; Amann Girrbach) and mounted on
stable resin cubes for conducting the experiments.
Crowns
The crown types tested in the study are listed in Table 1.
Three different types of prefabricated zirconia crowns were
tested (Fig. 2A–C), as well as CAD/CAM zirconia crowns
(Fig. 2D), and preveneered and conventional stainless-steel
crowns (Fig. 2E, F) (Table 1).
Manufacturing of CAD/CAM zirconia crowns
To fabricate the CAD/CAM zirconia crowns, the prepared
teeth were first scanned (ceramill map400 with ceramill
database software version 1.0; Amann Girrbach). For
designing the crown shape, an unprepared tooth was also
scanned, and a cement space of 50 lm was defined. The
crowns were milled out of zirconia blanks (Ceramill
ZOLID 71L 20 mm; Amann Girrbach) using a five-axis
milling unit (ceramill motion 2; Amann Girrbach) and
afterwards were sintered (sinter furnace ceramill therm 2;
Amann Girrbach). An unprepared tooth 85 (FDI nota-
tion) from the dental training model was used as a wax-
up. Finally, the crowns were glazed using VITA AKZENT
Plus Glaze Powder and VITA AKZENT Plus Powder
Fluid (both VITA Zahnfabrik, Bad S€ ackingen, Germany)
in a fully automatic firing unit (VITA VACUMAT 40;
VITA Zahnfabrik).
Cementation of crowns
All crowns were cemented on CoCr models with glass
ionomer cement (Ketac Cem; 3M ESPE, Seefeld, Ger-
many). For reproducible cementation, a specific device,
consisting of a punch and the weight, was used. This
device holds the crown in position and applies a continu-
ous force, of 827 g (750 g weight plus 77 g dead weight
from the punch), for 7 min onto the centre of the crown.
After curing, the excess cement was removed with a scaler.
NuSmile recommends NuSmile BioCem Universal
BioActive Cement (a dual-cure, resin-modified glass iono-
mer cement) for cementation of their crowns. Therefore,
in an internal pilot study, we investigated the possible
influence of the cement on the fracture load by fixing five
NuSmile Zirconia crowns with either BioCem (NuSmile)
or Ketac Cem (3M ESPE).

Table 1
Crown types tested in this study
Trade name Manufacturer
EZCrowns Sprig Oral Health Technologies, Loomis, CA,
USA (formerly Ez-Pedo)
Zirconia paediatric Kinder Krowns, St Louis Park, MN, USA
crowns
NuSmile Zirconia NuSmile, Houston, TX, USA
The authors of the manuscript
NuSmile Signature NuSmile, Houston, TX, USA
Stainless Steel 3M ESPE, Seefeld, Germany
Primary Molar Crowns
CAD/CAM, computer-aided design/computer-aided manufacturing.
Aging procedures
Following storage of crowns in a humid chamber for 24 h
at 37°C, the fracture load experiments were carried out
either directly or after two different aging procedures
(storage in saliva or chewing simulation), discussed below.
Artificial aging in saliva
Saliva samples were obtained from 10 volunteers (20–30 yr
of age) who were in good general and oral health. The sal-
iva samples were taken after stimulation (chewing on par-
afilm), in the morning before eating, and the volunteers
were asked not to brush their teeth in the 24 h before the
samples were taken.
The cemented crowns were then stored in the
pooled saliva samples for 12 wk at 37°C. The saliva was
changed biweekly. The pH value was kept constant between
pH6.5 and pH7.5, by using 1% HCl or 1% NaOH.
Artificial aging by chewing simulation
Antagonistic enamel specimens for the chewing simula-
tions were cut out of mesiobuccal enamel cusps from
freshly extracted, caries-free human molars (n = 72),
embedded in amalgam (Dispersalloy Fast Set 800 mg;
DENTSPLY DeTrey, Konstanz, Germany) on a stainless-
Fig. 2. Photographs of the crowns used. (A) Sprig EzCrowns.
(B) Kinder Krowns. (C) NuSmile Zirconia. (D) Computer-
aided design/computer-aided manufacturing (CAD/CAM)-de-
signed zirconia crown. (E) NuSmile Signature. (F) Stainless-
steel crown.
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Fracture load of paediatric crowns 371
Type
Prefabricated zirconia crowns
(all glazed)
Individually fabricated CAD/CAM
zirconia crowns; glazed
Preveneered stainless-steel crowns
Stainless-steel crowns
steel specimen-holder, and stored in 4°C deionized water
until use.
The cemented crowns and antagonists were mounted in
a chewing simulator (CS-4.8 with TC-4; SD Mechatronik,
Feldkirchen-Westerham, Germany). The specimens were
loaded with a vertical load of 100 N at a frequency of
1.5 Hz and a sliding movement of 0.7 mm for 1.68 9 106
chewing cycles with simultaneous thermocycling. During
thermocycling, the chambers of the chewing simulator
were flooded, alternating with 5°C and 55°C tempered dis-
tilled water for 30 s each. The number of cycles corre-
sponds to clinical usage over a time period of about 7 yr
(10, 11).
During the chewing simulation process, the crowns were
checked visually, three times a day. A failure was recorded
if a crown decemented, showed chipping of the veneer,
was fractured, or displayed fatigue cracks or a hole in the
occlusal surface (in the case of preveneered stainless-steel
crowns or conventional stainless-steel crowns). For the lat-
ter, the fracture load was not measured but a failure was
recorded for the survival rate analysis.
Fracture load tests
The crowns were placed in a universal testing machine
(Zwick/Roell Z010; Zwick, Ulm, Germany). The punch
(6 mm diameter) was placed perpendicular to the occlusal
surface, in the central fossa, and the measurement was
conducted at a crosshead speed of 1 mm min
1. To avoid
force peaks, a piece of 0.5-mm-thick tinfoil (Dentaurum,
Ispringen, Germany) was placed between the occlusal sur-
face and the loading jig. As soon as crack formation was
observed, the fracture load test was stopped and the corre-
sponding load was recorded.
The fracture load test was not applied to stainless-steel
crowns because of their high ductility.
Statistics
Data analysis was performed with SPSS (Version 22; SPSS,
Chicago, IL, USA). The data were given descriptively (mean
 SD; minimum and maximum). Normality of distribution
and homogeneity of variance were tested using the Shapiro–
Wilk test and Levene’s test. The differences between the
cementation groups (for the internal pilot study) were tested
using the Mann–Whitney-U test (a-level < 0.05). Differ-
ences between the groups in the main experiments were
analysed using the non-parametric Kruskal–Wallis test with
 16000722, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/eos.12645 by Egyptian National Sti. Network (Enstinet), Wiley Online Library on [04/12/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
372 Kist et al.

Mann–Whitney-U pairwise comparisons. The level of signif-
icance was Bonferroni adjusted because of multiple compar-
isons (corrected level of significance = 0.005). The impact of
the test parameters (type of crown and aging procedure)
with respect to the fracture load was determined by partial
g2. For each type of crown, the influence of the two aging
procedures on the fracture load was tested using an
unpaired t-test. The survival of the crowns with respect to
the load required to induce failure was described using the
Kaplan–Meier method, and survival curves were compared
using the Gehan–Breslow–Wilcoxon test (P < 0.05).
Results
In the internal pilot study, the fracture load measure-
ments (expressed as mean  SD) of NuSmile Zirconia
crowns were 1055.84  100.00 N using Ketac Cem and
1164.31  195.46 N using BioCem. No significant influ-
ence of the cement used was found on the fracture load
of NuSmile Zirconia crowns (P = 0.917).
All fracture load measurements followed a normal
distribution (Shapiro–Wilk, P > 0.05) except in the
EzCrowns group after aging with saliva (P = 0.013).
Tables 2–4 show the results of the fracture load
measurements without aging and after the two aging
procedures (Figure S1). Among the prefabricated zirco-
nia crowns, NuSmile Zirconia showed the highest
fracture loads, followed by Kinder Krowns, and
EzCrowns without pretreatment (Table 2). The individ-
ually fabricated CAD/CAM crowns showed signifi-
cantly higher fracture loads than the prefabricated
zirconia crowns without pretreatment (P < 0.001).
After aging with saliva, Kinder Krowns showed the
highest fracture load among the prefabricated crowns,
followed by NuSmile Zirconia, and EzCrowns
(Table 3). The resin-veneered stainless-steel crowns
(NuSmile Signature) showed the highest fracture loads
(6,251 N without aging, 5,348 N, after aging with sal-
iva).
After the chewing simulation, resin-veneered stain-
less-steel crowns (NuSmile Signature) again showed the
highest fracture loads, closely followed by CAD/CAM
zirconia crowns, Kinder Krowns, and NuSmile Zirco-
nia. EzCrowns showed the lowest fracture loads
(920 N, Table 4).
Regarding effect sizes, the major influence on the
fracture load was type of crown (g2 = 0.974), and only
a small influence was observed for the aging procedure
(g2 = 0.046). A direct comparison of the fracture loads
between the non-aged and the artificially aged crowns
in saliva showed no significant differences within the
four groups of zirconia crowns (t-test, P > 0.05, Fig-
ure S1). For the non-aged zirconia crowns and the
crowns aged by the chewing simulation, the same

Table 2
Fracture load (in N) at failure of crowns that have not been aged

Type of crown
Kinder NuSmile CAD/CAM NuSmile
Fracture load/statistical tests Sprig EzCrowns Krowns Zirconia zirconia crown Signature

Mean 893 1570* 1582* 2444 6251

SD 223 368 638 360 1170
Minimum 472 1250 1017 1728 4618
Maximum 1295 2613 3384 3002 8671
Levene’s test for P < 0.0001
homogeneity of variance
Kruskal–Wallis test P < 0.0001

*Estimates not statistically significantly different (Mann–Whitney U-test).

CAD/CAM, computer-aided design/computer-aided manufacturing.

Table 3
Fracture load (in N) at failure of crowns that have been artificially aged with saliva

Type of crown
Kinder NuSmile CAD/CAM NuSmile
Fracture load/statistical tests Sprig EzCrowns Krowns Zirconia zirconia crown Signature

Mean 797 1921* 1775* 2650* 5348

SD 266 615 662 572 606
Minimum 361 743 1033 1281 4070
Maximum 1160 3308 3266 3197 6106
Levene’s test for P = 0.461
homogeneity of variance
Kruskal–Wallis test P < 0.0001

*Estimates not statistically significantly different (Mann–Whitney U-test).

CAD/CAM, computer-aided design/computer-aided manufacturing.

Fracture load (in N) at failure of crowns that have been artificially aged by chewing simulation
Sprig
Fracture load/statistical tests EzCrowns
Mean 920
SD 306
Minimum 423
Maximum 1524
Levene’s test for P = 0.034
homogeneity of variance
Kruskal–Wallis test P < 0.0001
*Estimates not statistically significantly different (Mann–Whitney U-test).
CAD/CAM, computer-aided design/computer-aided manufacturing.
results were obtained, except for Kinder Krowns, for
which much higher fracture loads were observed after
the chewing simulation (t-test, P = 0.022, Figure S1).
For the preveneered stainless-steel crowns, the fracture
load was significantly lower after artificial aging with
saliva than without aging (t-test, P = 0.030). The effect
was even greater when the preveneered stainless-steel
crowns were aged by chewing simulation (t-test,
P < 0.0001, Figure S1).
To summarize, aging had a significant influence on
the preveneered crowns, and except for the Kinder
Krowns, had no effect on the CAD/CAM zirconia
crowns or the prefabricated zirconia crowns.
In order to compare the stainless-steel crowns with
the other crown types, chewing simulation experiments
were performed (Fig. 3). All of the zirconia crowns and
preveneered stainless-steel crowns withstood the stress
of chewing simulation (solid line, 100% survival rate),
whereas seven of the 12 stainless-steel crowns did not
survive (dotted line, 41.7% survival rate). The reasons
for failure were the appearance of fatigue cracks or
holes in the occlusal surface. This resulted in a signifi-
cant difference between the stainless-steel crowns and
the other crowns investigated (P < 0.0001).
Fig. 3. Results of Kaplan-Meier survival analysis after
1.68 9 106 cycles of chewing simulation (which corresponds
to clinical usage over a time period of about 7 yr). The solid
line resembles the 100% survival rate of all zirconia crowns
and the preveneered stainless-steel crowns. Only stainless-steel
crowns showed an decreasing survival rate over the entire
duration of the experiment (dotted line, 41.7%).
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Fracture load of paediatric crowns 373
Table 4
Type of crown
Kinder NuSmile CAD/CAM NuSmile
Krowns Zirconia zirconia crown Signature
2059* 2055* 2559* 3778
581 1010 410 867
1194 1171 2041 2866
3140 4269 3259 5944
Discussion
As the awareness of aesthetics and considerations
regarding gingival health are also increasing in paedi-
atric dentistry, this study aimed to investigate the frac-
ture load and survival rate of different tooth-coloured
crowns for primary molars. To appraise these results
accurately, the mean maximum bite force in 3- to 5.5-
yr-old children has been reported to be between
186.2 N (12) and 235 N (13) and in 6- to 11-yr-old chil-
dren between 330.5 N and 374.4 N (12). In the present
experiments, all crowns investigated showed signifi-
cantly higher fracture load values than the reported bite
forces in the mouth, even if there were differences
between the groups.
All crowns were cemented by Ketac Cem, as the
internal pilot study revealed no difference regarding the
fracture load when compared with cementation by Bio-
Cem, which is recommended by NuSmile. This was in
accordance with previous studies (14–16).
To increase the clinical relevance of our results, this
study included an aging process of the crowns by either
saliva or chewing simulation, simulating 7 yr of clinical
use. The crowns were cemented on CoCr dies, which
were made by duplication of prepared tooth models.
By contrast, previous studies have used perfect-fit
epoxy dies produced by impressions of the interior of
the crowns (7, 8). The thicker and irregular cement
layer and the poor quality of the margin of prefabri-
cated crowns lead to an inferior fit compared with
CAD/CAM crowns, which might decrease the fracture
load. In a previous study, the quality of the crown mar-
gin was reported to influence the fracture load, while
the internal fit and thickness of the cement gap did not
(17). Furthermore, it has been reported that the mate-
rial of the dies affects the fracture load of the materials
to be tested (18). The CoCr alloy has a higher Young0 s
modulus than dentine, which might result in higher
fracture-load values than in a clinical situation (19). In
order to compare fracture loads in different studies, the
experimental setup must be considered.
It has been reported that glazed zirconia surfaces
show higher flexural strength values than finished and
polished zirconia surfaces (20, 21). As all the zirconia

374 Kist et al.
crowns used in the present study were glazed, this fac-
tor is not applicable here. The observed high fracture
load values for resin preveneered stainless-steel crowns
have also been reported previously (7) and might be a
result of the higher ductility of the stainless-steel basis
of the veneer compared with the more brittle zirconia.
Whereas the results for EzCrowns crowns were compa-
rable with those reported in a previous study, the other
crown types showed a higher fracture load in the pre-
sent study (7). For example, values (mean  SD) of
576  132 N for Kinder Krowns, 691  113 N for
NuSmile Zirconia, and 1,937  546 N for NuSmile Sig-
nature have been reported. BEATTIE and coworkers
measured a distinctly lower mean value for the NuS-
mile Signature crowns than found in this study, namely
1,671  370 N (8). These discrepancies may be caused
by the methodological differences mentioned above.
The CAD/CAM-fabricated crowns were included as
an optimal control group for zirconia restorations in
this study. As expected, the CAD/CAM zirconia
crowns showed the highest fracture loads. The differ-
ences between these crowns and the prefabricated
crowns tested were significant in all experiments, except
for the NuSmile Zirconia crowns in the chewing simu-
lation experiment. This could be explained by the better
fit of the CAD/CAM crowns, as mentioned above.
Interestingly, the artificial aging process significantly
reduced the fracture load of NuSmile Signature crowns.
The effect of the chewing simulation was even higher
than artificial aging by storage in saliva. This observa-
tion might explain the frequently reported chipping of
the veneering material in clinical studies (3, 4, 6). How-
ever, in this study, no chipping was observed during
chewing simulation, which may be a result of the limi-
tations of the in-vitro testing.
No influence of aging was found for CAD/CAM zir-
conia crowns and two of the prefabricated zirconia
crowns. Surprisingly, in the case of Kinder Krowns,
higher fracture loads were found after the chewing sim-
ulation (Figure S1). A possible reason for this might be
the phase transformation from the metastable tetrago-
nal state to the stable monoclinic form caused by the
application of energy to the zirconia crowns during the
chewing simulation (22–24). Monocline zirconia materi-
als show higher flexural strength than tetragonal mate-
rials.
To compare the stainless-steel crowns with the other
crown types, a chewing simulation was performed. All
zirconia and preveneered stainless-steel crowns showed
a 100% survival rate during the chewing simulation,
while the stainless-steel crowns showed a survival rate
of only 41.7%. The failures were fatigue cracks and
holes on the occlusal surface. Fatigue cracks occurring
only in the stainless-steel crowns group can be attribu-
ted to the properties of metals. Repeated alternating
loads make metals susceptible to fatigue cracks.
Another explanation is possible thinning of the occlusal
surface as a result of plastic deformation during chew-
ing simulation. A previous review has reported failure
rates of 2%-25% for stainless-steel crowns after a mean
time of 5 yr (25). Unfortunately, not all reviewed
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studies included reasons for failures (26–28). Only one
clinical study reported fatigue cracks and holes on the
occlusal surface, in accordance with our observations
(29). It was reported that 10 of 673 stainless-steel
crowns on primary teeth formed a hole during chewing.
No data were given regarding the lifespan. Our experi-
ments show that the failure rate increases with more
than 106 chewing cycles, which corresponds to a period
of use of approximately 4 yr (10, 11).
The influence of prefabricated paediatric crowns on
gingival health and antagonistic wear is also worthy of
discussion. Zirconia crowns have been reported to
improve the gingival health situation in comparison
with preveneered stainless-steel crowns and composite
resin strip crowns (6). Investigation of the wear of pri-
mary teeth by antagonistic all-ceramic or stainless-steel
specimens showed higher, but not significantly different,
wear for monolithic zirconia (30).
As a next step, the longevity of zirconia crowns for
primary molars should be investigated in a clinical
long-term study. Furthermore, an in-vitro study regard-
ing the decementation rate of zirconia crowns would be
interesting.
Acknowledgements – The authors would like to thank Sprig Oral
Health Technologies, Kinder Krowns, and NuSmile for providing
the crowns, and Amann Girrbach for providing the CoCr and zir-
conia blanks. Additionally, the authors would like to thank dental
technician Marlis Eichberger and Dr Kurt Erdelt for their help
with the CAD/CAM and the universal testing machine. The study
was financed by departmental funding of the Department of Con-
servative Dentistry and Periodontology and the Department of
Prosthetic Dentistry, University Hospital, LMU Munich.
Conflicts of interest – The authors declare no conflict of interest.
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Supporting Information
Additional Supporting Information may be found in the online
version of this article:
Fig. S1. Fracture load in N of the different crowns in the three
experiments (non-aged, artificially aged with saliva and artificially
aged by chewing simulation).