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Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial



To evaluate the adhesion of Streptococcus mutans to preformed zirconia and stainless steel crowns and compare plaque accumulation and gingival inflammation over a period of 1 year.

Materials and methods

Thirty children between 6 to 9 years with pulpectomised bilateral mandibular primary second molars were randomly divided into zirconia/stainless steel groups. Plaque was collected from the crowns using swabs at 3, 6, 9, and 12 months. Gingival and plaque index were recorded at all follow-ups. S. mutans was cultured on tryptone-yeast-cysteine-sucrose-bacitracin agar, and organisms were expressed as colony-forming units. Within-group analysis was performed using repeated measures ANOVA and between-groups using the independent T test.


S. mutans were found in significantly higher numbers on the stainless steel crowns as compared with zirconia crowns at all the follow-ups. Gingival inflammation and plaque index scores were also significantly higher around the stainless steel crowns as compared with zirconia at the end of 12 months follow-up.


Adhesion of S. mutans to stainless steel crowns was significantly greater when compared with zirconia, and minimal gingival inflammation and plaque accumulation was found in the tooth restored with zirconia crowns as compared with stainless steel crowns.

Clinical relevance

Preformed zirconia crowns prevents adhesion of S. mutans onto its surface, and reduces plaque accumulation around the crown, inflammation of surrounding gingiva compared to conventional stainless-steel crowns. Pediatric zirconia crowns could help in reducing the overall microbial density and prevalence in the oral cavity, thus reducing the caries risk in the long term.

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Correspondence to Mebin George Mathew.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants (parents) included in the study.

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Mathew, M.G., Samuel, S.R., Soni, A.J. et al. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Invest 24, 3275–3280 (2020).

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