3D-printed Crowns Versus Zirconia Crowns for Primary Molars

in vitro part :All selected primary molars should fulfill the following criteria: 1. Freshly extracted molars with at least three sound walls. 2. Retain at least one third of their roots Teeth preparation All soft tissue debriswill be removed with a hand scaler and teeth will be disinfected, and then stored indistilled water at 4 degrees Celsius until the start of the study.Pulpotomy procedures will be performed to the extracted molars and the molars will befilled. Then, they will be randomly allocated into two groups.Group 1: Will receive 3D‐printed crowns Group 2: Will receive prefabricated zirconiacrowns The specimens will be embedded perpendicularly in Polyvinyl chloride (PVC) cubeswith the occlusal surface parallel to the ground using acrylic resin extending 2mm belowthe cementoenamel junction.Evaluations: teeth in both groups will be evaluated for the following: 1. Marginal gap:Precementation measurements of the cervical vertical marginal discrepancies will beperformed before cementation., Four optical images for each specimen will becaptured using a stereomicroscope (Wild 400, Switzerland) at a 32× magnification.Images will then be transferred to the computer software for image analysis. 2. Fracture Resistance:An axial loading condition through the functional cusp will be defined in the mechanicalfailure description. Failure‐to‐fracture strength will be tested with a universal testingmachine (LLOYD machine) at a 0.5 mm/sec crosshead speed. Application of a round‐endvertical loading tip on the occlusal third of a specimen fixed into a loading apparatusas functional loading simulation.in vivo part : Teeth will be polished using a polishing paste and brush, and dried beforebeing examined.A dental mirror will be used for clinical examination under light emitting diode (LED)illumination to confirm the fulfillment of the inclusion criteria of the patient'sselection. ‐ The molars will be randomly allocated into two equal treatment groups 23/each): 1. Group 1: 3D‐printed crowns 2. Group 2: prefabricated zirconia crowns Pulpotomy procedure for both groups: 1. Local anesthesia will be administered. 2. Teeth will undergo pulpotomy procedure' as follows: ‐ Caries removal will be done using a large size 4 round bur, mounted onto ahigh‐speed hand piece with constant coolant. ‐ All access cavity walls will be flared to allow complete exposure of the pulpchamber, and easy undisturbed access to the canals, followed by removal of all thesoft pulpal tissue tags by a sharp spoon shaped excavator. ‐ Bleeding control will be done using moist cotton pellet with gentle pressure. ‐ Formocresol will be applied using a cotton pellet for 3‐5 mins, for fixation. ‐ The pulp chamber will be filled with re‐inforced zinc oxide and eugenol that will bemixed according to manufacturer's instructions. ‐ Analgesics will be prescribed to the patient to be taken when needed.Intervention Group 1: 1. Crown reduction: The teeth will be prepared using taper diamond bur with round endfor buccal, lingual, mesial, and distal wall for 0.8‐ 1 mm, producing a chamfermargin circumferentially, and then, reduction of the occlusal surface will be doneusing a round wheel to produce occlusal clearance of 1.5 mm. 2. Impression for the preparation will be taken using putty and light poly vinylsiloxane material. 3. The impression will be sent to the lab and the patient will be dismissed. 4. The preparation will be optically scanned in the lab and the crown will be digitallydesigned using computer designing software. 5. The crown will be printed using 3D printer. 6. The 3D printed crown will be cemented in the 2nd visit.Control: Group 2: 1. Crown reduction: ‐ In order to compensate for the thickness of zirconia crown, reduction will be performed on the mesial, distal, buccal and lingual surfaces of the tooth for 0.7‐1.75mm. Reduction will be performed using fine needle stone in the beginning to free the contact from the adjacent teeth then followed by reduction of the other surfaces using a diamond stone. ‐ Reduction of the occlusal surface will be performed using a flame stone or wheel stone to produce occlusal clearance of 1.5‐ 2 mm. ‐ All line angles will be checked to remove any sharp line angles. 2. Selection of the matching size from zirconia crowns will be made taking intoconsideration that the preparation must be free from any undercuts to avoid crownfracture. 3. After checking the selected size of the crowns, it will be removed, dried andcemented to the tooth using resin cement.Method of evaluation:After cementation , at baseline ,3rd ,6th and 12th months evaluation of the crowns willbe performed clinically using the modified U.S. Public Health Service criteria forretention, marginal integrity and gingival health for both groups. Also, parentalsatisfaction will be evaluated at end of the study using 5‐point likert scale.