The Impact of Adhesion Strategy on the Clinical Performance Of Indirect Dental Restorations

June 8, 2026 updated by: Malmö University

The Influence of Cement Systems on the Outcome of Tooth Supported Zirconia Crowns in the Posterior Region: a Randomized ,Multicenter, and Practice-based Clinical Trial

The goal of this clinical trial is to evaluate whether different cement systems influence the clinical outcome of posterior tooth supported zirconia crowns in adult patients requiring single crown restorations. The main questions it aims to answer are:

  • Do glass ionomer cements provide clinical outcomes comparable to those of resin cements for posterior zirconia crowns?
  • Do marginal discoloration, marginal integrity, and biological complications differ between the cement systems?
  • Do patient reported and clinician reported outcomes differ between the cementation procedures?

Researchers will compare zirconia crowns cemented with either a glass ionomer cement or a resin cement to evaluate differences in clinical outcomes.

Participants will:

  • Receive posterior zirconia crowns fabricated according to standardized clinical procedures
  • Be randomized to cementation with either a glass ionomer cement or a resin cement
  • Undergo clinical examinations assessing crown survival, marginal adaptation, discoloration, caries, periodontal status, and wear
  • Complete questionnaires regarding patient comfort and treatment experience
  • Attend baseline and annual follow-up examinations for up to 10 years

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

Tooth damage has significant impact on a person's quality of life and damaged teeth should be treated to restore lost functions and prevent further damage. Loss of tooth substance can be restored by a direct (filling) or indirect restoration (artificial crown). These interventions differ in some operative aspects but share key challenges, particularly in achieving optimal adhesion to tooth substance to secure predictable retention and the integrity of the marginal seal.

Failure of the adhesive interface is a major determinant of restoration longevity and may manifest across patient-centered, biological, and technical outcomes.

Marginal degradation may result in discoloration, representing an early clinical indicator of interface breakdown that negatively affects patient satisfaction and may lead to a need for retreatment. Progressive marginal leakage facilitates bacterial access, increasing the risk of biological complications such as secondary caries and pulpal involvement.

Loss of retention represents a major technical complication, often requiring replacement of the restoration and contributing to cumulative loss of tooth structure over time.

Despite advances in restorative materials and adhesive systems, clinical outcomes remain variable, and the relative contribution of material properties, procedural complexity, and biological factors to long-term failure is not fully understood. In particular, the role of technique sensitivity and procedural complexity as independent determinants of restoration survival remains insufficiently characterized. Improved understanding of these interacting factors will enable more precise selection of restorative materials and cementation strategies.

This project will: (a) identify and quantify clinically relevant determinants of restoration failure, enabling improved prediction of restoration survival and patient satisfaction, (b) elucidate how interfacial degradation and technique sensitivity contribute to biological and technical complications, (c) aid clinical decision-making by guiding selection of materials and procedures based on their performance and complexity.

Study Type

Interventional

Enrollment (Estimated)

110

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Sweden
    • Skåne County
      • Hörby, Skåne County, Sweden
        • Sandin Dentalklinik
      • Malmö, Skåne County, Sweden, 21118
        • Tandläkare Le

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Need of one single crown on vital posterior tooth
  • Speak and understand Swedish language
  • Free from dental/oral disease; caries, periodontal disease

Exclusion Criteria:

  • Only individuals who do not meet the inclusion criteria will be excluded.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Resin cement
Tooth-supported zirconia crowns cemented with a resin-based cement
Other: Resin cement
Zirconia crowns cemented with resin cement
Active Comparator: Glass-ionomer cement
Tooth-supported zirconia crowns cemented with a glass-ionomer cement
Other: Glass-ionomer cement
Zirconia crowns cemented with glass-ionomer cement

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Clinical outcome of tooth-supported zirconia crowns from baseline to 1-year follow up
Time Frame: Baseline and 1 year.
Clinical performance of tooth supported zirconia crowns assessed using modified CDA criteria, including survival, success, biological complications, technical complications, marginal integrity, discoloration, and surface morphology.
Baseline and 1 year.
Clinical outcome of tooth-supported zirconia crowns from baseline to 3-year follow up
Time Frame: Baseline and 3 years.
Clinical performance of tooth supported zirconia crowns assessed using modified CDA criteria, including survival, success, biological complications, technical complications, marginal integrity, discoloration, and surface morphology.
Baseline and 3 years.
Clinical outcome of tooth-supported zirconia crowns from baseline to 5-year follow up
Time Frame: Baseline and 5 years.
Clinical performance of tooth supported zirconia crowns assessed using modified CDA criteria, including survival, success, biological complications, technical complications, marginal integrity, discoloration, and surface morphology.
Baseline and 5 years.
Clinical outcome of tooth-supported zirconia crowns from baseline to 10-year follow up
Time Frame: Baseline and 10 years.
Clinical performance of tooth supported zirconia crowns assessed using modified CDA criteria, including survival, success, biological complications, technical complications, marginal integrity, discoloration, and surface morphology.
Baseline and 10 years.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from Baseline in "Patient-reported Outcome Measurement" at 1 year
Time Frame: Baseline and 1 year.
Patient reported and operator reported outcomes will be assessed using structured questionnaires evaluating treatment comfort, clinical handling, and overall satisfaction. Questionnaire scores range from 1 to 5, where higher scores indicate greater satisfaction and improved treatment experience.
Baseline and 1 year.
Change from Baseline in "Patient-reported Outcome Measurement" at 3 year
Time Frame: Baseline and 3 year.
Patient reported and operator reported outcomes will be assessed using structured questionnaires evaluating treatment comfort, clinical handling, and overall satisfaction. Questionnaire scores range from 1 to 5, where higher scores indicate greater satisfaction and improved treatment experience.
Baseline and 3 year.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Malmö University

Investigators

  • Principal Investigator: Christel Larsson, Ph.D., Malmö University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 1, 2026

Primary Completion (Estimated)

July 1, 2028

Study Completion (Estimated)

June 1, 2036

Study Registration Dates

First Submitted

June 3, 2026

First Submitted That Met QC Criteria

June 8, 2026

First Posted (Actual)

June 12, 2026

Study Record Updates

Last Update Posted (Actual)

June 12, 2026

Last Update Submitted That Met QC Criteria

June 8, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026-03170-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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