Restorative options for primary teeth in pediatric dentistry

Restoration of primary teeth is a fundamental component of pediatric dental care, as primary dentition plays a critical role in mastication, speech development, esthetics, and the maintenance of arch integrity for the eruption of permanent teeth. Dental caries remains one of the most prevalent chronic diseases in children worldwide, making the selection of appropriate restorative materials essential for achieving durable and biologically acceptable outcomes. This narrative review aims to evaluate the restorative options available for primary teeth in pediatric dentistry, with emphasis on their clinical performance, advantages, and limitations. Due to the anatomical and histological differences between primary and permanent teeth—such as thinner enamel and dentin, larger pulp chambers, and shorter functional lifespan—restorative material selection in primary teeth requires specific considerations. Traditional materials, including dental amalgam, have demonstrated long-term durability and moisture tolerance; however, their use has declined due to esthetic demands and concerns regarding mercury exposure. Glass ionomer cements and their modified forms offer chemical adhesion to tooth structure, fluoride release, and cariostatic properties, making them particularly suitable for children at high caries risk, despite their relatively lower mechanical strength. Resin-based materials, such as composite resins, compomers, giomers, and ormocer-based systems, provide superior esthetics and acceptable mechanical properties, but their clinical success is highly dependent on proper isolation and technique sensitivity. Full-coverage restorations, including stainless steel crowns, veneered crowns, prefabricated zirconia crowns, and newly developed polymer-based crowns, are recommended for extensively damaged primary teeth, especially following pulp therapy. Stainless steel crowns remain the gold standard for posterior primary teeth due to their durability and cost-effectiveness, whereas zirconia and aesthetic crowns offer improved esthetic outcomes with certain limitations related to tooth preparation and retention. Recent advancements in restorative materials and digital technologies, such as CAD–CAM-fabricated crowns, have expanded treatment options in pediatric dentistry. In conclusion, no single restorative material fulfills all clinical requirements. The selection of restorative options for primary teeth should be individualized based on the child’s age, caries risk, tooth location, functional demands, esthetic expectations, and level of cooperation. Appropriate material selection contributes significantly to the long-term oral health and overall well-being of pediatric patients.