Periodontal Health of Endodontically Treated Molars Restored with Composite CAD/CAM Endocrowns versus Stainless Steel Crowns in Egyptian Children: A Randomized Controlled Trial

Background Subgingival crown margins have been linked to chronic gingival inflammation in pediatric patients. This clinical trial evaluated periodontal outcomes in first permanent molars that had undergone root canal therapy and were subsequently restored with either CAD/CAM composite endocrowns or stainless steel crowns (SSCs). Patients and methods Twenty-four children diagnosed with extensive caries in their first permanent molars were recruited from the Pediatric Dentistry clinics at the Faculty of Dentistry, Cairo University. Participants were randomly allocated to one of two treatment arms, where they received either a CAD/CAM composite endocrown or an SSC. Periodontal parameters—including Plaque Index (PI), Gingival Index (GI), and Probing Pocket Depth (PPD)—were measured at the baseline visit and at follow-up appointments scheduled at 1 week, 3 months, 6 months, 9 months, and 12 months. Radiographic evaluation relied on the Periapical Index (PAI), and statistical comparisons employed both parametric and non-parametric procedures, with p-values ≤ 0.05 considered statistically significant. Results At baseline, both groups were comparable in age, gender, and all clinical indices (p > 0.05). During follow-up, mean PPD values were significantly lower in the endocrown group than in the SSC group at all time points (p < 0.001). GI values were significantly lower for endocrowns at 1 week and 6 months (p = 0.031 and 0.004, respectively). PI values showed no significant intergroup difference (p > 0.05), though both groups improved over time. Radiographically, both groups demonstrated favorable periapical healing with no significant differences in PAI scores after 12 months. Inter- and intra-observer reliability was excellent (ICC > 0.8). Conclusion Composite CAD/CAM endocrowns were associated with significantly reduced probing pocket depth and healthier gingival conditions compared with SSCs, which suggests that CAD/CAM endocrowns offer a biologically conservative interim restoration for molars treated endodontically in pediatric patients. Clinical trial registration: ClinicalTrials.gov, NCT05250609. Registered 22 February 2022. Retrospective registration. https://clinicaltrials.gov/study/NCT05250609.