STAINLESS STEEL CROWNS

Dr. Ezra Arora MDS 1st Year Department of Paedodontics and Preventive Dentistry

DEFINITION

Crown is a restoration that covers a tooth to restore it to normal shape and size. SSC introduced to pediatric dentistry by W.P Humphrey in 1950.

Semi-permanent restorations.
Used commonly in primary teeth: Tooth integrity destroys faster Pulp horns are larger

a. b.

Natural tooth

Biocompatible Ideal characteristics Economical Mesio-distal width

Restore function & arch length

Classification
Untrimmed, uncontoured crowns (Unitek) Pre-trimmed crowns (Unitek, 3M, De novo crowns) Precontoured crowns (Unitek, Ni-chro ion crowns)

Types

Stainless Steel Crowns. Open faced Stainless Steel Crowns/Facial cutout Stainless Steel Crowns Resin Veneered Stainless Steel Crowns

OPEN FACED

RESIN VENEERED

Open-faced Stainless Steel Crown

TECHNIQUE

Cut a labial window in the cemented crown using a no. 330 or no. 35 bur.

Extend the window: Just short of the incisal edge Gingivally to the height of the gingival crest Mesio-distally to the line angles

TECHNIQUE

Smooth the cut margins of the crown with white finishing stone.

Place a layer of bonding agent.

Add additional material in 1mm increments and polymerize.

Place resin based composite into the cut window forcing the material into the undercuts and polymerize.

Finish the restoration with abrasive disks.

Resin Veneered Stainless Steel Crown

Advantages Disadvantages

Enhanced esthetics single, short appointment Retention similar to traditional Stainless Steel Crowns

Fracture or loss of veneer. Relatively inflexible, brittle, resin facing material Expensive Limited shade Significant removal of tooth structure Difficulty placing multiple approximating crowns

Available as

Cheng Crowns Whiter Biter Crowns II Nu-smile Primary Crowns Kinder Crowns Dura Crowns

COMPOSITION
Stainless Steel Crowns (18-8) Austentic alloy 17-19% chromium 10-13% nickel Nickel-Base Crowns Inconel 600 alloy

72% nickel
14% chromium 6-10% Fe 0.04% carbon 0.35% manganese e.g. Ion Ni-chro

67% iron
4% minor elements e.g. Rocky mountain and Unitek.

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Advantages of Stainless Steel Crowns

Durable Inexpensive Quickly placed Preventive aspect Restoring the function

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Disadvantages of Stainless Steel Crowns

Appearance Occlusal surface may wear Gingivitis is common around defective margins

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INDICATIONS

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Extensive decay in primary teeth

Following pulp therapy

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As a preventive restoration

Avoid amalgam failure or tooth fracture Difficulty in placing durable mesio-occlusal distal (MOD) restorations

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As an abutment for a space maintainer

Crown & loop

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Single tooth crossbite

Reversed stainless steel crown

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Temporary tooth

restoration

of

fractured

For teeth deformed by developmental defects or anomalies or with hypoplastic defects For extensive carious destruction of young permanent teeth requiring full coronal restorations For orthodontic corrections

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Contraindications

No absolute contra-indications. Relative contraindications include:

1.

Primary posterior teeth in which conservative amalgam restorations can be placed Teeth expected to exfoliate within a brief period.

2.

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Pliers
Crown contouring Crown crimping Ball and socket

No. 112 (Dentaurum of Postfach, Pforzheim, West Germany)

Johnson 114

Gordon no. 137

No. 417 (Unitek Corp.)

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Crown and bridge scissors

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Polishing wheel

Dental floss

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Rubber dam kit

CLINICAL PROCEDURE

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Under Rubber dam isolation

A)

PRELIMINARY STEPS
Evaluate the pre-operative occlusion Opposing tooth has extruded Mesial drift

Local anesthesia

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Isolation Rubber dam mandatory: Protect surrounding tissue Improve visibility & efficiency Better management of behavior Prevent ingestion Removal of Decay
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B) SELECTION OF CROWN

M-D dimensions of the tooth Light resistance to seating

Proper occlusal height

Not too large

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C) TOOTH PREPARATION Aims of tooth preparation Provide sufficient space Remove caries Leave sufficient tooth for retention

Troutman (1976):occlusal reduction should be followed by proximal reduction.

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Occlusal reduction
69L or 169L bur 1.5 to 2mm

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Connect the depth cuts

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Completed occlusal reduction

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Proximal Reduction
Wooden wedges Inter-proximal embrasures

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Proper slice

Improper slice

Converge slightly towards the occlusal & lingual.

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Contact with adjacent teeth must be broken gingivally and bucco-lingually

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Bucco-Lingual Reduction

No more than 0.5-1mm Feather edge

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Evaluation Criteria for Tooth Preparation

Proximal slices
Buccal & Lingual reduction: 0.5mm,converge slightly occlusally.

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Gingival marginal contour

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TECNIQUE

Reduce the crown height

(margin adjustments: no.137 gordon)

Shape the crown margins

3 points: Mesio-Buccal,Buccal & Disto-Buccal Mesio-Lingual,Lingual & Disto-Lingual

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Crown Contouring

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Crown crimping

Mechanical retention Gingival health

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FINISHING AND POLISHING

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SEATING THE CROWN

No blanching Adjacent proximal contact must be maintained. The occlusal relationship re-established 1mm into the gingival sulcus.
Wiland L 1973 Myers DR 1975

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Evaluate the margins

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Checking the Final Adaptation

Snap into place No rocking on the tooth Correspond to the marginal ridge height Proper occlusion No high points 1 mm gingival to gingival crest No opening exists between the crown & the tooth Maintain oral hygiene.

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Radiographic confirmation of the gingival fit

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CEMENTATION OF THE CROWN

Zinc phosphate cement

Reinforced Zinc oxide eugenol cement

Polycarboxylate cement Glass ionomer cement
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Clinical Procedures

Isolate

Mix the cement

Fill the crown Seat the crown

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Correctly adapted Stainless Steel Crown

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Post cementation instructions

1.

Avoid heavy chewing with crown for 24 hours

2.

Maintain oral hygiene

Recalled once every 6 months for evaluation.

3.

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Modifications
(Mink & Hill 1971, McDonald & Avery 1994)

Undersized tooth or Oversized crown

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Cut the crown in buccal or lingual surface from gingival to occlusal surface

Pinch the crown together

Spot weld the overlapped edges together.

Retry the crown 52 on tooth

Oversized tooth or undersized crown

Check the crown on the tooth

Cut a V in the crown

Weld a strip of metal in buccal surface

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Complications
Inter-proximal ledge

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Aesthetics Poor margins Crown tilt Occlusal wear Inhalation or Ingestion

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CAUSES OF STAINLESS STEEL CROWN FAILURES

Poor tooth preparation. Poor crown adaptation & subsequently poor retention. Improper cementation methods with lost crown or open margins. Failure of pulp treatment. Recurrent caries, especially in interproximal areas.

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Polycarbonate crowns

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Steps in preparation

Removal of caries Administration of LA Selection of crown size Placement of rubber dam Preparation of tooth

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Adaptation of crown

Roughening of the interior surface Cementation

Finishing

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Advantages Esthetics phonation

Disadvantages Difficult to place Poor retention Prone to wear Cant be crimped No shade choice brittle

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Pedo strip crowns

Appropriately sized celluloid crown forms for primary incisors, which is used in conjunction with composite resin

retention can be obtained by mechanical undercuts & enhanced 61 by acid etching

Indications

Extensive or multisurface caries Congenitally malformed incisors Congenitally discolored Fractured Amelogenesis imperfecta

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Strip crown technique

Isolation is done with rubber dam

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Mesial and distal slicing is done leading to a knife edge gingival margin.

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Celluloid strip crown forms are selected

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Advantages

Disadvantages

Esthetics

More technique sensitive

Improved retention

Better wear resistance

Fracture or de-bond when traumatized

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References

Sidney B. Finn. Clinical Pedodontics. 4th edition; 2004; Saunders Company McDonald, Avery, Dean. Dentistry for the Child and Adolescent. 8th edition; 2004; Mosby Publications Pinkham, Casamassimo, Fields, McTigue, Nowak. Pediatric Dentistry. Infancy through Adolescense. 4th edition;2005; Saunders Company Ray E. Stewart. Pediatric Dentistry Scientific Foundations and Clinical Practice. 1st edition; 1982; Mosby Company Richard R Welbury, Monty S. Duggal and Marie Therese Hosey. Pediartric Dentistry. 3rd edition; 2005; Oxford

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