Stainless steel crowns in paediatric dentistry: Indications, contraindications, clinical procedure, clinical modifications, modifications for anteriors, recommendations, prognosis

1. “STAINLESS STEEL CROWNS IN PAEDIATRICDENTISTRY”
By
Sumaiya hassan
Supervisor: Dr Mohammad amin
Sumaiya Hasan

2. “Stainless steel crowns are prefabricated crown forms that are adapted to
individual teeth and cemented with biocompatible luting agent”
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

3. INDICATIONS
• Restoration of primary molars needing large multisurface restorations.
• Restoration of primary molars in children with rampant caries.
• Restoration of teeth after pulp therapy.
• Restoration of teeth with developmental defects.
• Abutment for space maintainers.
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

4. • Protection of molars in children with bruxism.
• In patients undergoing restorative treatment under GA, if two or
more tooth surfaces are involved.
• Where breakdown of intracoronal resorations is likely.
INDICATIONS
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

5. CONTRAINDICATIONS
• If the primary molar is close to exfoliation with more than half the
roots resorbed.
• In patients with known nickel allergy.
• Partially erupted teeth
• Esthetically unappealing
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

6. CLINICAL PROCEDURE
• Local anesthesia and rubberdam application
• Caries removal and appropriate pulp therapy .
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

7. CLINICAL PROCEDURE
• Crown selection.
◦ Mesiodistal width of tooth meausred with callipers and matched
with stainless steel crown.
◦ Height of crown should be same as that of uncut tooth with cervical
margin being not more than 1mm below the gingival margin.
◦ Assessment of gingival marginal contour described as ‘smile’,
‘stretched S’ or ‘frown’.
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

9. CLINICAL PROCEDURE
• Wedge placement
◦ Acts as tooth separators.
◦ Protects the underlying soft tissues
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

10. CLINICAL PROCEDURE
• Occlusal reduction:
Initial placement of 1mm depth grooves.
Flame shape or tapered fissure bur used.
1-1.5 mm occlusal reduction following the natural occlusal
anatomy.
◦
◦
◦
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

11. • Buccal and lingual reduction:
Required if the buccal or lingual bulge is exagerrated and
hinder crown placement.
45 degree bevel on occlusal one- third.
CLINICAL PROCEDURE
◦
◦
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

12. • Approximal reduction:
Use of tapered fissure bur.
Preparation should have a smooth edge cervically
with no step or shoulder and vertical walls should have slight
convergence.
When there is no adjacent tooth, approximal reduction is still necessary
to prevent marginal overhang specially incase of primary second
molars
CLINICAL PROCEDURE
◦
◦
◦
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

13. • Trial fitting, trimming and contouring the crown:
Crown with a tight snap fit is selected.
Excess material cut with curved scissors.
Crown contouring done using 114 plier and crimping plier and
bending the gingival third of the crown inward resulting in a tight
marginal fit and smooth marginal outline
There should be no or minimal gingival blanching.
CLINICAL PROCEDURE
◦
◦
◦
◦
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

14. • Crown cementation:
Glass ionomer, zinc phosphate or zinc polycarboxylate cement used.
Rinse and dry the internal crown surface.
Prepare cement and fill 2/3rd of crown with all internal walls covered.
Seat the crown, remove excess cement from margins and interproximal
areas.
Check occlusion.
CLINICAL PROCEDURE
◦
◦
◦
◦
◦
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

15. CLINICAL MODIFICATIONS
•Adjacent SSC.
Selection and adjustment of crowns done together  Posterior tooth
prepared first  crown for posterior tooth fitted to occluion 
Adjacent tooth prepared  Crown for adjacent tooth fitted to occlusion
 Cementation of distal crown followed by adjacent crown
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

16. • Decreased arch length.
More reduction done mesiodistally
Deep subgingival cavity.
Solder an extension of band cervically
Open interproximal contacts.
Selection of larger crowns
CLINICAL MODIFICATIONS
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

17. • Undersized tooth and oversized crown.
‘V’ cut made on the buccal surface of crown from gingiva to occlusal
 Edges of ‘V’ reapproximated to overlap  Crown tried on tooth
And amount of overlap needed is marked  Overlapped edges welded
CLINICAL MODIFICATIONS
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

18. • Oversized tooth and undersized crown.
Crown tried  ‘V’ cut made on buccal and lingual side as necessary
 Crown tried again  Ortho band placed and spot welded
CLINICAL MODIFICATIONS
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

19. COMMON ERRORS
• Over trimming of crown margins  Reduced adaptation of crown
margins into the undercut area  Reduced crown retention
• Excessive tooth reduction  Frequent dislodgement of crown
• Distal crown overhang in deciduous second molar  Impaction of first
permanent molar
• Uncleaned cement around margins after cementation  gingivitis
• Failure to round off line angles
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

20. STAINLESS STEEL CROWN MODIFICATIONS FOR ANTERIORS
• Facial cut out stainless steel crowns
Allow cement to set completely  Cut a window buccally just short of
incisal edge, gingivally till the height of gingival crest and mesiodistally
till line angles  cement removed  Etch, bond, composite placement
 polish from resin to metal
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

21. STAINLESS STEEL CROWN MODIFICATIONS FOR ANTERIORS
•Pre veneered stainless steel crowns with esthetic facings
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

22. PROGNOSIS OF STAINLESS STEEL CROWNS
According to a publication by the Royal College of Surgeons of England
(https://www.rcseng.ac.uk/fds/publications-clinical-
guidelines/clinical_guidelines/documents/SSCs.pdf):
• Retrospective studies have shown stainless steel crowns to have markedly
superior longevity when compared to multisurface restorations.
• Prospective studies have shown higher success rate for stainless steel crown
as compared to amalgam restorations for large carious lesions.
• Pulp therapy in primary molars has been shown to be more successful
where the definitive restoration was stainless steel crown.
• Prefabricated crowns with esthetic facings have been shown to be prone to
fracture in vitro.
• Prefabricated crowns with esthetic facing have been shown to be bulkier,
resulting in poorer ginigval health and have shown chipping off of the facing.
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

23. RECOMMENDATIONS
According to a publication by American Academy of Pediatric
Dentistry (http://www.aapd.org/assets/1/7/G_Restorative.pdf):
• Children at high risk exhibiting anterior tooth caries and/or molar
caries may be treated with SSCs to protect the remaining at risk tooth
surfaces.
• Children with extensive decay, large lesions, or multiple-surface
lesions in primary molars should be treated with SSCs.
• Strong consideration should be given to the use of SSCs in children
who require general anesthesia.
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University

24. REFERENCES
•American Academy of Paediatric Dentistry. [Online].; 2014 [cited 2015 May
30. Available from:
http://www.aapd.org/media/Policies_Guidelines/G_Restorative.pdf.
•Royal College of Surgeons of England. [Online].; 2007 [cited 2015 May 31.
Available from: https://www.rcseng.ac.uk/fds/publications-clinical-
guidelines/clinical_guidelines/documents/SSCs.pdf.
•Welbury R, Duggal M, Hosey M. Paediatric Dentistry. 4th ed. Oxford:
Oxford University Press; 2012.
•Koch G, Poulsen S. Paediatric Dentistry: A Clinical Approach. 2nd ed.:
Wiley Blackwell; 2009.
Sumaiya Hasan
MDS Trainee (Operative Dentistry)
Dow University