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PRESENTED BY,
SINU JAYAPRAKASH
PG STUDENT
DEPT OF PEDIATRIC & PREVENTIVE
DENTISTRY
STAIN LESS STEEL CROWNS,
CONTENTS
.INTRODUCTION
.DEFINITION
.CLASSIFICATION
.Indications and contra indication
armamentarium
.modification
.Clinica...
INTRODUCTION
In the last half century ,the emphasis on treatment of extensively decayed
primary teeth ( common pediatric d...
STAIN LESS STEEL CROWNS
ROCKY MOUNTAIN
COMPANY
1947
INTRODUCED TO PEDIATRIC
DENTISTRY BY
HUMPHREY & ENGEL
1950
1968-Mink a...
DEFINITION
Stainless steel crowns can be defined as the
prefabricated crown forms that are adapted to the
individual teeth...
ACCORDING TO TRIMMING
UNTRIMMED
CROWNS
Not trimmed
not contoured
require lot of
adaptation ,
time consuming.
Eg.THE ROCKY
...
ACCORDING TO
COMPOSITION
STAIN LESS STEEL
CROWNS -18-8 austenitic
stainless steel (67%
fe,18%cr,8% ni)
NICKEL-CHROMIUM
CRO...
ACCORDING TO
COMPANY
ACCORDING TO
OCCLUSAL ANATOMY
The Rocky Mountains
Unitek
3M
Iconel
Nusmile
Ion –compact occlusal
anat...
RESTORATION OF PRIMARY &
YOUNG PERMANENT TEETH WITH
EXTENSIVE CARIOUS TEETH
RESTORATION OF HYPOPLASTIC
PRIMARY & PERMANENT...
RESTORATION OF TEETH WITH HEREDITARY
ANOMALIES SUCH AS –DENTINOGENESIS
IMPERFECTA ,AMELOGENESIS IMPERFECTA
RESTORATIONS IN...
1. Close to exfoliation
2. Clinical or radiographical evidence of radicular pathology
3. Excessive mobility
4. nickel alle...
ARMAMENTARIUM
Burs and stones
Burs no 169L or no 69L
Tapered diamond
Green stone or heatless stone
Rubber wheel
Pliers/instruments
Ball-and-socket plier { #112} or Johnson’s Contouring pliers{# 114 /
# 134}
Crown crimping plier {# 800...
CLINICAL PROCEDURE
A) Evaluate pre-operative occlusion
B) Administer LA
C) Place rubber dam
D) Crown selection
E) Tooth pr...
1.PRE-OPERATIVE EVALUATION
Diagnostic casts
Midline
Cusp fossa relationship bilaterally
Canine relation
Extrusion of oppos...
4.CROWN SELECTION
3 main considerations :
Mesiodistal diameter
Light resistance to seating
Proper occlusal height
Before p...
TOOTH PREPARATION
Aim of tooth preparation :
To provide sufficient space for SSC
To remove complete caries
To have suffici...
Evaluation of occlusal reduction
Forrester 1981 : Wax sheet
Visual examination
Mathewson : Use of explorer
PROXIMAL REDUCTION
Wooden wedge inter proximally
69L or 169L bur moved buccolingually
Begin at the marginal ridge & hold t...
Do not overtaper
Feather edge finish line-without any shoulder or ledge.
BUCCAL & LINGUAL REDUCTION
Natural undercuts : retention
Mathewson 1974, Andlow & Rock 1984, Mink & Bennet 1968:
Large buc...
CROWN ADAPTATION
Try crown on tooth : lingual to buccal
Mark scratch line
Cut 1 mm below it with scissors
Place the crown ...
CROWN CONTOURING
Gingival Contours
Buccal gingival contour of E : Smile
Buccal gingival contour of D : Stretch out ‘S’
Pro...
CROWN CRIMPING
Inward movement of margins
Crown crimping plier No.417
After crimping
Snap into position with firm finger p...
FINAL TRIAL
Resistance in seating without blanching
Check for ledges
Resistance to seating with blanching
CROWN FINISHING ...
CROWN CEMENTATION
Crown & tooth has to be cleaned
Vital tooth : cavity varnish {Meyers 1983}
Cements :
ZnOE
Polycarboxylat...
CROWN CEMENTATION
1. Place 2 X 2” gauze posteriorly to tooth
2.Tooth & crown cleaned
3. Isolation mandatory
4. Apply vasel...
CLINICAL MODIFICATIONS
Adjacent S.S.C
Adjacent S.S.C with amalgam restoration
Adjacent S.S.C with arch length loss
Undersi...
UNDERSIZED TOOTH/OVERSIZED CROWN (MINK & HILL,1971)
Due to longstanding mesial & distal caries
1.V cut made on buccal surf...
DEEP SUBGINGIVAL CARIES
ROUTINE
CROWN
PREPARATION
BANDS
AMALGAM/GIC
RESTORATION
SUBSTITUTE THE
TOOTH
STRUCTURE
SOLDER AN
E...
CAUSES OF S.S.C FAILURES
Inadequate tooth reduction
Inadequate crown contouring & crimping
Inappropriate established occlu...
COMMON ERRORS
Lack of feather edge
Failure to round all line angles
Incorrect crown size
Excessive reduction of tooth
Ledg...
stainless steel crown
stainless steel crown
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stainless steel crown

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stainless steel crown

  1. 1. PRESENTED BY, SINU JAYAPRAKASH PG STUDENT DEPT OF PEDIATRIC & PREVENTIVE DENTISTRY STAIN LESS STEEL CROWNS,
  2. 2. CONTENTS .INTRODUCTION .DEFINITION .CLASSIFICATION .Indications and contra indication armamentarium .modification .Clinical procedure .CONCLUSION .REFERENCES
  3. 3. INTRODUCTION In the last half century ,the emphasis on treatment of extensively decayed primary teeth ( common pediatric dental problems ) shifted from extraction to restoration . Although ssc has ben used since 30 years very less significant research was done in this field.
  4. 4. STAIN LESS STEEL CROWNS ROCKY MOUNTAIN COMPANY 1947 INTRODUCED TO PEDIATRIC DENTISTRY BY HUMPHREY & ENGEL 1950 1968-Mink and Bennett –initial crown preparation 1960s - significantly improved crown (Unitek) 5
  5. 5. DEFINITION Stainless steel crowns can be defined as the prefabricated crown forms that are adapted to the individual teeth and cemented with a biocompatible luting material
  6. 6. ACCORDING TO TRIMMING UNTRIMMED CROWNS Not trimmed not contoured require lot of adaptation , time consuming. Eg.THE ROCKY MOUNTAINS PRETRIMMED CROWNS straight,non - contoured sides festooned Eg,Unitek ,3M Co. and Denovo crowns PRECONTOURED CROWNS festooned precontoured though a minimal amount of festooning and trimming may be necessary . Eg,Ni-Chro Ion crowns,Unitek stainless steel crowns,3M Co.
  7. 7. ACCORDING TO COMPOSITION STAIN LESS STEEL CROWNS -18-8 austenitic stainless steel (67% fe,18%cr,8% ni) NICKEL-CHROMIUM CROWNS –Nickel chrome alloy(70%ni,15%cr,10%fe) ACCORDING TO POSITION CROWNS FOR POSTERIOR TEETH CROWNS FOR ANTERIOR TEETH
  8. 8. ACCORDING TO COMPANY ACCORDING TO OCCLUSAL ANATOMY The Rocky Mountains Unitek 3M Iconel Nusmile Ion –compact occlusal anatomy Unitek –best occlusal anatomy Rocky Mountains – occlusally small Ormco-smallest & least occlusally carved.
  9. 9. RESTORATION OF PRIMARY & YOUNG PERMANENT TEETH WITH EXTENSIVE CARIOUS TEETH RESTORATION OF HYPOPLASTIC PRIMARY & PERMANENT TEETH RESTORATION OF PRIMARY TEETH FOLLOWING PULPOTOMY OR PULPECTOMY PROCEDURES INDICATIONS
  10. 10. RESTORATION OF TEETH WITH HEREDITARY ANOMALIES SUCH AS –DENTINOGENESIS IMPERFECTA ,AMELOGENESIS IMPERFECTA RESTORATIONS IN DISABLED INDIVIDUALS OR OTHERS IN WHOM ORAL HYGIENE IS EXTREMELY POOR AND FAILURE OF OTHER MATERIALS IS LIKELY AS AN ABUTMENT FOR SPACE MAINTAINERS OR PROSTHETIC APPLIANCES
  11. 11. 1. Close to exfoliation 2. Clinical or radiographical evidence of radicular pathology 3. Excessive mobility 4. nickel allergy or sensitivity 5. Partially erupted teeth 6. Esthetically unappealing 7. Where conservative restorations can be placed 8. More than half the roots resorbed CONTRAINDICATIONS
  12. 12. ARMAMENTARIUM Burs and stones Burs no 169L or no 69L Tapered diamond Green stone or heatless stone Rubber wheel
  13. 13. Pliers/instruments Ball-and-socket plier { #112} or Johnson’s Contouring pliers{# 114 / # 134} Crown crimping plier {# 800-417} Howe plier { #110 } Crown remover Crown scissors
  14. 14. CLINICAL PROCEDURE A) Evaluate pre-operative occlusion B) Administer LA C) Place rubber dam D) Crown selection E) Tooth preparation F) Evaluation of tooth preparation G) Crown adaptation H) Crown finishing & polishing I) Crown cementation J) Post operative instructions
  15. 15. 1.PRE-OPERATIVE EVALUATION Diagnostic casts Midline Cusp fossa relationship bilaterally Canine relation Extrusion of opposing tooth 2.LA ADMINISTRATION To reduce the discomfort during subgingival preparation 3.RUBBER DAM PLACEMENT Protect surrounding tissues Visibility Improve efficiency
  16. 16. 4.CROWN SELECTION 3 main considerations : Mesiodistal diameter Light resistance to seating Proper occlusal height Before preparation : Boley gauge After preparation : trial & error Smallest crown selected Friction to be felt when crown slips gingivally
  17. 17. TOOTH PREPARATION Aim of tooth preparation : To provide sufficient space for SSC To remove complete caries To have sufficient tooth for retention of crown OCCLUSAL REDUCTION * Humphery 1950 • All sides reduced • Retain crown structure * Rapp 1966 • Occlusal reduction to keep atleast 4 mm from gingival margin * Mink & Bennett 1968 • Uniform occlusal reduction 1- 1.5 mm • *Troutman . 1mm *Kennedy. 1.5 to 2mm
  18. 18. Evaluation of occlusal reduction Forrester 1981 : Wax sheet Visual examination Mathewson : Use of explorer
  19. 19. PROXIMAL REDUCTION Wooden wedge inter proximally 69L or 169L bur moved buccolingually Begin at the marginal ridge & hold the bur slightly at an angle to the long axis of tooth and extend the slice to buccal & lingual line angles giving 2-5 degree taper
  20. 20. Do not overtaper Feather edge finish line-without any shoulder or ledge.
  21. 21. BUCCAL & LINGUAL REDUCTION Natural undercuts : retention Mathewson 1974, Andlow & Rock 1984, Mink & Bennet 1968: Large buccal bulge : buccal reduction required no reducation required :Pinkham
  22. 22. CROWN ADAPTATION Try crown on tooth : lingual to buccal Mark scratch line Cut 1 mm below it with scissors Place the crown again : If blanching seen : rescribe & retrim If doesn’t seat completely : reduce occlusal surface
  23. 23. CROWN CONTOURING Gingival Contours Buccal gingival contour of E : Smile Buccal gingival contour of D : Stretch out ‘S’ Proximal contour of primary molars : Frown Lingual contours of all molars : Smile Contouring pliers used : # 112 Ball & Socket Plier #137 Gordan plier # 114 Johnson plier Used for initial contouring in middle third : Belling effect
  24. 24. CROWN CRIMPING Inward movement of margins Crown crimping plier No.417 After crimping Snap into position with firm finger pressure Mechanical retention Protection of cement from exposure to oral fluids Maintenance of gingival health
  25. 25. FINAL TRIAL Resistance in seating without blanching Check for ledges Resistance to seating with blanching CROWN FINISHING & POLISHING Unpolished : plaque & gingivitis Large green stone : Knife edge finish cervically Rubber wheel : to smoothen the margins Wire brush : to polish entire crown Rouge : to give fine lusture
  26. 26. CROWN CEMENTATION Crown & tooth has to be cleaned Vital tooth : cavity varnish {Meyers 1983} Cements : ZnOE Polycarboxylate ZnPO4 GIC Reinforced ZOE Silicophosphate Most commonly used : GIC
  27. 27. CROWN CEMENTATION 1. Place 2 X 2” gauze posteriorly to tooth 2.Tooth & crown cleaned 3. Isolation mandatory 4. Apply vaseline to contact areas 5. Mix luting cement till 1 ½” strings are formed 6. Place the cement in crown to fill approx 2/3rd 7. All inner surfaces covered with cement 8.Seat crown from lingual to buccal 9.Cement should be expressed out from sides 10. Ask to chew in centric occlusion 11. Excess cement removed with scaler or explorer 12. Floss moved buccolingually 13. Support the mandible during the procedure
  28. 28. CLINICAL MODIFICATIONS Adjacent S.S.C Adjacent S.S.C with amalgam restoration Adjacent S.S.C with arch length loss Undersized tooth / oversized crown Oversized tooth / Undersized crown Deep subgingival caries Open contacts
  29. 29. UNDERSIZED TOOTH/OVERSIZED CROWN (MINK & HILL,1971) Due to longstanding mesial & distal caries 1.V cut made on buccal surface from gingival to occlusal surface 2.Cut edges reapproximated to overlap one another 3.Crown tried on tooth & amount of overlap necessary marked 4. Overlapped edges spot welded
  30. 30. DEEP SUBGINGIVAL CARIES ROUTINE CROWN PREPARATION BANDS AMALGAM/GIC RESTORATION SUBSTITUTE THE TOOTH STRUCTURE SOLDER AN EXTENSION ON INTERPROXIMAL AREA OF CROWN
  31. 31. CAUSES OF S.S.C FAILURES Inadequate tooth reduction Inadequate crown contouring & crimping Inappropriate established occlusion Inappropriate cementation Pulp treatment failure Recurrent caries : improper contact Crown abrasion : occlusal surface
  32. 32. COMMON ERRORS Lack of feather edge Failure to round all line angles Incorrect crown size Excessive reduction of tooth Ledges formation

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