Download The use of stainless steel crowns in primary teeth

College of DentistryDivision of Pediatric Dentistry
UKCD PDO 822
The use of preformed stainless steel
crowns in primary molars
June 8, 2016
Enrique Bimstein
Professor of Pediatric Dentistry
The use of SSC on primary molars
Goal:
You will acquire the basic
knowledge required for the
tooth preparation, adaptation
and cementation of primary
molar preformed stainless
steel crowns.
Topics
1. Introduction:
crown types, definitions, rationale,
indications and contraindications.
2. Characteristics, advantages and
disadvantages.
3. Clinical procedures:
tooth preparation, crown adaptation
and cementation.
4. Summary and conclusions.
Crown types for primary teeth
Cast :
Stainless steel:
Strip crowns
Zirconia crowns
Lifelike™
CAD-CAM crowns
Gold crowns
occlusal anatomy
trimmed
contoured
pre-veneered
Composite
Prefabricated
Prefabricated
In-office
Stainless steel crowns
• SSCs are an
invaluable
restorative
material in the
treatment of
badly decayed
primary teeth.
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Definition of SSC
Full coverage
metallic ,
definitive
restoration for
primary teeth.
(Or temporary for
permanent teeth)
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Characteristics of SSC
Pre-veneered: metal with esthetic facing
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• Have a resin-composed facing bonded
to Occ. and B. surfaces.
• Expensive, require more tooth
reduction, and allow only for minimal
crimping.
• Relatively low success rate.
Pre-veneered: metal with esthetic facing
Long-term clinical
performance: at the 4
year evaluation all the
esthetic crowns
showed chipping of
the esthetic facing,
with poor esthetic
appearance.
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Ram D et al. Pediatr Dent 25:582-4, 2003
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Ceramic crowns - Zirconia
CAD-CAM
Definition of SSC
Is a metal shell
with preformed
anatomy that
can be adapted
to the tooth,
and still remain
elastic.
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Characteristics of SSC
Stainless steel crowns may
be:
With occlusal anatomy
Trimmed
Contoured
Crimped
Pre-veneered
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Unlock your mind and
snap the crown!
Characteristics of SSC
3M Stainless steel
Shape
ION Ni-Chro
Size
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3M Stainless steel
ION Ni-Chro
Length
Cervical
constriction/
contour
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Rationale for using a SSC
Perio health
# of visits
Time
Difficulty
Lab required
Cost
Esthetics
Good
Several
Hours
Difficult
Yes
Expensive
“Bad”
Good
One
Minutes
Easy
No
“Cheap”
“Bad”
Rationale for using a SSC
Stainless steel crowns
are used to restore
primary molars in which
the failure of an amalgam
or composite restoration
or recurrent caries is
clear in your mind.
Indications for using a SSC
Extensive caries destruction.
An adequate
isthmus is
difficult to obtain
with a small
occlusal surface
a wide contact
and large pulp .
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Indications for using a SSC
No gingival floor possible for a
proximal – occlusal restoration
Indications for using a SSC
Early childhood caries
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Indications for using a SSC
Multi-surface restorations
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Indications for using a SSC
Failure before the age of 8 years
1st primary
molar
One surface
70%
restorations
Two surface
75%
restorations
Stainless
12.8%
steel crowns
Dawson et al. ASDC J Dent Child 1981.
2nd primary
molar
32%
71.4%
11.0%
Indications for using a SSC
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Indications for using a SSC
After endodontic treatment
Pulpotomy
Pulpectomy
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Indications for using a SSC
Pulpotomized primary
molars can be successfully
restored with one surface
amalgam if their natural
exfoliation is expected within
not more than 2 years.
Holan et al. Success rate of formocresol pulpotomy in primary molars
restores with stainless steel crowns vs amalgam. Pediatr Dent 24:212, 2002.
Indications for using a SSC
Delopmental abnormalities
Enamel hypoplasia
Enamel hypoplasia and caries
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Indications for using a SSC
Compliance and behavior?
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Indications for using a SSC
Space maintainer
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As an abutment for space
maintainers or prosthetic
appliances.
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Indications for using a SSC
Fractured molars due to trauma
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Tejani Z, Johnson A, Mason C, Jane Goodman J. Multiple crown-root fractures in primary
molars and a suspected subcondylar fracture following trauma: a report of a case.
Dental Traumatology 2008; 24: 253–256.
Contraindications for SSC
Primary tooth close to exfoliation
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Contraindications for SSC
Extensive dental caries
there is not enough crown
structure left, caries located
to apical.
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Contraindications for SSC
No restorability due to
extreme mesial drift
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Contraindications for SSC
Esthetics.
Contraindications for SSC
Allergy to nickel
• Stainless steel crowns (Unitek and Rocky
Mountain) crowns composition consist of 1719% chromium, 9-13% nickel and 0.08-0.1
carbon.
• Nickel based crowns (Ion Ni-chro from 3M)
composition consists of 76% nickel, 8% iron,
0.04 carbon and 0.35% manganese.
MS Muthu- N Sivakumar. Pediatric Dentistry. Principles and practice. Elsevier 2009.
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Contraindications for SSC
Pazzini CA, Pereira LJ, Marques LS, Generoso R, de Oliveira G Jr.
Allergy to nickel in orthodontic patients: clinical and histopathologic
evaluation. Gen Dent. 2010 Jan-Feb;58(1):58-61
Kolokitha OE, Chatzistavrou E. A severe reaction to ni-containing
orthodontic appliances. Exposure to nickel-containing orthodontic
appliances may cause intra- or extraoral allergic reactions. Nickel is the
most typical antigen implicated in causing allergic contact dermatitis,
which is a Type IV delayed hypersensitivity immune response. Angle
Orthod. 2009 Jan;79(1):186-92
Bruce GJ, Hall WB. Nickel hypersensitivity-related periodontitis.
Compend Contin Educ Dent. 1995 Feb;16(2):178, 180-4; quiz 186
Ehrnrooth M, Kerosuo H. Face and neck dermatitis from a stainless
steel orthodontic appliance. Angle Orthod. 2009 Nov;79(6):1194-6
Clinical procedures for SSC
• Rationale.
• Tooth preparation.
• Crown selection.
• Crown adaptation.
• Complications.
• Cementation.
• Cleaning.
Rationale for SSC tooth
preparation and adaptation
a. do not require the retention
features that are incorporated in
cavity design of cast crowns.
b. The retention of SSC is based on
the flexibility and elasticity of
the thin, contoured and crimped
crown margins, and its
cementation.
Rationale for SSC tooth
preparation and adaptation
The tooth preparation and crown
adaptation of SSC in primary (and
permanent) molars is based (among
other) on the crown’s:
Flexibility: easily bent or shaped.
Elasticity: the tendency of a body to
return to its original shape after it
has been stretched.
Rationale for SSC tooth
preparation and adaptation
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• Preformed metal crowns are flexible and
elastic (they snap).
• The tooth cervical bulge is “surrounded”
by the crown.
Characteristics of SSC
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Rationale for SSC tooth
preparation and adaptation
Subgingival depth
≈ 1.5 mm
C. E. J.
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Clinical procedures for SSC
• Rationale
• Tooth preparation.
• Crown selection
• Crown adaptation.
• Complications.
• Cementation.
• Cleaning
Armamentarium for adaptation
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114 contour
plier
Crimping
plier
Sharp
scaler
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Round
scissors
Check Occlusion before
starting tooth reduction.
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Occlusal preparation (a)
Create a “channel” ± 1.25 mm deep
between the cusps (or use a football bur).
Occlusal preparation (a)
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Occlusal preparation (b)
Tooth preparation for SSC
• Buccal and lingual surfaces
a)Limited to occlusal 1/3 of the B
& L surfaces at a 45º bevel.
b)Round off all line angles.
c)A large mesio-buccal or
cervical bulge may require
more buccal and lingual
reduction.
Buccal and lingual reduction.
Prepare a slight bevel, at the occlusal 1/3
portion of the surface.
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Buccal and lingual reduction.
Prepare a slight bevel, at the occlusal 1/3
portion of the surface.
What’s next?
Caries removal
Pulp therapy (if required)
Proximal surfaces
Proximal surfaces
Caries removal
Pulp therapy (if required)
Caries removal
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Apply a liner or perform
pulp therapy if needed
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Tooth preparation for SSC
Proximal surfaces
a) 169L tapered fissure or thin tapered
diamond bur.
Tooth preparation for SSC
Proximal surfaces
a) 169L tapered fissure or thin tapered
diamond bur.
b) “Open ” the proximal contacts at
appropriate depth in single sweeping
motion (or gradually O G).
c) With slight convergence in an occlusal
and lingual/palatal direction.
d) Feather-edge finish line; common
error: ledge formation.
Proximal surfaces
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Proximal surfaces
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Rounding angles.
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SSC selection & adaptation
General considerations
a)Place or “seat crown” from
lingual to buccal.
b)Push crown over the buccal
buldge for a snap fit.
c)Check margins for close
cervical adaptation extending
1-1.5 mm subgingivally
(temporary gingival blanching possible).
Placing the crown
SSC selection & adaptation
Too small M-D
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SSC selection & adaptation
Too big M-D
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SSC selection & adaptation
Crowns which
are to big M-D
may prevent the
adequate
eruption of
adjacent
permanent
tooth.
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SSC selection & adaptation
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SSC selection & adaptation
Sharp scaler
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SSC selection & adaptation
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SSC selection & adaptation
• Crown and Bridge Scissors
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Additional crown adaptation
Polish the crown
with a heath less
stone.
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SSC selection & adaptation
114 Contouring Pliers
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SSC selection & adaptation
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SSC selection & adaptation
Crimping Pliers
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SSC selection & adaptation
Examine the occlusion.
The occlusion
should be the
same before
starting the
procedure.
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WARNING !
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WARNING !
Aspiration is possible
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Adewumi A. Kays DA. Stainless steel crown aspiration during
sedation in pediatric dentistry. Pediatr Dent 30:59-62, 2006.
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SSC Cementation and cleaning
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