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Stainless steel crowns in Pediatric Dentistry

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A crown is a tooth shaped covering which is cemented to the tooth structure & its main function is to protect the tooth structure & retain the function

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Stainless steel crowns in Pediatric Dentistry

  1. 1. “YOU HAVE FERRARI IN CARS, HARLEY DAVIDSON IN BIKES AND STAINLESS STEEL CROWNS IN PEDIATRIC DENTISTRY”
  2. 2. STAINLESS STEEL, POLYCARBONATE& RESIN VENEERED CROWNS
  3. 3. CONTENTS Introduction History Composition Classification Indications Contraindications Armamentarium used for placement Clinical procedure Modifications Common errors Esthetic crowns Relevant articles Conclusion References 3
  4. 4. STAINLESS STEEL CROWNS (SSCS)  A crown is a tooth shaped covering which is cemented to the tooth structure & its main function is to protect the tooth structure & retain the function 4
  5. 5. HISTORY  1950- Humphrey and Engel recommended stainless steel crowns  1968-Mink and Bennett encouraged familiar treatment modality  1960s - significantly improved crown (Unitek) 5
  6. 6. CLASSIFICATION: BASED ON COMPOSITION 1. Stainless Steel crown ( Unitek and Rocky Mountain crowns) 2. Nickel-Base crowns (Ion Ni-chro from 3M) 3. Tin –base crowns 4. Aluminum -base crowns
  7. 7. Composition Stainless steel crowns (18-8) austenitic type (Rocky mountain) • 17-19%chromium • 10-13% nickel • 67% iron • 4% minor elements Nickel base crowns (InConell 600 alloy) • 72% nickel • 14% chromium • 6-10% iron • 0.04% carbon • 0.35% manganese • 0.2% silicon 7
  8. 8. Chemical Composition of Two types of Crowns Expressed Manufactur er as Percentages Iron Chromium Nickel Carbon, Manganes e, Silicon Unitek 67 17 12 4 3M 10 16 72 2 Brook & King. Dent Update 9:25, 1985. 8
  9. 9. CLASSIFICATION: BASED ON MORPHOLOGY 1. Uncontoured/ untrimmed crowns (Unitek) 2. Pretrimmed crowns (Unitek stainless steel crowns,3M,De novo crowns) 3. Precontoured crowns( Ni-chro ion crowns and Unitek)
  10. 10. Classification 10 Untrimmed crowns (e.g. Rocky Mountain) • neither trimmed nor contoured • longer • lot of adaptation • time consuming Pre trimmed crowns (e.g. Unitek stainless steel crowns, 3M and Denovo crowns) • straight, non-contoured sides • but shorter • festooned • require contouring
  11. 11. Pre contoured crowns (e.g. Ni-Cr Ion crowns , Unitek stainless steel crowns,3M) • Festooned, Pre Contoured & Pre trimmed • minimal amount of adjustment necessary • more difficulty in adaptation since trimming will result in removal of manufacturers gingival crimp Preveneered SSC • Aesthetic posterior crowns • Resin based composite bonded to the buccal and occlusal surfaces • Allow only minimal crimping 11
  12. 12. AUSTENITIC V/S FERRITIC • Increased ductility and ability to be cold worked without fracturing • Strengthening during cold working • Greater ease of welding • Ability to overcome sensitization (> 6500C) 12
  13. 13. AVAILABILITY 3M Crown Shape Number of sizes Width range available mm Upper 1st primary molars 6 7.2 to 9.2 Upper 2nd primary molars 6 9.2 to 11.2 Lower 1st primary molars 6 7.3 to 9.3 Lower 2nd primary molars 6 9.4 to 11.4 Sizes 4 & 5 are most often used supplied in kit form with user needing to reorder only those sizes frequently used. 13
  14. 14. DENOVO Stainless Steel Crowns- Pretrimmed •1st Primary Molar Kit & 2nd Primary Molar Kit •Total of 56 Crowns (2 crown per size, 7 sizes per quadrant) •1st Permanent Molar Kit •Total of 64 Crowns (2 crowns per size, 8 sizes per quadrant) 14
  15. 15. 15
  16. 16. 16
  17. 17. 17
  18. 18. INDICATIONS 1.Restoration of carious primary molars where more than two surfaces are affected, or where one or two surface carious lesions are extensive. 2.If restoration is needed to last >2 yrs 18
  19. 19. 3. Child < 6yrs SS crown preferrable to restorations 4. Following pulpotomy or pulpectomy procedures. (Kindelan 2008) 19
  20. 20. 5.Localized or generalized developmental problems, e.g.:Enamel hypoplasia, Amelogenesis imperfecta, Dentinogenesis imperfecta 6. Restoration of fractured primary molars. 20
  21. 21. 7. Extensive tooth surface loss due to Eg : Attrition : Abrasion/erosion : Bruxism 8. In patients with a high caries susceptibility 9. As an abutment for certain appliances, such as space maintainers. 21
  22. 22. 10. In patients where routine oral hygiene measures are impaired. 11.In patients undergoing restorative care under general anaesthesia if two or more surfaces are involved 12. In patients with infra-occluded primary molars 13. Single tooth cross bite 22
  23. 23. 14. As an “emergency” measure to reduce the sensitivity of these teeth 15. For :temporary restoration of permanent teeth :fractured permanent anterior teeth and :young permanent molars following endodontic treatment. 16. Recurrent caries around existing restorations 23
  24. 24. CONTRAINDICATIONS 1. If the primary molar is close to exfoliation with more than half the roots resorbed or exfoliation within 6-12 months 2. Clinical or radiographical evidence of radicular pathology 3. Tooth exhibits excessive mobility 24
  25. 25. CONTRAINDICATIONS 4. Primary posterior teeth - conservative amalgam restorations can be placed 5. Partially erupted teeth 6. Esthetically unappealing 7. Where conservative restorations can be placed 25
  26. 26. CONTRAINDICATIONS 8. In a patient with a known nickel allergy or sensitivity -ESPE SSC consists of a chromium-nickel steel of surgical quality. - Incidence of Ni allergy due to orthodontic treatment 1 in 100 (Hensten& Petersen 1992) -Conventional SS crowns do not aggravate hypersensitivity (Janson 1998) 26
  27. 27. ARMAMENTARIUM Burs and stones  Burs no 169L OR no 69L F.G  Tapered diamond F.G.  No 6 or No 8 R.A  Green stone or heatless stone  Rubber wheel 27
  28. 28. ARMAMENTARIUM Pliers/instruments  Ball-and-socket plier { #112} or Johnson’s Contouring pliers{# 114 / # 134}  Crown crimping plier {# 800-417}  Howe plier { #110 }  No 137 Gordon pliers  Crown remover  Crown scissors 28
  29. 29. 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 29
  30. 30. PRE-OPERATIVE EVALUATION  Diagnostic casts  Midline  Cusp fossa relationship bilaterally  Canine relation  Extrusion of opposing tooth  Mesial drifting of adjacent teeth 30
  31. 31. LA ADMINISTRATION  To reduce the discomfort during subgingival preparation 31
  32. 32. RUBBER DAM PLACEMENT  To protect surrounding tissues  To improve visibility  To improve efficiency  To better manage the behaviour 32
  33. 33. CROWN SELECTION  3 main considerations :  Mesiodistal diameter  Light resistance to seating  Proper occlusal height 33
  34. 34. CROWN SELECTION  Before preparation : Boley gauge  After preparation : trial & error  Smallest crown selected  Friction to be felt when crown slips gingivally 34
  35. 35. TOOTH PREPARATION Aim of tooth preparation :  To provide sufficient space for SSC  To remove complete caries  To have sufficient tooth for retention of crown 35
  36. 36. OCCLUSAL REDUCTION 36 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 & Kennedy support it
  37. 37. OCCLUSAL REDUCTION 37
  38. 38. OCCLUSAL REDUCTION Evaluation of occlusal reduction  Forrester 1981 : Wax sheet  Visual examination  Mathewson : Use of explorer 38
  39. 39. OCCLUSAL REDUCTION Occlusal anatomy preservation  Crown retentive potential  Less chances of pulp exposure  Preservation of tooth structure 39 Maxillary molars Mandibular molars
  40. 40. PROXIMAL REDUCTION  Wooden wedge inter proximally  69L or 169L bur moved buccolingually  Begin at the marginal ridge & at 10 degree converging towards occlusal surface  Do not overtaper  Feather edge finish line 40
  41. 41. PROXIMAL REDUCTION 41
  42. 42. PROXIMAL REDUCTION  Contact with adjacent teeth must be broken gingivally & buccolingually.  Proximal slices converge slightly towards the occlusal & lingual (Meyers 1976) 42 Proper slice Improper slice
  43. 43. PROXIMAL REDUCTION  Proximal slice must be extended below gingival crest to avoid leaving a ledge  Ledge may cause:  Obstructed crown placement  Popping out of crown  Stress area 43
  44. 44. PROXIMAL REDUCTION  Evaluation :  Pass explorer through proximal areas  Broken contacts 44
  45. 45. CONTROVERSIES  Mathewson, Pinkham and Mink & Bennet :  First proximal reduction followed by occlusal  Stewart, Welbury, Forrester & Brocre :  First occlusal reduction followed by proximal 45
  46. 46. BUCCAL & LINGUAL REDUCTION  Natural undercuts : retention  Mathewson 1974, Andlow & Rock 1984, Mink & Bennet 1968:  Large buccal bulge : buccal reduction required 46
  47. 47. BUCCAL & LINGUAL REDUCTION  Pinkham :  Large mesiobuccal bulge : both buccal & lingual  Using Preveneered crown : both buccal & lingual 47
  48. 48. EVALUATION OF TOOTH PREPARATION  Occlusal clearance 1 – 2mm  Proximal slices converge towards occlusal & lingual  Explorer can be placed between the prepared tooth & proximal tooth 48
  49. 49. EVALUATION OF TOOTH PREPARATION  Buccal & Lingual surface if required reduced 0.5 mm with feather edge margin  Buccal & Lingual surface converge slightly towards the occlusal  All line & point angles rounded 49
  50. 50. CROWN SELECTION  Can be selected before or after crown preparation  Crown should have :  Tight snap fit  Restore original contour & occlusal anatomy  Choose smallest crown that well fits  Usually No 4 & No 5 sizes are commonly used. 50
  51. 51. THREE MAIN CONSIDERATIONS *A) -Adequate M-D width -Light resistance to seating -Proper occlusal height *B)Crown :larger : tooth to be adapted, especially when the gingival part of the crown is trimmed & crimped. *C)Too large crown will rotate on the tooth preparation.
  52. 52. 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 52
  53. 53. CROWN CONTURING  Gingival Contours  Buccal gingival contour of E : Smile  Buccal gingival contour of D : Stretchout ‘S’  Proximal contour of primary molars : Frown  Lingual contours of all molars : Smile 53
  54. 54. CROWN CONTOURING  Contouring pliers used :  # 112 Ball & Socket Plier  #137 Gordan plier  # 114 Johnson plier  Used for initial contouring in middle third : Belling effect 54
  55. 55. CROWN CRIMPING  Inward movement of margins  #137 Gordan plier  # 114 Johnson plier  Crown crimping plier  After crimping : Snap into position with firm finger pressure 55
  56. 56. CROWN CRIMPING  Evaluation :  Check with explorer  If margins open : recrimp  If overextended : start again  Blanching : Johnson 1987  Bitewing radiograph : More & Pink 1973 56
  57. 57. CROWN CRIMPING Tight fit of crown aids in:  Mechanical retention  Protection of cement from exposure to oral fluids  Maintenance of gingival health 57
  58. 58. FINAL TRIAL  Resistance in seating without blanching  Check for ledges  Resistance to seating with blanching  Crowns too wide  Crowns too long  Tissue caught in margin 58
  59. 59. CROWN FINISHING & POLISHING  If Unpolished : accumulation of 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 59
  60. 60. CROWN FINISHING & POLISHING  Burs shavings : spun inside of crown  Wheel run slowly : Light brush movements towards centre of crown  Allows metal closer to the tooth without reducing crown height 60
  61. 61. CROWN FIT  Spedding 1984: Principle 1  View from proximal surface : B-L surfaces converge occlusally  Any point above greatest diameter: visible  Any point below greatest diameter : not visible clinically 61
  62. 62. CROWN FIT Spedding 1984: Principle 2  Correct contours of buccal & lingual gingival margins of crown to gingival tissues  Margins apical to the greatest diameter : good adaptation 62
  63. 63. 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 63
  64. 64.  Mathewson (1979) : retention of S.S.Crown is due to cementing medium rather than due to mechanical adaptation.  Savide et al (1979) Conducted study to compare the retention capabilities in 5 different types of tooth preparation.  Concluded that non-cemented preparations demonstrated only little mechanical retention.  Following cementation : retention values increased.
  65. 65. CROWN CEMENTATION 65 Place 2 X 2” gauze posteriorly to tooth Tooth & crown cleaned Isolation mandatory Apply vaseline to contact areas Mix luiting cement till 1 ½” strings are formed
  66. 66. CROWN CEMENTATION 66 Place the cement in crown to fill approx 2/3rd All inner surfaces covered with cement Seat crown from lingual to buccal Cement should be expressed out from sides Ask to chew in centric occlusion
  67. 67. CROWN CEMENTATION 67 Excess cement removed with scaler or explorer Floss moved buccolingually Support the mandible during the procedure
  68. 68. CLINICAL EVALUATION OF CROWN CEMENTATION 1. The crown & its margins are smooth & polished 2. Properly adapted to the prepared tooth 3. The proximal contacts are established properly 68
  69. 69. CLINICAL EVALUATION OF CROWN CEMENTATION 4. Crown is in proper occlusion 5. Crown margins extended 0.5 -1mm into gingival crevice 6. Excess of cement is removed completely 69
  70. 70. RADIOGRAPHIC EVALUATION OF CROWN CEMENTATION  Crown margins should be adapted to proximmal surface  They should not be too long  Proximal contours are well reproduced 70
  71. 71. POST OPERATIVE INSTRUCTIONS  Atleast for 1 hour avoid :  Sticky foods like caramel, gum, toffes  Hard candies  Chewing on ice  Popcorn kernels  Any other hard substances 71
  72. 72. 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 72
  73. 73. ADJACENT S.S.C( NASH,1981) 73 Both placed at same time Posteriormost prepared 1st Then crown adjusted over it & fitted into occlusion Crown reduction of adjacent crown done For broad contacts : # 110 Howe’s plier used
  74. 74. ADJACENT S.S.C WITH AMALGAM RESTORATION 74 Crown preparation completed S.S.C adjusments made S.S.C removed & cavity preparation completed S.S.C placed & restoration done S.S.C cementation done
  75. 75. ADJACENT S.S.C WITH ARCH LENGTH LOSS(MC EVOY, 1977) 75 Crowns not prepared at same time More reduction in M-D dimension Flattening Mesial & Distal areas
  76. 76. UNDERSIZED TOOTH/OVERSIZED CROWN (MINK & HILL,1971)  Due to longstanding mesial & distal caries 76 V cut made on buccal surface from gingival to occlusal surface Cut edges reapproximate d to overlap one another Crown tried on tooth & amount of overlap necessary marked Overlapped edges spot welded &
  77. 77. UNDERSIZED TOOTH/OVERSIZED CROWN 77
  78. 78. OVERSIZED TOOTH/UNDERSIZED CROWN Try the crown on tooth Cut V on buccal or lingual side as needed Again Try crown on tooth Place ortho band and spot weld it 78
  79. 79. OVERSIZED TOOTH/UNDERSIZED CROWN  #114 plier : to adapt band  Scratch the band where it adapts to tooth  Reposition the scratch & band , spot weld, solder & finish it 79
  80. 80. OVERSIZED TOOTH/UNDERSIZED CROWN 80
  81. 81. DEEP SUBGINGIVAL CARIES 81 • Amalgam/GIC restoration substitute the tooth structure Routine crown preparation • Solder an extension on interproximal area of crown Band
  82. 82. OPEN CONTACT  Leads to food packing, plaque retention & gigivitis  Larger crown selected  Interproximal contour exagerated with #112 plier  Or addition of solder interproximally 82
  83. 83. 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 83
  84. 84. COMMON ERRORS  Lack of feather edge  Failure to round all line angles  Incorrect crown size  Excessive reduction of tooth  Ledges formation 84
  85. 85. GINGIVITIS Goto et al : 33% gingivitis  Crowns with defective margins / excessive cement retention : supra gingival plaque accumulation 85
  86. 86. GINGIVITIS  Durr et al and Checchio et al  Poor Oral hygiene  Improperly contoured S.S.C  Salma & Meyers  Reduced : careful polishing of crown margins 86
  87. 87. FULL CORONAL RESTORATION FOR ANTERIOR TEETH Indicated when: 1.Mulitsurface caries 2.Incisal edge is involved. 3.Extensive cervical decalification 4.Pulp therapy is indicated 5.High caries risk patient 6.Child behaviour makes moisture control diffiicult for class III restr’n.
  88. 88. PREFORMED AND HELD ON TO TOOTH BY LUTING CEMENT 1. S.S.Crowns 2. Facial cutout S.S.Crowns 3. Resin veneered S.S.Crowns 4.Polycarbonate crowns THOSE BONDED TO THE TOOTH 1.Strip crowns/Celluloid crowns 2.Pedo jacket crowns 3.New millenium crowns 4.Art Glass crowns
  89. 89. FACIAL CUT OUT S.S.C  Composite material on labial fenestration  Time consuming  Metal margins still visible  Difficult to control hemorrhage  Increased chairside time  Gradual deterioration in appearance 89
  90. 90. FACIAL CUT OUT S.S.C Technique :  Allow cement to set completely  Cut window- just short of incisal edge - gingivally till the height of gingival crest - mesiodistally till line angles 90
  91. 91. FACIAL CUT OUT S.S.C  Remove cement  undercuts at each margin with ½ no. round bur  GIC liner to mask color of tooth structure  Etching, bonding & composite placement  Polishing always from resin to metal-prevents metal particles from incorporating 91
  92. 92. VENEERED S.S.C Merits -decrease chair time & less moisture sensitive compared to strip crowns Disadvantages - include sterilization - high costs(5 to 8 times as much as a plain stainless steel crown or strip crown) - If the facing chips or breaks after placement, esthetic repair is difficult and usually requires replacement of the crown. 92
  93. 93. ARTGLASS  Multi-functional methacrylate matrix – 3 D molecular networks with a highly cross-linked structure  75% filler (55% microglass and 20% silicafiller)  Available in 6 sizes for every primary tooth A-T and every Vita shade 93
  94. 94. ARTGLASS Merits  One appointment placement  Provide greater durability and esthetics than strip crowns.  Easily adjusted or repaired intraorally  Color stable  Wear of polymer glass similar to enamel, kind to opposing dentition- feels natural to the patient 94
  95. 95. ARTGLASS Seating instructions :  Preparation similar to S.S.C with more reduction  Fits passively  Place artglass liquid for 1 min inside crown  Then place flowable composite in crown and then place on tooth  Finish with carbide bur 95
  96. 96. NUSMILE CROWNS  Specially Formulated Hybrid Composite Substructure  -2 Shades for Anterior Crowns(XL and NL); Posterior Crowns(XL only)  Centrals and Laterals sizes 1-6, Cuspids Sizes 0-6, 1st & 2nd Primary Molars Sizes 1-7 96
  97. 97.  Waggoner and Cohen [1995] reported Cheng Crowns Kinder Crowns NuSmile Primary Crowns have resin composite facings Whiter Biter Crown II has a flexible thermoplastic veneer.
  98. 98. NUSMILE CROWNS Merits  Single appointment  Easy placement technique  Reduces operatory time  Less technique sensitive 98
  99. 99. NUSMILE CROWNS Demerits  More tooth preparation due to their greater bulk.  Avoid crimping - facing susceptible to fracture, so the tooth is prepared to fit the most appropriate crown.  Single-use only-sterilization is recommended 99
  100. 100. NUSMILE CROWNS Selecting a Crown  approx 1-2 sizes smaller than the stainless steel  IMP in cases with: tight interproximal contacts, : crowded dentition/mesial-distal space loss.  Very short clinical crowns and crowded dentitions may not be ideal for beginning case selections. 100
  101. 101. Preparation of the Tooth  crown fits the tooth passively: flexing of metal substructure from pressure during fitting or seating can cause micro-fractures
  102. 102. NUSMILE CROWNS Anterior teeth  Reduce the incisal length of the tooth by approximately 2mm and open the interproximal contacts.  feather-edge margin  tapered diamond burs : proceed from coarse to fine as the preparation is completed. 102
  103. 103. NUSMILE CROWNS Posterior teeth:  The tooth should be reduced by approx 30%  More preparation : buccal and occlusal aspects (at least 2mm)  Crimping not necessary  Do not crimp excessively or near the facing  Minimally on lingual aspect of crown 103
  104. 104. CHENG CROWNS  Peter Cheng Orthodontic Laboratory-1987  anterior crowns faced with a high quality composite (mesh-based with a light cured composite.) 104
  105. 105. CHENG CROWNS Merits  chore of cutting windows in stainless steel crowns  completed in one patient visit (and with less patient discomfort)  natural looking  stain resistant  doesn’t cause wear of opposing teeth Demerits  fracture of veneers during crimping  expensive. 105
  106. 106. CHENG CROWNS 106 Anterior Crowns Centrals Laterals Cuspids left & right left & right sizes (1-6) sizes (1-6) upper& lower sizes (1-6) Posterior Crowns First primary molar Second primary molar upper and lower - left and right sizes (2-7) upper and lower - left and right sizes (2-7)
  107. 107. CHENG CROWNS 107
  108. 108. PEDO PEARLS  Heavy gauge aluminum crowns coated with FDA food grade powder coating and epoxy-resin. 108
  109. 109. PEDO PEARLS Merits  Universal anatomy-use on either side  Easy to cut and crimp, without chipping or peeling.  Non bulky & fits easily Disadvantages  less durability and the crowns are relatively soft  self-cured or dual-cured composite is recommended for repairing 109
  110. 110. DURA CROWNS  White-Faced Crowns  Crowns can be crimped labialy and lingually,  can be easily trimmed with crown scissors,  easily festooned and has got a full-knife edge  Starter Kit includes: 24 Crowns.  Centrals, left and right sizes 2,3,4 two of each.  Laterals, left and right sizes 3,4,5 two of each 110
  111. 111. KINDER KROWNS  1988 by pediatric dentists  natural shades and contour available  Great depth and vitality from the lifelike composite 111
  112. 112. PEDO JACKET  It is a tooth colored copolyester material which is filled with resin and left on tooth after polymerization instead of being removed.  Anterior crown jackets & primary 1st molar 112
  113. 113. PEDO JACKET Merits  It does not split, stain or crack.  Crowns can be easily trimmed with scissors.  Thin yet strong interproximal wall allows multiple adjacent restorations with a minimum amount of tooth reduction. 113
  114. 114. PEDO JACKET  Using a plastic primer, they can either be bonded into place with composite resin or cemented with a glass ionomer cement Demerits  Only one size is available. 114
  115. 115. NEW MILLENIUM CROWNS  This is similar in form to the pedo jacket and strip crown,  except that it is lab enhanced composite resin material.  Like others, this is also filled with resin material and bonded to the tooth
  116. 116. PEDO CHEMPU CROWNS  Sizes 2-4 Color : White Color stable, plaque resistant,  match natural pediatric shades.  Available for the right and left central and lateral as well as cuspids. Kit includes -centrals, left and right sizes 2,3,4 (2 of each) -laterals, left and right sizes 2,3,4 (2 of each) 116
  117. 117. POLYCARBONATE CROWNS  Provisional crown should be easy to adapt to the prepared tooth and easy to remove when needed.  Made of a polycarbonate resin incorporating microglass fibers 117
  118. 118. POLYCARBONATE CROWNS Merits  good durability and strength.  easy to trim with dental burs or crown scissors, and can then be easily adjusted with pliers  smooth surface finish  universal shade 118
  119. 119. POLYCARBONATE CROWNS Demerits  Do not resist strong abrasive forces thus leading to occasional fracture, hence it is contraindicated in cases of  Severe bruxism  deep bite  abrasion  crowding  decreased space between teeth 119
  120. 120. POLYCARBONATE CROWNS 120
  121. 121. STRIP CROWNS  Automatically contours restorative material to match the natural dentition  Thin interproximal walls  Sufficient strength for easy handling  Ideal for chemical or light-cured composites  Simple to fit & trim  Removal is fast & easy  Easily matches natural dentition 121
  122. 122. STRIP CROWNS  Leaves smooth shiny surface  Easy shade control with composite  Superior esthetic quality  Ideal for photo cure  Crystal clear and thin  Large selection of size  Easy to repair 122
  123. 123. STRIP CROWNS Demerits  technique sensitive  adequate tooth structure is required  moisture and hemorrhage control 123
  124. 124. STRIP CROWNS Contraindications  grossly decayed teeth with inadequate structure for retention  extensive caries with no intact enamel left  impinging deep overbite  presence of periodontal disease. 124
  125. 125. STRIP CROWNS STEPS  Cleaning  Select an appropriate crown form  Reduce the mesial and distal proximal surfaces 125
  126. 126. STRIP CROWNS Tooth Preparation  Reduce the incisal edge approximately 1 mm.  Remove all caries with a spoon excavator or a #4 round bur.  Trim crown with fine scissors & try it 126
  127. 127. STRIP CROWNS  Place a vent on the lingual surface of the crown on mesial & distal corner of incisal edge  Seat the filled crown form carefully 1 mm below the gingival margin after filling with composite  Remove excess soft composite resin 127
  128. 128. STRIP CROWNS  Remove the cellulloid sheet  Trim & polish if necessary 128
  129. 129. PUSH CROWNS "Hall technique”  Basis : If the environment of an actively cariogenic plaque biofilm can be altered, for example by sealing in the caries with a restoration and so isolating it from nutrients from the oral cavity, then the caries process could arrest.  No local anaesthesia needed  Useful for fearful children  Consider how long the tooth needs to be preserved in the mouth before exfoliating. Norna Hall 2009 129
  130. 130. Charles R, Jessica Y, Timothy W  Parental satisfaction high with pre-veneered crowns  High fracture rate & Loss of resin facing maximum Ped Dent 2001 130
  131. 131. Sean Beattie et al  Regardless of the type esthetic SSC are able to resist occlusal forces over a short clinical periods. J Cand Dent Assoc 2011 131
  132. 132.  Omar Meligy S.S.C might impede the exfoliation of primary molar Int J Ped Dent 2010 132
  133. 133. Champagne C, Waggoner W, Ditmer M  Parental satisfaction with preveneered SSC was more than only SSC Ped Dent 2008 133
  134. 134. A Khatri, B Nandlal, Srilatha 2007  Nano composite resin used along with sandblasted SSC had more shear bond strength than conventional composite resins. JISPPD 2007 134
  135. 135. Ari Kupietzky  Ultra-soft toothbrush  Curved crown scissors  Resin-modified glass-ionomer base/liner)  Resin composite restorative  Masking agent Pediatr Dent 2002 135
  136. 136. N Sue Seale  SSC is superior in durability & longevity to Class II amalgam in primary teeth Pediatr Dent 2002 136
  137. 137. W F Waggoner  Crown doesn’t matter for retention of preformed crowns  It depends upon technique & precision Eur Archives Pediatr Dent 2006 137
  138. 138.  Guelmann M  Compared Dura crowns, Kinder Krowns, NuSmile crowns & SSC for retention  Group I : crown only crimped {SSC most retentive}  Group II : crown only cemented {NuSmile least}  Group III : cemented & crimped : Kinder krowns most retentive Pediatr Dent 2003 138
  139. 139. Lee Y K  NuSmile crowns more resistant to # than Kinder Krowns & Cheng crowns  Kinder krowns had more facing loss Houston Biomed Research 2004 139
  140. 140. Yual Yilmaz  Polycarbonate crowns showed lowest tensile bond strength as compared to open face SSC & NuSmile crowns J Dent Child 2004 140
  141. 141. Dustin James  NuSmile crowns withstand higher loads than Kinder Krowns & Cheng crowns Pediatr Dent 2007 141
  142. 142. Monica Gupta  Veneer resistance to fracture was more with the crimped crowns than non-crimped crowns JISPPD 2008 142
  143. 143. Y Yilmaz, G Guter  Sterilization & disinfection results in crazing, contour alterations and vestibular surface changes of pre-veneered SSC.  Chemical disinfection in an ultrasonic bath is preferred for preveneered crowns JISPPD 2008 143
  144. 144. GT Wickersham  NuSmile crowns exhibited higher fracture resistance with chemiclav & autclav sterilization  Chemiclav sterilization caused negative color changes  Autoclav sterilization had no effect on fracture resistance & color changes Pediatr Dent 1998 144
  145. 145. CONCLUSION  Preservation of tooth for natural space maintainer  Esthetics  Phonetics  Mastication  Overall development of child 145
  146. 146. THANK YOU 146

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