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1. CONTENTS
1. STAINLESS STEEL
2. INTRODUCTION TO STAINLESS STEEL CROWN
3. INDICATION
4. FACTORS TO BE CONSIDERED IN PRE-OPERATIVE
EVALUATION
5. TOOTH PREPERATION
6. CROWN ADAPTATION
7. COMPLICATIONS.
STAINLESS STEEL CROWN
When 12.30% of chromium is added to steel containing 1.2% carbon alloy called
stanless steel.
COMPONENTS
Chromium Nickel Carbon
Ferritic 11.5-26% 0% 0-20%
Martensitic 16-26% 7-22% 0-25%
Austenitic 11.5-12% 0-25% 0.5-1.25%
PROPERTIES:
1. Resistts furnish and corrosive because of fascinating effect chromium.
2. A thin, transparent yet tough and in porous adherence layer of G2O3
forms on the surface of stainless steel when exposed to oxidizing
atmosphere.
3. If oxide layer ruptures by mechanical or chemical agents a temporary loss
of protection against carosin occurs.
The stainless steel crown, developed for use in pediatric dentistry in the early 1950’s has
helped ro solve the problem of the extensively carious tooth.Because of the alarming rate
of failure of class II amalgam restorations in the primary molars, particularly the pediatric
dentist has used the stainless steel crowns as a certain treatment in selected cases. The
crown is prefabricated in a variety of sizes for each tooth. Tooth preparation precedes the
fitting contouring if necessary and cementation all at one appointment.
INTRODUCTION
Stainless steel crown:
It is a semi-permanent restoration used in the primary and young permanent teeth.
It was introduced as chrome stel crown by Humhry in 1950, which proved to be a
fovaour to the pediatric dental practice.
Stainless steel crown is more frequently found in deciduous dentition than in
permanent dentition.
1. In small deciduous teeth neglected caries can destroy tooth’s integrity
faster than in the larger teeth of permanent teeth.
2. The deciduous teeth pulp is larger than permanent pulp in relation to it
dentin and enamel envelop. Thus it is difficult to make the dentinal stump
for a gold casting or to use a pin system of retention for more extensive
amalgam restoration.
ADVANTAGES;
 The most advantageous system of restoration because of its retention and
resistance.

2.  They are acceptable to both the patient and the dentist.
 They are also more cost effective because of comparatively simple procedures
involved in restorating even severely affected primry molars.
 OBJECTIVES:
 To achieve biologically compatible, masticatory compotent and clinically
acceptable restoration.
 To maintain the form and function and where possible, the vitality of tooth should
be maintained
COMPOSITION.
Stainless steel crowns (18-8) /austantic type of alloy is used.
17-19% chromium
10-13% nickel
67% iron
4% ninor elements.
NICKEL BASED BASE CROWNS
72% nickel
14% chromium
6-10% Fe
0.04% carbon
0.35% manganese
0.2% silicon
INDICATIONS
1. Extensive decay in primary teet
 A crown is indicated whenever one or more cusps are destroyed or
weakened by caries. This commonly occurs in the 1st
primary molr
when the distal interproximal lesions is not treated early when decayed
it involves whole of broad, flat contact area, the disto lingual and
distobuccal cusps or both weakened. AZttempts at a Class II cavity
preparation would result in proximal bone whose buccal and lingual
walls flare amrked by towards the embrasure, this would encourage
failure of the amalgam at these margins.
When a primary tooth can be expected to enfoliate within a year of
restorationHowever parent child and operator may all be frustrated by the
failure of extensive amalgam restorations in primary teeth. The
experience clinician can place stainless steel crown faster than a three
surface amalgam alloy restoration and so disadvantage of additional time
is overcome.
2. Following pulp therapy: In both primary and permanent teeth, pulp
therapy leaves the treted teeth more brittle. That the tooth structure might
subsequently fracture has led to the accepted wisdom of cuspal coverage
after endodontics in permanent teeth. This should also apply to primary
teeth. Post operative fgailure be prcvented by placing a stainless steel
crown in first place. A tooth that is a candidate for pulp therapy will
probably also be a candidate for a crown.
3. As a preventive restoration- If the patient has a high susceptibility to caries
manifestating it either by numerous gross carious lesions or by rampant

3. caries and in a handicapped child whose luck of oral hygiene may
encourage further dcay. Evidence of a developing Class V lesion is a sign
of lapse in dietary and oral hygiene habits. When this occurs in the
preschool child. Who also has a Class II lesion in the same tooth. The
stainless steel crown should be considered .
4. For teeth developmental defects: Linear hypoplastic defects can
undermine the occlusal surface of first primary molars if the etilogical
systemic upset occurred at or around birth. Similarly amalfenesis and
dentinogenesis impefecta can alter tooth morphology and predispose the
dentition to excessive wear and loss of the vertical dimension. Hypoplastic
and hypocalcified defects on the teeth may be more susceptible to caries if
the anatomy encourages plaque retention although this does not always
occur. In placements of stainless steel crown on hypoplastic teeth
treatment may involve crowing of teeth in all four quadrants. Thus there is
a danger of altering the vertical dimension by impinging on the free way
space. So the crown should be fitted quadrant wise.
FACTORS TO BE CONSIDERED IN PRE OPERATVE EVALUATION
Dental age of the patient.
 This is recrded by the root development of the underlying tooth. When
the primary tooth can be expected to enfoliate within 2 years of
restoration, amalgam restoration in the primary teeth can be
frustrating.
 Co-operation of the patient: If the patient is un co-operative whether it
is due to age or due to megative behaviour of child is strubbarn and
does not want to co-operative because of age a chair side GA amy
have to be considered.
 Motivation of parents: whether the patents are willing to come for
dental dental visits for the follow up.
TOOTH PREPERATION
ANTERIOR:
With the development of the acid etch retained composite strip crown, the indications
for anterior steel crowns have fallen markedly. Although stainless steel crowns are
very functional and long lasting . Their appearance provide a great carrier to their
acceptance by both patients and parents.The aims of tooth reduction are to provide
sufficient space for the steel crown, remove the caries and leave. The sufficient tooth
substance for creation of the crown. Mesial and distal reductions are required to clear
the interproximal contacts. The anterior steel crown can be closed, or open faced for
better aesthetics. In this latter existence of the crown should be fitted up to the point
of cementation before its labial surface is finally removed.
POSTERIOR:The aims of tooth reduction are the same as the described for the
anterior crowns and reduction is accomplished using a N0.699 tapered fissure, turbine
bur throught. The steps in its placement are described n the following sub sections.
CARIES REMOVAL
This is best accomplished before the main preparation for the crown lesions. If the
pulp thrapy is subsequently required , it will not be compromised by the gingival

4. bleeding that might result from the crown preparation,A temporary dressing is easier
to place into a class I and II cavity than over a tooth prepared for a crown.
OCCLUSAL REDUCTION
This should approximately follow the anatomy of the tooth to a depth of 1.0 – 1.5
mm, which allows sufficient space for the metal crown. It maintains the original
contour of the cusps. Reduction of occlusal surface can be judged by comparision
with the marginal ridges of the adjacent teeth.
PROXIMAL SLICES
We have to place the wooden wedges in the interproximal embrasures. The
wedges separate the adjacent teeth, thus minimizing the risk of damaging the tooth
enamel. The bur is moved across the proximal surface ,beginning at the marginal
ridges and at angle slightly convergent to occlusal surface. Preperation should be
taken gingivally for enough to avoid the development of the ridge, which would make
it difficult to seat the crown properly . because of cervical constriction of the primary
tooth, adequate depth of the proximal preparation will result in a feather edge finish
line.
DISTAL REDUCTION UNDER RUBBER DAM.
As preparation of a second primary molar is being carried out under rubber dam
it may be that this tooth also being clamped. Therefore a problem arises when the
distal proximal slice needs to be made without snagging the rubber dam in the
bur.This can be dealt with by simply pushing the rubber away from distal tooth
surfacewith a large flat-plastic instrument.
BUCCO-LINGUAL REDUCTION
Reduction of the buccal and lingual surface is either unnecessary or very minimal.
Natural undercuts of these surfaces assists the retention of stainless steel crown.
FINISHING
Any remaining caries should be removed with a slow running round bur. The
preparation is completed by leveling the eternal line angles around the occlusal part
and where the proximal reduction meets the buccal and lingual surfaces. This will
ensure proper seating of the stainless steel crown whose internal contour s is force
from sharp angles. When caries has been removed and a Pulpotomy or Pulpectomy
has not been completed, then pulp protection is required. Therefore, after final caries
removal, a suitable protective base should be placed. The tooth is now ready for trial
fitting of the crown.
CROWN ADAPTATION
SEATING THE CROWN
Now the crown is tried on the preparation of acting the lingual first and applying
pressure in a buccal direction so that the crown slides over the buccal surface into the
gingival sulcus. Resistance should be felt as the crown slip over the buccal bulge.
Each time the crown is placed on the tooth, gingival tissue should be carefully
examined. They should meet compress and produce blanching of the marginal
gingival tissue.
CROWN CONTOURING
Initial crown contouring is performed with a 114 plier in the middle 1/3rd
of the
crown to produce a belling effect. This will give the crown a more even curvature.

5. Contouring of proximal metal surface is not done with these pliers as they are already
in contact with the adjacent teeth.
FINISHING AND POLISHING
Accumulation of the plaque and inflammation of gingiva is commonly seen in
practice of restorative dentistry due to rough and unpolished restoration. To avoid
these compications the crown should be polished prior to cementation with a cubber
wheel to remove all scratches.
PROCEDURE OF POLISHING
While polishing the crown, margin should be blunt since knife edge finish
produces sharp ends which act as areas of plaque retention. A broad stone wheel
should run slowly in light brushing strokes, across the margins towards the centre of
the crown. This will draw the metal close to the tooth without reducing the crown
height and thus improves the adaptation of crown.
CEMENTATION
It should be cemented only on clean dry tooth. Isolation of tooth with cotton rolls
is recommended.
 Rinse the dry the crown inside and outside and prepare to cement it.
ZnPO4 or GIC is preferred.
 If Zn PO4 is used 2 coats of cavity varnish should be applied on vital
tooth before cementation and cement should be of consistency so that
it strings from mixing pad with the spatula.
 Seat the crown completely on dried tooth surface preparation. Final
placement should follow an established path of insertion of the crown.
Cement should be expressed around all margins.
 Before the cement sets, ask the patient to close into centric occlusion
by applying pressure through a cotton roll and confirm that the
occlusion has not been altered.
COMPLICATIONS
a) Inter proximal ridge: Incorrect angultion of the tapered fissure bur can
produce a ridge instead of shoulder-free interproximal slice. further

6. Contouring of proximal metal surface is not done with these pliers as they are already
in contact with the adjacent teeth.
FINISHING AND POLISHING
Accumulation of the plaque and inflammation of gingiva is commonly seen in
practice of restorative dentistry due to rough and unpolished restoration. To avoid
these compications the crown should be polished prior to cementation with a cubber
wheel to remove all scratches.
PROCEDURE OF POLISHING
While polishing the crown, margin should be blunt since knife edge finish
produces sharp ends which act as areas of plaque retention. A broad stone wheel
should run slowly in light brushing strokes, across the margins towards the centre of
the crown. This will draw the metal close to the tooth without reducing the crown
height and thus improves the adaptation of crown.
CEMENTATION
It should be cemented only on clean dry tooth. Isolation of tooth with cotton rolls
is recommended.
 Rinse the dry the crown inside and outside and prepare to cement it.
ZnPO4 or GIC is preferred.
 If Zn PO4 is used 2 coats of cavity varnish should be applied on vital
tooth before cementation and cement should be of consistency so that
it strings from mixing pad with the spatula.
 Seat the crown completely on dried tooth surface preparation. Final
placement should follow an established path of insertion of the crown.
Cement should be expressed around all margins.
 Before the cement sets, ask the patient to close into centric occlusion
by applying pressure through a cotton roll and confirm that the
occlusion has not been altered.
COMPLICATIONS
a) Inter proximal ridge: Incorrect angultion of the tapered fissure bur can
produce a ridge instead of shoulder-free interproximal slice. further