The document discusses the use of stainless steel crowns in restorative pediatric dentistry, including their history, indications and contraindications, comparison to other restoration methods, and the Hall technique involving placement of stainless steel crowns. Stainless steel crowns provide durable restorations for primary teeth with extensive decay and have survival times over 40 months, making them an economical option despite initial higher costs compared to other materials like glass ionomer cement. Case examples are presented to illustrate when stainless steel crowns are suitable or not suitable for carious primary molars.
Inlays and onlays / implant dentistry course/ implant dentistry courseIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The cast metal restoration is versatile and is especially applicable to Class II onlay preparations. The process has many steps, involves many dental materials, and requires meticulous attention to prepration.
Tooth treatment planned to be restored with an intracoronal restoration, but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite, would not be able to sustain or bear forces.
Additionally, when decay or fracture incorporate areas of cusp or remaining tooth structure that undermines perimeter walls of a tooth, an onlay might be indicated.
Stainless steel crowns in Pediatric DentistryRajesh Bariker
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
Inlays and onlays / implant dentistry course/ implant dentistry courseIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The cast metal restoration is versatile and is especially applicable to Class II onlay preparations. The process has many steps, involves many dental materials, and requires meticulous attention to prepration.
Tooth treatment planned to be restored with an intracoronal restoration, but the decay or fracture is so extensive that a direct restoration, such as amalgam or composite, would not be able to sustain or bear forces.
Additionally, when decay or fracture incorporate areas of cusp or remaining tooth structure that undermines perimeter walls of a tooth, an onlay might be indicated.
Stainless steel crowns in Pediatric DentistryRajesh Bariker
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
A detailed presentation on the contemporary (presently preferred), conventional and potential modalities of caries diagnosis in the vast and developing world of dentistry.
This slide was prepared in conjunction with Dr. Janhavi Rajput & Dr. Ishaan Adhaulia.
Hope this presentation brings clarification and light to the detailed topic.
Prosthodontics seminar 3rd stage University of Anbar College Of Dentistry
Created By Mohammed Amer Hekma
Supervised by: Dr Osama Abdul Rasool Hammoodi
References
• FUNDAMENTALS OF REMOVABLE PARTIAL PROSTHODONTIC DESIGN by Kenneth R. McHenry, D.D.S., M.S and Terrence McLean, D.D.S.
• Stewart's Clinical Removable Partial Prosthodontics, Fourth Edition by Rodney D Phoenix, D.D.S, M.S, David R Cagna, D.M.D, M.S and Charles F DeFreest, D.D.S
• McCRACKEN’S REMOVABLE PARTIAL PROSTHODONTICS, TWELFTH EDITION BY Alan B. Carr, D.M.D, M.S, and David T. Brown, DDS, MS
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
A detailed presentation on the contemporary (presently preferred), conventional and potential modalities of caries diagnosis in the vast and developing world of dentistry.
This slide was prepared in conjunction with Dr. Janhavi Rajput & Dr. Ishaan Adhaulia.
Hope this presentation brings clarification and light to the detailed topic.
Prosthodontics seminar 3rd stage University of Anbar College Of Dentistry
Created By Mohammed Amer Hekma
Supervised by: Dr Osama Abdul Rasool Hammoodi
References
• FUNDAMENTALS OF REMOVABLE PARTIAL PROSTHODONTIC DESIGN by Kenneth R. McHenry, D.D.S., M.S and Terrence McLean, D.D.S.
• Stewart's Clinical Removable Partial Prosthodontics, Fourth Edition by Rodney D Phoenix, D.D.S, M.S, David R Cagna, D.M.D, M.S and Charles F DeFreest, D.D.S
• McCRACKEN’S REMOVABLE PARTIAL PROSTHODONTICS, TWELFTH EDITION BY Alan B. Carr, D.M.D, M.S, and David T. Brown, DDS, MS
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
A broad idea about Esthetic Crown objectives and their Indications along side with the drawbacks of SSC also the Classification of esthetic crowns plus the Pros and cons of each esthetic crown.
The presentation features the types, advantages, disadvantages, objectives, indications, contraindications, factors involved, clinical procedure, modifications and complications of Stainless Steel Crown.
Stainless steel crowns are prefabricated crown forms that are adapted to individual teeth and cemented with a biocompatible luting agent. “The SSC is extremely durable, relatively inexpensive, subject to minimal technique sensitivity during placement, and offers the advantage of full coronal coverage.”
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The pediatric dentistry in the restorative to the damaged tooth by the caries and the prevention for the further shedding and erupting of the permanent tooth.
Similar to Stainless steel crown for Paeododontics (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. WHEN YOU ARE PRESENTING TO YOUR FELLOW COLLEAGUES ,
IT IS SIMILAR FEELING TO STAND IN THE FIRING SQUAD
3. CONTENTS:
• Guide of restorations in Paediatric dentistry
• Classification of Paediatric crowns and types
• Stainless steel crown (SSC) as restorative treatment option
• Comparison with GIC, compomers resin modified GIC
restoration
• Alternative or Atraumatic Restorative Treatment (ART) and
Aspects of SSC
• History of SSC
• Case control studies about Hall Technique
• How SSC works in Hall Technique
• Indications and contraindications in pictures
• To be or Not to be: Case discussion
• Restoration Protocol- Hall Technique
• Restoration protocol with Tooth preparation
4. Age: Year 2-14
Restorative and
preventive Dental
treatment is very
important.
1. developmental status of the dentition
2. caries-risk assessment
3. patient’s oral hygiene
4. anticipated parental compliance and likelihood of recall
5. patient’s ability to cooperate for treatment
IMPORTANT ASPECTS IN PAEDODONTICS
6. 1. Dentin/enamel adhesives
2. Bisphenol A and dental materials
3. Pit and fissure sealants ( for healthy permanent teeth)
4. Glass ionomer cements
5. Resin-based composites
6. Amalgam restorations
7. Resin Infiltration ( Example: ICON technique for white lesions)
8. Fixed prosthetic full coverage crown restorations ( stainless steel and others)
9. Removable prosthetic appliances
•Removable prosthetic appliances may be indicated in the primary, mixed, or
permanent dentition when teeth are missing. Removable prosthetic appliances may
be utilized to:
•1. maintain space using space maintainers
•2. obturate congenital or acquired defects
•3. establish esthetics or occlusal function; or
•4. facilitate infant speech development or feeding
JOHN HAS DECAYS IN PRIMARY TEETH.
WHAT TREATMENT OPTIONS WE CAN DO after or before classic caries removal
process?
7. The types of full coverage for primary teeth currently available
are:
• Stainless steel crowns
• Open faced steel crowns
• Polycarbonate crowns
• Resin (composite) strip crowns
• Pre-veneered steel crowns
• Zirconia Crown
The crowns that are available for
restoring primary teeth can be placed
into 2 categories:
• those that are preformed and held
onto the tooth by a luting cement.
Example: Stainless steel crowns.
• those that are bonded to the tooth.
Example: Open faced or pre veneered
CLASSIFICATION: BASED ON COMPOSITION
1. Stainless steel crowns
2. Nickel-Base Crowns
3. Tin-Base Crowns
4. Aluminium base crown
10. Restoration and
Placement Area
Aesthetics Durability Time and how easy for
placement
Cost Selection Criteria
Stainless Steel
crowns(Posterior Teeth)
Poor Very good. Very
retentive. Wears well.
Fast. Easy to fit. Aesthetic
not a concern.
Moderate cost. Aesthetics not involved. Severely decayed
teeth. Use when unable to control gingival
haemorrhage or moisture and less than ideal
patient cooperation.
Open faced Stainless
Steel crowns (Posterior
and anterior Teeth)
Fair. Metal
shows
through
facing
Good. Crown retentive.
But facing may
dislodge.
Long two steps process.
1. Crown cementation
2. Composite
replacement
Moderate cost and
including composite
it is higher than SSC.
Severely decayed teeth. Good durability and
retention needed ( Bruxism, trauma prone
child). Parents are concerned about
aesthetics.
Pre-veneered stainless
steel crowns (Posterior
and anterior Teeth)
Good.
Limited
shades
Good. Crown retentive.
But facing may break.
Moderate. Longer than SSC
due tooth reduction and
adaptation
Higher than only
Stainless steel
crown.
Severely decayed teeth. Good durability and
retention needed. Child is trauma prone and
bruxes. Parents are concerned about the
aesthetics. Posterior and anterior colour
match for restoration.
Resin Composite strip
Crowns (Anterior teeth)
Very good Required adequate
tooth structure for
retention. Easily
fractured with trauma
or traumatic occlusion.
Will vary with ability to
isolate teeth and control
moisture. Most technique
sensitive. Very little finishing
of the restoration is required
when the celluloid crown has
been properly fitted.
Depending on the
resin composite it is
higher than pre-
veneered SSC.
Aesthetics are of great concern. Adequate
tooth structure. Patient is not prone to
trauma. Patient is cooperative.
Polycarbonate Crowns
(Posterior and anterior
teeth)
Very good Required adequate
tooth structure for
retention. Less prone to
fracture than resin
composite strip crowns.
Not as technique sensitive as
resin composite crown.
The cheapest option
of full coverage
crown.
Aesthetics is a great concern. Patient is
cooperative and require adequate tooth
structure.
Zirconia Crown Very good Very good retentive.
High strength. For
anterior and posterior.
No impression: only 1 visit.
Saliva an haemorrhage
control is very important
compare to other crowns.
Try-in crowns are effective
and time saving.
Very high cost. Aesthetics is a high priority for parents.
Strength and biocompatibility is concerned.
Patient is not suffering bruxism. Patient is
cooperative.
Poor Fair Good Very Good
12. Guide to the use of restorative materials in Paediatric Dentistry
PRIMARY DENTITION
Occlusal ( Class I) Glass Ionomer cement (GIC)
Composite Resin
Compomer
Proximal (Class II) GIC
Compomer
Amalgam
Composite resin/GIC sandwich
Stainless Steel Crown
Gross Carious breakdown or restoration after pulp therapy Stainless Steel Crown
PERMANENT DENTITION
Occlusal table Fissure sealant
Occlusal enamel caries Fissure sealant
Occlusal caries with minimal involvement of dentine Preventive resin restoration
Occlusal caries with extension into dentine Composite resin
Interproximal Amalgam
Incisal edge Composite resin
Cervical GIC Composite resin
13. Posterior Primary Teeth
GICs, resin-modified GICs and compomers
Indications
• Small occlusal and interproximal cavities.
Because of their lack of strength, GICs should not
be used in large restorations, particularly in
teeth that need to be retained for 3 years or
more.
• The use of polyacid-modified composite
resins/compomers show considerable potential,
particularly in terms of handling characteristics
and radio-opacity.
• However, they have limited fluoride-leaching
ability.
SUCCESS
The median survival time for conventional GICs is
around 33 months.
The failure rate of GICs is 33% over 5 years. High
viscosity GICs demonstrate greater durability.
Stainless steel crowns for Posterior Teeth
Indications
Stainless steel crowns are preformed extra-coronal
restorations that are particularly useful in the
restoration of:
• Grossly broken down teeth.
• Primary molars that have undergone pulp
therapy.
• Hypoplastic or hypomineralized primary or
permanent teeth.
• Dentitions of children at high risk of caries,
particularly children having treatment under general
anaesthesia.
SUCCESS
Stainless steel crowns undoubtedly provide the most
durable restoration for the primary dentition with
survival times in excess of 40 months.
Relatively expensive in relation to both time and
money in the short term. However, the rate of
replacement of these restorations is low (3%
compared with 15% for class II amalgam
restorations). This makes them economic.
14. The technique is named after Dr Norna Hall, a general dental practitioner from
Scotland, who developed and used the technique for over 15 years until she
retired in 2006. A retrospective analysis of the outcomes for the teeth she treated
in this way was published in the British Dental Journal in 2006.
1990 : HALL TECHNIQUE
1950: Humphrey and Engel recommended stainless steel crowns
1968: Mink and Bennett encourages familiar treatment modalities
HISTORY OF STAINLESS STEEL CROWN
STAINLESS STEEL CROWN IS KNOWS AS:
1. Untrimmed crowns: e.g. Rocky mountain
2. Pre-trimmed crown: straight, non contoured sides but are festooned to follow a
line parallel to the gingival crest, e.g. (Unitek stainless steel crowns, 3M Co., and
Denvo crowns, Denvo Co. Arcadia, CA).
Pre-contoured crown : festooned and precontoured, (e.g. Ni-Chro Ion crowns and
Unitek stainless steel crowns and 3M Co.).
15. Stainless Steel Crowns Composition:
• 17-19% chromium
• 10-13% nickel
• 67% iron
• 4% minor element
• These crowns are available in various sizes.
• Mostly these crowns are used in posterior teeth which
undergone pulp therapy.
Other compositions: Nickel – base Crowns
72% nickel , 14%chromium, 6-10% Iron, 0.04% carbon
0.35% manganese, 0.2% silicon
• The alloys have good formability and ductility
necessary for clinical adaptation of crowns and
wear resistance to resist opposing occlusal forces.
16. 2 year results for 124 teeth treated with
the Hall Technique compared to 124
conventional restorations in a split mouth
study with matched caries lesions prior to
treatment
Patient, carer and dentist preferences
for Hall Technique or conventional
restorations in a split mouth study for
132 children (264 teeth). Data from
same study discussed above.
A clinical trial set in nine general dental practices in Tayside, Scotland looked at outcomes
at two years for teeth where a Hall crown was fitted, compared to teeth which had
undergone conventional restorative treatment.
17. Alternative or Atraumatic Restorative Treatment (ART) AND
STAINLESS STEEL CROWN
Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal
cavities in primary molars: study protocol for a randomized controlled trial.
Department of Cariology, Endodontics and Pedodontology, Academic Centre for Dentistry Amsterdam
Hesse et al. Trials (2016) 17:169
ART was developed approximately 30 years ago and involves the use of manual
instruments to prepare cavities, followed by placement of a high-viscosity GIC
“A recent systematic review of the
literature has shown the longevity of
occluso-proximal ART restorations in
primary teeth to be similar that of
conventional restorations using amalgam,
composite resin and compomer,
suggesting that the real problem might be
related to the type/extent of cavity and
not the restorative material.”
“However, preformed metal crowns offer
physical protection to teeth affected by caries,
through complete tooth coverage, as well as
arresting caries progression. “
18. HOW STAINLESS STEEL CROWN CAN ARREST CARIES
PROGRESSION?
For decades, conventional teaching has been that all carious tooth tissue should
be removed before restoring the tooth; how can leaving caries in the tooth be
acceptable?
However , except in extreme cases, the majority of tooth
surfaces are relatively immune from caries.
base of fissures
contact point of proximal surfaces.
99% of dental caries begins on these two sites, which is Total 1% of the teeth
Lack of supply of
carbohydrates, oxygen,
or pH for cariogenic
potential of plaque
Plaque and sugar would inevitably, after time, result in dental
caries.
19. • Most plaque is not actively cariogenic.
• Plaque which has matured in a sheltered environment to achieve cariogenic
potential can lose that potential if its environment is altered.
• The bacteria within the community respond to the environment and in an
unfavourable environment, cariogenic bacteria will not continue to flourish.
• Effective sealing from the oral environment can cause the necessary
environmental change, resulting in plaque losing its cariogenic potential for as
long as the seal is maintained.
• The Hall Technique or Stainless Steel Crown is one method of achieving that
seal for primary molar teeth.
What about the soft dentinal lesion? How does the pulp react to caries?
• dentine/ pulp complex is far from passive
when exposed to dental caries.
• tissues mount an active defence response
from the earliest stages of carious lesion
formation in the enamel.
The dental pulp of a primary
molar responding to
dentinal caries by the
deposition of reactionary
dentine
• This lesion is generally soft
and active
• the caries of soft dentinal
lesion can be arrested,
with the colour changing
to dark brown or black.
20. • Stainless steel crown restorations are
indicated for the restoration of primary and
permanent molar teeth with1,3
• Extensive carious lesions which undermine
cusps and expand beyond line angles
• Cervical decalcification
• Developmental defects such as hypoplasia
and hypocalcification
• Following pulpotomy or pulpectomy
• For restoring a primary molar tooth to be
used as an abutment for a space maintainer
• The intermediate restoration of fractured
teeth
CONTRA-INDICATIONS FOR USE
Stainless steel crowns are contra-
indicated when:
• More than two thirds of the roots are
resorbed
• There is clinical and/or radiographic
evidence of radicular pathology
• The tooth exhibits excessive mobility
• Patient is non-cooperative where the
clinician cannot be confident that the
crown can be fitted without
endangering the patient’s airway.
• Parent or child unhappy with
aesthetics.
INDICATIONS FOR USE
21. irreversible pulpal involvement, and would contraindicate the placement of a
Hall Crown/Stainless Steel Crown without pulp therapy
There is a buccal sinus
associated with this maxillary
first primary molar (64).
This mandibular first primary
molar (84) has inter-radicular
pathology, indicative of a
dental abscess.
This maxillary second primary
molar (55) has an extensive
mesioocclusal cavity, that has
been painful, keeping the child
awake at night. This is indicative
of an irreversible pulpitis, or
even an abscess developing.
a mandibular first primary molar (84) which has
given occasional pain, but is currently
symptomless, is found to have non-physiological
mobility. This, with the DO cavity and history,
indicates a dental abscess
This mandibular first primary molar ( 84) has a large disto-occusal cavity. Although
symptomless, and with no inter-radicular pathology visible, there is no clear band of
normal dentine between the caries and the pulp chamber. The pulp is almost certainly
non-viable, and the tooth should have pulp therapy if a crown is to be placed.
22. This maxillary first primary molar (54) has a
large multisurface cavity, with clinical
exposure of a non-vital pulp chamber. Even
in the absence of symptoms, this tooth
should be extracted.
This mandibular second primary molar (75) has
a large occluso-lingual cavity which clearly
involves the pulp chamber. Even in the absence
of symptoms, the tooth should either be
managed with pulp therapy or extraction.
This maxillary first primary
molar (64) has a pulp polyp.
The pulp, although exposed,
is vital. In the absence of
symptoms, and clinical and
radiographic signs, of sepsis,
it would not be unreasonable
to simply monitor the tooth
This mandibular second primary molar (75)
has a similar pulp polyp associated with the
mesial root
26. ???
When can Stainless Steel crowns be a suitable
management option for carious primary molars?
27. When is there no need to fit stainless steel crowns?
Insufficient tooth tissue
Prevention needed. Caries
arrested.Primary tooth already
resorped
Small Occlusal caries
29. Instruments Needed
Essential:
• Mirror
• Straight probe
– to remove separators, if used
• Excavator
– to remove crown if necessary, and
– useful for cement removal
• Flat plastic
– to load crown with cement
• Cotton wool rolls
– for child to bite down on and push crown
over tooth, and
– to wipe away cement
• Band forming pliers
– can be useful for adjusting crowns,
particularly where the primary molar
has lost length mesio-distally due to caries
• Gauze to protect the airway and wipe off
excess cement
• Elastoplast to secure the crown for airway
protection
30. Step 1.
Assessing the tooth shape,contact points/
areas and the occlusion
Step 2.
Protecting the airway
32. Step 5.
Fitting the crown, and first stage seating
Step 6.
Wipe the excess cement away, check fit, and
second stage seating
Step 7.
Final clearance of cement,
check occlusion (adjusting
crown if necessary) and
discharge
33. Evaluate the preoperative occlusion
• Take the alginate impression of U/L jaws.
• Pour the cast with dental stone
• Note the dental midline and the cusp fossa relationship
bilaterally
Selection of crown
• The correct size crown is selected by the M-D dimensions of the
tooth to be restored using Boley gauge.
• To produce steel crown margins of similar shape examine the
contour of gingiva of the buccal & lingual marginal gingiva.
STAINLESS STEEL CROWN
AFTER CROWN PREPARATION
34. Before Preparation, what need to do:
• L.A. should be administrated
• Isolation by rubber dam or cotton rolls
• Remove the decay
35. • Occlusal reduction
A 69L or 169L bur is used to reduce the occlusal surface by 1.5-2.0mm.
• Proximal slices
place the wooden wedges in the interproximal embrasures, the 69L
bur is moved B-L across the proximal surface.
• Buccolingual reduction
• Round off all the line angles: It is done by using side of bur.
36. INITIAN ADAPTATION:
Two principles related to SSC length and margin shape that are based on an
understanding of the tooth morphology and gingival tissue contours were
presented by Spedding 1984.
• The crown should be of a correct length and its margins should be
adapted closely to the tooth.
• For shaping the crown margins mark 3 light points on the metal at the
(mesiolingual, lingual and distolingual)and at (mesiobuccal, buccal,
distobuccal) surfaces at the crest of respective marginal gingiva without
compressing the marginal gingiva.
Final finished margins are placed approximately 1mm below these marks.
SEATING THE CROWN
Now the crown is tried on the preparation by seating 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 slips over the buccal bulge.
37. 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.
CROWN CRIMPING
The tight marginal fit aids in:
1. Mechanical retention of the crown.
2. Maintenance of gingival health.
3. Protect of cement from exposure to oral fluids.
CROWN
CONTOURING
CROWN
CRIMPING
38. CHECKING THE FINAL ADAPTATION OF THE CROWN
• The crown should be replaced on the preparation after the
contouring procedure to see that it snaps securely into place.
• The occlusion should be checked at this stage to make sure that
the crown is not opening the bite or causing a shifting of
mandible into an undesirable relationship with opposing teeth.
FINISHING AND POLISHING
• Accumulation of plaque and inflammation of gingiva is
commonly seen in practice of restorative dentistry due to rough
and unpolished restoration.
• To avoid these complications crown should be polished prior t o
cementation with rubber wheel to remove all scratches.
RADIOGRAPHIC CONFIRMATION OF GINIGIVAL FIT:
Before cementation a bitewing is taken to verify proximal marginal
integrity
39. CEMENTATION:
• SSC should be cemented only on clean dry mouth,
isolation of teeth with cotton roll is
recommended.
• Rinse and dry the crown inside & out side and
prepare to cement it.
• A zinc phosphate, polycarboxylate or GIC is
preferred.
• Before the cements set ask the patient to close
into centric occlusion by applying pressure
through a cotton roll and confirm that the
occlusion has not been altered.
• Remove the excess cement by an explorer or
scaler & for interproximal area can be cleaned by
passing dental floss through them.
• Interproximal ledge.
• Crown tilt.
• Poor margins.
• Inhalation or ingestion of crown.
POSSIBLE COMPLICATIONS:
40. SPECIAL CONSIDERATION FOR SSC
Quadrant dentistry ( Nash, 1981)
-Prepare the occlusal reduction of one tooth completely before
beginning the other as there is tendency to under reduce both
when reduction on them is done at the same
time.
-Reduce the adjacent proximal surface of the teeth being restored
more than when only one tooth is restored.
-Both crown should be trimmed, contoured and prepared before
cementation simultaneously to allow for adjustment in inter
proximal space and establish proper
contact area.
Crown in area of space loss(Mc - Evoy 1977)
Preparing a SSC adjacent to a class II amalgam (Mc - Evoy 1985)
42. • AJ Nowak. Clinical performance of esthetic posterior crowns in Primary molars: a pilot study. Ped. Dent.
21:445-448, 1999.. Academy of Pediatric Dentistry. Pediatric Dentistry Handbook. ed.: 86-87, 1999.
• American Association of Paediatric Dentistry. Guideline on Pediatric Restorative Dentistry. Clinical Affairs
Committee – Restorative Dentistry Subcommittee. 2008
• Dafydd Evans & Nicola Innes. The Hall Technique minimal intervention, child centred approach to managing
the carious primary molar:. University of Dundee 2011
• Daniela Hesse1*, Mariana Pinheiro de Araujo2, Isabel Cristina Olegário2, Nicola Innes3, Daniela Prócida
Raggio2 and Clarissa Calil Bonifácio1. Atraumatic Restorative Treatment compared to the Hall Technique for
occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial.. 1Department of
Cariology, Endodontics and Pedodontology, Academic centre for Dentistry Amsterdam (ACTA), Gustav
ahlerlaan 3004, 1081LA, Amsterdam, The Netherlands. Hesse et al. Trials (2016) 17:169
• Fuks AB., Ram D., Eidelman E. Academy of Pediatric Dentistry. Special issue. Reference Manual. 21(5): 105,
1900-00.
• Mcdonalds. Dentistry for Child and Adolescent,; 9th edition, chapter 16,17 and 18.
• Paul S.Casamassimo , Henry W., Jr. Fields , Dennis J. McTigue , Arthur Nowak Pediatric Dentistry: Infancy
through Adolescence,; 5th edition.
• Randall RC., Vrijhoef MMA., Wilson NHF. Efficacy of preformed metal crowns vs amalgam restorations in
primary molars: a systematic review. J.A.D.A. 131: 337-343, 2000
• Roger J Smales & Hak-Kong Yip. The atraumatic restorative treatment (ART) approach for primary teeth:
review of literature.. American Academy of Pediatric Dentistry. Pediatric Dentistry – 22:4, 2000
• Sigal MJ. Paediatric Dentistry Manual. Faculty of Dentistry, Department of Paediatric Dentistry, University of
Toronto. ed.: Seventh Edition:168-177, 1998.
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