Stainless steel crowns are tooth-shaped coverings cemented onto teeth to protect tooth structure and retain function. They were introduced in 1950 and are commonly used restorations for children and adolescents. They are classified based on composition (e.g. stainless steel, nickel-base) and morphology (untrimmed, pretrimmed, precontoured). Indications include extensive caries, teeth requiring pulpotomy/pulpectomy, developmental defects, and high caries risk. Contraindications include mobile or unerupted teeth. Placement involves tooth preparation, crown selection and fitting, then cementation. The Hall technique places crowns directly over caries with little preparation for cooperative children.

1. Stainless steel crown

2. • Stainless steel crown  A crown is a tooth
shaped covering which is cemented to the
tooth structure and its main function is to
protect the tooth structure and retain the
function

3. History
• Chrome steel crowns, introduced by
Humphrey in 1950, have proved to be
serviceable restorations for children and
adolescents and are now commonly called
stainless-steel crowns
• 1950 Humphrey and Engel recommended
stainless steel crowns
• 1968 Mink and Bennett encouraged familiar
treatment modality
• 1960s significantly improved crown

4. 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

5. Classification: based on morphology
1. Untrimmed: They are long and usually
requires trimming
2. Pretrimmed (pre festooned): These crowns are
short in length but are not contoured and so has
a parallel sides
3. Precontoured: These crowns are contoured and
have a bell shape.
1 2 3

6. 1. Untrimmed crowns
• These crowns are neither trimmed nor contoured
and require lot of adaptation , thus are time
consuming.
• e.g : The rocky mountains

7. 2. Pretrimmed crown
• They have straight, non-contoured sides but
are festooned to follow at line parallel to the
gingival crest.
• They require contouring and some trimming.
e.g unitek , 3M CO, Denovo crowns

8. 3. Precontoured crown
• These crowns are festooned and are also
precontoured through a minimal amount of
festooning and trimming may be necessary.
• e.g : Unitek stainless steel crown, Ni-Chro ion
crowns

9. Indications
1. Extensive Caries:
Cl II cavity where one or more cusps are
destroyed or weakened by caries.
Caries involving 3 or more surfaces
Rampant caries.
2. Child < 6yrs SS crown preferable
to restorations

10. 3. Following pulpotomy or pulpectomy procedures
• The tooth becomes brittle and weakened following
pulp therapy leading to fracture especially in
mesiodistal direction leading to extraction. Thus a
stainless steel crown should be routinely used
following pulp therapy.

11. 4. Localized or generalized developmental
problems e.g.:
Enamel hypoplasia
Amelogenesis imperfecta
Dentinogenesis imperfecta
5. Restoration of fractured primary molars

12. 6. Extensive tooth surface loss due to
Eg : Attrition
: Abrasion/erosion
: Bruxism
7. In patients with a high caries
susceptibility
8. As an abutment for certain
appliances, such as space maintainers

13. 9. Handicapped Children:
Oral hygiene maintenance is difficult, so stainless
steel crowns are preferred to restore carious tooth
than amalgam restorations

14. Contraindications
1. If the primary molar is close to exfoliation with
more than half the roots resorbed or exfoliation
within 6-12 months
2. Tooth exhibits excessive mobility
3. Partially erupted teeth
4. As a permanent restoration in a permanent
dentition

15. Equipment used
Burs
• Round : For caries removal
• Flame shaped diamond bur: For
occlusal reduction
• Long thin tapered diamond bur:
For proximal, buccal and lingual
reduction.
• Rubber wheel or point / green
stone: for finishing and polishing (A): Flame shaped bur
(B): Round end tapered bur
(C): Flat end tapered bur
(D):Long thin tapered bur
(A) (B) (C) (D)

16. Pliers
• No. 417 (Unitek) crimping
pliers – to produce marked
curvature in cervical region.
• Johnson No.114 (Rocky
mountain): for general
contouring in the occlusal
and middle region
• No. 137 Gordon- used for
general contouring and
shaping.
Pliers used for fabrication of stainless steel
Crown; A: Crimping pliers; B: Johnson ball
and socket plier, used to get a bell shaped
contouring ; C: Gordon plier, used for
general contouring and shaping

17. 1. Scissors
2. Abrasive wheel
3. Rubber wheel

18. (a)Boley gauge to measure mesial-distal width
of primary molar.
(b)Boley gauge to measure mesial-distal width
of stainless steel crown.
(a) (b)

19. Clinical procedure
• Administer LA
• Place rubber dam
• Crown selection
• Tooth preparation
• Evaluation of tooth preparation
• Crown adaptation
• Crown finishing and polishing
• Crown cementation

20. Clinical procedures
• Irrespective of whether the tooth to be restored is vital
or non-vital, local anaesthesia should be used when
placing a stainless steel crown because of the soft-
tissue manipulation.
• Rubber dam, although sometimes difficult to place in
the broken down dentition, should be used where
possible.
1. Restore the tooth using a GIC prior to preparation for
the stainless steel crown.
2. Reduce the occlusal surface by about 1.5 mm using a
flame-shaped or tapered diamond bur.

21. • 3. Using a fine, long, tapered diamond bur, held slightly
convergent to the long axis of the tooth, cut
interproximal slices mesially and distally. The reduction
should allow a probe to be passed through the contact
area
Coronal and proximal preparation required for the placement of a
stainless steel crown.
Note that in the proximal areas, there is a smooth contour
without any ledge or step. Any such step will cause great difficulty
in seating the crown.

22. • 4. Buccolingual reduction should be kept to a
minimum, as these surfaces are important for
retention. However, reduction may be needed when
there has been significant proximal space loss or
anatomical features, such as a prominent Carabelli’s
cusp.
• 5. An appropriate size of a precontoured crown is
chosen by measuring the mesiodistal width.
• 6. A trial fit is carried out before cementation. It is
important that the crown should sit no more than 1
mm subgingivally. If there is excessive blanching of
the gingival tissues, the length of the crown should
be reduced and the margins should be smoothed
with a white stone.

23. • 7. Cement the crown with a GIC.
• If the crown has been built up before the placement
of the crown, a glass ionomer luting cement may be
used, otherwise a restorative GIC should be used.
• Care should be taken while holding the crown as it
can be easily dropped during placement. Excess
cement should be wiped away and a layer of Vaseline
placed around the margins while the cement is
setting.

24. (A) Interproximal reduction is
completed with a fine tapering
diamond bur taking care not to
damage the adjacent tooth
(B) Occlusal reduction of up to
1.5 mm is performed with a
large diamond flat fissure bur, a
small wheel or in this case a
flame diamond bur
(A)
(B)

25. (C) Glass ionomer cement
is used to build up the
carious distal aspect of the
crown.
(D) Trial fit of the crown, by
seating from the lingual
onto the buccal surface.
(C)
(D)

26. (E) A large spoon excavator
can be used to remove the
crown.
(F) The crown is filled with
glass ionomer cement for
luting
(E)
(F)

27. (G) The crown placed with
finger pressure
(H) The completed restoration
should last the lifetime of the
tooth.
(G)
(H)

28. The Hall crown technique
• The Hall crown technique involves the placement of
stainless steel crowns, directly over carious lesions in
primary molars with little or no tooth preparation or
caries removal.
• indeed the technique not only outperformed
conventional restorations but was preferred by the
children and clinicians.
• It is not appropriate in all cases and in particular
should only be used for teeth that are symptom free
and without signs or symptoms of pulpal pathology.

29. Indications
 Primary molar teeth with moderate decay, but no
clinical signs or symptoms of pulpal pathology
 Dentitions of children with limited cooperation, who
are unable to accept conventional restorative
treatment with local anaesthesia.
 Healthy children.

30. Success
• In a prospective, randomized control clinical trial, the
Hall technique, statistically, significantly outperformed
standard restorations at 5 years.
• Any disruption of the occlusion following crown
placement, will usually self-correct within a few
weeks.

31. Clinical procedure
This technique is used without local anaesthetic:
1. Pre-procedure radiograph and examination to exclude
pulpal pathology.
2. Orthodontic separators may be placed at a prior
appointment, to ease placement of the crown.
3. Child should be sat upright or semi-reclined, but not
supine and gauze may be used to protect the airway.
4. The tooth can be cleaned with a toothbrush and if
desired gross caries may be removed with a hand
excavator.

32. 5. A stainless steel crown is selected, which will fit over
the tooth without any preparation.
6. A GIC cement is placed in the crown which is bitten
into place by the child.
7. Excess cement may be washed or wiped away, before
it has set.