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“YOU HAVE FERRARI IN CARS, 
HARLEY DAVIDSON IN BIKES AND 
STAINLESS STEEL CROWNS IN 
PEDIATRIC DENTISTRY”
STAINLESS STEEL, POLYCARBONATE& RESIN 
VENEERED CROWNS
CONTENTS 
Introduction 
History 
Composition 
Classification 
Indications 
Contraindications 
Armamentarium used for placement 
Clinical procedure 
Modifications 
Common errors 
Esthetic crowns 
Relevant articles 
Conclusion 
References 3
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
HISTORY 
 1950- Humphrey and Engel recommended stainless 
steel crowns 
 1968-Mink and Bennett encouraged familiar 
treatment modality 
 1960s - significantly improved crown (Unitek) 
5
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
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
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
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)
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
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
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
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
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
16
17
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
3. Child < 6yrs SS crown preferrable to restorations 
4. Following pulpotomy or pulpectomy procedures. 
(Kindelan 2008) 
19
5.Localized or generalized developmental problems, 
e.g.:Enamel hypoplasia, 
Amelogenesis imperfecta, 
Dentinogenesis imperfecta 
6. Restoration of fractured primary molars. 
20
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
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
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
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
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
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
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
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
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
PRE-OPERATIVE EVALUATION 
 Diagnostic casts 
 Midline 
 Cusp fossa relationship bilaterally 
 Canine relation 
 Extrusion of opposing tooth 
 Mesial drifting of adjacent teeth 
30
LA ADMINISTRATION 
 To reduce the discomfort during subgingival 
preparation 
31
RUBBER DAM PLACEMENT 
 To protect surrounding tissues 
 To improve visibility 
 To improve efficiency 
 To better manage the behaviour 
32
CROWN SELECTION 
 3 main considerations : 
 Mesiodistal diameter 
 Light resistance to seating 
 Proper occlusal height 
33
CROWN SELECTION 
 Before preparation : Boley gauge 
 After preparation : trial & error 
 Smallest crown selected 
 Friction to be felt when crown slips gingivally 
34
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
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
OCCLUSAL REDUCTION 
37
OCCLUSAL REDUCTION 
Evaluation of occlusal reduction 
 Forrester 1981 : Wax sheet 
 Visual examination 
 Mathewson : Use of explorer 
38
OCCLUSAL REDUCTION 
Occlusal anatomy preservation 
 Crown retentive potential 
 Less chances of pulp exposure 
 Preservation of tooth structure 
39 
Maxillary molars Mandibular molars
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
PROXIMAL REDUCTION 
41
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
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
PROXIMAL REDUCTION 
 Evaluation : 
 Pass explorer through proximal areas 
 Broken contacts 
44
CONTROVERSIES 
 Mathewson, Pinkham and Mink & Bennet : 
 First proximal reduction followed by occlusal 
 Stewart, Welbury, Forrester & Brocre : 
 First occlusal reduction followed by proximal 
45
BUCCAL & LINGUAL REDUCTION 
 Natural undercuts : retention 
 Mathewson 1974, Andlow & Rock 1984, Mink & Bennet 
1968: 
 Large buccal bulge : buccal reduction required 
46
BUCCAL & LINGUAL REDUCTION 
 Pinkham : 
 Large mesiobuccal bulge : both buccal & lingual 
 Using Preveneered crown : both buccal & lingual 
47
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
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
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
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.
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
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
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
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
CROWN CRIMPING 
 Evaluation : 
 Check with explorer 
 If margins open : recrimp 
 If overextended : start again 
 Blanching : Johnson 1987 
 Bitewing radiograph : More & Pink 1973 
56
CROWN CRIMPING 
Tight fit of crown aids in: 
 Mechanical retention 
 Protection of cement from exposure to oral fluids 
 Maintenance of gingival health 
57
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
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
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
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
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
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
 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.
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
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
CROWN CEMENTATION 
67 
Excess cement 
removed with 
scaler or explorer 
Floss moved 
buccolingually 
Support the 
mandible during 
the procedure
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
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
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
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
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
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
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
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
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 &
UNDERSIZED TOOTH/OVERSIZED CROWN 
77
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
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
OVERSIZED TOOTH/UNDERSIZED CROWN 
80
DEEP SUBGINGIVAL CARIES 
81 
• Amalgam/GIC 
restoration 
substitute the 
tooth structure 
Routine 
crown 
preparation 
• Solder an 
extension on 
interproximal area 
of crown 
Band
OPEN CONTACT 
 Leads to food packing, plaque retention & gigivitis 
 Larger crown selected 
 Interproximal contour exagerated with #112 plier 
 Or addition of solder interproximally 
82
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
COMMON ERRORS 
 Lack of feather edge 
 Failure to round all line angles 
 Incorrect crown size 
 Excessive reduction of tooth 
 Ledges formation 
84
GINGIVITIS 
Goto et al : 33% gingivitis 
 Crowns with defective margins / excessive cement 
retention : supra gingival plaque accumulation 
85
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
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.
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
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
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
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
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
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
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
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
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
 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.
NUSMILE CROWNS 
Merits 
 Single appointment 
 Easy placement technique 
 Reduces operatory time 
 Less technique sensitive 
98
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
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
Preparation of the Tooth 
 crown fits the tooth passively: 
flexing of metal substructure from pressure during 
fitting or seating can cause micro-fractures
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
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
CHENG CROWNS 
 Peter Cheng Orthodontic Laboratory-1987 
 anterior crowns faced with a high quality composite 
(mesh-based with a light cured composite.) 
104
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
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)
CHENG CROWNS 
107
PEDO PEARLS 
 Heavy gauge aluminum crowns coated with FDA food 
grade powder coating and epoxy-resin. 
108
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
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
KINDER KROWNS 
 1988 by pediatric dentists 
 natural shades and contour available 
 Great depth and vitality from the lifelike composite 
111
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
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
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
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
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
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
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
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
POLYCARBONATE CROWNS 
120
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
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
STRIP CROWNS 
Demerits 
 technique sensitive 
 adequate tooth structure is required 
 moisture and hemorrhage 
control 
123
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
STRIP CROWNS 
STEPS 
 Cleaning 
 Select an appropriate crown form 
 Reduce the mesial and distal proximal surfaces 
125
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
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
STRIP CROWNS 
 Remove the cellulloid sheet 
 Trim & polish if necessary 
128
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
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
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
 Omar Meligy 
S.S.C might impede the exfoliation of primary molar 
Int J Ped Dent 2010 
132
Champagne C, Waggoner W, Ditmer M 
 Parental satisfaction with preveneered SSC was more 
than only SSC 
Ped Dent 2008 
133
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
Ari Kupietzky 
 Ultra-soft toothbrush 
 Curved crown scissors 
 Resin-modified glass-ionomer base/liner) 
 Resin composite restorative 
 Masking agent 
Pediatr Dent 2002 
135
N Sue Seale 
 SSC is superior in durability & longevity to Class II 
amalgam in primary teeth 
Pediatr Dent 2002 
136
W F Waggoner 
 Crown doesn’t matter for retention of preformed crowns 
 It depends upon technique & precision 
Eur Archives Pediatr Dent 2006 
137
 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
Lee Y K 
 NuSmile crowns more resistant to # than Kinder 
Krowns & Cheng crowns 
 Kinder krowns had more facing loss 
Houston Biomed Research 2004 
139
Yual Yilmaz 
 Polycarbonate crowns showed lowest tensile bond 
strength as compared to open face SSC & NuSmile 
crowns 
J Dent Child 2004 
140
Dustin James 
 NuSmile crowns withstand higher loads than Kinder 
Krowns & Cheng crowns 
Pediatr Dent 2007 
141
Monica Gupta 
 Veneer resistance to fracture was more with the 
crimped crowns than non-crimped crowns 
JISPPD 2008 
142
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
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
CONCLUSION 
 Preservation of tooth for natural space maintainer 
 Esthetics 
 Phonetics 
 Mastication 
 Overall development of child 
145
THANK YOU 
146

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Stainless steel crowns in Pediatric Dentistry

  • 1. “YOU HAVE FERRARI IN CARS, HARLEY DAVIDSON IN BIKES AND STAINLESS STEEL CROWNS IN PEDIATRIC DENTISTRY”
  • 2. STAINLESS STEEL, POLYCARBONATE& RESIN VENEERED CROWNS
  • 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. 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. HISTORY  1950- Humphrey and Engel recommended stainless steel crowns  1968-Mink and Bennett encouraged familiar treatment modality  1960s - significantly improved crown (Unitek) 5
  • 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. 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. 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. 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. 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. 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. 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. 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. 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
  • 16. 16
  • 17. 17
  • 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. 3. Child < 6yrs SS crown preferrable to restorations 4. Following pulpotomy or pulpectomy procedures. (Kindelan 2008) 19
  • 20. 5.Localized or generalized developmental problems, e.g.:Enamel hypoplasia, Amelogenesis imperfecta, Dentinogenesis imperfecta 6. Restoration of fractured primary molars. 20
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. PRE-OPERATIVE EVALUATION  Diagnostic casts  Midline  Cusp fossa relationship bilaterally  Canine relation  Extrusion of opposing tooth  Mesial drifting of adjacent teeth 30
  • 31. LA ADMINISTRATION  To reduce the discomfort during subgingival preparation 31
  • 32. RUBBER DAM PLACEMENT  To protect surrounding tissues  To improve visibility  To improve efficiency  To better manage the behaviour 32
  • 33. CROWN SELECTION  3 main considerations :  Mesiodistal diameter  Light resistance to seating  Proper occlusal height 33
  • 34. CROWN SELECTION  Before preparation : Boley gauge  After preparation : trial & error  Smallest crown selected  Friction to be felt when crown slips gingivally 34
  • 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. 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
  • 38. OCCLUSAL REDUCTION Evaluation of occlusal reduction  Forrester 1981 : Wax sheet  Visual examination  Mathewson : Use of explorer 38
  • 39. OCCLUSAL REDUCTION Occlusal anatomy preservation  Crown retentive potential  Less chances of pulp exposure  Preservation of tooth structure 39 Maxillary molars Mandibular molars
  • 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
  • 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. 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. PROXIMAL REDUCTION  Evaluation :  Pass explorer through proximal areas  Broken contacts 44
  • 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. BUCCAL & LINGUAL REDUCTION  Natural undercuts : retention  Mathewson 1974, Andlow & Rock 1984, Mink & Bennet 1968:  Large buccal bulge : buccal reduction required 46
  • 47. BUCCAL & LINGUAL REDUCTION  Pinkham :  Large mesiobuccal bulge : both buccal & lingual  Using Preveneered crown : both buccal & lingual 47
  • 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. 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. 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. 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. 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. 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. 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. 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. CROWN CRIMPING  Evaluation :  Check with explorer  If margins open : recrimp  If overextended : start again  Blanching : Johnson 1987  Bitewing radiograph : More & Pink 1973 56
  • 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. 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. 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. 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. 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. 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. 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.  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. 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. 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. CROWN CEMENTATION 67 Excess cement removed with scaler or explorer Floss moved buccolingually Support the mandible during the procedure
  • 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. 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. 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. 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. 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. 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. 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. 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. 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 &
  • 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. 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
  • 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. 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. 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. COMMON ERRORS  Lack of feather edge  Failure to round all line angles  Incorrect crown size  Excessive reduction of tooth  Ledges formation 84
  • 85. GINGIVITIS Goto et al : 33% gingivitis  Crowns with defective margins / excessive cement retention : supra gingival plaque accumulation 85
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.  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. NUSMILE CROWNS Merits  Single appointment  Easy placement technique  Reduces operatory time  Less technique sensitive 98
  • 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. 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. Preparation of the Tooth  crown fits the tooth passively: flexing of metal substructure from pressure during fitting or seating can cause micro-fractures
  • 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. 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. CHENG CROWNS  Peter Cheng Orthodontic Laboratory-1987  anterior crowns faced with a high quality composite (mesh-based with a light cured composite.) 104
  • 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. 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)
  • 108. PEDO PEARLS  Heavy gauge aluminum crowns coated with FDA food grade powder coating and epoxy-resin. 108
  • 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. 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. KINDER KROWNS  1988 by pediatric dentists  natural shades and contour available  Great depth and vitality from the lifelike composite 111
  • 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. 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. 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. 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. 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. 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. 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. 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
  • 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. 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. STRIP CROWNS Demerits  technique sensitive  adequate tooth structure is required  moisture and hemorrhage control 123
  • 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. STRIP CROWNS STEPS  Cleaning  Select an appropriate crown form  Reduce the mesial and distal proximal surfaces 125
  • 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. 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. STRIP CROWNS  Remove the cellulloid sheet  Trim & polish if necessary 128
  • 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. 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. 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.  Omar Meligy S.S.C might impede the exfoliation of primary molar Int J Ped Dent 2010 132
  • 133. Champagne C, Waggoner W, Ditmer M  Parental satisfaction with preveneered SSC was more than only SSC Ped Dent 2008 133
  • 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. Ari Kupietzky  Ultra-soft toothbrush  Curved crown scissors  Resin-modified glass-ionomer base/liner)  Resin composite restorative  Masking agent Pediatr Dent 2002 135
  • 136. N Sue Seale  SSC is superior in durability & longevity to Class II amalgam in primary teeth Pediatr Dent 2002 136
  • 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.  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. 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. Yual Yilmaz  Polycarbonate crowns showed lowest tensile bond strength as compared to open face SSC & NuSmile crowns J Dent Child 2004 140
  • 141. Dustin James  NuSmile crowns withstand higher loads than Kinder Krowns & Cheng crowns Pediatr Dent 2007 141
  • 142. Monica Gupta  Veneer resistance to fracture was more with the crimped crowns than non-crimped crowns JISPPD 2008 142
  • 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. 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. CONCLUSION  Preservation of tooth for natural space maintainer  Esthetics  Phonetics  Mastication  Overall development of child 145

Editor's Notes

  1. preformed metal crowns (PMCs)
  2. 1950- Humphrey and Engel recommended stainless steel crowns for the restoration of badly broken down primary molars and also as space maintainers
  3. Unitek-california, , 3M-minneapolis, rocky mountain-denver//NICKEL BASE –already work hardened while AUSTENTIC soft and malleable & harden when adapted with pliers… Ni base fit easily& require least adjustment(stephen wei)
  4. Untrimmed -THESE ARE CROWNS WITH STRAIGHT SIDES & MARGINS THAT FOLLOW THE GINGIVAL CONTOUR. THE GINGIVAL MARGINS CAN BE TRIMMED WHERE NECESSARY & ALSO NEED CONTOURING & CRIMPING TO ENSURE GINGIVAL ADAPTATION TO THE PREPARED TOOTH. Pre trimmed -Parallel crown walls saves chair time, minimizing the need for buccal, lingual, and mesial tooth reduction. Consistent wall thickness helps prevent bite through and minimizes trial fitting distortion. The Molar Crowns have shallow occlusal anatomy which reduces rocking during mastication, with minimal occlusal interference.
  5. Pre contoured –more rounded..POSSESSS MORE DIFFICULTY IN ADAPTATION SINCE TRIMMING WILL RESULT IN REMOVAL OF MANUFACTURERS GINGIVAL CRIMP & inc dimensiond os cervical margin
  6. Chromium oxidizes and forms a thin surface film of chromium oxide (Cr2O3), known as “passivating film” which protects against corrosion. Austenitic stainless steel is used extensively for the fabrication of dental appliances and is composed of chromium (11.5-27%), nickel (72.2%.),and carbon (0.25%). Nickel-Base Crowns Inconel 600 alloy 72% nickel 14% chromium 6-10% Fe 0.04% carbon 0.35% manganese 0.2% silicon
  7. Primary Molars 3M-There are 48 crown sizes available in the 3M ESPE stainless steel primary molar crown range.//. A size 7 is available for extra large teeth.
  8. Stephen wei.. ½ round bur-markin margins//No.4 round burs- caries removal//polishin Rubber wheel//No.114 Pliers (Johnson contouring pliers) & No.137 pliers (Gordon contouring pliers)- general contourin in occlusal & middle region//No. 17 crown pliers (Unitek corp,) for crimpin i.e. marked curvature in cervical region.// No.112 ball and socket pliers – produce convexity to simulate contact pt.
  9. Stephen wei.. ½ round bur-markin margins//No.4 round burs- caries removal//polishin Rubber wheel//No.114 Pliers (Johnson contouring pliers) & No.137 pliers (Gordon contouring pliers)- general contourin in occlusal & middle region//No. 17 crown pliers (Unitek corp,) for crimpin i.e. marked curvature in cervical region.// No.112 ball and socket pliers – produce convexity to simulate contact pt.
  10. Occlusal reduction -1.5 mm reduction - avoid significant occlusal prematurity - should follow the contours of the tooth slightly premature or high occlusal contact up to about 1.0 mm is normally well tolerated in children-capacity for dentoalveolar compensation, with the occlusion adapting to any prematurity within a few weeks.
  11. Occlusal reduction -1.5 mm reduction - avoid significant occlusal prematurity - should follow the contours of the tooth slightly premature or high occlusal contact up to about 1.0 mm is normally well tolerated in children-capacity for dentoalveolar compensation, with the occlusion adapting to any prematurity within a few weeks.
  12. Proximal reduction - achieved by using a tappered diamond bur at 10 to 15 ˚ -to allow the crown to be seated beyond the max bulbosity of the crown. -avoid creation of ledges/steps - distal surface of second primary molars Where a primary molar has no adjacent tooth important to avoid producing an excessive marginal overhang particularly on the distal surface of second primary molars : can impede the eruption of the first permanent molar//A DENTAL EXPLORER MAY BE FREELY PASSED BETWEEN THE f a step or ledge is present (fig. 5), the operator will have difficulty seating the crown and may be tempted to trim it unnecessarilyADJACENT TEETH & The best precaution is either to place a wooden wedge between teeth before the proximal reduction is attempted .//
  13. B)Crown should be somewhat larger than the tooth to which it is being adapted, especially when the gingival part of the crown is trimmed & crimped
  14. The crown wic doesn’t adhere to this will be ill adaptedAny point above greatest diameter
  15. Several factors can influence the decision of choosing cement, MOST IMP of all is Status of Pulp. Znpo4: zinc phosphate
  16. S.S. CROWN is used as a guide in reproducing the anatomy and morphology of the silver amalgam restr’n.