Stainless steel crown SBR TM ‘= Preformed metal crowns for primary and permanent molar teeth: review of the literature = The use of stainless steel crowns Preformed metal crowns for primary and permanent molar teeth: review of the literature Ros C. Randall, PAD, MPbiL, BCHD indications for use ‘placement techniques Risks Longevity 1 cost effectiveness ‘= utilization Preformed metal crowns (PMCs) = PMCs for primary molar teeth were first described in 1950 by Engel = The morphology of a primary molar tooth differs significantly from its permanent greatest convenity atthe cervical third ofthe © The enamel and dentin are much thinner than inthe permanent tooth = pulp is large with prominent pulp homs Pe SEE: Indications for use—primary molar teeth = after pulp therapy = for restorations of multisurface caries and for patients at high caries risk primary teeth with developmental defects where an amalgam is likely to f fractured teeth teeth with extensive wear abutment for space maintainer= Pinkenon suggested that indications for placement of a PMC should include child patients who are unlikely to attend regular recall appointment = tecth approaching exfoliation within 6 to 12 months should not be fitted with a PMC TE Indications for use—permanent molar teeth ‘interim restoration of a broken-down or traumarized tooth until construction of a permanent restoration can be carried out financial considerations teeth with developmental defects 1 restoration of a permanent molar which requires full coverage but is only partially erupted Placement procedures for primary molar crowns Primary molar tooth preparation '# placement of wooden wedges ‘© occlusal surface: reduced by about 1.5 mm , ‘maintaining its occlusal contour ‘© Proximally: avoid the exeation of ledges or steps atthe gingival finishing, slightly below the sgingivae ‘© Lastly, ensure that all line angles are rounded ‘# Effective local anesthesia of the tooth under preparation is generally recommended 1 ‘# Duggal and Curzon recommended trying the selected crown for size before carrying out any lingual or buceal reduction, ‘© To obtain retention, the erown must seat subgingivallyt to a depth of about ! mm and a degree of gingival blanching ‘© A crown thatis high in the occlusion (1-1.5 mm) is acceptable, as it is considered that primary. cems to be teeth can spontancously adjust for this amount of ‘occlusal discrepancy over a week Selection of crown size ‘= restore the contact areas and occlusal alignment of the prepared tooth, = trial and error measuring the mesiodistal dimension of the tooth space with dividers ‘= measure the dimension of the contralateral toothSelection of crown size = A correctly fitting crown should snap or ick into place at try-in = More and Pink recommended a bite-wing radiograph at the crown try-in stage to check for any margin overextension in the interproximal area adr) Crown modification ‘= Crown trimming can be carried out with crown scissors or an abrasive wheel © After trimming, the crown must be crimped to regain its retentive contour ‘= Once these adjustments are completed, the crown margins should be thinned and smoothed, final polishing being done with arubber wheel Cementation = need a generous mix of cement to adequately fill the crown space prior to seating «= itis recommended that the crown be first seared over the lingual or buccal wall and rolled over onto the opposite wall = Once seated onto the prepared tooth, the crown should be maintained under pressure while the cement sets, Placement procedures for permanent molar crowns = Occlusion: ‘= When a caries lesion has extended sub gingivally the original tooth morphology should be restored. with either a bonded composite resin or an amalgam restoration before commencing the crown preparation. It is not recommended to utilize only cement in these areas. = Resin-modified glass ionomer (RMGI) ‘cement has been recommended as the preferred material for cementation of permanent molar PMCsRisks = Periodontal concerns = Nickel allergy = Esthetics Periodontal concerns ‘© A well-adapted crown margin facilitates good oral hygiene and healthy gingivae, but gingivitis ‘ean occur ifthe crown mangins are inadequately ‘contoured or if residues of set cement remain in contact with the gingival suleus © Gaod- to moderat fitting erowns seem to produce minimal gingival problems or plague accumulation _ Periodontal concerns = Patients in need of PMCs are likely to be at a moderate-to-high risk for car tendeney to accumulate plaque and marginal debris. 5. with a = A preventive regime including oral hygiene instruction should be routinely included Nickel allergy © The nickel content in the formulation nickel-chromium crowns was around 70%, greater than that of contemporary stainless steel crowns, which contain 9%-12% nickel, similar to that of many orthodontic bands and wires 2 Nickel allergy = 1992, Hensten-Petersen: f= The incidence of adverse reactions attributed to orthodontic treatment is estimated as 1 in 100 = 1998,Janson et al ‘© concluded that orthodontic treatment utilizing ‘conventional Stainless Stel appliances docs not, in general, initiate or aggravate a nickel hypersensitivity reaction Esthetics ‘A well-known method of improving the appearance of metal crowns Is to eut a ‘window in the buccal wall of the cemented crown and to restore this with composite © Carrel and Tanzilli evaluated a veneering resin for both anterior and posterior crowns: = only 32% of the veneered erowns were intact at I year, 41% having debondled and 27% being partially retained‘con CT Longevity of preformed metal crowns dy ence Matin dae ln sealer dion Nine le Rese ee ton pia pi = ae 1501) 76 9058) Dawn 80" TIN) 81198) Mectieeigg BESTT B5C2) 381 IN) Raced Self HT 706M) SON) ova nd Dinning 9" 66 30585) GAG Raw data das) 2301, (578.065) 0 Cus) Man-5y a | = From Table 1, the average failure races are around 4 times greater for amalgam compared with PMCs over approximately 5 = col cluding that preformed crowns are superior to Class Il amalgam restorations for multisurface cavities in primary molars Cost effectiveness and utilization of preformed crowns eee eee aean ia se 10 BITS) Dowse al 80" iano 4 #0098) Mee ewig A 1177288028) um 5 Ral Sih TTIW SON) rand Danie 6 set Rw dc toc rw daca) 2201 a) 7210 Gay Maan-5 a hypothetical group of 100 Class II amalgam restorations and 100 PMCs in primary molars, with failure rates of 26% and 7° = PMCs ($91), Class II amalgam (S: 2.2 x(9.1x7)‘= Dentists spend approximately 50%- 60% of their time replacing restorations = Use of a well-fining PMC, where appropriate, could be expected to last the lifetime of the primary tooth PTT Result ‘= PMCs are superior to amalgam restorations for multisurface cavities in primary molar teeth The use of stainless steel crowns N. Sue Seale, DOS, MSD preformed metal crown (PMC) = more commonly known in the United States asthe stainless steel crown (SSC) = extremely durable relatively inexpensive 1 subject to minimal technique sensitivity during placement 1 offers the advantage of full coronal coverage main disadvantage: appearance Fy ‘= This paper discusses these factors, Caries risk factors ‘© restoration longevity = cost effectiveness Caries risk factors = A very important consideration in treatment decisions for the primary and mixed dentition is the future caries potential of the child. ‘= the best indicator for an individual's risk for future caries is his or her previous carious experienceTheir caries risk indicators for the child at high risk include: = dimfs the de year opment of ? or more lesions in 1 ‘numerous white-spot lesions ‘high titers of Sireptococeus mutans 4+ low socioeconomic strata © abistory ofa high frequency of sugar consumption ST = Another factor that must be considered in deciding risk-based treatment options for carious lesions is the ability to recall the patient on a timely bs ‘© the patient that is not likely to keep recall appointments is definitely at higher risk for the sequelae to progression of caries, failed restorations and new/tecurrent caries Restoration longevity andatl 200, = literature review of studies compared the longevity of SSCs with Class II amalgam restorations = The follow-up time ranged from 2 years to 10 years (mean: 5 years) ‘© The failure rate of Class I amalgams ranged from 2 to 7 times that of SSCs (mean: 4 times ) SSCs are superior to Class II amalgam restorations for multisurface cavities in primary molars “ = The average life expectancy of Class I amalgams in all studies was approximately 2 years. ‘= when the restoration is expectedineeded to last longer than 2 years, ot when the patient is younger than 6, best practice would be to choose an SSC in multisurface restorations of molars, in young children Cost effectiveness Randall,2002 literature review of 5 clinical investigations comparing the failure aces of SSCs with ‘multisurface amalgam restorations to calculate replacement costs for the 2 types of restorations 8) The follow-up time ranged from 2 years to 10 years (mean: $ years) ‘8 The failure rate of Class Il amalgams ranged from 2 to T times that of SSCs (mean: 4 times } ‘© PMCs ($91), Class Il amalgam (855) 5x4) 9124= The most important function of the primary molars is to maintain space for the permanent successors = Unless these broken/lost restorations are followed and replaced, many of these children will need orthodontics to regain lost space and accommodate the permanent teeth. Thus the expense incurred goes far beyond merely the eost to replace the restoration. PERRI] Children who require general anesthesia: = aggressive use of SSCs is suggested based on their longevity and the protection their full coverage provides from future caries ‘= may lengthen the time between the need for such costly and risky procedures conclusion = Poor children experience more cari initially and are at greater risk for recurrent decay because they are less likely to use preventive services and keep recall appointments = Children with maxillary anterior caries have significantly greater risk to develop buecal/lingual and proximal surface caries 4s = Children who experience approximal caries in the primary dentition will continue to experience approximal caries to a greater extent in the mixed dentition, regardless of socioecomonie status and recall status © The SSC is superior in durability and longevity to the Class II amalgam in primary teeth « Dental rehabilitation under general anesthesia is expensive and places the child at increased risk for morbidity or mortality. = A primary tooth with 2 or more surfaces involved may receive stainless steel crowns ifthe tooth is anticipated to exfoliate in 2 or more years Recommendations ‘= Children at high risk exhibiting anterior tooth decay and/or molar caries may be treated with stainless steel crowns to protect the remaining at-risk tooth surfaces = Children with extensive decay, large lesions or multiple surface lesions in primary molars should be treated with stainless steel crownsRecommendations = Strong consideration should be given to the use of stainless steel crowns in children who require general anesthesia Thanks for yout Developmental defects of teeth = Amelogenesis imperfecta = dentinogenesis imperfecta f= The rapid loss of tooth tissiae results in earky wear and loss of occlusal height, and can cause sensitivity in some individuals, f= PMCS are considered to be the treatment of choice For primary molar and permanent frst molar