CROWNS IN PEDIATRIC

DENTISTRY
anterior primary teeth as & posterior primary teeth.
Indications for Full Coverage
Tooth with large interproximal lesions
Tooth with hypoplastic defects
Unaesthetic tooth due to discoloration
Tooth that have undergone pulp therapy with significant loss of tooth structure
Tooth with significant tooth structure loss due to trauma or caries
Tooth with small carious lesions and with large areas of cervical discoloration
 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
Recent development s for anterior crowns.
 The crowns that are available for restoring primary teeth (Table 1) can be
placed into 2 categories:

those that are preformed and held onto

the tooth by a luting cement,

those that are bonded to the tooth.

 Open Faced Stainless Steel Crowns

More durable and retentive than amalgam or

composite stainless steel crowns are
unaesthetic, especially on the anterior teeth.
The advent of composite bonding, allowed for
a composite facing to be placed on the facial
surface of the tooth, thus improving
aesthetics.
 Open faced stainless steel crowns combine strength, durability and improved
aesthetics.

However, they are time consuming to place as the composite facing cannot be
placed until the stainless steel crown cement sets.

Although this technique is a dramatic improvement over the plain metallic

appearance of stainless steel, the procedure is time consuming and metal margins
can still be seen.
Advantages
The aesthetics are fair. (The metal shows through the
composite facing).
They are very durable, wear well and retentive.
The materials are fairly inexpensive.

Disadvantages
The time for placement is long as it involves a two-step process
(crown cementation / composite facing placement.)

Placement of the composite facing may be compromised when

gingival hemorrhage or moisture is present or when the
patient exhibits less than ideal cooperation.
Polycarbonate Crowns
Polycarbonate crowns are heat-molded acrylic
resin shells that are adapted to teeth with self
cured acrylic resin.
They were popular in the 1970s, however,
although they were more aesthetic than
stainless steel crowns the polycarbonate
material was:
i. brittle and
ii. did not resist strong abrasive forces,
exhibiting frequent fracture and
dislodgement.
Advantages
They are very aesthetic, with greater durability than composite
strip crowns and pre-veneered crowns.
They are not as technique sensitive as composite strip crowns as
the fabricated crown is cemented with self adhesive resin
cement rather than bonding.
They take about the same amount of time to place as stainless
steel crowns, composite strip crowns and preveneered crowns,
and less than open faced stainless steel crowns.
Disadvantages
They are not recommended in patients that are heavy bruxers.
Greater tooth reduction is required.
Polycarbonate Crowns Technique
Reduce the incisal edge a minimum of
2mm.

Reduce the labial surface & lingual surface a minimum of

2mm, finishing the preparation subgingivally.
Composite Strip Crowns

Composite strip crowns are

composite filled celluloid crowns
forms.
Composite strip crowns rely on dentin
and enamel adhesion for retention.
Therefore the lack of tooth structure,
the presence of moisture or
hemorrhage contributes to
compromised retention.
A 2002 study by Tate, et al. found
that composite strip crowns had a
failure rate of 51%, compared to an
8% failure rate of stainless steel
crowns.
Advantages
It provides superior aesthetics. The cost of materials are
reasonable (approximately $6/crown).
The time for placement is reasonable.

Disadvantages
It is extremely technique sensitive.
It is not as durable or retentive as stainless steel/open faced
crowns, pre-veneered crown or polycarbonate crown and is not
recommended on patients with a bruxism habit or a deep bite.
Adequate moisture control might be difficult on an
uncooperative patient.
Pre-veneered Stainless Steel Crowns
They were introduced in the mid 1990s.
They are aesthetic, placement and
cementation are not significantly affected
by hemorrhage and saliva and can be
placed in a single appointment.
The stainless steel crown is covered on its
buccal or facial surface with a tooth colored
coating of polyester/epoxy hybrid
composition.
 A clinical disadvantage is they are relatively inflexible as the
resin facing is brittle and tends to fracture when subjected to
heavy forces or crimping.
Advantages
They are aesthetically pleasing.
They require relatively short operating time.
They have the durability of a steel crown.
They are less moisture sensitive during placement than composite strip crowns.
Disadvantages
They are 3 times more expensive than stainless steel, strip and polycarbonate
crowns
The technique does not allow for major recontouring and reshaping of the
crown.
The tooth is adjusted to fit the crown, rather than adjusting the crown to fit the
tooth.
As crimping is limited to lingual surfaces there is not close adaptation of crown
to tooth.
There are reports of the veneer facing fracturing, however it can be easily
repaired using the open faced stainless steel crown technique.
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

Waggoner and Cohen [1995] reported Cheng Crowns ,Kinder

Crowns ,NuSmile Primary Crowns have resin composite facings
whereas Whiter Biter Crown II has a flexible thermoplastic
veneer( exhibiting greatest shear force and retention
compared to other brands).
Advantages:
Single appointment
Easy placement technique
Reduces operatory time
Less technique sensitive
Disadvantages:
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
Selecting a Crown
Very short clinical crowns and crowded dentitions may not
be ideal for beginning case selections.
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.
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
CHENG CROWNS
Peter Cheng Orthodontic Laboratory-1987 anterior crowns
faced with a high quality composite (mesh-based with a
light cured composite.)
Advantages:
completed in one patient visit (and with less patient
discomfort)
natural looking stain resistant
doesnt cause wear of opposing teeth
Disadvantages:
fracture of veneers during crimping
expensive.
Anterior Crowns
Centrals : left & right sizes (1-6)
Laterals : left & right sizes (1-6)
Cuspids: upper& lower sizes (1-6)
Posterior Crowns
First primary molar: upper and lower - left and right sizes (2-7)
Second primary molar :upper and lower - left and right sizes (2-7)
PEDO PEARLS
Heavy gauge aluminum crowns
coated with FDA food grade
powder coating and epoxy-resin.
ADVANTAGES:
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
DURA CROWNS
White-Faced Crowns
Crowns can be crimped labially 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
KINDER KROWNS
1988 by pediatric dentists
natural shades and contour available
Great depth and vitality from the lifelike composite
Available in 2 shades; PEDO 1 & PRDO 2
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)
PEDO JACKET
It is a tooth colored copolyester material which is filled with
resin and left on tooth after polymerization instead of being
removed.
ADVANTAGES:
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.
Using a plastic primer, they can either be bonded into place with
composite resin or cemented with a glass ionomer cement.
DISADVANTAGES:
Only one size is available
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
ARTGLASS CROWNS
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 and every

Vita shade
Advantages
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.
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.
 Updyke studied 95 Artglass crowns that he placed in a 2-year period. Of 95
crowns,
79 received Alfa (representing clinically ideal),
11 received Bravo (representing clinically acceptable), and
5 received Charlie (representing clinically unacceptable) ratings.
The vast majority of the failures were due to bond failures. The difficulty in
interpreting this data is the absence of an independent observer and the fact
that the dentin adhesive was changed to a different product during the
study.
Nevertheless, this study format illustrates how a clinician can initiate a pilot
study in evaluating his or her own procedures to establish a more substantive
investigation.
[Updyke JR. Esthetics and longevity of anterior artglass crowns. J Southeastern
Soc Pediatr Dent. 2000;6:25-26].