CROWNS

IN PEDIATRIC DENTISTRY
 STAINLESS STEEL CROWN

• Stainless steel crowns can be defined as

prefabricated crown forms that are adapted to
individual teeth and cemented with a biocompatible
luting agent.
INDICATIONS

• Extensive caries: If the caries is involving three or

more surfaces, this leads to insufficient tooth
structure to hold a restoration.
• Extensive decalcification: On any one surface like
proximal; is also an indication as it might lead to
space loss at a later stage. ™
• Rampant caries: it is much cost-effective and
much less traumatic to place an SSC on the
tooth. ™

• Recurrent caries: Placement of crown will also

help in removing the possibility of recurrent
caries around existing restoration. ™

• After pulp therapy: Following pulp therapy,

the tooth structure is weakened due to
removal of dentin.
• ™ Inherited or acquired enamel defects: for example,

hypoplasia, amelogenesis imperfecta (permanent and primary

teeth).

• Fractures of permanent and primary incisors: If an incisor is

fractured, crowns in anterior teeth can be given as a

temporary dressing to cover the exposed dentin. ™

• Severe bruxism: When teeth show extreme
wear and tear owing to bruxism.

• Abutment teeth to prosthesis: ™ As part of a

space maintainer: Crowns can be a part of
crown and loop or crown band and loop space
maintainer.
 CONTRAINDICATIONS

• Primary molars close to exfoliation ™.

• Primary molars with more than half the roots
resorbed. ™
• Teeth that exhibit mobility. ™
• Teeth which are not restorable. ™
• Patients with known nickel allergy.
ACCORDING TO TRIMMING
 ACCORDING TO COMPOSITION

Stainless steel crowns—18-8 Austenitic Nickel–chromium crowns

stainless steel

(67% iron, 18% chromium, 8% nickel), e.g., Nickel chrome alloy (70% nickel, 15%

Unitek stainless steel crowns, 3M Co chromium, 10% iron) e.g., Nichro ion

crowns, Inconel
 Tooth preparation
 Occlusal reduction should be done first
followed by proximal.

 Large round bur, tapered fissure or flame

shaped diamond can be used

Uniform occlusal reduction of 1-1.5 mm – Mink &

Bennett
Reduction of 1mm is sufficient – Troutman
Reduction of 1.5 – 2mm - Kennedy
Proximal reduction:

 Tapered fissure bur is used to reduce trauma to

the soft tissue.
 Bur is moved in a buccolingual direction starting
at the occlusal surface 1-2 mm away from the
adjacent tooth, until the contact area clears
gingivally & buccolingually .
 Gingivoproximal line angle should have feather
edge finish line
Buccal & lingual reduction:
 Minimal but adequate buccal & lingual reduction is
necessary

 Buccal &lingual cervical bulges can be left uncut if

they do not interfere in the placement of the crown.
Finishing:
 All line angles must be rounded

 Occlusobuccal & occlusolingual line angles are

rounded by holding the bur at a 30-45o angle to the
occlusal surface & sweeping it in a mesiodistal
direction
 CROWN ADAPTATION…

 Place the crown on lingual side & rotate it towards

buccal side.
 With scaler scratch line around the gingiva margin on
the crown
 Cut crown with crown & bridge scissor 1 mm below
starch line
 Retry crown on tooth, if there is blanching of gingiva
retrim it.
Crown contouring
 Contouring is done at the middle 1/3rd of
the crown with a No. 114 plier to produce
a belling effect

 This gives the crown a more even

curvature
Crown crimping
 Crimping done at cervical 1/3rd of crown
with a No. 800-412 plier

 This aids in:-

- Mechanical retention of the
crown
- Protection of cement from
exposure to oral fluids
- Maintenance of gingival
health
 Crown Finishing
 Use a large green stone to make a knife edge finish at the
cervical margin

 Smooth and polish the margins with

a rubber wheel

 Polish the entire crown with a wire brush

 Fine luster is achieved by polishing with roughe, whiting or a

fine polishing material
 Cementation
 ZnOE, ZnPO4, polycarboxylate, GIC

 GI commonly preferred, ZnOE least preferred

 Debris & hemorrhagic material are removed from the tooth

surface by flushing with warm water

 Isolated with cotton

 All exposed dentin surface is protected with several layers of

varnish (Myers et al 1983)

 1/2 or 2/3rd crown is filled with cement

 Crown is seated on the tooth along the predetermined path

of insertion
 Cotton rolls are removed promptly & pt is
requested to bite gently on crown

 Occlusion is rechecked & excess cement is

removed
Post cement instructions:
 Avoid heavy chewing with crowns for 24 hrs
 Maintenance of oral hygiene
 Recalled once every 6 mon for evaluation
 Polycarbonate crowns
• Aromatic linear polyesters of carbonic acid
• Thermoplastic resins
• Extremely stable
• Save time
• Easy to trim
• Easily adjusted with pliers
 INDICATIONS CONTRAINDICATIONS

Grossly carious anterior teeth Severe bruxism

Malformed teeth Evidence of abrasion

Fractured teeth Deep bite

Discolored teeth

Teeth requiring

Pulpotomy/pulpectomy
 Polycarbonate Crowns…..

Technique for construction:

• Isolation
• Removal of carious lesion
• Crown selected acc. to M-D width, C-I length & shade of
tooth
• Labio-lingual reduction  0.5mm
• Mesio-distally  break contacts
• Incisal reduction  1-2mm
 Polycarbonate Crowns…..

• Crown is selectively ground at gingival aspect

• Then lined with luting cement
• Surrounding gingiva lubricated & crown Is seated
• While it sets ,it is reseated
a no. of times
• Margins trimmed & finished
• Cementation
 crown & bridge cement

 adhesive composite resin cement

Zinc oxide eugenol

 STRIP CROWNS
• These are celluloid crown forms that
are the most effective for use in
pediatric patients with extensive caries
in anterior teeth.

• These are commonly used crown

forms filled with composite and
bonded on the tooth.
 INDICATIONS

– Extensive / multisurface caries

– Congenitally malformed teeth
– Discoloured teeth
– # incisor – trauma
– Amelogenesis imperfecta
 BENEFITS AND FEATURES :
 Parent/patient pleasing
 Ideal for ankylosed tooth build –ups
 Simple to fit & trim
 Removal is fast & easy
 Easily matches natural dentition
 Leaves smooth shiny surface
 Easy shade control with composite
 Superior esthetic quality
 Ideal for photo cure
 Crystal clear and thin
 Large selection of size
STEPS
And cure it.
i.e; cure it.