CLINICAL PEDIATRIC DENTISTRY I DSV 441
CHAPTER 18 RESTORATIVE DENTISTRY
(364-387)
STAINLESS STEEL CROWNS FOR POSTERIOR TEETH
McDonald, Avery, Dean. Dentistry For The Child
And Adolescent, 8th Ed.
23
Tuesday 7\42015
1:00 pm-2:00 pm
OTHMAN AL-AJLOUNI
1
LECTURE OUTLINE
 PREPARATION OF THE TOOTH
 SELECTION OF CROWN SIZE
 CONTOURING OF THE CROWN (When
Necessary)
2
LEARNER OBJECTIVES
At the end of the lecture student should know
 How to do preparation for SSC
 How to select SSC
 How to fit and cement SSC
3
STAI N LE S S STE E LC R OWN S FO R PO S TE R I O RTE E TH
Chrome steel crowns, as introduced by Humphrey in 1950, have
proved to be serviceable restorations for children and adolescents
and are now commonly called stainless steel crowns. There are a
number of indications:
1. Restorations for primary or young permanent teeth with
extensive and/or multiple carious lesions
2. Restorations for hypoplastic primary or permanent teeth that
cannot be adequately restored with bonded restorations
3. Restorations for teeth with hereditary anomalies, such as
dentinogenesis imperfecta or amelogenesis imperfecta
4. Restorations for pulpotomized or pulpectomized primary or
young permanent teeth when increased danger of fracture of
remaining coronal tooth structure
5. Restorations for fractured teeth
6. Restorations for primary teeth to be used as abutments for
appliances
7. Attachments for habit-breaking and orthodontic appliances
4
S TAI N LE S S S T E E LC R O W N S FO R
POSTERIORTEETH
Randall compared performance of crown restorations with that of
multisurface amalgam restorations. Crown restorations were
superior to amalgam restorations in treatment of multisurface
cavities in primary molars.
Especially in children at high risk for caries.
Stainless steel crown (SSC) is an extremely durable restoration....
Children with extensive decay, large lesions or multiple surface
lesions in primary molars should be treated with SSC.
Because of protection from future decay provided by their feature
of full coverage and their increased durability and longevity, strong
consideration should be given to use of SSCs in children who
require general anesthesia.
Finally, a strong argument for use of SSC restoration is its cost
effectiveness based on its durability and longevity.
5
PREPARATION OF THE TOOTH
LA administered and a rubber dam placed.
Proximal surfaces are reduced using a No. 69L
bur at high speed. Care must be taken not to
damage adjacent tooth surfaces.
Wooden wedge placed tightly to provide a slight
separation for better access.
Near-vertical reductions are made on the
proximal surfaces and carried gingivally until
the contact with the adjacent tooth is broken and
an explorer can be passed freely between the
prepared tooth and the adjacent tooth.
Gingival margin of the preparation on proximal
surface should be a smooth feathered edge with
no ledge or shoulder present.
6
PREPARATION OF THE TOOTH
Cusps and occlusal portion be reduced with a
No. 69L bur revolving at high speed. The
general contour of occlusal surface is followed,
and approximately 1 mm of clearance with the
opposing teeth is required.
The No. 69L bur at high speed used to remove
all sharp line and point angles.
It is usually not necessary to reduce buccal or
lingual surfaces; in fact, it is desirable to have an
undercut on these surfaces to aid in retention of
contoured crown. In some cases, however, it
may be necessary to reduce distinct buccal
bulge, particularly on first primary molar.
If any carious dentin remains after these steps in
crown preparation are completed, it is excavated
next.
7
SELECTION OF CROWN SIZE
The smallest crown that completely covers
preparation should be chosen. Spedding
has advocated adhering to two important
principles that will help consistently to
produce well-adapted stainless steel
crowns. First, operator must establish
correct occlusogingival crown length; and
second, crown margins should be shaped
circumferentially to follow natural
contours of tooth's marginal gingivae. The
crown should be reduced in height, if
necessary, until it clears occlusion and is
approximately 0.5 to 1 mm beneath free
margin of gingival tissue..
8
SELECTION OF CROWN SIZE
Patient can force crown over preparation by
biting an orangewood stick or a tongue
depressor. After making a scratch mark on
crown at level of free margin of gingival
tissue, dentist can remove crown and
determine where additional metal must be
cut away with a No. IIB curved shears or a
rotating stone. With a curved-beak pliers, cut
edges of crown are redirected cervically and
crown is replaced on preparation. Child is
again directed to bite on an orangewood
stick to forcibly seat crown so that gingival
margins may be checked for proper
extension. The precontoured and festooned
crowns currently available often require very
little,
if
any,
modification
before
cementation.
9
CONTOURING OF THE CROWN (WHEN
NECESSARY)
A crown-contouring pliers with a balland-socket design is used at cervical
third (if loosely fitting, start at middle
third) of buccal and lingual surfaces to
help adapt margins of crown to
cervical portion of tooth. The handles
of pliers are tipped toward center of
crown, so that metal is stretched and
curled inward as crown is moved
toward pliers from opposite side. A
curved-beak pliers is used to further
improve contour on buccal and lingual
surfaces.
10
CONTOURING OF THE CROWN (WHEN NECESSARY)
The curved-beak pliers used to contour proximal
areas of crown and develop desirable contact
with adjacent teeth. Many clinicians prefer to
complete crown contouring procedures with a
crown-crimping pliers. If necessary, solder may
be added to proximal surfaces of crown to
improve proximal contacts and contour.
Trimming and contouring are continued until the
crown fits preparation snugly and extends under
free margin of gingival tissue. Crown should be
replaced on preparation after contouring
procedure to see that it snaps securely into place.
Occlusion should be checked at this stage to
make sure that crown is not opening bite or
causing a shifting of mandible into an
undesirable relationship with the opposing teeth.
11
CONTOURING OF THE CROWN (WHEN NECESSARY)
The final step before cementation is
to produce a beveled gingival margin
that may be polished and that will be
well tolerated by gingival tissue. A
rubber abrasive wheel can be used to
produce
smooth margin. On
occasion best-fitting crown may
need to be modified to produce a
more desirable adaptation to
prepared cervical margin. The
oversized crown may be cut and the
cut edges overlapped.
12
CONTOURING OF THE CROWN (WHEN
NECESSARY)
The crown is removed from tooth and overlapped
material repositioned and welded. A small amount of
solder is flowed over outside margin. Crown is finished in
previously recommended manner and cemented to
prepared tooth.
If tooth is too large for largest crown, a similar technique
may be helpful. Crown cut on buccal or lingual surface.
After crown has been adapted to prepared tooth, an
additional piece of 0.004-inch stainless steel band
material may be welded into place. A small amount of
solder should be added to outer surface of margins.
Crown may then be contoured in usual manner, polished,
and cemented into place.
13
14
Professor Othman Al-Ajlouni
Wednesday, April 15, 2015
Pre- Operative:
Wednesday, April 15, 2015
Professor Othman Al-Ajlouni
Post- Operative:
15
THANK YOU