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Conventional Technique of Stainless Steel Crown Dr. Sultana Jahan Intern doctor Department of Pediatric Dentistry Update Dental College & Hospital
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INTRODUCTION A crown is a tooth shaped covering which is cemented to the tooth structure and its main function is to protect the tooth structure & retain the function . It is a semi-permanent restoration used in primary teeth . It was introduced as chrome-steel crowns by dr. William Humphrey in 1950. Now it is commonly called as stainless steel crown. The stainless steel crown is used more frequently in deciduous dentition .
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Objectives To achieve biologically compatible, competent for mastication & clinically acceptable restoration. To maintain the form and function and where possible the vitality of the teeth should be maintained .
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Techniques of Stainless Steel Crown
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Conventional Technique
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Occlusal Reduction Proximal Reduction Buccal & lingual reduction Tooth Preparation
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Theories About Occlusal Reduction All sides need to be reduced. Retain the tooth structure as much as possible. Humphrey 1950 Occlusal reduction need to keep at least 4mm above from gingival margin. Rapp 1966 Uniform occlusal reduction 1-1.5mm. Troutman & kennedy support it. Mink & Bennett 1968
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Occlusal reduction
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Occlusal Reduction Evaluation of occlusal reduction Visual examination Mathewson : Use of explorer Forrester 1981 : Wax sheet
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Occlusal reduction Occlusal anatomy preservation Crown retentive potential Less chances of pulp exposure Preservation of tooth structure
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Proximal reduction 69L or 169L bur moved bucco-lingually. Begin at the marginal ridge & at 10 degree converging towards occlusal surface. Do not over taper. Feather edge or Chamfer finish line. 1-1.5mm
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Proximal reduction
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Cont. Contact with adjacent teeth must be broken gingivally & bucco lingually. Proximal slice must be extended below the gingival crest to avoid leaving a ledge.
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Evaluation Pass explorer through proximal areas. Broken contact. Cont.
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Buccal & lingual reduction Minimal or no reduction requires for buccal and lingual surface as it aid in retention because of under cut. No more than 0.5 to 1 mm tooth structure should be removed bucco-lingualy.
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Ideal method of crown selection is measuring the mesio-distal dimension of unprepared tooth using Boley’s gauge or divider and comparing it with selected crown. The correctly selected crown should cover completely the prepared tooth crown and provide resistance to removal. Crown Selection
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Crown contouring Contouring plier used : # 112 Ball & Socket Plier # 137 Gordan Plier # 114 Johnson Plier Used for initial contouring in middle third : belling effect
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Crown crimping Inward movement of margins # 137 Gordan plier # 114 Johnson plier # Crown crimping plier After crimping : Snap into position with firm finger pressure
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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 & retain. If doesn’t seat completely: Reduce occlusal surface.
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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 Iron Rouge : to give fine lusture.
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Crown cementation Clean and dry both the tooth and crown before cementation. Mixed the selected cement , (GIC type 1 commonly used) Fill the inner portion of crown specially the walls the luting cement. Now seat the crown on tooth from lingual to buccal direction. Wait for a while and remove excess cement with explorer & Check the margins. Ask the patient to bite on wet cotton over crown for proper fit.
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Case Presentation
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Patient Name : Naila Age: 5 year 3 months Sex: Female Address: Ashulia Chief Complaints: Pain on lower right posterior segment for 1 5 days.
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History of Pain Moderate, Continuous pain Pain was nocturnal in nature. Clinical Examination Plaque & calculus : Moderate Broken down root : Lower Rt. Deciduous 1st molar. Caries : Lower RT. Deciduous 2nd Molar.
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Investigation RVG on Lower rt. 2nd deciduous molar shows occlusal caries that extends to the pulp. Diagnosis Chronic irreversible pulpitis.
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Treatment plan Pulpectomy followed by stainless steel crown on lower right second deciduous molar tooth
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RVG after pulpectomy shows optimal seal of the root canals
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Tooth preparation for placement of crown
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Occlusal Reduction Proximal Reduction
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After Tooth preparation
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Mixing The Luting Cement (Glass ionomer cement)
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Proper adaptation of luting cement into the crown wall Loading the luting cement into the crown
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Adaptation of the crown to the prepared tooth
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After Cleaning The Excess Cement Lingual view Buccal view Occlusal view
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Radiovisiography After SSC Placement
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Post operative instructions Avoid sticky food, hard candies at least for 1 hour Brush the area gently today, thereafter normal brushing & flossing A soft diet for the rest of the day is suggestive If there is any emergency arise please contact to your relevant dentist The crown will fall out with the tooth when the permanent tooth is ready to erupt.
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Reference Principles and Practice of Pedodontics – 3rd edition. Crowns in pediatric dentistry – 1st edition Garg V, Panda A, Shah J, Panchal P. Crowns in pediatric dentistry. Journal of Advanced Medical and Dental Sciences Research, 2016; 4(2): 41-26. Ashima G, Bhatia SK, Gauba K, Mittal HC. Zirconia Crowns for Rehabilitation of Decayed Primary Incisors: An Esthetic Alternative. The Journal of Clinical Pediatric Dentistry, 2014; 39(1): 18-23. Yang JN, Mani G. Crowns for primary anterior teeth. International Journal of Pedodontic Rehabilitation, 2016; 1: 75-78. Innes N, Ricketts D, Evans D: Preformed metal crowns for decayed primary molar teeth. Cochrane Database Syst Rev 2007, 1. Castro AA: Evaluation of the Clinical Performance of Pedo Jacket Crowns in the Treatment of Maxillary Anterior Teeth with Early Childhood Caries: A Prospective Clinical and Laboratory Study. University of Toronto, 2014. Sajjanshetty S, Patil P, Hugar D, Rajkumar K: Pediatric Preformed Metal Crowns-An Update. Journal of Dental and Allied Sciences 2013, 2:29. Helpin M: The open-face steel crown restoration in children. ASDC journal of dentistry for children 1983, 50:34.
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Acknowledgement Dr. Sadia Afrin Anika Assistant Professor & Head of the department Department of Pediatric Dentistry Dr. Rownak Jahan Tamal Senior lecturer Department of Pediatric Dentistry Dr. Fatima Mazid Kona Lecturer Department of Pediatric Dentistry
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THANK YOU